Week 10 Blog: Was it all Worthwhile? (3/4/16)

Had a great chill with another ILO volunteer, Marion, over the Easter weekend. Bumped into a couple of guys from Johannesburg who invited me to play with them at the Maseru club. With Marion as my newly appointed camera crew and manager, a groovy evening was had by all, fulfilling my ambition to play some African music with some African musicians. See the results on You Tube by searching under African Vibes Jan Jeffrey

After that it was back to Morapeli to finish my assessments and a brief visit to Saint Angela's to catch up with proceedings there. It's great to see the kids again but things don't seem to have changed. Sister has had to go to town, but hopefully will be back by lunchtime to see me. By the end of the day I am still waiting to see her and also Lerato, who I recommended to have an x-ray back in February.

Sister doesn't return but at last Lerato is wheeled in by her mother. They both look drained and Lerato is obviously in a lot of pain. She still hasn't had her x-ray, despite Bob leaving the money to speed up the process. The social worker says she has had a problem finding a hospital with an x-ray machine that works. The mother says Lerato has deteriorated since I last saw her. Now both hips are painful and contracted and she has an abscess on her buttock and ankle.

I look at the abscess on her buttock which is the size of Lerato’s fist. Even the social worker looks shocked. I tell the mother she must take Loretta to hospital tomorrow. It will cost 15 Maluti (about 60 pence). I can't be bothered of going through the tedium of where the money will come from and give her 100 Maluti to cover all contingencies. It probably represents a small fortune to her, but it is only four pounds and nothing to me.

Sometimes I think I would like to stay in Lesotho. Other times I don't think I could cope with the guilt of living in a country where the cost of a cup of coffee in a cafe could be spent sending someone like Lerato to hospital. Anyway, my time is nearly up here, so was it all worthwhile?

To paraphrase Sir John Hunt from the successful first ascent of Everest "For those of us who took part in the venture the answer must surely be yes. We have shared moments of great living upon that mountain. ‘That mountain’, in my case being the Mountain Kingdom of Lesotho. I have had amazing experiences here, even if some of them have been horrific. I have met inspiring children, ventured into areas of physiotherapy I have never been to before and seen incredible scenery. I have coped with things I wasn't sure I could and achieved more than I thought I would.

In the short term, I did make a difference. How long those changes will last, I don't know. Encouragingly Sentebale is investing more into Phelisanong which will help sustain the physiotherapy and changes in the ways the children are fed. I feel less positive about Saint Angela's, but I have set up a physiotherapy room there, planted some seeds and brought to light some deficiencies. I have also made a plan to link together the physiotherapy for the four main care partners dealing with disabled children, which hopefully can be used to support and encourage developments in the future.

IIt’s hard to imagine life back in the NHS in Wales, where I don't have to think about a sink with running water and soap to wash my hands, or where a parent will find 65 pence to send their child to hospital. There have been moments of great frustration and despair, but also I have been uplifted by moments of "great living" in the Mountain Kingdom of Lesotho.

I will never forget my time here and have made a short movie to try and capture how I felt about it all. Please search on You Tube under Wales for Africa. Lesotho 2016 Jan, to view. For myself, personally, it certainly has been worthwhile, and hopefully I can come back soon. It has been the most rewarding and brilliant of times.

Reflections

I was dangling on a rope in space, over 600 feet above the ground, next to one of the highest waterfalls in Africa, Maletsunyane falls. The mist from the falls drifted across, soaking me. I was nearing the end of my time in Lesotho and had come to Semonkong lodge for my last few days. Semonkong translates as place of smoke. The town is famous for the falls and gorge and the outdoor activities that take advantage of the natural beauty here. Pony trekking, hiking and fishing are available, but I’d only come for the abseil, the highest commercial abseil in the world.

As I slowly made my way down the cliff, I could see the faces of all the children I had worked with. Alex showing me how his thin deformed arms could do Taekwondo, Thaby doggedly doing his exercises, Wagi standing on her head, Lineo putting toys in a bucket, Malafane, dribbling in fierce concentration while he played with a fire engine, Kolosoa and Tokiso proudly walking in the sunshine with their frames. 

My eight weeks, plus an additional two that the ILO had given me, were over, and at last I had time to reflect. The ten weeks had passed by in a blur of bright light, heat, smells (some of them not very pleasant), spectacular scenery and intense emotions. There had been no chance to pause as I dealt with the day to day crisis’s of the children’s health care, chaotic infrastructure and lack of resources. There had been no health expertise to draw on and little guidance for my assignment.

The only health professional I had met during my venture, had been Dr John, when he came to assess the children one day at Saint Angela’s. I had to become an expert on all manner of health issues during my time here, there was nobody else. Back in the UK I am only responsible for my one small area of physiotherapy. In Lesotho I had ventured into areas where I had previously not dared to tread and found depths to my skills and health knowledge that I didn’t know I had.

