Letter from Don

In November, I spent one week on the Big Island of Hawaii helping physical therapist Nancy Bloomfield with some of her more challenging patients. The following are some of my thoughts about working while in the middle of the Pacific Ocean.

I’m out the door early Monday morning for clinic work. No one is up in the house this early so I find my shoes under a pile of flip flops and beach gear by the door and let the screen door close behind me quietly.

It’s about an hour’s drive to where I have to meet Nancy, the physical therapist. The highway runs out of Hilo and follows the shore for the first 30 miles before turning west to cross the high ridge of the island. I pass through Papaikou, Honomu, Oakala Paauhau, Honokau, and I try to work out the pronunciations as I drive. I have an FM station from Honolulu tuned in, green mountains to my left, and the blue Pacific on my right to keep me company. At Honokaa, I buy a sack of hot Portuguese donuts and a coffee and spend the last miles to Waimea trying to keep the greasy, sugary mess under some control.

Waimea is ranch country, cool and high, and the mall where I am to meet Nancy has a western theme to the storefronts; it works. Nancy is exactly on time and so begins the end of taking it easy. She has a list of kids to see, the first being right around the corner. At our first stop are little feet that need careful, precise positioning, from as comfortable and as flexible support as possible.

Except for the breeze through screens and tropical birds outside the windows I could be anywhere. We have used the Softy^TM option on this patient before and it has worked very well. I do fresh casts with footplates between two layers of stockinet, positioning carefully while they set.

I like to cast the feet with moderate compression. This compression molds the footplate to the foot and defines the surface anatomy and volume more precisely. A compressed casting doesn’t translate into a final brace with compression, so comfort should not be a concern.

Finishing up the order form with color choices, we are off to another setting. It’s another classroom with teachers, aides, bulletin boards, backpacks, screens on the windows, a pleasant breeze blowing through, and ocean stretching away as far as you can see. There might be whales and turtles to see for some people, but not for me this day. Another classroom, another patient, and off we go again, eating as we drive. We are a little behind on our schedule but nothing that high speed driving can’t fix.

We finished our day on the Kona side at a school that has a large, open, but covered area where the buses and parents come and go. The entire school goes through or alongside this area at the end of the day. Lots of people stop a few minutes to watch the casting and talk to the kids being casted. This is the best clinical setting I have ever worked in for making these kids, who need DAFOs, feel part of a larger community. How many times can I answer, “what are you doing this for?” before I get tired of explaining? I don’t know yet.

Now I get back in the car and have one more home call, up on the mountain in Waimea on the way home before the day’s work is done. This home is at the end of a side road and I have to open the gate to drive the last quarter mile to the house. It is a working ranch surrounded by cattle and horses.

The family has a two-year-old boy with very low tone, very pronated feet, an unsteady gait. A pair of precisely fitting and flexible DAFO 4 SMOs, with horses on the straps, should work as well in Waimea as they do in Warrensburg, so I get that done. I open the gate to leave, close it behind me, and begin down the highway to Hilo that is starting to light up in the gathering dusk. What have I learned?

In every place that people live, you will find families that have children that can be helped with carefully conceived and applied braces. This is demanding work and even in paradise, a cup of coffee on the last leg home is refreshing and comforting as I turn on the wipers to clear away the beginning of the evening’s tropical shower.

-- Don Buethorn

Don Buethorn, CPO, is founder-owner of Cascade Dafo, Inc., and Cascade Prosthetics and Orthotics.