Wednesday, November 6, 2013

POST TRIP MUSINGS: READING MY ORIGINAL GOALS A YEAR AGO

I am back on US soil...this re-entry is a very real thing. I have now crossed over 2 time zones being on the East coast for a week and now am on the West coast. I am now nearly opposite in time. Opposite in many other ways in addition to that. I am trying to hold onto the incredible peace I felt when I left. It is hard. I had the opportunity to go to church at Holy Angels where Father Dan did a blessing ceremony when I left. He was there in the lobby to greet me when I returned. He had a compassionate and knowing look in his eyes when he greeted me as if he could see the angst in my soul having left a completely purposeful life. He did a return blessing with the people around...it was a closing to a wonderful year.

I am now amidst the misty fog of the Puget Sound on Whidbey Island. Liz and Mike, my dear friends, have anticipated my emotions having known me for many years and in many life circumstances. They have me set up in my own space in the amidst the tall second growth fir along with the deer and the call of the eagles. They knew my heart needed HOME. During this time, I have been reviewing pictures and thoughts...eating old food and feeling ravenous for something missing. My dreams even point to this....

I told Father Dan that the realization I had recently is that I think I went to Africa to heal...heal on many levels which I could not have done here. My job now is to bring the light I experienced in Africa back to this world full of dark hopelessness and purposelessness. This is a bigger job than what I just did for the last year. It will take another few weeks to adjust and accommodate to this new world. I must bring the peace and joy I experiences there back here...HOME.

I was reviewing some documents trying to thin out my computer....I ran across this goal list which I wrote a year ago...only a month into my stay in Kampala....I want all of you to know that thanks to YOU and YOUR support and prayers, pretty much all the goals I outlined at the start have been completed....IT IS FINISHED!!!


LONG TERM GOALS: (IF we start NOW this is possible for the next 6 months or sooner)

1)   2 full equipped enclosed rooms for physical therapy including a sink and a bathroom (or at least a sink with a bathroom nearby)
2)   A policy/procedure for documentation on the children receiving PT including initial assessment and quarterly follow up assessments with goals and plans
3)   A coordination between the MO’s and the PTs with weekly meetings re patient issues
4)   PT Quarterly assessments going in the medical charts the MOs keep
5)   A weekly schedule of PT patients adjusted according to illness or schooling
6)   Consideration of having an orthotist to come to each home quarterly to assess and measure for new bracing to avoid the cost of transporting various children and staff to outlying clinics (which take a full day and ends up being costly)
7)   Weekly PT meetings for training and education and review of any questions re new procedures being implemented.
8)   Quarterly PT continuing education (researched and taught by the present PT’s to broaden teaching skills and create interest for new learning)
9)   Classes to teach the PT’s how to write professional foundation request letters (will allow for more incoming funds for the children along with the improved documentation) and a computer program that will correct spelling and grammar.



MEDICAL BASED GOALS:
1)   Work with the MO on gathering base data on each child for height, weight, vitals for baseline comparisons to track illness or improvements.
2)   Assist the MO (on the PT portion aspect) to complete a medical file on each child
o   This will allow future volunteers to feel confident about delivering the quality care the child needs without injuring the child. Presently, I am treating most of the children “blind” in that, I have had to find out by asking matrons, PT’s or through observation which children have congenital hip dislocation, osteogenesis imperfecta, seizures or occult fractures. This information is VITAL to any PT or nurse treating a child as serious injury can occur by NOT knowing this information. This information needs to be clearly outlined in the medical chart of each child along with the baseline info as noted in above bullet. This offers a comparison when a child is ill or injured.

3)   Consideration needs to be made if there is going to be 3 charts (the intake charts, the medical chart and the PT charts) where each will be kept and how information will be shared


BASIS FOR THE FOLLOWING REQUESTS:
1)   Lined paper, 3 pocket folders, and temporary print out of daily roster and PT assessment:
o    It usually takes a professional up to a year to learn new procedures while working full time. This will start the habit of completing the documentation, which will be the hardest thing to overcome. The longer we wait the less time I will be there for guidance
o   The sooner we start using these tools, the sooner we will learn if we need to modify them based on the patient population or time schedules
o   I found it easier to carry the lined paper recording all the children I am seeing in one folder and then place the paper in the patient chart when full. We may need to change this again as the PT’s start working with this process
2)   File cabinet in the PT room with hanging file folders:
o   The organization of PT assessments and patient charts can be started
3)   Need for a large dry erase board at both clinics:
o   To allow for setting up a daily schedule
o   There will be a general daily schedule with some of the children being seen daily and some 1-2 x week and some 1 x month. The schedule will vary depending on child illness or schooling, but this will help the PT’s see more patients without accidentally double treating. This will help track productivity and be a good feedback tool for the PT’s themselves
4)   Weekly training sessions may be lengthy at first:
o   As always when learning a new skill, it takes time to practice and have reinforcement for not only documentation but for treatment procedures
o   NOTE: Real treatment education is not feasible until at least 1 of the PT rooms is set up. There is too much distraction and interference with the other children and the PT’s presently lack the equipment/supplies they need to do the job they need to do.
COSTS:

The only costs to the MOP for initiating this program (to make the MOP rehab better than even the Katalemwa clinic) includes the cost for the following:
o   Lined paper (ongoing for patient charts)
o   Printed roster and assessment sheets
o   3 pocket folders
o   A file cabinet
o   File folders
o   Black pens (medical documentation needs to be done in black)
o   Time to allow training of the PT’s 1  x week
o   Time to take the PT’s to see Corsu rehab to get an idea of the rehab set up and equipment before we purchase our own
o   Time to allow me to shop for the needed equipment and supplies for the rehab departments
o   Time for me to visit Patricia (the old PT volunteer’s) hospital and rehab: gives me an idea of the standards of care so I am not asking the girls to do more than what the general hospital based practice is doing)
o   Time to meet with orthotists in the area for introduction (to feel out the feasibility of one of them coming to our homes quarterly including costs and transport) this will allow us to weigh the benefit of going out or bringing in. FYI: MANY MANY OF our children are going to need specialty chairs and braces to make the progress towards independent mobility.

AS with all decisions, the final decisions rests with you. I have already outlined the implementation plan in previous E-Mails so will attach the last one I sent. I implore you on behalf of the children that we serve, do not let the "Polan Polan" (slowly by slowly) way of life create un-needed fear of growth and change. Everyone is afraid of change and it may be a challenge for all but I doubt this. I believe this goal list has a very real capacity for being brought into fruition. 


 Alas...I am a list person...this was included for those who enjoy such things...AND for those who thought I was working under a whim and a prayer....I spent a month watching and thinking...these are the goals that resulted in that. 

Carol 

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