Blog 21 Was it all worthwhile? Part 2

…and so, my final day in Lesotho and at Saint Angela's dawns, and in a way, it epitomises the contrasting emotions, hopes, despair, laughter and madness of my stay here over the last eleven weeks.

I go with Christine on a social outreach visit to the home of one of the children at Saint Angela’s, John, who has brittle bone disease. His mother died a year ago and Christine went to his home, a small round hut shared with his father, a herdsman, his two sisters, who also have brittle bone disease, and his brother.

The hut is dark, the walls black with soot from the open fire in the middle, a wall is falling down and braced with a plank. The family of five sleep on bed made from a door with a few thread bare blankets. When John returns in the holiday he is unable to negotiate the high mud step with his wheel chair, and get in and out of the hut.

Next door is a much better building owned by the grandmother, which for reasons of family politics was not being used. Christine told them this is ridiculous and insisted they let Johns family move into it. She is not a lady to be messed with so this has happened, but the problem of the bed and wheel chair access remain. Our mission is to build a wheelchair ramp and improve the sleeping arrangements.

I spend the last of the donations given to me on a couple of mattresses. Spare blankets are found in the cupboards at Saint Angela’s and we scavenge the grounds for bricks, breeze blocks and even find a broken bag of cement to make a ramp. The two care mothers join us with bread and soup and we set off in the Buckie, deep into the countryside outside Maseru.

We arrive and the driver, Kaneiloe, and I start assembling the building materials into something that looks like a wheelchair ramp while the care mothers sort the bed. John’s little sisters skip around and various relatives turn up, his father, grandmothers, nephew’s, and join in the construction work, bringing earth and mixing cement.

Everyone pitches in and there’s a holiday atmosphere. It’s a strange thing because John has been without a wheelchair ramp for all these years, and it would have been easy to build one out of mud and stones. Christine says it’s why the outreach program is so important, because sometimes when you live in abject poverty the obvious things to be pointed out.

The wheelchair ramp costs nothing, it just takes someone to initiate it and community action does the rest. This is what gives me hope in Lesotho, the community spirit is there and the desire to improve things, it just needs people like Christine to harness these positive aspirations.

The ramp may be the only one going into a private dwelling in the whole of Lesotho, certainly I’ve never seen a hut with its own wheelchair ramp before. It’s even set at the right angle and has a safety curb running at the side. It feels really good looking at it is knowing how much independence it will give John.    

We leave and not far down the road the Buckie is playing up. Kaneilo gets out and pulls something out from under the bonnet, which I think is the starter coil covered in melted plastic. I contribute tools from my first aid kit, a pair of pliers and scissors. Christine does some minor surgery on a plastic bag, and ties it round the wire, Kaneilo plugs it back into the engine, shuts the bonnet and turns the key.

The engine roars back into life and soon we are hurtling down a hill, with me wondering what other parts of the Buckie are being held together with a plastic bag. Also, the thought that the future of a country must be bright when there are young people who can fix an engine with a plastic bag, build a wheelchair ramp and bring a community together in the course of one day. Surely anything is possible with their enthusiasm and imagination.

So, was it all worthwhile? Yes definitely. Going back a second time and working with the same children meant I could build on the work I did here a year ago. I was able to research the children's problems and what treatment would be most suitable. Also, what equipment was needed. The equipment all worked well and there’s nothing I would change about what I took. It was a godsend being able to take 100 kg of specialised equipment on the plane. Thank you Dolen!

The walking frames worked well over the rough terrain, the donated 9 pairs of specialised orthopaedic boots all amazingly fitted the children they were given to, with one pair left over. The therapy balls were the right size, the kids loved the Duplo and it helped their motor skills. The blenders and special spoons helped the children with eating difficulties, the Lecky corner seat supported a couple of children who needed help to sit up. The water filters mean there is always clean water to drink in the dining room at Saint Angela’s.

However, the biggest blessing was the physiotherapy assistants. This was not planned, it just transpired. Christine happened to start on the same day that I did and turned out to be a talented physiotherapy assistant and social worker. When I went down to Phelisanong, Sylvia and Malineo just appeared and I grabbed them with both hands. Having six pairs of hands made a real difference to the number of children we could treat.

Hopefully training the physiotherapy assistants means the physiotherapy will be sustainable.  Christine has now been appointed as the social worker and physiotherapy assistant at Saint Angela’s, while Sylvia and Malineo are on the payroll of Sentebale as physiotherapy assistants. With a bit of luck the physiotherapy house will go ahead at Phelisanong and add to the physiotherapy resources there.

Now I am back in Wales exhausted. For various reasons the trip took a lot out of me but I’ll bounce back. I made a video of the eleven weeks and it looks like it was one long party. It wasn’t, it was just I tended to get the camera out when there was singing and dancing happening, and there was a lot quite a lot of singing and dancing. Here is the link on You Tube.

https://www.youtube.com/watch?v=GYcv5W8QgsY

Thank you to everyone that supported and encouraged me and made donations of money and equipment. It was all put to good use, so know that your contributions helped some children in Lesotho have access to physiotherapy and a little more independence, have a chance to walk, sit up, be fed upright, have clean drinking water, take part in Taekwondo lessons, train three physiotherapy assistants, also train a bunch of teachers and care mothers in hand hygiene and that somewhere in a small house in the Lesotho countryside, there is a family sleeping on a comfortable mattress tonight. It was definitely all worthwhile.             

