This week was supposed to be getting ready for our Spring 2020 trip to Zambia. We would have been leaving this coming Saturday, April 11th...with new team members, with excitement to see patients we've seen before and new patients, with anticipation of Protashow returning to the U.S. with us to stay for a month for more training in prosthetics. And then...plans changed. The coronavirus happened. Our world is turned upside down.
I know we aren't unique. There's are thousands, no, millions of people whose plans have been changed by Covid-19. The school year for students is upended, vacations are cancelled, weddings rescheduled, baby showers and birthday parties cancelled. Even bigger is that people's paths of life have been changed with jobs lost and economic uncertainty. The list of changed plans goes on and on. And when we stop to think about it, as important as all of these are, they pale in comparison to those whose plans and lives are changed because family, friends, neighbors or coworkers have been afflicted by Covid-19. This is all scary and can be overwhelming, so my disappointment in not being able to go to Zambia this month seems a bit unreasonable.
Where we're at as Prosthetic Promises:
We're in communication with Protashow, our Zambian team member, who has notified patients and the Disabilities Office in Choma (who we coordinate with to help patients needing prosthetic and ocular prosthetic services) that we're unable to come due to the virus and travel restrictions. Protashow has been talking with patients when he contacts them to see if they need to come to the clinic for repairs, adjustments or new supplies. He has been seeing patients independently to provide this follow up care, which are so grateful that he is able to do. We currently don't know when we'll be able to make another trip to Zambia, but we are anxiously awaiting the time when we can.
I've been reflecting on the situation we're in as Prosthetic Promises since figuring out in March that we wouldn't be able to make our April trip. And this week two dear people in my life sent me pictures, a song and a video that make me think about how sad I am that a return trip to Zambia is a big question mark right now. It's been important to me that we've worked at establishing relationships and trust with patients in Zambia. We're trying so hard not to just be Americans swooping in to "fix it" in our terms. So cancelling our trip and not having an answer on when we'll be back is stressful to me.
Sadness, disappointment, anxiety...those are all valid feelings people are having right now. But I'd like to look at a few encouraging thoughts shown to me this week as well.
In a theology discussion group (that's being done via online video right now), a pastor shared something that really struck me. Among the whole conversation this question stuck out (paraphrasing here)...."This is all very frightening, but what are some ways that we can be helpful right now?" How can I be helpful and hopeful during this time when I can't physically be in Zambia? Prayer. I've been thinking of patients one by one. When we met them, interactions, excitement seeing them walk with a prosthesis, whatever comes to mind....and then praying specifically for them and their families. So, if you follow what PPIHN does and the people we've been able to help in Zambia, I invite you to think of a story of someone we've posted about or told you about and pray for them.
Another specific encouragement I've had this week was in my daily devotional. But first something about me that makes this such a "lightbulb moment". I don't do rest very well. I really am working on it, but my tendency is to be busy all the time. So this excerpt really struck me:
"Rest is often thought of as the opposite of labor, something perhaps earned after hard work. But biblical rest is the opposite of hurry, heaviness, and anxiety. It is freedom from the need to control circumstances and people. It is not laziness or passivity, but an active trust in God. Rather than being something we earn, rest is a gift God gives for our freedom and health."
Wow, this really is impactful right now. Collectively, we're in a time of rest from activities because of distancing measures to combat Covid-19. This also gives us time to realize we're not in control. Silly human beings with our plans and need to control circumstances and people. This global pandemic is a really awful thing, yes. But I'm going to try really hard to see this resulting rest from the normal life as a gift. How can I be helpful and hopeful during this time?...for my neighbors near, my far away Zambian neighbors, and for myself.
"Each of you should use whatever gift you have received to serve others, as faithful stewards of God’s grace in its various forms. If anyone speaks, they should do so as one who speaks the very words of God. If anyone serves, they should do so with the strength God provides, so that in all things God may be praised through Jesus Christ. To him be the glory and the power for ever and ever. Amen."
1 Peter 4:10-11 (NIV)
**This is the first of day-by-day recap blog posts about PPIHN's September 2019 trip to Zambia. Each trip I do these posts to give an in depth look at what PPIHN is all about--to see what amazing things God is doing through this ministry, to describe what we as team members cannot in just a conversation with you and to be accountable to those who donate to make these trips happen.
