Erin Williams Reflection – Improving Comprehensive Assessment and Prosthetic Delivery for Patients with Lower Limb Amputation

Erin Williams is a College of Health Professions student at MUSC. She was awarded a Center for Global Health Student & Trainee Travel Grant in early 2024 to pursue a project in Masindi, Uganda. View more photos of Erin's time in Uganda in this Flickr photo gallery.

The first week of my trip was outreach week. There were 26 healthcare providers from the U.S. including physical and occupational therapists and students, physicians, nurses, and a pharmacist, and we worked with some of the One World Health Hospital staff from Masindi. Traveling to three different rural villages throughout the week, we saw some crazy things. Everywhere we went, people would sleep outside there in a giant line the night before, to ensure they would be seen by us. The experience reinforced my love for PT and my desire to be the best therapist I can. It is easy to get caught up in the norms and think that PT is all stretching and strengthening. In some ways it is, but to see the true need for it, and see the look they give when you have just changed their lives forever, is a look that will now be engrained in my brain forever. It's an impact that even as a PT student, I didn't really understand was possible for me to have one someone.

One lady, that we had the first day of clinic, we are pretty sure had had a stroke. She had no idea what happened to her. She just knew that one day she woke up and could not use the right side of her body. She came into the clinic crawling. Picture a woman with no use of her right arm or leg crawling. It is a heart-breaking image. She told us that was usually how she got around the village, got to church, did her chores, unless someone was willing to carry her, which was not usually the case. We were able to fit her for a wheelchair and teach some of her village members how to maneuver her in it. Her face lit up! That type of mobility was something she had never thought would be possible for her.

Here are common things we did or some interesting things we saw throughout the rest of the week. We saw and cleaned A LOT of machete wounds, children, adults, all ages. To cut the crops, cut the grass, cut down sugar cane, they all use machetes, so whether it be from themselves or someone else's miss, there were a lot of leg wounds. We would clean it out and wrap it up, and then give them a big baggy of ointment, clean tissues, gauze and explain to them how to clean it and the need to boil the river water, let it cool and then use it on their skin. We saw some fused displaced fractures, some kids with hydrocephalus, and a lot of back pain. Most of the back pain was from positioning while working in the fields, carrying babies on their back and things on their heads, so that was a lot of education and alternative movements.

Throughout the first week we treated more than 1,100 people. Of the people treated for malaria, 48.6% were positive and given medication. The PT implication that malaria being this common had, was that we saw a lot of kids with "cerebral palsy that started when they were 9." Technically to be diagnosed as CP it must be recognized before the age of 2, but when malaria goes untreated for long enough, it begins to attack the brain and manifests as CP.

The second week was a much smaller group, seven of us and two Ugandans. The goal of this week was to fit and deliver wheelchairs while educating the patient and family on how to use them safely. This week we had a set number of patients coming for chairs, so it was not as fast paces, but more attention to the little details for the best fit. We distributed 40 wheelchairs between children and adults, which is incredible. We also fit some people for crutches, and I did my project of fitting two people for prosthetics. A bonus was that I also fit Peter (a Ugandan working with us) for some adjustments to his current prosthetic.

Peter's story of how he came to be a part of this team is amazing. Three years ago, Peter came to one of the outreach clinics after having been in a bad accident, losing one of his legs and breaking his femur on the other. They saw him that week and referred him to come back the next to get a wheelchair, so he did. He got fit for a wheelchair, and they gave him some strengthening exercises to work on after they left. They had some extra crutches and walkers so they gave him those too in hopes he would get stronger and be able to use those instead. The next year he came walking in with his crutches just to say hi to the team. They were so amazed by his progress and how much stronger he had gotten that he got set up to receive a prosthetic leg. It was such a long and difficult process especially because of the unusual shape of his "good leg" due to the previous fracture that had since healed itself displaced. He now helps every year with translating and assembling wheelchairs during this week. He was the catalyst of my project to make the delivery of prosthetics more efficient and possible. Going into this week I knew that I would be fitting two people for prosthetics that were predetermined but had no idea who they were. Come to find out the second patient I had was Peter's friend, who was also in the accident with him and had also lost his leg. It melted my heart to see them together and see the way he looked at Peter with his leg knowing that he would soon be able to have a leg too.

The people I met, the stories I heard, and the experiences gained from this trip are and will forever be unmatched. I could talk about this forever and am so grateful to have had this opportunity.