I had made mistakes in my enthusiasm to help, and my assumptions were sometimes wrong. At Saint Angela’s there was the episode of the wheelchair cushions. At Phelisanong I thought that some of the children, who were walking on bent and twisted limbs, might benefit from extra support. I found the usual response, when I offered them crutches, was a look of confusion. Why would they want walking aids when they were already walking? They would politely accept them and when I next saw them passing by they would be carrying on as usual, having left their crutches behind in a dusty corner somewhere.

My greatest sense of achievement in Lesotho was getting the children with swallowing difficulties fed upright and Sentebale agreeing to fund extra care workers to sustain this. The most profound thing that happened to me was the experience of working with the children with learning disabilities at Phelisanong. As I started to solve some of the practicalities of how to feed them, I began to see their personalities emerge and see beyond their titanic struggles to swallow. I soon realised that these children had beautiful souls, you could look into their eyes and see straight to their heart. They were pure and untainted. These children were a delight to engage with and my ability to work with them was a total revelation to me.

My biggest pleasure during my time in Lesotho was sharing Tokiso’s utter joy when he got a walking frame to use. His determination to get fitter, more independent and realise his dream of walking to school was truly inspirational. I will never forget his face as he walked out of the door on his frame for the first time. Fortunately, I captured it on film to replay and relive in darker times ahead. He also provided my most heart breaking experience when I had to leave Phelisanong and he broke down in tears. His devastation encapsulated my own fears of what would happen to the children, and the changes I had made, when I left.

Seeing the children and staff in the play room on my final morning at Phelisanong gave me hope that the staff would continue to play and work with the children after I was gone. Hope, that the children might have more to look forward to than endless hours of looking at the ceiling and floor, and that with some stimulation, they might gradually gain a little more independence and control over their lives. That some of them might sit up. That some of them might walk. I wanted to help them build on the small successes they had already achieved. It was a compelling force that made me want to return to Lesotho. For now, though, it was time to go home.     

Week 9 Blog: Ups and Downs (27/3/16)

On Sunday, I was picked up from Maseru by the Sentebale driver to take me to a new guest house so I could start at my next placement, Morapeli, on Monday. He doesn't speak much English and from the amount of times he stops I gather he doesn't know where he is going. Neither do I, but we eventually arrive at a very nice lodge and I spend the night there. When I meet the manager the next morning he tells me I've been brought to the wrong guest house. I have to pack up my stuff and walk down the road to Lindy's guest house and unpack again. For once, I am glad that Imperfect taxi's failed to pick me up on time, but an hour and a half later I am starting to get a little annoyed.

At last the lovely Sabbath arrives, who I have shared many a journey with to Saint Angela's, and we set off to Morapeli. Unfortunately, neither I, Sabbath nor any of the locals know where it is, and eventually I call Manyanye who points us in the right direction. When we arrive there are no senior staff because they have gone to meetings in Maseru, and no children, because they are in exams. Not only that, they are all going on Easter break on Wednesday. There is little point in hanging around, so Sabbath takes me back to Lindy's.


While I wait for things to be sorted I visit the oldest church in Lesotho, then climb the local mountain and play my sax on top and watch the sunset. It is spectacular. The climb is equivalent to the climb up Cadair Idris and done by the primary school children every day to get back home from the primary school at the bottom of the mountain to their village at the top. I join them as they trail up the mountain and wonder what a seven-year-old in Wales would say if they had to tackle it.

I get back in the dark, glad that I took a torch and a young local girl, Caroline, with me as guide. We get back to Lindy's and the night guard unlocks my accommodation and comes in to sort the keys out. We exchange pleasantries and Caroline leaves, but the night guard stays on and plugs in his phone. I am not happy. I am the only guest on site and he is the only member of staff. I suggest that I bring his phone out to him, but he doesn't seem to understand me. He is making me feel very uncomfortable and in the end I make coffee and ask him to drink it outside. He finally gets the message and goes. 

Unfortunately, I have been told not to lock the house because there is supposed to be another guest arriving that night. The key to my bedroom door won't lock and the bolt is misaligned and also doesn't work. I improvise with a chest of drawers and breathe a sigh of relief when an hour later I hear the other guests arrive.

Transport fails again the next day and Manyanye sends in the Chief. A local and reliable driver who reassures me and takes me to Morapeli. The staff that attended my workshop at Saint Angela’s are there and are very helpful. We get loads of work done and I assess a lot of the youngsters in my new physiotherapy room, which is a floor with some blankets on it. Morapeli is like Saint Angela's with teenagers who are basically physically disabled. They do not have the young children with the severe learning difficulties that Phelisanong had.

I see a range of things from spinal cord injuries resulting from gunshot wounds, to hemiplegia's, a girl with thalidomide, a boy with severe scoliosis, burns, birth defects and very deformed feet. I don't have any medical notes and I have long given up on any help they can provide me with anyway. I see an eighteen-year-old boy who was a normal boy up to five years ago before he started getting tired and weak, and is now in a wheelchair. Neither his parents or the staff at Morapeli have taken him to a doctor. The staff tell me he is lazy. I look at his severe muscle wasting and think it is more likely he has muscular dystrophy.