This trip we saw 57 patients total for prosthetics, orthotics and physical therapy, and we fabricated 26 new prostheses during the trip. And all of this happened in just 9 working days! Our prayer is that all the people we were able to help saw the love of Christ through our work, our words and our actions.
Our journey started on Saturday, September 14th, earlier for the guys than the gals. Andy and Graham traveled from Minneapolis to DFW airport in the afternoon, then Amanda, Traci and myself met them (and introduced ourselves for the first time) inside the terminal at DFW.
The Texas gals after check-in with 15 bags.
Group photo after meeting in the terminal.
Team Introductions (L to R):
First time team members Andy (prosthetist) and Graham (technician) from Minnesota. They heard about Prosthetic Promises through an O&P magazine article that referenced our use of the All-Terrain knee from LegWorks in Zambia and then contacted us to see about joining the team on a trip. Amanda (physical therapist) from DFW Texas, who was part of the April 2018 team. Katie (prosthetist/orthotist) from Gainesville, Texas, who is a long time team member and board member for PPIHN. Traci (prosthetist/orthotist) from Houston, Texas, who was part of the April 2017 team.
After meeting up with Andy and Graham and introductions, the British Airways counter paged Traci and myself about the container with resin that we checked in as luggage. After conversations with multiple people, explaining what resin is, MSDS sheet reference and tons of prayer (and panic on my end), they agreed to allow the resin onto the plane. It was absolutely necessary that the resin get through to Zambia, as we cannot make any prostheses without the resin to laminate the sockets.
After the extremely stressful resin issue, we left on our first flight from DFW to London. In London, we had a 9 hour layover so took advantage of the time to go out into the city for a little sightseeing and touristy stuff....saw Buckingham Palace, Big Ben, Westminster Abbey, etc and had fish and chips for lunch before catching the Tube back to Heathrow airport.
London touristy selfie!
Our flight from Heathrow to Johannesburg left over an hour late after sitting on the tarmac due some luggage issue, which made us really close on our connection at Johannesburg. We got off the plane in Johannesburg when were supposed to start boarding the plane to Livingstone...so we had to RUN across the airport to catch our flight.
In Livingstone, we had 1 of our 19 bags total not make it. We filled out the necessary paper with contact info to get our last trunk sent to Choma by bus when it would arrive the next day for us to pick up. Protashow, our Zambian team member, was at the airport with the van and trailer from New Day to pick us up and all of our luggage.
After about a 3 hr bus ride, we arrived at New Day Orphanage and was greeted by everyone with handshakes, hugs and singing. We then unloaded our trunks of supplies at the PPIHN clinic before dinner and settling in at The Ark (guesthouse).
Lots of introductions!
Such a sweet greeting with all the New Day kids!
Our travel to Zambia was definitely not the smoothest our team has had, but we were thankful to be at New Day and ready to get to work first thing Tuesday morning with seeing patients.
Next post: Tuesday, Sept. 17: Patients from the Macha area
Tuesday started with our team splitting up to go screen patients who were meeting at the Macha radio station and to go get the clinic set up and receive any patients who arrived directly at the clinic. Traci and I went with Protashow to the Macha radio station, which takes about 45 minutes to get to from New Day Orphanage down a very bumpy road (the same road to get to the Macha Hospital...I can't even imagine traveling down that road if you were needing to get to the hospital quickly.)
The market area outside of the radio station in Macha. Everything is so dry in the midst of a historic drought!
The Macha radio station where we tell patients to meet for screening. We have noticed this year, April and this September trip, that more patients from the Macha area and near New Day are coming directly to the clinic now or are closer to the main road. This is great that we have consistent patients coming for follow up each time, and we can plan to change our pick up patient location in the future to make it easier for patients and us on our schedule.
Meanwhile at the clinic, Andy, Graham and Amanda were able to start getting things set up and started seeing the patients who were arriving directly to the clinic.
Clyness came for check up and some adjustments to her prosthesis with new supplies. It was so good to see her! She was fit in April with an above knee prosthesis after elective amputation at Beit Cure Hospital in Lusaka due to a chronic infection in her leg. We have been seeing her since April 2017 and got in contact with Beit Cure about her having a revision amputation. Clyness and her family have trusted us along the way, and we are grateful for the opportunity to continue providing her with prosthetic care.
