27 June 2013

This Is What Improv Looks Like

A month ago, a lady came to see me . . . she comes from a city four hours away from Galmi, and back in the fall, she had been evaluated by a visiting orthopedic surgeon who had written a script for OT.

Unfortunately, I was still in the US.

But word-of-mouth made it's way to her, and she came with the hope that something could be done.

Her diagnosis was 'osteopenia (R) UE with h/o carpal fractures' . . . in other words, she had lost bone density in all the joints of her right arm and had sustained minor fractures in several of her wrist bones.

When she walked through my door, she couldn't lift her shoulder, flex her elbow or wrist, her hand was fixed palm-up and the she was unable to close her fist or pinch her thumb to her index finger.

Her hand was swollen like a series of jello-filled water balloons.  The skin from her finger tips to mid-forearm was scaly and incredibly sensitive to touch.

She was staying with a relative for the month and was, therefore, willing and able to put the time and effort into daily hand therapy.

We began with a manicure . . . using an OR scrub brush, her homework for the first week was to wash her hand with soap and begin removing the dead skin . . . which also worked to desensitize her skin, allowing us to apply more and more pressure to her upper extremity in order to reduce swelling and increase range of motion.

But I knew that daily sessions of stretching, joint mobilization, therapeutic exercises, thermal treatment and functional activity weren't enough.  She would also need a prolonged stretch of her fingers and thumb.

I considered my typical fall back improv of building a splint out of plaster gauze . . . but it would be heavy and corse . . . and when it comes to working with the intricacies of the fingers, plaster just doesn't cut it!

I knew what she needed was a flexion glove . . . a soft glove with loop-holes at the finger tips through which elastic strings run to a hook at the wrist, keeping all the finger joints in a flexed position.  With time, the strings can be shorted to increase the degrees of movement.

But I didn't have any flexion gloves, and there is certainly no medical supply companies from which I could (affordably) order one.

If H. was going to get her glove, I knew I had one option: make it myself.
Original sketch of the glove

Now, you need to know, my mom is a tremendous seamstress and she attempted to teach me how to sew when I was a kid.  But I hate measuring and basting and, more often than not, I spend the bulk my time undoing the mistakes I've made because I'm rushing to finish.  I can't sew a straight line . . . and I had decided to undertake making a GLOVE!

It took me several (as in FOUR!) attempts . . . I threw away more pieces than I kept . . . and my prototype looked more like a cartoon hand than a glove.

The slot for the little finger was fatter and longer than that of the middle, the index finger was too tight, the thumb was way too high, and web spaces way too low!

When I first brought the near-final product in for H. to try on, she took one look at it and said 'That thing is so ugly!!!  But if you think it will help my hand, I'll wear it'; and I'm pretty sure B. laughed out loud.  So much for the vote of confidence!
H.'s measurements

But draft after draft, we finally got it as-close-to-right-as-possible!!

Lesson learned: Niger is not the place for a perfectionist!!

I say that tongue-in-cheek, but the reality is, being an Occupational Therapist in a place like Galmi requires constant improvisation.  We live in a corner of the world where resources are so poor creativity is vital for progress . . . they don't call it 'African Ingenuity' for nothing!

Pinning it together
Adding the loop holes
The final product (Yup!  Those are rubber bands!  And
the hook is twisted wire sewn onto the strap.)
How else do we improvise?  No hydrocollator? No problem!
Using hot water boiled in a kettle and towels to provide moist heat for
a patient with severe arthritis in both knees
No kiddo-sized knee braces?  No worries! An XS-Adult
neoprene sleeve cut down, resewn and improved
upon to provide extra medial support so
 that he can walk pain-free!

Got foot drop?  No AFO?  How about a strap instead?


elisabeth barnett said...

One home leave I did a women's institutes glove making course by correspondence, it was very useful. I worked in leather. All stitching was on the outside, so seams outside to prevent rubbing. When I was last in Danja the shoemaker went to Kanno to buy leather. I thinh they had kid which is not to hard to stitch by hand.
The Women Institute, WI as it is called is a very English institution, or was, but may have gone by now.good luck Elisabeth

Beth Bo said...

Where there's a will there's a way! Thankful that God has blessed you with the creativity to figure out solutions even when you don't have the perfect pieces, Deb!

Deb. said...

Thanks Elisabeth! I really need to visit the Danja shoemaker again!

Deb. said...

$2,000???? That's it!! I'm changing careers!! :)

Deb. said...

Thanks Beth! (are you back yet??)

Virginia johnson said...

Deb, is there any way to send you a stack of those light weight work gloves so if you have to improvise, at least you wouldn't have to sew each glove.