      

  

         

 

Blog 20: Goodbye Phelisanong

Last week was frenetic, but thank goodness Sylvia and Malineo returned to help me through it. I have another meeting with the care mothers, the main point being to introduce the concept that when I leave they now have two physiotherapy assistants that will continue the work. The problem is that that Sylvia and Malineo only started here a couple of months ago and already they have risen to a more senior position. It’s a delicate situation where longevity of service counts for a lot.

I hope I strike the right note and finish the presentation with certificates and a video to try and show what an excellent job both the physio assistants have done. The previous day they had a test which went on for hours, as I got them to show me the exercises we have been doing with the children and grilled them with questions about it. On Thursday, they will have to do it all again as the parents are coming to learn about their children and how they can best help them during the holidays.    

About 20 percent of the children here are orphans, or have been abandoned. The majority do have parents and have been placed here either because the parents can’t cope at home, or its their best chance to go to school, with the school being right next door. The children with parents will go home for the long winter break, it’s too cold to stay here over July and August. While they are home hopefully the parents will encourage them to continue their physio and become involved in their rehab.

Thursday dawns and chooses to bless us with unremitting rain, not ideal for the children trying to show how well they are doing with their walking frames. Myself, Sylvia and Malineo tear up and down the pathway with umbrella’s over heads, sloshing our way through puddles, trying not to slip and keep children dry. It’s a little taxing but the children rise to the occasion, even though some are a little overwhelmed to see their parents.  Kolosoa can’t even look at his mother at first and hides his head in his hands. He recovers and shows her how well he can do his exercises and walk with his frame.

Bokang loves to walk, but is rather wobbly and needs a frame to support him and someone to guide him. Bokang’s mother is so impressed with his progress she says she is going to give away his wheelchair. It is not quite the miracle of Lazarus, it’s just that there is little culture of physiotherapy here and the children only need a chance. The other problem is that volunteer physiotherapist’s come and go, sustaining a legacy is a problem. That’s why I have put so much effort into training Sylvia and Malineo and hope that a physiotherapy house will be built here. This might encourage more frequent visit of outside physiotherapists and hopefully maintain more consistent input into Phelisanong.

Touching moments continue throughout the morning. Loreto’s father videoing her lifting her head and following his movements. She’s only at the first stages of development, but she has great potential to go further with help. She smiles and loves company, but she needs help to sit up and stimulation to get her to use her neck muscles. It will be painstaking work, but rewarding, as she will gradually gain a little independence of movement if her physiotherapy continues.

The day ends with guiding Lithape’s mother with how to blend her food and feed her upright. I am a little anxious because Lithape muscles can go into spasm if she gets stressed or excited and exacerbate her swallowing difficulties. All goes well though, and Lithape mother agrees it is a much better to feed her this way, than laying her on her back. I have a spare blender to give her to take home and I pleased with how the day went, despite the weather. More parents are due to come tomorrow, but Sylvia and Malineo can cope without me. It’s time for a break and I head for the high mountains.

…

When Justice messages me about the chance of joining a trek in the remote Mokhotlong District, I jump at the opportunity. It’s an area I’ve been wanting to go to, but was unsure how to arrange transport to get there. There are seven of us in the group, including the tour guide, Stephen, and two 4x4 vehicles. Myself and Mathakane are picked up on route, in Leribe, as the others drive up from Maseru. As always things get behind schedule and by them time we reach the diamond mine, where we head off road, it’s getting dark.

We are at over 10, 000 feet and when the sun goes down its bitterly cold.  The mine is open cast and life must me very harsh for the miners that work here. We sign in, promise not to steal any diamonds, and start the descent to the small village that runs the campsite where we are staying the night. The facilitates were set up by the mine to try and provide the locals with some income. The mine is South African owned, as are all the best resources in this country. The other six people on this trip are all from Lesotho and we discuss why a country so rich in minerals, water, and beautiful scenery is so poor and is unable to exploit its own resources. Nobody has any answers.

By now it dark and the track we are descending is a jumble of large boulders. One of the 4x4 has little clearage and there are lots of sickening crunches as we inch our way down. We have to get out and try out to make out the hazardous route inch by inch. The men do lots of manly shifting of boulders by flash light, but it still takes over two hours to go about a mile, until the track finally smooths out at the end.

There are quite a few 4x4 at the campsite who have all crossed over the border from South Africa. Everyone has gone to bed to try and keep warm by the time we arrive. An old man brings us some wood and lights a fire, while we chuck some food on the braai and put up tents. A very cold and sleepless night follows and it’s a relief when the sun comes up and starts to melt the thick frost on the tents.