Melvin came for check up and new supplies. Here we're talking about how the prosthetic knee functions.
Graham was helping us along the way with all the repairs. Such nice teamwork this trip with practitioners, Graham as a technician and Amanda as a physical therapist. It was the whole team approach all together in the same clinic! I really can't emphasize enough how awesome it is to have a group of people who don't work together every day (and also some who just met each other) come together to be such an amazing team!
Traci and Protashow working on repairs in the center area of the clinic. The doorways you see are to the patient rooms. We had all 3 patient rooms on that side of the clinic in use this trip with 3 practitioners. Protashow worked along side us as he continues to learn and develop skills. It was great that he had so many different people to learn from during this trip.
Traci fitting Mweetwa with a new liner. He needed new supplies this time.
Papa Wes came by the clinic to check out the activity. On patient days, between all the patients, us as team members and New Day staff that comes up to the clinic to help with translating, taking pictures and overall assisting where they can, it's quite the happening place to be.
Preparation of lunch outside the clinic. Each patient day during our trips, we hire several ladies to cook a meal for the patients who wait on the porch to be seen. I love that we can do this. These ladies do such a wonderful job cooking and serving the patients each a plate of food. We appreciate them being part of this ministry in preparing food.
We were talking in recap during our travel back about how the group of patients waiting on the porch ends up being a sort of amputee support group in a way. And I feel like the addition of a meal really rounds out the sense of community and communion with each other. Many of these patients come each trip to be seen for check up and get to see each other at the clinic. They don't all live in the same area, so it's a chance to see each other again for them, as well as us. This is what it's all about....not just giving people a prosthesis but establishing relationships, investing in the lives of others with the talents God has given us. We certainly aren't getting it "right" all the time, but we pray that what we are doing through the ministry of Prosthetic Promises is touching lives and showing others the love of Christ that we know.
Protashow casting Moomba for a left below knee prosthesis. In April, we fit Moomba with a right below knee prosthesis, and he has since had a left side amputation as well.
Killion came for check up. He needed a new prosthesis this time since the socket didn't fit well after having it for quite some time. We've been seeing him since 2014.
This mother brought her infant to the clinic due to contractures of her fingers. She's about a month old with finger contractures on both hands. Traci and Amanda evaluated her and advised the mother on stretching and to seek further medical advice on cause and treatment. This is an example of the sometimes difficult cases we see at the clinic. Many times we have people come for medical help that is outside our scope of practice. It's often a difficult conversation to have (through a translator most times) that we are unable to help them. We've seen that so many times there are many unanswered questions on diagnosis, or proper diagnosis, of medical conditions with often times inability to fully treat the condition or disease with the medical care available in Zambia.
Nurse Carol and Fostina bringing up a picnic lunch for the team. Fostina cooks for our team during our stay at New Day and wow, she is a great cook! (My favorites are her chicken pot pie, lasagna and potato salad😊) On patient days at the clinic, Fostina packs a picnic lunch to bring up to us so that we can continue working and just stop for a quick bite in the midst of seeing all the patients.
Here's a great example of how the prosthetic feet wear out or fail. This foot was fit on Trywell in April 2018. He got a new prosthesis this trip---he had outgrown his socket (he's 17 years old), the foot and knee both were broken. He has wired the foot pieces together to keep them in the prosthetic foot shell, but I'm really amazed that it all stayed together for him to keep walking.
Joel came for check up and new prosthetic supplies. He's so fun to see each trip! Always a huge smile on his face. We've been seeing him since 2014.
Here's Joel on the front porch checking his phone. It's a bit odd for us from the U.S. to see people who walk for their main mode of transportation or are riding in an oxen cart to take maize to the grinding mill and be talking on a cell phone. But with most people having cell phones in Zambia, it's such an advantage to connect people who can't easily travel far. It also makes it easier for us to contact patients or they contact Protashow when needing to be seen at the clinic for a new prosthesis or repair to their existing one. Only problem we run into is that people seem to change their phone numbers fairly often, so we can't get in touch with some people.
