Today, the group again split into two parties. Some of us ventured to San Manuel to hold our Pediatric Medical and Dental clinics.
One highlight of the day was assessing an 9 year old boy who had suffered an injury to the eye the day before. On examination, it was clear that his eye was very compromised, and worsening. With the assistance of our local Honduran medical contact, Dr. Mabel, we were able to arrange for him to be transferred to a centre with an Opthalmologist, who will be waiting to see him when he arrives. We believe it is early enough in the course of his symptoms that his vision should be able to be saved! We felt fortunate that we happened to be in his town at the time of his symptoms, otherwise he may not have had access to urgent medical attention.
Another memorable patient encounter was with an 8 year old boy, this one coming in to clinic for not being able to talk. Unfortunately, it became clear that this young man had some developmental delays in multiple areas of development, with the most predominant being his speech and language abilities. We were able to discuss this diagnosis with his mother, and reassure her that the actions she was taking at home to provide developmental care for her son were admirable. The amazing part, however, was connecting with his Gr. 1 classroom teacher, who came into clinic to hear about how to best support him in the classroom.
Meanwhile, Dr. Heather Flieger (2nd year Pediatric Resident) joined Dr. Klein, Ashley, and Sharon at the rehab centre (CRILE).
The day at CRILE started with a group prayer by the staff that work there, and then we started to work. Typically Dr. Klein will first see patients and make a diagnosis or do an assessment of a child who has already been diagnosed to see what their function and overall health is like. Then, if they require a physiotherapy / occupational therapy assessment for strengthening or balance exercises or for orthoses, the child will be seen and assessed by Sharon (PT) and Ashley (OT) who are working with the clinic physiotherapist there as well. Today we saw several children of various ages with cerebral palsy as well as as child with Prader-Willi Syndrome, children with seizures, and two children who are deaf. Sharon and Ashley have gotten very creative in engineering assistive equipment for these children. In addition to remodelling ankle-foot othoses (AFOs) which were kindly donated secondhand by many of the children at the Lansdowne Children's Centre, they also created assisted seating devices out of car seats, pool noodles, and duct tape so that children with low tone can improve truncal tone, have greater use their hands, and be able to be more interactive with their environment.
This is a picture of Sharon and a two year old little boy who was given one of these "seaters" today:
By far, the most vivid part of our day today was in the form of a home visit to a 12 year old girl with seizures and regression of her developmental milestones. The family is very poor and lives nearby, but high up on a hill and they have limited means to be able to bring her to the clinic. Home visits by health care professionals are eye-opening even in Canada, as you are able to appreciate your patient's actual environment and how they live, but in Honduras the experience was truly humbling. The director of CRILE, Rafael, and his wife, Cynthia, drove us a few minutes outside of Gracias and then we had a short, but steep trek up the hill to visit Johanna and her family. Johanna lives with her mother and grandmother, with many members of her extended family, including lots of tiny cousins, nearby. She is a 12 year old girl who's had seizures from a very early age, and is now having more and more trouble with ambulation and self-care. The family graciously invited us into the outdoor kitchen of their simple home and provided us with chairs - also present in the outdoor kitchen were two new litters of puppies, and many chickens and baby chicks! Johanna was in a hammock, where she spends a lot of her day and her family told us her seizures are getting worse and she is also not able to walk as well as she used to. Johanna impressed, however, us by being able to weight bear and had eye contact and seemingly the ability to follow what was going on around her, although she is non-verbal and has never talked. We witnessed two atonic seizures while we were there (aka: drop attacks) and luckily were able to catch her before she fell, although she did have several scars on her forehead from previous falls where she was not so lucky. The family gave a history of different seizure types so we are suspicious that her regression with walking and self-care is due to uncontrolled seizure activity. Although we were not able to make a definitive diagnosis at this assessment, we were able to offer her seizure medication as well as a helmet which we can have made and sent to Rafael once we return to Canada. Dr. Klein will also be creating a written document of his assessment in case she is able to be seen by a specialist here in Honduras in the future. This is so extremely different from how a child with a similar presentation would be assessed and treated in Canada but, sadly, we do not have easy and free access to lab tests, imaging, and specialist care here.