I see another boy who had an operation on his foot three years ago and the wound has been weeping ever since. There has been no money for a follow up appointment and that's the way he has been left. I despair of the health care in this country, but the people's resilience is amazing. I meet John as I look around the school. He is my age and the Sisters have built him a small house to live on site.

His paralysed arms hang down by his side and he sits with his virtually useless legs out in front of him. With the help of some friends he has designed a cart which he manages to get on and off using a washing up bowl, and punts around with the aid of a stick. Even though he shows me how it works, it still seems totally impossible given the very limited movement he has.

I'm constantly uplifted by people like John and feel that every battle for better conditions is worth fighting. I have less than two weeks left now and hope I can still make some small differences in this time. Tonight, I have received the fantastic news from Ma that she has visited Phelisanong and found the children in the physiotherapy room being supervised by the staff. She was so impressed that Sentebale are going to fund three more care workers from today. This makes it more likely that the changes I have tried to bring about there will continue. The week is certainly ending a lot better than it started and the ups have definitely made the downs worthwhile.

Week 8 Blog: No happy endings ? (20/3/16)

When the three children's zimmer frames turn up at the beginning of the week I am thrilled. I know just who will be able to make use of them. I start with Tokiso and Kolosoa. The boys pull themselves up, salute me and make for the door. Kolosoa is out first and rather haphazardly steers himself down the path. Tokiso radiates joy and can't stop himself from laughing. It is a dream come true and I can see he feels ten feet tall. 

We slowly make our way towards the house where they both live.

Tokiso is looking around to see who is watching that he, Tokiso, is walking.

He is actually just dragging his twisted feet along, but it’s the first time he is moving under his own propulsion. It takes eight rests to get to the house, but we make it. "I am training" says Tokiso. He has to take most of his body weight on his arms and its very tiring way for him to walk. We compare biceps. I too have been inadvertently training as I lift hundreds of kilos of children every day, on and off the beds and floor, and in and out of wheelchairs.

Some days I am so tired I can barely walk the half mile up the rough track that leads on to the road. However, with training both myself and the children are getting stronger and better at what we do. The children who come to the play room are all gradually improving their coordination skills and ability to play. It’s such a pleasure watching their small successes.

Training day dawns for the staff and I hope I can give them the knowledge and encouragement to continue the work I have started here. The morning is taken up with nutrition and feeding. I don't think I totally endear myself to the care staff by getting them to feed each other on their backs so they can experience what it feels like and how easy it is to choke. We then go down to the houses to feed the thirteen children that are normally fed on their backs. It takes some time but they are all successfully fed sitting upright. I am really impressed with the staff’s willingness to learn a different way of doing things and so pleased for the children, especially Malefane. He has an enlarged tongue which he struggles to keep in his mouth. The carers normally lie him on his back and make a trough with one hand while they shovel the food into his mouth with a spoon. It's horrific to watch. 

Now he sits upright and, given a little time, can organise his tongue and lips to swallow the food without much spillage. He can't talk, or walk and has problems controlling his movement, but he's smart and has the most charming smile that comes right from the heart. When I pick him to come to the play room he looks at me with a big smile and slowly brings his hand to his chest as if to say "Me? Really?" I don't think anyone has ever chosen Malafane for anything before.

The afternoon session is taken up with a short talk on child development and playing with the children. I feel the day has been a great success. I leave the staff to it, they seem to be having as much fun as the children. It's late afternoon and I make my way to London to buy some beers. I can smell something delicious cooking as I walk back down the road. My nose tracks down a bakery. I end up sitting on the front step drinking beer, with some new found friends, while I wait for some buns to cook. They turn out to be the best buns in the world and it's the perfect end to a perfect day.

On my last day I spend most of the morning in town looking for some further sources of fruit, vegetables and protein to supplement the children's diet. When I get back the school choir has magically appeared and start singing goodbye to me. With the beautiful mountains behind them they sing and dance in the way that only African children can, and I am totally choked up. There are lots of people there I've never even met before and they all line up to give me a hug.

Mamello gives a speech and I am presented with a traditional Basotho hat. I present Mamello with the Welsh flag and try to give a speech in between sobs. The children of Phelisanong have really got to me and I feel very emotional about leaving them. I then go down to the houses to give the children I have been working with sweets. I only have two Welsh wrist bands left so decide to give one to a girl, Masela, and one to a boy, Tokiso, as representatives of the efforts all the children have put in over the last three weeks.

Mamello is translating for me and I see Tokiso's face fall and he starts to cry. He doesn't even want to accept the band I am giving him and won't look at me. Mamello later tells me that when she said I was going he said "No! You are not to say that!" I had told him earlier in the week that I was leaving, but I guess he didn't understand me. I feel wretched and that I've built up his hopes of walking and improving only to pull the rug from beneath him.

