Of Curry & Customs: SAM'S JOB

Have you ever had days, or even moments, when you are engaged in an activity, task, or job and you find yourself thinking “Eureka! This is what I want to do when I grow up!”? I have. Today. It was wonderful. Epic even. Until I realized that a.) at twenty-eight I should really be grown up by now, and b.) I think my dream job is nearly impossible for me to do. Before I go on, I should mention that if you haven’t read this post yet, you should probably stop reading this now and read that post first. This one might make more sense if you take my advice. Or not. This whole post may be hard to understand. But I digress.

Today, my chains fell off. I was sent on yet another village visit. Determined to make the best of it, I bumped along in the back of the mobile clinic with three other OT students and had them teach me some Tamil words and phrases. What seemed like an hour later, we arrived at the village. As the mobile clinic team began to set up shop, us OTs waited for Sam to arrive. Sam (“Sam, sir” they call him) is the head OT at CHAD. He runs the show on his own. He is a brilliant man, full of great knowledge. A solid mentor. I, unfortunately, have not had much of an opportunity to pilfer some of his knowledge until today.

The first patient we saw was a young boy (age four) who was born with right side hemiplegia. We spent about an hour with him reassessing, treating, educating, and coming up with ideas to improve his function. And someone actually translated for me. Brilliant! We discussed different ways to improve trunk control and shoulder strength to increase his hand function. (Proximal stability for distal mobility! See? I did remember some things from school.) I suggested activities for bilateral hand usage, and we contemplated the pros and cons to constraint-induced therapy. It was brilliant. It was fun. It was what I thought I’d be doing all along. Our ideas, suggestions, and treatment may or may not have good follow through by the parents, but we did all we could do in a short once-monthly visit.

Sam in action.

Upon finishing up treatment with our first patient, we noted that there was an hour left before the bus would come by to take the students back to Vellore for their afternoon class. It was enough time to visit one other patient. We marched on to his house only to find that he was away. He had walked on out to a farm a ways away, and if we wanted to visit him we could, but it would take a while. A brief team conference ensued. There was no way the students would be able to go; but Sam and I could if we wanted to. I took a quick read of the situation and surmised that Sam was riding the fence on this one. I saw this as my opportunity and piped up with a “Well, I’m free this afternoon. Let’s go visit him!” Sam gave me a surprised and quizzical look and repeated that it was about a thirty minute walk to see the patient. I replied with “Let’s do it. I’ve got legs.” And so we split ways; the students back to Vellore, and Sam and I out to a new kind of civilization.

As I walked on, I thought to myself, “This kind of home health OT is sooooo cool. I’m out trekking in the middle of India for a half hour to go see a patient! Winning!” Once we arrived at the location I was in awe. There were cows and goats tied up to stakes in the ground. There was one large shade tree that we were placed under while our guide to this settlement ran to get our patient. There were two thatch-roofed shade structures for livestock, one small mud and thatch out building, and a house that made up our “therapy room.” A banana grove (orchard? plantation? farm?) bordered one side of the space as well. Epic. I knew I would probably never experience anything quite like this again, and was soaking it in. I was here to do therapy. And I was loving it.

This was the view on the trek.

Along the way... over the rice fields and through the bananas groves.

Our guide, who ran barefoot over the stony, thorny path.

This was the view from where we conducted treatment.

This guy was standing around during treatment. Moral support.

This was where our treatment happened. Isn't home health OT in India amazing!?!?

On our trek out, Sam had told me that our twenty-something patient had an undiagnosed condition that caused lower extremity weakness which was spreading to the arms. He had been to the CHAD out-patient occupational therapy about a month and a half ago, and we were there to see how he was doing. Our patient arrived in worse condition then Sam had last seen him in. His speech was now slurred. I cannot describe much of the physical presentation, but I will attempt to describe our therapy treatment.

We had no diagnosis, so we started with some assessments. We did some gross muscle strength testing, range of motion screening, sensory screening, visual test, and gathered more background information. We watched him move. He has some peculiar movement patterns which we discussed as he transitioned from supine to sitting, sitting to standing, standing to walking and then to crouching and back to standing. (Side note: full crouching is not a position that is often screened in the US, but is common here due to the typical toileting habits.) We were stumped as to what was causing the deficits, and even more so what was causing the odd movement patterns. We recommended further testing by neurology at the hospital and educated them on why it would be important to seek answers. We also discussed solutions to functional issues such as bathing and toileting. His limited range of motion in upper extremities prohibited him from washing his face and head with ease, and his lower extremity weakness kept him from transitioning from crouching to standing. We found some tubing and have decided to return to implement a siphon system for bating. We are also planning to implement a raised toilet seat with some rock and logs upon our return. It was an amazing occupational therapy home health visit… Indian style.

After the treatment, the family members began talking about tender coconuts. Before I knew it, one of the family members was scaling a coconut tree and chucking green, tender coconuts from above. A short while later he shimmied down the tree, found an old rice sack, sat down with a huge machete-looking knife and set to work chopping off the top of a coconut. Then he handed it to me. So there I am standing in the middle of a farm with my camera dangling around my neck, holding a large piece of fruit with a hole in it, being stared at by six sets of chocolate eyes. I haven’t the slightest idea how to get the coconut water from the coconut into my mouth. There isn’t really a lip on the tender coconuts that one can put their lips around. I looked at them and smiled. They must have sensed my dilemma because they all started talking to me at once and making quick jerky hand motions towards their faces. I wasn’t understanding them so they gathered closer, began shouting at me, and even grabbed the coconut and tipped it into my face. By this time I was laughing… and fearing for the life of my camera which was about to be drenched in coconut water if I didn’t act fast. I finally got them to cut open another one and demonstrate for me how it is done. My patient willingly taught me how to drink from a coconut. After I finished one, they quickly swapped a full coconut for my empty one. My empty coconut was once again subjected to the machete knife as it was split in two. A scrap piece of coconut, and my halved fruit was returned to my hands as they demonstrated how to use the scrap to scoop out the tender meat and slurp it off the “spoon.” About this time I was thinking, “Is this really happening? And Sam, you have the best job ever.”

Scaling the coconut tree.... like it's his job.

Cutting into my tender coconut.

Teaching me to drink a tender coconut.

Hacking into the coconut to gain access to the soft fruit in the middle.

The aftermath

This little one was living out in the area. I couldn't resist taking her photo.

She was unsure of me.

I will not forget this face, and the memories attached to it.

A few hours after we arrived at this remote farm, we headed back to find the mobile clinic. They had moved on. Sam had a meeting to return to, so he put me on the bus and told me to get off at the village where I spotted the mobile clinic. I knew that would be easier said than done. I jumped aboard the bus hoping that it was the right one, and excited about another impromptu adventure. I was happy to be doing something and going somewhere rather than just returning to CHAD where I would likely sit around and wait for the end of the day to arrive. I successfully found the mobile clinic where I received a crash course in antenatal care and fetal palpations. I heard the heartbeat of a few babes-in-womb and was allowed to palpate a breech presentation pregnancy. Though I don’t think I’ll use those skills much, I did find it fascinating.

On our way back to CHAD, I bumped along in the mobile clinic (seated on the examination table) and thought about how incredible my day had been. I may not have changed any more lives than I did yesterday, but at least I was given the chance to try. I loved thinking of ways to create a raised toilet seat for a man who doesn't have a toilet. I thoroughly enjoyed coming up with play activities to encourage bilateral hand use in our four year old patient.

When I grow up, I want to be a home health occupational therapist in rural India. I want Sam's job.