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Belize, days four and five May 21, 2011

Posted by markgeil in Travel.
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Thursday was a marathon in the clinic. I think it was an 11 hour work day. The space is cramped already, but when the makeshift waiting room is overflowing with patients and families, the bustle can be overwhelming. The team continued their stellar work, each one nimbly handling multiple patients at once. Ian pointed out that everything takes longer here than it does back home, and he’s right. It’s not the time with the patients that seem so long, it’s fabrication time. There are lots of extra hours searching for parts and tools; with everyone using everything at the same time in an unfamiliar setting, stuff gets lost. A lot.

There are also delays because much of the work is done on equipment that’s either outdated or improvised. A particular example comes to mind. Orthotic fabrication involves heating sheets of thermoplastic in a special oven before draping them over a mold of the limb. A vacuum pump then pulls the plastic tightly around the mold while it cools and hardens. For one fairly complicated AFO, the orthotics team needed the largest sheet of plastic we had along with three smaller squares. However, the kitchen oven we use only has one rack. Since all the plastic must be heated at the same time, we had to devise a complex plan involving four people to stretch the plastic, cut off the end, rotate it and fold it, and build up the heel, all within a few seconds of removing the sheet from the oven. The plastic is blazing hot, so orthotists use these special heat gloves. Of course, we only had two good pairs, so two of us had to use layers of wool prosthetic socks to protect our hands. The whole process looked a bit like bizarre synchronized swimming, but it worked.

By this point I had gathered all the information I needed for my grant-writing purposes, so I looked for ways to be useful. I learned how to cut the unfinished AFOs off of the plaster positives, so I set about removing three of them, making a terrible mess and a terrible racket with the pneumatic cutoff saw. I think I’ll have shards of molten plastic in my skin and hair for weeks. One AFO remained, but Ian had not drawn the trim lines on it yet. It was part of a pair, so I looked at the other one and drew my best guess. Ian checked and approved the lines, so I fired up the saw again.

Once the AFOs are removed, the edges must be smoothed using these special grinders and routers. I decided to give this a go too, and the more knowledgeable team members were happy to teach me a few tricks along the way. I worked on that last orthosis, the one I had drawn the lines for, and it probably took me ten times longer than it would have taken anyone else on the team. I had to stop a lot, because the team shares much of the limited equipment, and there were more urgent cases to be worked on. But I stuck with it, and in the end I marked the patient’s name – Julisa – on the orthosis with a wax pencil and turned it over to the professionals.

Some time later a family walked in, a mother and three daughters. The younger two had on school uniforms, and the oldest was in fairly typical teenager clothes. I think families have to pay for schooling here, so mid-afternoons feature similarly-aged children in school uniforms walking home for lunch past children who don’t go to school at all. As this family of fortunate schoolgirls entered, I could tell immediately who our patient was. She had a familiar abnormal walking pattern called scissors gait.

We listened for a moment to see what language the family spoke. The official language of Belize is English (actually, I think it’s English With Almost Unintelligible Creole Accent), but many speak only Spanish, or very Spanish-heavy Spanglish. We only heard Spanish from this bunch, so Allison asked our patient her name. “Como te llamas?”

“Julisa,” the girl replied, and then she smiled and giggled.

So, this was my AFO! I proudly fetched the completed pair of orthoses as the students started their history and evaluation.

“Quantos anos tienes?” Allison continued.

“Nueve,” Julisa replied, and then she giggled some more and looked at her companions. I think she was a little nervous but pleased to be the center of opinion.

I mentioned that everything takes longer than expected here, so there is a lot of waiting for the patients. During some of that waiting time, I decided to try out some of my limited Spanish with Julisa and her family.

“Mi hija es nueve anos tambien,” I declared.

I’m note sure if I said it right, but I was trying to point out that my daughter is also nine years old. Julisa’s mother could clearly spot my gringo language skills, so she replied in English.

“Oh, you have baby nine years old!”