I take him to the play room and try and console him with the spaceship we were building the previous day, but he's not interested. He's a small boy with big problems, who had pinned his hopes of a better future on me and I am leaving Phelisanong with his dreams. He eventually stops crying and we go back to the house where I play some music and take some photo's. It's a temporary fix and I know he feels deeply wounded and let down.

I wish I could fix things for him and the rest of the children, but I can't. On Monday I go to another centre for two weeks. I'm leaving my heart with the children at Phelisanong where there are no happy endings, just a continuous struggle for them all. I can only hope that the small seeds I have planted grow and the future might be a little brighter.

Post script:

I posted the above last night. This morning Ma arrived to pick me up for a meeting at Phelisanong before we go back to Maseru. I dash to the Physio room to pick up some paperwork I have left there, and startle with complete surprise. The children are all there in the play room. Tokiso, Lesojane, Lineo, Kolosoa, Malefane, Palesa, Mothimokholo, and more besides. I am overjoyed and kiss them all.

The staff are carrying on without me and as I look out the door Mama Jo is walking up the path, helping Masela use her walking frame. Tokiso gives me a big grin and shows me the flashing light he has found on the space ship. We do some walking and he laughs with the pleasure of his new-found independence. He can carry on without me and so can the staff. Maybe there will be a happy ending after all.

Reflections:

The problems at Phelisanong meant some fundamental changes were needed in the way things were run, together with changes in the attitudes of the staff. When I arrived there I had adopted a pragmatic approach and tried not to be overwhelmed by the enormity of the difficulties I faced. It was obvious with only a maximum of three weeks there, that just doing physiotherapy with some disabled children was not going to make much difference. 

The lack of staff, resources and training meant no one had any time to think about improving the children’s quality of life. Staff were entirely focused on the daily tasks of cleaning and feeding their charges. Once Sentebale had sent the toys, the care staff were able to see that the children were capable of a lot more than sitting on the floor or lying in bed. I didn’t have to worry about physiotherapy exercises. The children were naturally using their muscles to sit or stand upright, in their desire to reach and stretch for the toys. All the staff had to do was supervise the play and put appropriate toys within the children’s reach.  

Getting involved in the problematic area of the children with feeding difficulties was a fearful, and at times, nauseating experience for me. Being covered in Weetabix, pap and dribble was not fun. My early attempts to help at lunch times, made me fully appreciate why the staff found feeding the children on their backs the most practical option. The laws of gravity, swallowing difficulties and the complications of muscle spasms that wracked some of the children’s bodies, made feeding them upright incredibly difficult.

I had no idea how to deal with their swallowing difficulties and could only hope that with some practical experience I would eventually find a way. Each lunch time I had to force myself to go down and help with the feeding. It was not what I wanted to do, which is why I made myself do it. My willingness to be involved went some way in helping to win the staff over in changing their practice of feeding them on their backs.

Training gave the staff the chance to experience how unpleasant it is to be fed on your backs and the practical knowledge of how to feed every child upright. It was encouraging for both myself and the staff, that the centre manager, Mamello, joined us for training and got thoroughly involved. Her leading by example made it more likely that the changes in attitudes and practice would be sustained. Mary told me that I had made more difference in the three weeks I had been there, than a physiotherapist they had once had on placement, who had stayed for two years. Her remark made me feel I had achieved something worthwhile during my short stay.   

By the time I left Phelisanong, I had answered the initial questions I had about the centre when I visited at the beginning of my trip to Lesotho. The children were being fed on their backs due to lack of knowledge and staff shortages. Unlocking the children’s minds and communicating with them, happened as I played with them, became involved in their lives, and got to know them. Playing was also a natural way to help them move, improve their coordination and balance and stretch their muscles. The children weren’t being buried in the garden, the stones marked donations given by people who supported Phelisanong. It had been a steep learning curve, but a very rewarding one.          

Week 7 Blog: Small steps (13/3/16)

Phelisanong offers completely different challenges to Saint Angela's and I'm having to think carefully about what I can realistically achieve here. With conditions so basic the care here doesn't get much beyond food and shelter. The children who can’t go to school stay in the house and are left to crawl and roll around on the floor. Those that are unable to move lie in bed looking at the ceiling. Without any stimulation, it’s like their brains stopped developing soon after birth. I know some of them could achieve more, but it will take a lot of input which they are not getting.

Its small steps like getting Lineo to hold a spoon at meal times and patiently guiding it to her lips, instead of her sitting there like a baby bird while the food is put into her mouth. Lineo has Downs syndrome and is very small for her age. She was found malnourished in a remote region being brought up by her grandmother. She has very low muscle tone, but I think could eventually walk given enough encouragement. Already, after a week, she will stand for several minutes against a bed or a chair, before giving a huge sigh and letting her legs collapse under her. She very funny and I think only stands to humour me and is quite happy to have everything done for her. 

