Physical therapy student reflection from Masindi, Uganda: Holly Knapp

In May 2019, I was given the opportunity to go to Masindi, Uganda to conduct the first ever wheelchair seating and mobility clinic. This trip helped me grow more than I ever imagined, both in my personal life and as a future clinician. I learned how to conduct various evaluations, I improved my communication skills through the use of a translator, and I learned how to adapt services provided based on the availability of resources. 

During my first year as a physical therapy student, I didn’t formally learn how to conduct standardized assessments, especially in pediatrics. Under the supervision of our faculty member, Dr. Dodds, I was able to fully conduct the PEDI-CAT and the WMST independently. There were many times that required me to be flexible and find a way to evaluate both children in a way that could work around their conditions. For example, one of the children presented similar to cerebral palsy and had a diagnosis of developmental delay. He was unable to walk and had knee flexion contractures. After spending the morning getting a thorough history, measurements, and fitting him in the chair, the patient was fairly overstimulated. Because he was easily frustrated, it was difficult to get an accurate assessment of his ability to self-propel the chair. We decided that in would be in the patient’s best interest to assess the caregiver’s ability to navigate the skills with the child in the chair instead. It is also likely that this method will be a more realistic depiction of use until the child gets more comfortable with the wheelchair. While this isn’t how I intended for the evaluation to go, I was able to be flexible and still assess wheelchair proficiency. 
Communicating with patients via translator was another big learning curve for me. I was constantly having to figure out what words translated well and what didn’t. I found it interesting that the world “relax” did not translate at all. I tried the words floppy, heavy, sleep, soft; I even demonstrated on someone else. This is just one example of the language barrier we faced despite having wonderful translators. 
Language was not the only aspect that forced us to get creative. The minimal resource availability and level of care in Uganda was unsettling. One patient that really sticks with me was a 10-year old living with a spinal cord injury after being hit by a car on his way to school three months prior. The accident left him paralyzed from the waist down. Prior to the clinic, he had been isolated to his home, only moving when his parents were around to pick him up and carry him. They had tried to obtain a wheelchair a few weeks earlier, driving 2+ hours to a neighboring city only to find a broken adult wheelchair that they couldn’t afford. During our examination we found that the child had slight sensation in his legs. What really struck me was the realization that if he had access to intensive therapy and the technology available in the states, it is possible that his prognosis may look completely different. However, we had to be realistic and address what we could in the short time we were there. Luckily, we were able to fit him with a wheelchair that will allow him to regain a greater level of independence. Because of the decreased sensation, he is at major risk of developing pressure sores, so we also taught him pressure relief techniques that will function to strengthen his upper body as well. My favorite part of the trip was witnessing the way this child lit up when he got in the wheelchair, started moving around, and immediately regained hope of one day returning to school. He was a natural in the chair and with a little bit of cueing, he was navigating all over the clinic. Seeing a child’s future change because of the work our team put in is a lesson that I will never forget. 
Over all, this trip helped me grow as a student and a future clinician more than I could have ever imagined. I now feel much more confident in my ability to clinically reason, individualize treatment, and work with more involved populations. This trip has also provided me with the skills to conduct a thorough pediatric wheelchair seating evaluation, which is a skill that I would not have learned in the same depth in our curriculum. I am so grateful for the opportunity that the MUSC Center for Global Health has given me and because of this grant, I was able to gain a much greater understanding and appreciation for global healthcare and how I can use my education to make a difference. The need for pediatric wheelchair seating and mobility clinics was significant. My hope is that dissemination of the data collected from this clinic will support the clinic replication in the future.
By Holly Knapp