Belize, day two

Monday night I slept the fitful sleep of a stranger in a strange land and a different time zone. A particular bird started his full-throated morning song at about 4:30 am. It was an eight-note sequence repeated over and over, and the bird apparently does not understand time signatures, so it kept me up for good. I’ve read that birds sometimes sing for no known purpose. It seems they sometimes just like to sing. There’s a great truth in that, so as I struggled to get a couple more hours of precious sleep I was not grumpy, I was grateful.

Hours later, I met the team for a walk through Orange Walk Town and breakfast at Mary Anne’s food stand. The town is dynamic and vibrant in the morning, and I was again struck by the novelty of everything I saw. Breakfast was eggs and beans and waffles with queso accompanied by delicious watermelon juice. All the food is so much fresher here than what I’m accustomed to, and it’s easy to taste the difference.

We walked the rest of the way to the clinic, and a busy day started in earnest. I was unable to finish my AFO sorting project before patients started coming. Every room at the clinic is used for three or four different purposes, so my stock room became an exam room. I met Justin, a little boy with big brown eyes that revealed his thoughts about the treatment he was receiving for club feet.

At the same time, Oscar was receiving a new prosthetic leg. The process usually involves lots of feedback from the patient about fit, comfort, and alignment. Oscar’s feedback was not really useful. He just smiled and nodded about every question asked of him. He was easily the most agreeable patient I’ve met, and he had a wonderful smile.

Shortly thereafter, a lady poked her head in the door wondering if Adrian was here. Adrian is the clinic manager. He lives in town and was missing both his legs at birth. He gets around on a modified skateboard and makes me laugh every day. She had found the right place, so she brought in two other adults and Fatima, a charming 4-year-old with spina bifida. She had a squeaky little voice, an impressive vocabulary in both English and Spanish, and a concerned family. They had traveled to Guatemala some time ago to try to get some care for her equinovarus feet, but they believed the orthoses they received were actually making her condition worse. I was able to consult with Ian, the team’s orthotist, regarding her options, and I was glad to be useful. I’ve had years of training in human locomotion, but I never get to use it for actual patient care. Unfortunately, Fatima’s options were limited. Ian modified her orthoses, but she really needs either a method of serial casting called the Ponseti method, or surgery to lengthen her Achilles tendons. Adrian started making phone calls, only to be told that Ponseti is not done anywhere in the country.

All the while, Fatima was happily playing with the coloring book we gave her. She didn’t actually do much coloring, but she sure had a good time. She would hand me a crayon, and we would talk about the color (in English and Spanish) and then she would declare, “I like colors”. She must have said that 15 times. She melted all our hearts, and we were sad to send her away. (She actually only got upset when it was time to go!) Adrian is committed to following up on her care after the team goes home.

Patients kept coming, so we ordered lunch from a nearby Chinese restaurant. (Yes, they have Chinese restaurants in Belize. Lots of them, actually.) We ate quickly and then returned to the task at hand. Patrick lost one whole leg and a couple of toes on the other due to diabetes, a big problem here. Rob took care to make sure the prosthesis he received would accommodate his primary means of transportation, his bicycle. Later, two particularly challenging patients arrived, and I got to watch the team really excel.

These would have been difficult cases in even the best of settings, so I was doubly impressed that they were even taken on here. One was a young girl and the other an older lady, but both were motivated and strong. The girl lost her leg due to cancer, and was the most difficult level of amputation to treat, a hemipelvectomy. The lady was also an amputee with major challenges. Rob turned into a bit of a superhero at this point, simultaneously managing both patients while we all continued to ask him where certain parts were or how to do certain procedures. This lasted late into the evening, and Rob never once let the pressure get to him. He also never made a mistake, which would have been easy to do with this concurrent and complex treatment. I shall remain forever impressed.

I was also impressed with the patients. The girl’s suspension required some improvisation, and we wound up having to fashion a couple of straps and buckles out of spare parts. This required some sewing, and the clinic’s old Pfaff sewing machine sadly stopped working after the first line of stitches. Rob tried to fix it, I tried to fix, and ultimately Adrian decided to pour oil into every hole he could find, all to no avail. Eventually a chain in the drive mechanism broke. While Adrian was madly oiling the Pfaff, Rob and I were trying to resurrect an old donated Sears Kenmore machine. I fixed the bobbin while Rob dealt with the other patient. These sorts of delays tend to spring up in settings like this, and though the patients are remarkably understanding, we all feel bad that they sometimes have to give up a whole day for their treatment.

In the end, after a whole bunch of modifications and adjustments, both ladies took timid, measured steps on their new prosthetic legs. It was a sweet time and a beautiful accomplishment. Darkness had fallen outside, but the room was lit with smiles. Each member of the team, grimy and tired though we were, shared a moment of realization that these were profound, life-changing steps, and we all played some small role in making them happen.

After a late dinner I went straight to bed, more tired than I realized. Unlike the night before, I slept a deep, sound sleep, surprised by the sunlight when I finally opened my eyes.