In contrast, some of the kids are so desperate to walk their efforts put their bodies into complete spasm, making it even harder for them to achieve any control or balance. I found Kolosoa attempting to use the small pair of crutches I have brought with me to try and walk. Since he has no balance and is unable to straighten his legs he has little chance. Masela is the same and I try and work with them on some sitting balance and coordination skills, like putting a ball in a bucket. Such small gains can make them hugely excited, a disaster for a child like Lesojane whose limbs flail and stiffen on movement. His arms lock out like a fast bowler so when he does manage to get hold of a ball its best to duck quickly.

Another unforeseen problem is their trousers fall down all the time, so once I do get them standing their trousers are in a heap on the floor. That together with all the snot, dribble and occasional wet patch add to all the difficulties, but I find their efforts to succeed totally engaging. To my joy a small consignment of toys has turned up from Sentebale. The children are thrilled and drag themselves towards me begging to come to physiotherapy.

It’s too small a space to take many and I have to leave some behind. I take Kolosoa and Tokiso, who is quite bright and speaks a little English. "Yes, yes, yes", he says and punches the air triumphantly as I wheel him along. He must be the most enthusiastic physiotherapy patient ever.

Next week I must do some more training with staff on nutrition and feeding difficulties. Suddenly within a week I seem to have become an expert on this subject, which is slightly alarming. I will do my best with a little bit of knowledge and common sense. There are thirteen children here that are being fed on their backs, which is unacceptable for several reasons, but principally due to the danger of choking.

My aim is to change the meal culture of the house mothers and help them to feed the children sitting upright. To my surprise I managed to do it reasonably successfully when I assessed these children last Friday, so bring on the Weetabix. I never thought I'd be saying that after my first efforts to feed these children, but sometimes a lot can change in a week :)

Week 6 Blog: Trial by Weetabix (6/3/16)

Phelisanong is home to 180 children, a mixture of non disabled and disabled youngsters. Some are orphans, some have HIV, some have learning difficulties, and a whole spectrum of other health issues I am unfamiliar with. Set in the foothills of the Maluti Mountains, the beautiful scenery contrasts with profoundly disabled children living in cramped, spartan conditions. The care staff really do care, but have few facilities or knowledge to make these children's life's easier. There is often two children to a bed and no room to play the huts they live in.

The wheelchairs are left outside because there is no space indoors. A concrete path runs around in front of the buildings, which is the only smooth place to walk and push wheelchairs. A prehistoric swing on small patch of rough land provides the only place to play. Plumbing and toilet facilities are very limited. Only the two houses with the most disabled children have an indoor toilet and sink, but the toilets don't flush, while the water barely dribbles out of the tap. The clothes are washed down at the river. The school is right next door to the home, and it is here that the more able children go to school.

I have already met three of the staff from the physiotherapy training course I ran at Saint Angela’s, and will be working with Mary the social worker. Fortunately, most Basotho have a Christian name as well as a Sesotho name, because I often find Sesotho very hard to pronounce with all the clicks in the language. Mary takes me to the room which has been designated for physiotherapy, which has been cleaned out since I last visited over a month ago. It consists of a concrete floor, walls and a roof. It adjoins Mary's office and the clinic. The people queuing for the clinic also use it as a waiting room so there isn't much space and I often have an audience. The is no sink or running water.

Mary takes me to the two houses which accommodate the children with the worse disabilities. As I will only be here for three weeks, the selection process for physiotherapy is harsh and only the children with the most potential are chosen. Originally, I had some naïve plan of a daily routine of stretches, exercises and games that the house mothers might do with the  children unable to go to school. This is rapidly dropped when I see what a struggle it is just to feed and clean these children.

There are no toys or stimulation in the room, just beds and a few bits of basic furniture. One of the houses has a walking frame. Its adult size and nearly fallen apart, but it appears to be the only walking frame on site. With its help, some of the children can walk and I choose these ones for physiotherapy. I send an urgent request to Justice for three small children's Zimmer frames at Saint Angela's that I know are not being used.

Lunchtime comes and I decide the best I can do for the other children, is to try and help feed them. Nutrition is a fundamental need before any physiotherapy and a number of them have feeding problems because they are unable to support their heads or control their swallowing. I have consulted my bible (Hinchcliffe) on the matter and chapter 9 on feeding and drinking difficulties. This says the child should be in an upright stable position, have an elongated spine and neck, and food presented on a spoon in the midline, pressing down on the tongue. 

The house mothers preferred position for feeding the children is lying them on their backs which puts them in danger of choking. I tell them this is not a good idea and children should be upright. None of them really speak any English, but I sense the unspoken response is, "You try it smart arse". They watch interested as I position a child in Hinchcliffe’s suggested position.

Today’s lunch time menu is Weetabix mixed into a porridge. The boy smiles happily at me as I put the spoon into his mouth, and for a second I feel vindicated, until it all comes pouring out again. I try repeatedly, but he simply has no swallowing reflex. Eventually, one of the mothers takes him from me and pours it into him by lying on his back. I try again with other children with varying degrees of success. 

