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.
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