My third week

Last Friday and Saturday two medical students who are completing their elective placement in a nearby hospital visited our Nilphamari hospital for the weekend. We went for several long walks outside the compound to get a closer insight into the local community’s everyday life. We walked through many rice fields (picture 1) and passed through villages where the community gathered to get their picture taken (picture 2). It was a lovely opportunity to exchange experiences and thoughts with other Westerners who are here doing similar things to me.
On Sunday there was a clinic for outpatients to attend, specifically for cerebral palsy (CP) and club foot babies and children. In the morning I worked with the Physiotherapist in the CP clinic, together we assessed the children, the physio would teach parents stretching exercises to do with their child at home (picture 3). I made myself useful by looking the family’s son (picture 4).
In the afternoon I joined the other Physios helping to cast the club foot children (picture 5). Club foot management was preformed according to the Ponseti model. Ponseti developed a method of clubfoot management that is inexpensive and effective for use in developing countries. Long-term follow-up studies show that feet treated by Ponseti management are strong, flexible, and pain free. The treatment takes approximately 6 weeks by completing weekly manipulations of the foot followed by plaster cast applications slowly moving the foot into the correct position. When possible, it is best to start club foot management soon after birth (7 to 10 days). When start¬ed before 9 months of age, most clubfoot deformities can be corrected by using this management. In Bangladesh, there is a distinct lack of awareness in detecting clubfoot babies, therefore, many children’s treatment only start when the parents notice their children do not start walking at the correct age. It is then that they seek treatment; this may be too late for correction of the foot alignment through plaster casting leaving surgery as the only option. Picture 6 shows a 13 day old baby with a cleft palate. The family brought this baby to visit the Doctor in Nilphamari in the hope to get surgery for their childs cleft palate. Luckily the doctor also diagnosed the child with club feet, so the baby received plaster casting at the ideal age and will receive surgery for his cleft palate when he reaches 10 pounds in weight.
On Sunday night I attended the leprosy patients entertainment night. Every Sunday, they meet in the Physio room and take it is turns to sing and tell each other jokes. This encourages the patients to bond with each other, get to know other patients in the hospital and relax and have some light hearted fun.
On Monday I was collected early in the morning and traveled with the Physios to a neighbouring district were another clinic was held for club foot children. We moved tables and chairs outside and carried out the casting in an area under the trees (picture 7). Picture 8 shows me with one of the Physios after our days work.
On Tuesday I observed many surgical procedures carried out by the doctor who was trained by a Surgeon from Switzerland who worked in Nilphamari for 9 years but left earlier this year. I observed club foot surgery, skin graft, below and above knee amputations and thinning of an inflamed nerve using a meshing technique.
On Wednesday and Thursday I worked with both the Physios and Doctor in the wards (picture 9 and 10). This involved assessing the patient’s sensation in both their hands and feet (picture 11) and reviewing the progress of many patients.
On Friday I travelled back to Dhaka to enjoy the weekend. I was sad to leave Nilphamari, during my stay I became very close to many of the staff members and patients. The staff included me into their team with no hesitation; they shared many stories about their families, culture and worries. I feel I have left Nilphamari with many valued friends (picture 12 and 13) who I hope to one day see again.