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What a Challenge: Querétaro, Mexico

Updated: Feb 28, 2021

When google-translating the meaning of Querétaro, like all good Americans would prior to entering a foreign country, I came up with nothing. I broke it down into some phrases I knew & found that "que reto" translated into "what a challenge." Nothing like a good omen prior to boarding an international flight to calm the mind and bring some comfort.

I had the amazing opportunity to go to Querétaro with several prosthetists to treat patients with limb loss at Crimal, a rehabilitation organization dedicated to providing obtainable services to the people of Querétaro. The organization is going on 25 years of service, with years of similar humanitarian trips to the one I attended. This one, however, had a fun & different twist when we were joined by Dr. Chuck Dietzen aka Dr. Doom, former pro wrestler and current physiatrist & founder of Timmy Global Health, and Brian Burhenn, also known as "Cargo." Dr. Doom and Cargo organized a Lucha Libre event in support of the Crimal clinic.

In Mexico, Lucha Libre events are highly revered as a fun gathering for families and friends. Our lucha libre event began with four local wrestlers taking over the arena and getting the crowd excited for the main event. In America, Dr. Doom & Cargo are known for their matches against small but mighty opponents. They compete against children with disabilities, for the opportunity to show that determination and perseverance prevails. Dr. Doom & Cargo have been doing this for quite some time, but our tiny heroes showed resilience against their gigantic competitions.

The Ant atop the shoulders of Dr. Doom

The arena was splitting with energy and the crowd went crazy when each child was awarded their own personal championship belt! It was a marvelous opportunity for the community to get involved and for the kids to participate in a grand show.

On Monday, the prosthetists got straight to work evaluating and casting 26 patients for new prosthetics or modified sockets. We had amazing translational assistance from the Crimal clinic physios and nutritionist.

The process begins with an evaluation of the patient's residual limb. Obtaining measurements and understanding the patient's sensitivities and pains. The CPO marks landmarks of where the patient has bony prominences that need to be protected, and where the patient would be able to apply weight comfortably and safely.

Marking bony prominences and weight bearing surfaces

Casting to capture the shape of the residual limb

In some cases, the prosthetists evaluate the patient's previous socket to see if they can modify it or if they need to start anew. They're able to discuss the fit of the past prosthesis with the patient in order to make an even better one!

Translator extraordinare, Adam, assisting Jason, CPO with an evaluation

After the casting has been done the prosthetist (or Maria) applies a few strips to the proximal end to make it easier for the plaster and molding processes. This is my favorite part because it's easy and difficult to mess up.

Next comes filling the cast with plaster, cracking off the cast (harder than it sounds) and beginning the modifying process. Now we have the positive mold. The coolest part about the modifying process is seeing the shape of the residual limb appear in plaster. In understanding the anatomical structures and weight bearing surfaces of a below knee amputee, the CPO builds up aspects he wants to avoid excessive pressure (fibular head) and carves out load bearing surfaces (patellar tendon).

After the positive mold is complete, we utilized the lamination process to make sturdy carbon fiber prosthesis. Laminating was new to me, so it was really cool to see the layers of material congeal with the resin to make the socket.

And, just like that - the final socket is born.

During this trip, I had the pleasure of translating as best as possible, getting to know the patients and their stories, and finding out more about their daily life in Querétaro. One of our patients was a 15 year old soccer and basketball player, who had outgrown his prosthetic. Initially we began conversing in Spanish, but he told me that he wanted to practice his English with us. He had been learning from Minecraft videos on Youtube. What a cool way to engage in learning a new language - beats Duolingo! His prosthetist, Billy, ensured the patient would have just what he needed to succeed on and off the basketball court.

Steve created this patient's first prosthetic limb. The first walk down the hallway was breath-taking. The whole clinic was elated to see this dream actualized. But, learning to walk again is no easy feat and these patients endure several more gait training sessions prior to taking their limb home.

As a PT, I had the opportunity to interact with some amazing Crimal physios. We traded techniques and showed one another innovative concepts: some we had been taught and some stratified through trial and error. It's hard to eloquently describe the camaraderie in the gym other than to say we quickly bonded over our shared passion of rehab and the parallel bars.

One of the patients we got to know had suffered a fall after using her prosthetic for 8 years. She struggled to stand, weight shift side to side and said that the knee of this new prosthetic wouldn't bend. We consulted the prosthetist and found that in order to sit she was able to make the knee bend, but to take a step was frightening. She told us that this was a huge set back, "poco a poco, paso a paso" little by little, step by step we assured her she could overcome this but she would need to trust us, herself and her prosthetic. We took our time and went back to basics. We practiced weight shifting and sit to stands. As she grew more confident in the prosthesis, her worries visibly melted from her shoulders. Again, we assured her that the trouble she was facing was something she had overcome before. Throughout the training, she learned how to trust herself again. By the end of the appointment, she was walking through the parallel bars to our cheers and applause. Though she didn't walk out of the clinic with her gait perfected, she was able to leave knowing she had accomplished something. These little moments throughout the week, the shared joy in the room I felt, are ones I will likely never forget. The smiles, laughter and triumphs we shared made me so thankful to have the opportunity to meet these people.

Will adjusting a patient's new prosthesis

Small but mighty

I am extremely fortunate to have the chance to learn, grow and help as best I can in this stage of my education. I look forward to more opportunties to grow as a clinician and person, whether that be in the hospital at my current clinical affiliation or somewhere down the line on another humanitarian trip. The more I've learned, the more I can recognize how little I know & how much room there is to develop as a physical therapist. What can't be taught in the classroom is waiting for me inside many a clinic, hospital or in my daily interactions.

Endless gratitude for the opportunity and continued mentorship from Mo Kenney, CPO. And to the Crimal IAP for letting me join in on an amazing learning experience.

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