“Si,” I said. “Se llama Rebekah.”

Julisa giggled. Maybe she thought Rebekah was a funny name.

She had come straight from school wearing little plastic sandals on her feet. We really needed her proper shoes in order to size the AFOs, so we asked if someone could go get them. The mother sent the other uniformed daughter, and about 30 minutes later she returned with shoes and two extra boys. Cousins, we learned later. Footplates were cut, straps were sized and attached, and finally Julisa received her AFOs. A lot of kids hate them, but she beamed with pride at her new white ankle braces. She walked around, and the progress was excellent, but it became apparent that she really needed twister orthoses, which of course we did not have. So, once again, we improvised. Ian fashioned a little network of straps and fasteners to wrap around her legs and keep the knees from crossing each other. The sewing machine broke (again) during this process, but during all the waiting Julisa continued to smile and laugh. She and her sisters looked our way and giggled a lot. I’m not sure what was so funny about us, but I was glad to see them smile. Finally, well after dark, Ian put on the finished product, and Julisa walked with dramatically improved gait. She should have been treated sometime long before in her nine years, but at least now she’ll be able to walk faster, trip less, and avoid continued development of improper bone growth.

There’s a custom in which patients get their picture taken out front by the clinic sign. I asked to get my picture taken with Julisa while she wore what was the first AFO I helped fabricate.

There’s one other picture that summarizes this whole experience for me. It’s a picture of Pablo, a serious-looking older man who came to the clinic to receive his first prosthetic leg. We stood by watching intently as he took his first steps. He was almost regal in his stature, with a sort of military cadence in his gait that’s quite unusual, particularly with a new prosthesis. Adjustments were made, and Pablo continued. At one point, he was using his walker to unload the artificial limb. We encouraged him to trust the leg, to put more weight on it, and to feel it underneath him, holding him up. He silently complied. He never said a word through this process, but I could tell his thoughts were many. I believe he’s a man of determination, and I think he’ll do very well with his new leg. I snapped a picture as he walked out the door. It was unintentionally backlit, but I like the silhouette of Pablo, walking off into the sunset, tackling a new life with steely dedication.

Later that night, the team worked on the next day’s fabrication, which included the first carbon fiber AFO ever made in the country of Belize. Don laminated until about 9:00, never once complaining about the interminably long hours. We had to finally leave a vacuum pump running while we went to get dinner. This last dinner (for me) was a feast. We went to a local ceviche restaurant. It’s all they serve, and when they run out for the night they just close the doors and turn out the lights. We were so glad to find the lights still on, and so satisfied by plate after plate of the simple but delicious dish. Stories and smiles were shared, with a little reflection on the day, some plans made for the weekend, and some more “how many habaneros can you eat” posturing.

The next morning I said goodbye to my new friends and wished them well. I hopped into Foxy’s cab again. He is Foxy now, since we’re friends. Turns out his real name is Antonio, which is how he introduced himself when we first met. He gave me some homemade hot sauce to take home, and once again regaled me with stories in his thick accent. Here’s a sample of one bit of the conversation.

Foxy: Over there, cashews grow wild. (He likes the cashew stories.)

Me, nodding just enough to encourage him, because I love these stories: Really?

Foxy: All the pirates come and eat the cashews.

Me, baffled: That’s strange.

Foxy, sensing my confusion: You have pirates?

Me, still confused: Yes, we have pirates.

Foxy: Okay. So the pirates all come flying over to get to the cashews. Sometimes you see them right over the road.

Me, catching on: Oh, parrots!

The flight home was simple enough, and the simplicity of life in Belize stuck with me as a bit of reverse culture shock took me by surprise. I’m rarely gone from home this long, which is a profound blessing, so I was delighted to see Amy and the girls. Now, I’ll get to work on writing grant proposals to support this excellent work and the excellent people who give so much to people they don’t even know. I have lots of names and faces to pray for now, lots of stories to tell, and far more memories of this small country with a big heart.

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