27 September 2013

One OT Fits Most

When living in a land of plenty, there are certain things we take for granted; conveniences we've stopped thinking about, because when we want them, they are there.  Things like boneless-skinless-chicken-breasts . . . AAA . . . high speed internet . . . and Speech & Language Pathologists.

Known to the common man simply as a SpeechTherapist, the SLP is a vital member of the rehab team.  They focus on the motor aspects of speech and the cognitive components of language . . . but they also address swallowing deficits.  Which, as a an OT with my hyper-active gag-reflex, it was always nice to have a colleague who took over once food entered the patient's mouth.

Dysphagia is the technical term we give for 'difficulty swallowing' . . . it is often related to an injury of the brain, such as a stroke or TBI, but it can also be present in some cases of dementia or other neurologic conditions.  And at home, without fail, if there is a diagnosis of dysphagia, we call in the big guns and the SLP arrives on the scene, armed with applesauce, a spoon and a packet of Thick-It.



I am a firm believe that God does not waste experiences.  Whether it be a volunteer position or that project report the boss made asked me to do . . . even when I don't understand the purpose behind it, the skill I developed as a result of what was seemingly meaningless often creeps into use sometime in life.

The best preparation I had for coming to Niger to start our little therapy department was working at a Level 1 TraumaCenter in NorthPhilly.  The wide range of experience I gained there has proven to be invaluable in Galmi.  Spending time on the Burn Team and on the Rehab Unit . . . working in Neurology and Neurosurgery . . . being in the Trauma ICU and on the MedSurge floor . . . helping out in the Hand Therapy Clinic and stretching patients during Wound Care.

All of it . . . PRICELESS.

For my work as an Occupational Therapist.

What made my time at Temple that much more valuable was the frequent co-treatments with Physical Therapists and Speech & Language Pathologists.  A co-treat is when a patient requires the skilled services of two separate disciplines at the same time.

I often receive emails from therapy students and recent grads asking for advice concerning the emergence of their career . . . well, today you get some free 'wisdom': co-treat, co-treat, co-treat!  Don't just do your thing while you're working with another discipline, watch and learn!  You never know when you're going to need to borrow their skills.

Working in Galmi, there is rarely a day that goes by when my work doesn't require that I blur the line between physical and occupational therapy and I have to concentrate more on mobility and less on function.  It's just the nature of what happens when the rehab department is made up of a motor-moron suffering from a terminal case of clumsiness and highly-capable-but-part-time therapist-assistant-in-training.

But I don't just borrow from PT . . . every now and again I say a quick prayer of thanksgiving for and blessing over J. the SLP I used to work with in Philly.

J. taught me about the different  thicknesses of liquids . . . the importance of the chin-tuck when swallowing . . . the signs of aspiration . . . and how to give simple-to-follow verbal-commands to patients with aphasia.  It's been years since we worked together, but yesterday, in my memory, I was back in the ICU while machines beeped and blinked, watching J. do a swallowing assessment.

One of our docs had ordered therapy for a 40 year old patient who had arrived in our ER after having a stroke . . . she couldn't move her right side, she was aphasic and she was unable to eat.  A nasogastric tube was placed immediately, but it wouldn't be a permanent option . . . either she'd need to be able to take food and water orally, or she would be referred to surgery for a permanent feeding tube.

Needless to say, no one wanted to have to resort to the tube.

Her evaluation wasn't too promising . . . she coughed and sputtered with each tiny sip of water. Millet porridge dribbled from the right side of her mouth down the zunni tided around her chest.  Clearly thin liquids weren't the way to go . . . but how on earth would we thicken things . . . the porridge was easy, add more millet powder.  But what about making sure she had enough water?

I knew I couldn't pray that God would rain down Thick-It packets from the sky, but surely there was something!!

And there was!

Tapioca.

A few months back, a sweet lady that was helping me work on my barely-comprehensible-Hausa was selling tapioca.  Now, being a grown-up with texture issues, I only eat tapioca when someone else makes it . . . but she's such a sweet lady . . . so I bought some . . . but 'some' was actually 'a lot' . . . like more than I could eat in a year if I made it everyday.

When I purchased the powder from her, I had no idea what tapioca was used for except pudding . . . so I asked my friend Google, and he told me that tapioca often works a lot like corn starch.  At the time I thought, 'Well isn't that interesting' and tucked in away for a rainy day.

Well, not only did it work, but the family said they have lots of tapioca at home!!  Using an adapted cup I had made by dremeling a cut-out for her nose on the side a plastic cup I bought in the market, my patient was able to chin-tuck as she drank her tapioca-thickened water!!

Goodbye NG Tube!!

So, J. you may still be in the States, but this week, you kept a 40yo Nigerien woman from needing a feeding tube for the rest of her life!!  On behalf of all of us in Galmi, thank you!

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