I feel I am making a little progress until the house mothers hand me the most difficult child. Her body is wracked into extensor spasm and she is also in rotation. I try to get her upright but it’s incredibly difficult. She may not weigh much but the spasms make her muscles like steel. When she opens her mouth her jaw goes into spasm and when she manages to close it her teeth grind with such huge force that she has worn them down into stumps. Every mouthful she takes engages a monumental battle in her body between the forces of hunger and choking.

Weetabix comes spraying out as she gags. The house mother technique for this is to cover her mouth with a rag, I can't bring myself to do this and get sprayed. The battle wages on unendingly, with the Weetabix in the bowl never going down. Eventually I stop. The girl and I are both exhausted and covered in Weetabix, as is most of the room from the efforts of the other children to eat their lunch.  

I pause for a moment and watch perplexed as the house mothers suddenly go into a frenzy of cleaning. It’s the fastest I've ever seen anybody move since I came to Lesotho. The snot, saliva and Weetabix are wiped up and the clean children are arranged attractively on the beds. The floor is swept and the mad child who runs around cackling and screaming all the time is shut in the toilet. Whatever can be happening? Ah! The minister is coming!

That morning there has been a long ceremony of cot blessing as Phelisanong has been given some new beds for the children. Now the minister is spreading his benevolence and blessing to the children who couldn't make the ceremony. He enters the room with his entourage and a camera man. We are all frozen like statues, slightly guilty, hoping he won't step in any Weetabix blobs that may have been missed.

The children all smile sweetly and don't writhe around or do anything to suggest their behavior can be a little bit unusual. It all takes less than 30 seconds before the minister leaves with a parting gift of sweets for the children. Normality returns. The mad girl is let out of the toilet to continue her running around and screaming. Sweets are sucked on and spat out, while another round of Weetabix is prepared for the children who have not yet eaten.

I leave exhausted and walk up the track to the road. A storm is coming and I hail a passing taxi, you never seem to have to wait more than a minute for one to pass. Large raindrops start to fall and the driver toots his horn looking for more business. Two very large women get in the back with me, squashing me in the middle so I can barely breathe. The taxi is full but two more men want to get in. One somehow gets in the back by lying across us, while the other squashes onto the knee of the front passenger. The windows are completely steamed up, but we don't have to worry about the impact of a potential crash as there's no room to have a whiplash injury.

Fortunately, the inappropriately named London is only a few kilometers away, and I get out to try and find some food. London town is a bit like the wild west except the shops I go into are all owned by Chinese who don't wear any Stetsons. The only thing I can find in the first store is Weetabix, giving me a horrid flashback. I quickly leave. In the second store I clamber over various boxes to find something more appetising to eat than cereal. Mission accomplished, I pay at the checkout being guarded by a man with a very large rifle. I leave before the shootout begins and walk back to the guest house where I am staying.

The next day I arrive at my bare physio room with a bag of plastic balls and a wooden bench I have found in the office. I am hoping for inspiration, far better I find some men with a roll of carpet and plastic chairs. Very excited I ask them to take the wooden bench and bang in the nails that are protruding from it, while I find a blanket to cover it with. Mary manages to find me a bowl of water and a piece of soap and I am ecstatic. I feel like a real physiotherapist.

I add to my haul a plastic bucket for playing ball games with. I am not quite so sure about its addition when later I turn around to find one of the girls using it for the toilet. I think my bag of balls are the only toys at Phelisanong so it’s not surprising she is confused by my ball in the bucket game. My first week here has been a whole new ball game for me. I wonder what next week will bring.

Week 5 Blog: Goodbye Saint Angela’s (28/2/16)

Candidates for the physiotherapy training course were supposed to turn up on Sunday night. I was unsurprised when Justice emailed me that he had called in at their lodgings to find no one had arrived. Monday dawned with still no trainees and no idea what the invitation to them had said. The invitation had been sent by Sentebale and copied to Sister's email but Sister was away last week.

Sister returns, but is unable to enlighten us and has to go to town for an appointment. Unfortunately, she doesn't return as she has been signed off sick for the week and will not be joining the training as planned. Three candidates turn up and then three more. By 11 am I decided to start. With two others from Saint Angela's there are eight trainees in all and by the end of the day another turns up making nine.

I decided to go for a practical approach as half of the group appear to speak little English and look blankly at me as I welcome them. Things improve as I get one to translate, reminding me of bilingual meetings back in Wales without the headphones. I take them on a tour of Saint Angela's making them use the broken crutches and a wheelchair I have taken off the children. I brutally make my point that equipment must be fit for purpose and the buildings and grounds wheelchair friendly. After a bit of persuasion, we all get into the outside disabled toilet, and everyone gags. Even if you were able to drag yourself onto the toilet you would get covered in faeces and there is no water or soap to wash it off.

We go and test the concrete wheelchair ramps at the nearby school the children go to. The ramps are thoughtlessly set at 45 degrees. One of the ladies bravely flies down one with a scream and spectacularly gets catapulted out of her seat as she reaches the bottom. Even the fittest man does not have the strength to propel himself back to the top.

