Week 2 Blog: A week in the life of a physiotherapist (7/2/16)

Somehow, despite the excruciating inertia of the pace of life here, on my first day at St Angela's I manage to commandeer a classroom for physiotherapy. Aided and abetted by a member of the board, Justice, the fait accompli is completed by installing an odd selection of physiotherapy equipment in the classroom. This equipment has been donated by benefactors and stored away, but never used. Justice even manages to get a man to screw a rather lethal set of parallel bars to the floor.

The children attend the adjoining school and once they have finished for the day they come to meet me in the new physiotherapy room. English is the second language of Lesotho and they all understand at least a few words. I tell them I am from Wales and that I will show them the flag of Wales, which has a good dragon on it (many Africans think dragons are bad).

I unfurl it and there is a large intake of breath and a scream. I think something was lost in the translation and cultural relations have just suffered a significant setback. I ask them what they think a physiotherapist does and they mime someone torturing them. As a Welsh physiotherapist, it looks like my work is going to be cut out trying to get them on side.

The next day, I go to see Sister Augustine and her interesting filing system, to try and establish the age and basic medical details of the children. Normally, I take it for granted that the physio assistant will have made up all the notes and just pull them out of the drawer. There are 31 students here and most are of high school age but many haven't graduated from primary school due to learning difficulties. The most common conditions are cerebral palsy, osteogenesis imperfecta (brittle bone disease), burns (from open fires), road traffic accidents (driving is lethal here) and Spinae Bifida.

I start to try and assess them and come across things I have never seen before. One girl has had both her feet burnt off in a fire when she was three months old, and by some miracle of the human spirit and biomechanics manages to walk really well on her scarred stumps. Another girl, with burns to her lower leg, has to use crutches as her knee joint is permanently flexed to a 120 degrees. Her crutches are completely worn out and I tell her I will get her new ones; I just don't know when. The crutches all need to be condemned here. One boy with bilateral club feet is using a bent pair, of different lengths, which are nonadjustable and have no tips. I see another girl with a below the knee amputation who has been waiting for a false leg for over four years.

The children are resilient and stoic beyond anything I've ever seen. They smile a lot. There are five boys with brittle bone disease of a very severe form. Multiple breaks, badly set so the bones stick out, twisted spines, barrel chests, stunted growth and wasted muscles. They are using the most shocking of wheelchairs, which don't fit, are worn out and have no cushions to soften the sheet of fabric they sit on. Sister says the wheelchair people are coming but doesn't know when. The boys like to show me their wheelies. The first time they do it I say something ridiculous like "be careful". What a stupid thing to say to someone whose broken their bones dozens of times.

The next day I go to Lesotho orthopaedic supplies to make an order for physiotherapy equipment for the departments I am setting up. I am told there is no catalogue and the equipment will be made in their workshop. I spend the morning trying to describe and draw the equipment I want to show an assistant. It is tedious beyond. I get back to St Angela's and receive a call from the owner who says he has a catalogue!!!!!! I ask him to bring it straight up and any crutches he has. He appears quite quickly with a catalogue and crutches. Amidst the black ones there are a golden pair. Once he has gone I spot the girl I promised crutches to. When I tell I have got her a golden pair she can't believe it. Nor can I.

Word quickly spreads and all the kids turn up for new crutches. There is general mayhem in the physio room while I give out the crutches. The rest of the kids roll around on the mats and throw the physio ball about. I don't want to discourage them from having fun but the noise is intense. I step outside into the corridor. This is when I notice a flood of biblical proportions is taking place. It is particularly vexing as the toilets next to the physio department don't work and I am using a bucket of water to wash my hands. The staff have all gone home and so I phone the ever helpful Justice, who saves the day. He finds the stop cock, while the kids rally with mops and buckets.

The next day the orthopaedic man comes to take my catalogue order. I forgive him for being an hour late when he tells me he makes prosthetics. I ask him to examine the girl with the amputated leg and he agrees she is an ideal candidate for a false leg. When he shows her the pictures of a similar job he has done, she cries. I tell him to put the quote for the leg on the order and email Ma to plead the girls case. I also apologise to her for getting the crutches ahead of the quote, which she wasn't too pleased about, and to my relief I am forgiven.

The end of the week sees a flurry of emails and meetings as I try and tread delicately through the politics of Sentebale and St Angela’s whilst trying to make things happen. I tell Ma I can't possibly set up three physio departments, assess all the children and train the staff in eight weeks and leave anything worthwhile and sustainable. We agree to two departments (quite honestly one is pushing it). Somehow next week I still have to assess another twenty children, write a staff training programme and manual for a two-day training course the following week, and deal with all the everyday hassles that Africa throws at you. Whatever my problems they are minor compared to the kids, that's for sure.

Week 2

- Hours waiting for Perfect taxis- 4

-Hours wasted at orthopaedic supplies-3

-Physio departments set up-1

-Physio equipment ordered-lots

-Biblical floods-1

-Golden crutches -1

-False legs ordered-1

-Children assessed- 10

-Mass physiotherapy sessions-2