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Only 2 days left until we leave for Haiti !
Still a few more job related responsibilities tomorrow (an on-site planning meeting at our soon to open 25,000 square foot UNC Center for Rehabilitation Care, completing some patient notes on WebCIS, our our online electronic medical record) with the remainder of the day to be spent spraying my clothes with permethrin and packing for our trip.

Today was my last clinic day B.H. (Before Haiti) and it brought with it some experiences that made me pause to consider what is in store for us over the next week.

• One of my patients this morning had spasticity, an increase in muscle tone that is contributing to the development of contractures (tight tendons) around his knees. After discussion with his mother, we pulled some botulinum toxin out of its storage freezer, mixed it into some saline and injected it into his hamstrings to temporarily loosen those muscles and enable his family and therapists to more effectively stretch out his muscles and tendons. How easy for me to choose this treatment, prepare it, and administer it to my patient(s) !! I don't think botulinum toxin's (widely) available where we're going, and wonder just how beneficial simple range of motion/stretching exercises are going to be for the children I'm going to see very soon.
• Another patient also led me to think forward to my upcoming encounters with the children at Zanmi Beni Orphanage - I was asked to see a 40 day old infant with spina bifida (a congenital condition similar to a spinal cord injury) who had  also been born 10 weeks early. As she lay in her father's arms, I examined her and was happy to be able to tell her father that, although she might need braces on her legs and crutches, she  should be able to walk and not have to use a wheelchair to get around the community. His tears of joy (he had assumed that she would always have to use a wheelchair) made my day. Later, I wondered about what might have happened to this girl had she been born in Haiti instead of the United States. What are the chances of survival for a Haitian child born so premature? Even if she survived, would she ever receive the equipment or therapy she would need to become independent in her mobility? 

I often lament the ills of our mismanaged healthcare industry, but I also recognize how lucky I am to live and work here in the United States. We are so blessed to live in a country where healthcare resources are so readily available. It's going to be quite a challenge to see how I can serve children with disabilities in a country that is not so very rich. But it's a challenge I'm thankful to have.

Bonswa (Good Evening) !