Traci helped Munsanda with a repair to her prosthesis for a foot that was loose and not staying secured. She also got new prosthetic supplies and shoes.
The storage room with bins of shoes. Thank you to everyone who has donated shoes for PPIHN! With 57 patients total this trip, we've again diminished our shoes supply. We're good on pediatric shoes, but if you have adult shoes size 9 or larger (men's and women's) that you would like to donate, please get in touch with us. It's so important to have a shoe on the prosthetic foot to protect the foot from excessive wear and to make the prosthesis function properly with correct alignment.
On Tuesday, we saw 12 patients total at the clinic. It was a busy start to our trip, and we knew that Wednesday would be even busier with patients from Choma.
Next post: Wednesday, Sept. 18: Patients from the Choma area
On Wednesday, we again split up with Andy and I traveling with Protashow to Choma to screen patients at the Disabilities Office and Traci, Graham and Amanda staying at the clinic to get started on fabrication with the casts taken the day before, more setting up the clinic and being available for any patients who arrived directly to the clinic. We have a great working relationship with the Disabilities Office in Choma to screen patients at their office, and they communicate with patients needing prosthetic services to let them know about our trips.
Andy worked with Protashow translating to screen patients while I worked with Hildah from the Disabilities Office to screen patients. With us doing 2 patients at a time in the small office space, it was a tight fit but sped up the process since we had a lot of people waiting to be seen.
We had brought a bag with us of a few prosthetic supplies and tools in case we could take care of someone at the Disabilities Office rather than them coming back to the clinic since we have limited space on the bus for people. Here Andy is taking tracings of Beauty's feet for shoes that will have a lift on one side. She has one leg shorter than the other and needs a shoe lift. With the measurements and tracings, we were able to make the shoe lift and send back to the Disabilities Office without her needing to come all the way to the clinic.
Justin was one of the patients who only needed supplies, and we were able to take care of with the supplies we brought with us.
Wrapping up before heading back on the bus to the clinic.
The bus was packed and the clinic porch quite full of people once we got back.
I'm always amazed at how patient everyone is waiting on the porch to be seen.
When we got back to the clinic with the bus it was just about noon. Graham had been trying to get the generator up and going since we would need it all afternoon for electricity at the clinic with a scheduled electricity outage (load shedding due to the drought) from noon to 6pm. But, the generator just wasn't working. We witnessed a miracle on Wednesday...the electricity went out at noon and came back on about 10-15 minutes later to stay on the rest of the day!
Traci casting Alan for a below knee prosthesis. He was in a car accident early this year which resulted in an amputation. We saw him in April when he wasn't ready for fitting yet, so we had fit him with shrinkers (tight compressive socks for his residual limb to help decrease swelling and shape his leg in preparation for prosthetic fitting).
We had several prostheses needing repair that Graham was taking care of while Traci, Andy and I were casting people for new prostheses. Protashow was spending a little time with each of us learning from everyone and assisting in castings.
Traci casting Christopher for a new below knee prosthesis. He current prosthesis had broken.
Lawrence, who we've seen in the past, was casted for a new prosthesis this trip.
Andy fit Malawo with a passive arm prosthesis that we made in the U.S. and brought with us. A huge thank you to my bosses for the ok to fabricate this at the office I work at, Alliance Orthotics and Prosthetics, and thank you to our technician, Shawn, who did the fabrication.
Once the cosmetic glove was put on the arm prosthesis, Malawo was really pleased with the result. And I think everyone waiting on the clinic porch was in awe of the cosmetic arm!
A great "in action" shot in the clinic. We were all busy with seeing patients.
Hildah from the Disabilities Office with Amanda. Hildah helped translate, and Amanda helped me a lot on Wednesday with filling out measurement sheets and assisting in casting patients.
Little Miss Rhoda came for a check up. Her bent knee prosthesis for her right side for clubfoot needed to be repaired and lengthened since she's grown. She was really shy when we first saw her in 2016, but now she's all smiles!
Here I'm finding a liner to fit River before casting him for an above knee prosthesis. River and I got off to a funny start with my misunderstanding of his name. The pronunciation of "L" and "R" is very similar in the Zambian accent, which when you mistake the first letter of his name for a "L" makes for a very odd name. We all got a really great laugh out of that mistake!
