Tuesday, January 28, 2014

Fun with Plastic

 We've been really busy at the Center and realizing you can do everything with 3mm and 5mm Copoly plastic :)
Patellar tendon bearing prosthesis for a terrible chopart amputation with a chronic ulcer on the distal end.

 Clam shell design allows for donning of the prosthesis. Otherwise the patient's ankle is too large to pass through the smaller proximal circumference.

Flexible AFO to provide medial-lateral ankle stability for a patient with a longitudinal partial foot amputation.
 "Stove-pipe" design prosthesis for Symes amputation. This is the right foot of the same patient using the AFO shown above, on his left foot.

We'll be doing a hip prosthesis in the near future and many "normal" trans-tibials and trans-femorals.

Sunday, January 26, 2014

Raising Kids Abroad

I’m not going to say that my experiences are the same as all of those traveling and living abroad with kids, but I do think that perhaps some of you might be able to identify with me.

My level of flexibility had to go from novice to yogi overnight. In La Paz it is very difficult to find healthy foods for your kids…people are eating ice cream and lollipops at 9am, and there is evidence of this consumption all over the playground. This has been incredibly difficult for Amelia, as it seems to her that her parents are cruel and are withholding the best things in life from her. I have definitely had to relax in the “healthy eating” department as people love to give her treats, and I have had to be creative in the kitchen to provide nutritious meals for my family.

In the developed world we are sleep obsessed. We have sleep consultants, we schedule when our kids sleep and it is our goal to get our kids to sleep through the night as quickly as possible. One of the questions I heard the most after Amelia was born was, “Does she sleep through the night?”. Nobody asks me that here. Kids are not scheduled…in fact, I don’t think children even have naps. They sleep when they are tired which ends up being on the bus, or in their parents arms wherever they may be at that moment. I seriously see kids sleeping everywhere here. Also, kids don’t have a scheduled bedtime. They are up very late, but seem to function just fine. Many do not understand our scheduled sleep routines and I have had to relax a bit in this department as well.

I did not think that a 2 year old would have a difficult time adjusting to another culture…I was wrong. We went through a month or more of difficult transition, with Amelia missing her friends and really not liking the attention she receives here. I wasn’t prepared for the difficulties facing an introverted child in a country where kids don’t get the luxury to be so. Children are passed around from day one, and get used to many hands and many faces. On numerous occasions I have had to decline the outstretched arms of a vendor at the market who wants to hold Amelia (as she desperately clings to me). The people are so sweet here and love our blonde little girl, but unfortunately she does not reciprocate their affection. The other day, Amelia and I were walking down the street and a woman walked up, picked Amelia up, swung her around and said, “You are an airplane” in Spanish. Amelia’s stunned expression said it all. Just as quickly as it began, it was over and Amelia was back on the ground asking, “What happened?”. If this had been 2 months ago, her reaction just wouldn’t have been as impassive. She has developed coping mechanisms, and has adapted to the way that things are done here. That’s not to say that she has accepted the attention she receives, but we’ve come miles from where we started.

I am perhaps the one who still needs to change. I think of the big, open fields in our cities, our spacious yards, our public libraries, recreational activities and I feel like parenting is easier at home. I miss the consistent friends for Amelia, and I feel like I’m not able to provide her with what she needs…but this is only my conception of her actual needs. Truly, all of the things I have listed are luxuries that are a part of our daily lives at home…things that I took for granted. I am aware that we are now at our halfway point in our adventure and culture shock is more a reality now then it was at the beginning of our trip. I am trying to seize everyday.

Just to be clear, this is not a criticism of how other cultures (specifically this one) parent…not in the least. Bolivians deeply care for their children and more often than not, provide safe and loving homes for them. Weekends are for families. It says something positive about the family construct when you see teenage girls still holding their mother’s hands. This is more a reflection on the difficulties of culture change and how that has affected me, my child, and my ideas of parenting. Ultimately, it has been such a positive experience, and being stretched and challenged in the way one does things can’t ever be bad!  

Wednesday, January 15, 2014

Nuestra Casa

Ok...so we have officially as of today, been in our "new" house for a full month. I cannot even begin to express how this place has changed our existence here in Bolivia. This is our third place in 3 months, and by far the best. Amelia's entire demeanour changed when we moved into this house (which may be a result of our renewed emotional state) and we immediately felt like we were home.
One of our living rooms...the previous renter bought the couch set at El Alto and the taxi driver strapped all of them to the top of his car.
The other living room where we spend most of our time...hippy living. Amelia loves sitting on the floor. 

Dining room.
Hallway lit with skylights. 
Our kitchen...it's rare to see a full-sized fridge.

The office. This is the warmest and cosiest room in the house.
Our bedroom.

Amelia's bedroom.

We took this place over from a couple from Spain. It is spacious, completely furnished, shares a garden with another Spanish family (who have kids), is incredibly quiet, private and safe, and has fruit trees ripe for the picking. When it rains, the beautiful aroma of the citronella tree wafts through the yard. The entire house is lit with natural light due to the skylights that run the length of the flat. Being that we are in rainy season, we have the pleasure of daily listening to the drops hit the plastic skylights, creating a cosy, romantic feel. We are a mere 4 blocks from the Centre, live directly across the street from a convenience store (and when I say convenient, I mean convenient...toilet paper, eggs, wine, beer, diapers that you can buy individually, chips, noodles, the best banana bread...EVERYTHING), live next door to a SalteƱ
aria, and a place that sells "almuerzo familiar" (familiar lunch...for 10Bs ($2) you get soup, meat and rice, and a dessert).

Plums. I made plum jam out of them. I don't think Bolivians have ever tried it. They were very surprised when I told them. 
The garden. Our house is on the right.

Purple plums. 

Tumbo. Looks like passionfruit on the inside, but tastes like nothing I've ever had before. Really sour...used mostly for juice. 

Anyone want to come over? We'd be happy to have you!

Wednesday, January 8, 2014

Next Time Your Boss Tells You to Clean Up

Several weeks, or maybe months ago (yeesh, we've been here a long time already!) I had the privilege of visiting "the other" prosthetics clinic in La Paz. This clinic is in a fascinating old building and truly is the most memorable clinic I have ever seen. If was founded many decades ago by a German who shipped EVERYTHING OttoBock over on a big ship. The amount of money spent on machinery and fabrication equipment, let alone the shipping costs to get it here, would have been astronomical. I'm sure in its beginnings it would have been quite a beautiful place. The interesting thing is that it appears nothing has changed during the decades that passed, I mean nothing. No desks have been cleared, no corners swept, no walls washed, no squeaky hinges oiled, no clocks wound back up....this place is one-of-a-kind. 

Next time your boss tells you to clean up the plaster room, just remember this one, and tell her it can wait :)
This clinic is different than the one I work at, in that each patient who goes here must pay for their prosthesis. Due to the high cost of prosthetic components and the low income of most Bolivians, this is usually unattainable. Centro de Miembros Artificiales, where I volunteer, is able to provide prostheses for low cost, or no cost.

The prosthetists here were really keen guys and will likely join us for a few of my teaching sessions in the coming months.