The tour continues with similar findings in the inside toilets and washrooms at Saint Angela's. If your lower limbs were paralysed would you really want to try and shower sat on a concrete floor, unable to reach the taps and with no privacy? Everyone gets the point; it's not made with any subtlety. Physiotherapy is about helping people to move and improve their function and independence. It’s an uphill battle if your surrounding environment work’s against you.

The following day the focus is more on exercises and the trainees finish the day putting into practice what they have learnt by working with the children of Saint Angela's. Despite its slow start, I feel the course has been a success, the trainees are a little more empathetic towards the children in their care and have thought about a few simple things they could do to make their life easier.

I go home tired but reasonably happy. My laptop has now been working for four days and tomorrow I can start working on my report to St Angela's. I plug it in to charge it and the screen suddenly goes blank. After investigation it becomes apparent something is wrong with the charger. Morning finds me in High Tech trying to source a new transformer for the lap top of doom. Of course, they haven't got one with the same connector as mine.

Eventually I persuade the shop assistant, Mr Guy, to splice my connector onto a new transformer. I tell him I love him and leave for Saint Angela's to put my laptop on charge and begin work. Unfortunately, when I arrive at St Angela's there is no electricity. Justice lends me his bike to go down to his mum’s house and find a power source. I realise at this point why I have never ridden a bike in a long skirt as the material gets caught in the back tyre and nearly gets ripped from around me. I arrive at my destination, with my dignity only partially intact, and put my computer on charge. I ride carefully back to St Angela's to find that power is now back on. I ride back again to retrieve my laptop.

By now it is 1 pm and I am meeting Marion who is a nurse and has just arrived from Wales and is waiting to go out on placement. Meanwhile, I ask her whether she will see a school girl with me who the social worker at Saint Angela’s has referred. The girl, Lerato, was a normal 10 year old until last September when she suddenly developed a fever and pain in her left hip and has been in a wheelchair since.

Her notes say the doctor has seen her, remarked she has a painful hip and prescribed some painkillers and steroids. Has it really taken years of medical training to come up with that conclusion? When I examine her, the left hip is contracted at 90 degrees. I can't move it and feel that there have been some changes to the femoral head, and that she may have osteomyelitis. It will not get better unless she has an operation. She needs an x-ray for diagnosis. I can't believe she's been sitting in this wheelchair for six months and no one has done anything about it (actually, I can).

The social worker says that maybe they will be able to get some money next week from a fund at St Angela's and take her for an x-ray. Lerato can no longer stand upright as her pelvis has rotated forward and her lower back muscles have contracted. I teach her mother some exercises to do with her to try and stop the contracture getting worse and strengthen her leg. I also give her a frame for her to use at home so she can get out of the wheelchair. I emphasise again that I cannot fix Lerato's hip and she must have an x-ray to see what the problem is. I think I might as well have said she needs to go to the moon.

The mother seems to accept her daughters fate. Without money or the NHS, what can she do? I'm afraid this story is continually repeated throughout the developing world. Wherever there is poverty, there are helpless children like Lerato who may now spend the rest of her life in a wheelchair if she doesn't get the treatment she needs.

I finish my last couple of days at Saint Angela's running the regular after school physiotherapy sessions. It's more like an after school club with the children doing the activities they enjoy and me wandering around doing bits of physiotherapy with them. The Marketing officer, Wendy, turns up to an afternoon session. There is a group of boys playing floor football, scooting across the floor on their backsides and knees, other children are pumping weights, some spinning hoops, some doing exercises.

It’s a really lively session and no one is in a wheelchair.  She looks around the room baffled. I ask her "What's wrong?" She says "I've never seen them out of their wheelchairs before." I realise this is my greatest achievement at Saint Angela's. The wheel chair shaped children are now just children playing on the floor. Whether the sessions will continue I don't know. They have the space to do it but need the commitment of staff to continue to supervise sessions. Hopefully I will catch up with them all before I leave Lesotho in April. I will miss the children for sure and always remember their smiles.

I leave for Phelisanong children's home tomorrow and a whole new challenge with quite different children. There is no internet at Phelisanong and I'm not sure how good communications will be. It will depend on how the dongly thing works and the laptop of doom. I am not quite so in love with Mr Guy after it stopped charging again half way through this blog and I had to take it back to the shop. This time it's the strange two pin cable he had given me. Fortunately, he swaps it for a three pin and I am back in business. Who knows how long it will last.

Reflections

In the middle of Maseru there is a statue of a black man playing a saxophone on a roundabout. I use to pass him most days on my way to Saint Angela’s. He plays a golden tenor sax and wears golden boots, blue trousers, a red shirt and a blue cap. I asked lots of people who he was, but nobody knew. To me he was a sign of good fortune and a sign that I was meant to be in Lesotho. I am a passionate musician and play the saxophone.