Traci casting Greenford for a new below knee prosthetic socket. We've been seeing him for several years now, and he needed a new socket since his was not fitting well now.
Moses is on the left side of the picture, who was casted for a below knee prosthesis. The man in the center is Njanji, who is wearing a prosthesis that he carved himself out of a tree trunk. And Mama Loveness on the right, who is one of the house mothers from New Day who came up to the clinic to help with translating.
Njanji's amputation was in 1964. He made himself this prosthesis about 3 years ago he said. When asked what prompted him to make his own prosthesis, his response was because his crutches broke. We were amazed at his ingenuity, but so thankful we were able to help him by providing him with a properly fitting prosthesis and protection to his leg.
Traci taking notes and measurements for Patress. He's had this prosthesis for several years which has cut out areas that have been causing skin issues. We repaired the prosthesis and provided him with new supplies in April of this year and told him we would make a whole new prosthesis for him in September. So, he was one patient we were planning to see this trip.
Here I'm getting ready to cast Olina for an above elbow prosthesis. I casted her to bring the cast back to the U.S. for fabrication to take back in April. She was at the clinic the same day that we fit the below elbow prosthesis, so she was excited to see what a prosthetic arm can look like.
At the end of the day when patients were loading back up on the bus. Protashow drove them back to Choma, and the ones who were casted for new prostheses on Wednesday would come back the following week for fittings.
The bus headed back to Choma about 6pm and we closed up the clinic for the day.
On Wednesday, we saw 33 patients total. (As I'm typing that number I'm amazed that we could see all those people in one day). It was such a wonderful teamwork effort and empowerment from the Holy Spirit! We had so many people in the clinic with 3 of us doing castings, Protashow and Amanda assisting everyone and Graham working on repairs, we didn't actually have a firm number on how many prostheses we had casted for that day. We just knew that Thursday was the start to A LOT of fabrication.
*Next post: Thursday, Sept. 19- Friday, Sept. 20: Fabrication begins and more patients!
Thursday we all started the fabricating process for all the prostheses. Graham had started some of filling casts on Tuesday and Wednesday, so we had plaster models first thing to start with modifications.
Since we didn't have someone other than our team at the clinic on Friday, we failed to get pictures of the other 4 patients who came on Friday.
The process of fabricating a prosthesis is to take the negative plaster cast that was taken of the patient's residual leg, fill it with plaster to make a positive mold, take the cast off the hardened plaster mold, make modifications to the mold, then laminate over the mold with a carbon and other material layup with resin under vacuum. After the lamination is ready, the plaster mold is broken out to give the final negative socket that will fit over the patient's residual leg with all the components attached underneath. Ta-da!
We quickly started with everyone working at a different stage of the process...Protashow was filling all the remaining casts with plaster, Graham set up the laminating area, Andy, Traci and I were modifying molds and Amanda started selecting a prosthetic foot and other supplies for each patient.
We also had 2 patients come to the clinic on Thursday.
Bester has a prosthesis from another clinic that is now not fitting well. We repaired the prosthesis and changed some design aspects to give her better cushion and protection to her residual leg. She was really pleased with the outcome!
Little Malawo came with his father for check up on his prostheses. They are fitting well, he just needed new socks. He'll likely need new ones soon though since he's growing.
Doesn't he have the cutest smile?! Dad says he'll be starting school soon, so he inquired about a pediatric wheelchair because of the distance. He's using the prostheses at home, but that would be too far to walk when going to school. As I'm writing this blog post, I just found out from Suzanne (prosthetist who's been on two previous trips with us) that she has a pediatric wheelchair that's been donated. That will go on the shipping container later this month to be sent to Zambia. So exciting we found a wheelchair for him!! Team PPIHN is so grateful for our ever increasing network of people who have donations to help this mission keep going!
Everyone was hard at work around the clinic...but we got some goofy photos in too. :) Sisters!...it was great to work with Traci for two weeks and be able to see her more. We live at opposite ends of the state so don't get a lot of time together.
Andy using our very nice sewing machine. I'm so thankful for this sewing machine every time I sit down to sew!
