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.