“I have to have a picture with him,” I told the taxi driver, “please could you stop and take one for me?” He pulled over and I passed him my camera and grabbed my sax case. We both jumped out the taxi and ran across the road onto the roundabout. I played with the sax player with the golden horn, while the traffic beeped at me and the taxi driver took some shots. I knew that my placement in Lesotho was going to work out fine, in an African kind of way, and there was going to be some memorable music along the way.  

Having Justice as a contact and finding the physiotherapy equipment made it a blessing that I started my placement at Saint Angela’s. On my first morning there, this good fortune was not apparent. I realized, after a disturbed night, that sleeping at Saint Angela’s was going to be impossible. All night thumping music from a local bar, put paid to any thoughts of peaceful rest.

The morning saw me bleary eyed, eating breakfast with a picture of the Pope and his various cronies, while hundreds of eggs gently simmered in the summer heat. The eggs were a result of Sentebale deciding to fund a chicken farm to try and help Saint Angela’s generate its own income. The project didn’t seem to be very well run. The hens lived in a filthy shed and the eggs were collected and then stored, for an indefinite time, in the warmth of the dining room. I certainly didn’t find the thought of ‘going to work on an egg’ appealing.

After breakfast, I quickly made arrangements to relocate back to the ILO guest house in Maseru. Although this put me at the mercy of Perfect taxi’s to get to Saint Angela’s, I decided that sleep was higher priority. I had enough problems to tackle without adding sleep deprivation to the long list. Trying to set up a physiotherapy department without any supporting network, was by itself sufficient challenge.

The second week I was at Saint Angela’s, Ma’s nephew was brutally murdered. Understandably, after that she was caught up with family matters and communication with Sentebale proved to be erratic. Cover was not provided for her absence and none of the physiotherapy equipment I ordered arrived. In view of this, I was so lucky to find the donated equipment and have the support of Justice.  

Sister proved to be an elusive figure to track down, and if it hadn’t been for the fortunate appearance of Justice, I’m not sure what I would have achieved at Saint Angela's. Although, as a member of the board he didn’t have any particular authority, Justice proved to be a veritable gold mine of contacts and information. He had previously worked placing Australian volunteers in Lesotho, so knew the difficulties faced by someone like me, working in an environment very different from home.  

Whenever I was stuck, Justice always knew a man who could fix the problem. I don’t know how many times throughout my stay at Saint Angela’s, I would say “Thank God for Justice,” but maybe his timely appearance is evidence there is a God? The further miracles that followed might be additional evidence to support this. How amazing to find a heap of physiotherapy equipment and a huge empty classroom to put it in. 

I didn’t have any particular plan for how I might approach the physiotherapy in Lesotho, but the mass sessions which evolved at Saint Angela’s seemed to work quite well. After individual assessments, the youngsters could get on with their exercises while I supervised and did some treatment. It was a bit chaotic, but a very efficient use of my time and everyone got to do lots of physiotherapy. In the UK, children are normally only seen individually, but adopting this method would have given me very little contact time with thirty plus children and only a few weeks based at Saint Angela’s.

Running these larger physiotherapy sessions was also made more viable by the difference in attitude of the children in Lesotho. They are far more independent and resilient than their UK counter parts. They get on with things without expecting people to help them out. The sparsity of health care available in Lesotho means if you don’t do it for yourself, you stay as you are. I’ve told the children that they are the most important people when it comes to doing their physiotherapy. 

Creating a space for the children to get out of their wheelchairs was my greatest achievement at Saint Angela’s, although my horror about the state of their wheelchairs also led to a mistake with the cushions I had made for them. Initially the boys seemed really pleased with their new comfortable seats, until they found out it made their wheelchairs less easy to do tricks in than the sunken canvas’s they were used to. The hygienic plastic covers of the cushions also made them hot and sweaty to sit on and before long I found many of the children had discarded them. It’s been a lesson in not letting my emotional response get in the way of careful planning and research.

I never found the physiotherapist that was supposed to be working here. Justice thinks that half her salary is paid by Sentebale and half paid by Saint Angela’s. However, Saint Angela’s stopped paying their half some time ago because the finances of this place are crazy. Justice did see the physio some weeks ago, but she had only come to pick up some vegetables. There seems to be some sort of illusion here that when things are paid for, that means they actually happen.   

I think the mysterious physiotherapist is probably one of a few in the whole country. It seems that those who do qualify go to work in South Africa, jobs and salaries are often not attractive enough to keep trained health professionals working here. Maybe there are one or two physiotherapists employed in Maseru hospital, but I don’t know. It’s unlikely Saint Angela’s will see another physiotherapist, now I’m going. I just just hope the staff keep the physiotherapy room open and encourage the children to continue to use it. 

Overall, it’s been a mixed bag at Saint Angela’s. I achieved a lot while I was there, but can’t see that it’s sustainable unless the staff support those changes. Justice is fighting a heroic battle, but without support, he’s never going to win. Now it’s onto Phelisanong and to face those unanswered questions that I’d first asked when I visited there a month ago.