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...