Smile! (and hydrate). With the dry climate and working all day in the clinic, we kept reminding each other to drink water.
Graham, our lamination extraordinaire! He had to use the generator in the morning for the first lamination on Thursday before the power came back on for the afternoon. It was important for us to know the schedule for load shedding (power outages) during the trip. If the electricity went out during a lamination, we would need to start the generator immediately and switch the plug in to prevent the lamination from being ruined.
Amanda picking out shoes for each patient to fit the prosthetic feet that had been selected.
We had so many plaster models, I just started lining them up on the floor for lack of table space.
Honest moment: I was thinking "yeah...we're doing pretty good on fabrication!". Then I walked into this room where Amanda had put all the selected feet labeled for each patient and thought "good gracious, we've got a lot of work to do!!"
End of the day on Thursday with a beautiful sunset view from the back of the clinic. We accomplished a lot on day one of fabrication. I think each team member was at a different place mentally though on how we felt we were doing...spanning from "it's all good" to "stressed to make this all happen by next week". We were looking forward to some restful sleep and then Friday for another full day of fabricating and expecting a few more patients.
On Friday, we saw Suzy for new AFOs (ankle foot braces). With the awesomeness of Facebook messenger connecting the world and making communication so much easier, I had been in contact with Suzy's foster mom, Jennifer (center in the picture), about new braces for her. You can see the light pink braces to the right of the mat in this picture that we fit Suzy with in April. These were braces that we had at the clinic that were helpful for her but not the best design to give her optimal function. Amanda was able to work with the whole family on exercises and strengthening that they can help Suzy with.
Traci's specialty is pediatric orthotics, so I had been sending her pictures and videos of Suzy walking along with measurements that I had Jennifer take of Suzy's legs and feet a few weeks before we left.
Traci had new AFOs and an attachment that comes around her hips with a band and metal bars down the sides to fully address all concerns with her legs.
The hip and knee portion of the braces can be detached with screws so Suzy can use just the AFOs most of the time and then the higher attachment portion for times they are working on therapy and gait training. This was a really awesome outcome with a teamwork effort ahead of time to bring some braces for her and the ability for Suzy's family to work with Traci and Amanda while at the clinic. Update from Jennifer since we've returned: Suzy is doing great with the new braces and using the hip and knee attachment every day some for training.
Since we didn't have someone other than our team at the clinic on Friday, we failed to get pictures of the other 4 patients who came on Friday.
- Luyando came for a new above knee prosthesis. I had been expecting her and her mother to come this trip for a new prosthesis. Since they live close to the capital city, Lusaka, which is many hours from our clinic, they would stay just one night close by. I told her to come back Saturday afternoon for fitting.....so we had a little over 24 hours to get a whole above knee prosthesis made.
- Felix came with his mother. We have been seeing him for the past several trips. He has a partial foot amputation due to a burn injury but has had a chronic wound so we haven't been able to make him a prosthesis yet. We had brought a walking boot for him that we modified to help keep pressure off the wound to help with healing, but the wound is not completely healed yet. It has been improved each time we see him, but still needs a little more healing before we can fit him. We made more modifications to the walking boot to help with better offloading of the wound and will hopefully be able to make him a prosthesis in April.
- Joyce came for repairs to her modified AFO (ankle foot brace). She has a foot deformity that requires a very unique brace design, which we made for her in April 2018. The brace was repaired this time, but we'll plan to make her a new one in April with hopefully an even better design.
- Amanda's pediatric patient with cerebral palsy, whose mother had brought him on Tuesday, came back for another therapy session on Friday as well. Amanda was able to go back over stretches and exercises with the mother for her to be able to do those daily at home.
At the end of the day on Friday, Graham had finished 8 laminations and we had almost all of the plaster molds modified. It was a long day for Graham since he had left the Ark at 6:30 to get an early start. We were discovering that the number of laminations needed to get everything made by the next week was going to be difficult to accomplish. So Andy and Graham made a plan on Friday night to make another lamination jig to be able to have two laminations going at once. We planned for an early start on Saturday to hopefully get lots accomplished.
*Next post: Saturday, Sept. 21- Sunday, Sept. 22: Ingenuity, our first prosthetic fitting and Sunday rest...