 |
Medical Team’s ‘Can Do’ Spirit Aids Colombians
By Jeff Fredrick, MS, CPO I've never seen an outbreak of bugs that have no
name.
"They are everywhere," we are told by a well-armed
policeman. "They are crawling all over the woman with the new
baby."
 |
Debbie with Bianca and family. Photos courtesy of Jeff Fredrick, MS, CPO. |
|
"We can go to Barranquilla and buy some bug
spray," I automatically respond.
"Not a good idea," Ligia Applegate of Humanitarian Universal
Connexion joins in from the makeshift pharmacy. "It might hurt the
new baby!"
Oops! Bad enough idea even in the States--spraying a whole house
full of bug juice with a critter still in a crib--and it's worse
here. Safety restrictions on chemicals are immune to North American
warnings. Chemical companies are not above shipping whatever they
can sell--even if the FDA will not allow the product to be used
around our own kids.
Greg Fox, a rehab specialist, and I follow four policemen
through the refugee camp. It's a good time of year to travel to
Colombia: hot, but windy. Unfortunately, the wind does more than
cool. "Fecal snow" is one term for it. A powder of dried, raw
sewage is picked up and blown through the camp. It's the same smell
given off by treatment plants in the United States. There is one
just beyond the runway we departed from two days ago. But back
home, it is only a smell--no particle ingestion!
 |
Colombian soldiers on a bug-fighting mission. |
|
Keeping bugs off a baby--is that anything like
saving cats out of trees? Five combat-ready policemen evidently
think so. They discuss the problem as seriously as if planning an
assault on a guerilla stronghold. They seem genuinely concerned
about the plight of the woman and the baby. It's the true heart of
Colombia, which is seldom reflected in worldwide media reports of
the violence here.
Great Day for Rehab Care
Deb Plescia, CPO, is eight for eight: five lower-extremity and
three upper-extremity prosthetic fittings with clinically excellent
results. A day of such spectacular deliveries is rare even
stateside, especially since there were no diagnostic fittings, no
laboratory, and few tools. The reasons are simple: good preliminary
focus, clear documentation, excellent fabrication technique, and no
time compression during the actual fitting/delivery process. The
results: a great day for a good prosthetist and her patients.
The success rates of the physical therapists and orthotists are
the same. Three adaptive wheelchairs, rejects thoughtfully
transported by Delta without extra compensation, are painstakingly
adjusted by Catherine Knickerbocker, PT. Three severely involved
patients whose positions without chairs were a harbinger of worse
things to come may dodge a decubitus bullet. Mike Hanna, PT, also
works patiently until the children are fit as professionally and
safely as if the chairs were specifically ordered for them.
Providing Help Realistically
 |
The face of a refugee. |
|
We stop to discuss our needs for the next trip.
Too often it is a question of how close you can get to what is
needed. Sometimes, "appropriate technology" is a misnomer that can
mean "less technical." It represents a cap, a limit defined not by
functional level or need, but by availability and economics
(sometimes even geography)--the least humanitarian and most crude
of the determinants that drive the rehabilitation process.
It makes sense to provide the appropriate device when one can.
If there is a need, and a less-than-perfect substitute exists,
maybe we should ask the patients to decide. Decisions for a
person's well-being in developing countries are often made by
expatriates who have everything. It's easy to be philosophic when
your child gets the best care and your own stomach is full.
Occasionally we need to be reminded there are two sides to the
appropriate technology issue! To serve effectively, sometimes we
must serve the need, not the ideal.
Can Do--No Matter What!
Bianca, who lost her leg in April 2002 in an assassination
attempt on the then president-elect of Colombia, Alvaro Uribe
Vélez, comes to the clinic to walk for the first time in two
years. The 17-year-old has lost weight and matured into a beautiful
young woman, just since our last trip.
"You look great," I tell her.
"I've accepted my difficulties--I feel better now about
everything," she responds, as though recognizing her earlier
obsessive focus on the tragedy had affected her looks.
"See, I'm okay!" she says with a big smile as Deb Plescia
carefully fits her new AK prosthesis. Those are pretty brave words
for a 17-year-old. I don't know who's smiling more as she walks
away on the new prosthesis--her or Debbie Plescia. Debbie's
attitude as well as Mike's and Catherine's remind me of the old
World War II adage, "can do," with a twist: "Can do, no matter
what!" It reflects a depth of professionalism that is unaffected by
inconvenience. Whether it's in the most beautifully furnished
office on Physician Road in Anytown, USA, or a mud hut with filthy
floors in Colombia, it doesn't matter. Their attitude and output
would remain the same. I couldn't be more proud of them. Problems
don't matter; output and results do. It shows on the amputees'
faces as they walk by to leave the clinic, and in the expressions
of the mothers pushing their catastrophically challenged children
in new wheelchairs, instead of carrying them.
Medical Clinic
 |
Current and appropriate enough technology. |
|
The next day, we're back at the the primary
medical clinic in Barranquilla.
We don't find any orthotic and prosthetic needs, just scabies,
worms, malnutrition, and a few untreated wounds from war and
traffic accidents.
Sometimes humor coexists with tragedy.
"I feel bad about it," I overhear Debbie Plescia confess from
the pharmacy.
"What?" I ask provocatively.
"I gave a prescription to the wrong patient," she confesses
solemnly. "He nodded his head when I asked if he was the man the
prescription was written for."
"Is it serious?" I ask, growing more concerned.
"He took a stool softener that was meant for a constipated
child," Debbie responds, still solemn.
We laugh as we imagine the results, until Dr. Lisa Kohler
interrupts with news that a ten-year-old she saw last clinic for
routine problems has died of pneumonia.
I can't help wondering, if we hadn't delayed so long in
returning, perhaps we could have saved the little girl? I doubt if
a stool softener will hurt the man who misrepresented himself and
took it, but it might cost him some inconvenience for a while. In
the end, maybe it will do him some good!
Corruption, Violence: People Suffer
Sometimes I feel the same way about this whole country. It, too,
seems to have taken a wrong drug or two. In the end, the violence
of the old drug cartels, the cruel kidnapping by guerrillas, and
the retaliation of the paramilitary would benefit from a similar
error that might soften their rhetoric and agendas. Who knows? In
the meantime, sadly, the people continue to suffer. There's nothing
new about this in the historical sense. It's always the people who
pay for corruption and violence. It's what scares me so much about
our own country. The corners we cut and our growing disrespect for
law and order could be seeds of the anarchy, chaos, and violent
competition that cost people so much in Colombia.
The trip ends with over 500 medical and 80 O&P and physical
therapy patients served, including one man who perhaps has learned
a valuable lesson. Maybe sitting around a little more over the next
day or two will give him pause to consider the importance of
representing himself more honestly?
Jeff Fredrick, MS, CPO, BOCP, is director of Hangers
Rehabilitation for Development (Hanger RFD) and branch manager at
Hanger Prosthetics & Orthotics, Tallahassee, Florida. 
Table Of Contents - August 2004
|
|