Packing up and organising donkeys to carry the tents takes most of the morning. A third donkey is needed to carry our stuff and its decided that most of us should start while the search for an elusive third donkey continues. This leads to some navigational challenges as we head over into the next valley towards the Solane hot springs.  The sky is clear blue and the sun intense, as we sweat our way up to the col and down to the next valley to follow the river. The stark beauty of the area is magnificent, and the whole experience takes me away from the startling health facts about this country, instead focusing me on its unique geography and culture.

A herd boy and his dogs join us and guide us to the springs. The herd boys, are the only people out here. They spend their time looking after their animals as they graze through the summer months. They have nothing but a bag of maize, stick, blanket, and their dogs. They live at a “cattle station”, which is a just a small simple hut, build of rocks and grass. It’s a tough life, if they don’t keep a fire light at night they will freeze to death. Some of these boys are only primary school age and they get paid one sheep a month for their work. This means if they survive the rigours of life out here by the time they are a young man they will have their own flock.

The cattle stations are quite close to each other, for security reasons, as sometimes thief’s will try and steal the animals. The boys can shout across the valley to each other and normally have about half a dozen dogs each to guard their flocks.  At night, the flocks make their way back to the cattle station and spend the dark hours around the hut. The boys count them in and know each animal individually, if one is missing they will know which one. The sheep are kept for wool and by early May the boys will leave the cattle station and bring their flock to spend winter around the village. Most of the boys will have spent little if any time at school, I’m not sure what school could teach them anyway.

By the time we reach the hot spring we have made two river crossings and are deep in the mountains. The shadow has fallen into the valley, the steam is rising from the hot pool and the frogs are beginning to croak. The pool is swampy, sulphurous and primeval. Silver bubbles rise from a small hole and the stones are tinged with yellow, while strands of green algae gently waft in the ripples. We get the tents up, the fire going and the stars come out to witness our cooking and musical entertainment. I have brought my sax and the others improvise with spoons, pans and plates. It won’t be making the charts, but the music fits the occasion and we enjoy ourselves while the herd boys look on bemused.

The morning starts with a warm shower where the water from the hot pool flows over the edge of a small cliff. I sit on a stone showering watching the river flow by below me. While we pack up I learn more about the herd boy’s life, which I am fascinated by and we call by another cattle station on the way back. It is impossible to approach a cattle station without a herd boy or the dogs will tear you apart. The dogs are only fed pap, so are rather skinny, and are trained to go crazy if they scent a stranger. I peer into the hut, which is about a 6-foot circle, containing a small fireplace in the middle, a bed on brushwood and skins, some battered pots and pans, and that’s it.

It’s as simple and as close to nature as you can get. I guess it’s easy to romanticise, given the complexity of western life, and the trend for getaway retreats. There is no getaway for the boys out here, this is their life for half of the year. I’m sure it’s sometimes lonely and at times brutal. We have the luxury of viewing it from a comfortable distance. We leave them to it, walking back to our 4x4, admiring the views and taking pictures of a life we will never experience. We drive back to the tarmac via a longer, but much easier route than the one we arrived. Once we hit the road we make quick ground to Afri ski, the highest restaurant in Africa. Presently a motorbike and mountain bike playground until the snows come and the ski season starts.   

We have a quick meal at the bar. Inside it could be any ski resort I’ve been to in Europe yet, only some hours before I was standing beside a grass hut with an African herd boy. The contrast in life styles is incongruous, but it’s just another day in Lesotho.

I've made a video of the trip and put it on You Tube

https://www.youtube.com/watch?v=J4HH1oVY9LY

…

When I get back to Phelisanong the kids are in great form and Sylvia and Malineo have been carrying on like troopers without me. Mahali has moved all his stuff, apart from the wardrobe, into the clinic and suddenly the physio room appears twice as big. We celebrate with a slightly crazy game of football with myself, Malineo and Sylvia each holding a child upright. The kids get rather over excited. Their legs go all over the place and their trousers fall down, but every is having a good time. Lesojane has returned from a long illness and busting a gut to make his wobbly knees control his feet so he can kick the ball. 

It’s difficult to believe I’ve now been at Phelisanong six weeks, but my last day dawns here and I walk down the track for the last time. I walk the kids to school, then go down to house 8 to play some music and dance with the little ones down there. School ends early on Friday so we gather up the hard-core physio crew from house 5 and take them to the physio room. I present them all with a small rucksack and a lollipop for their brilliant efforts over the last six weeks.

I tell them that Malineo and Sylvia will now continue their physiotherapy and to keep working hard at their exercises. Then it’s party time, I’ve brought my sax, Ashton is on drums, while the children bang on the table. Joyous music follows before we walk them back to their house. I was going to see them all later on in the afternoon, but suddenly I can’t face any more goodbyes and I slide away. Everyone was on a high and it seemed the right moment to go. I’m going back to Maseru on Saturday and will check in at Saint Angela’s, for a few days to see how they are getting on, before flying out next Thursday. My time in Lesotho is drawing to a close.

                                     

               

     

              

Blog 19: The long road

As I approach Phelisanong on Saturday morning there is a pile of rubble outside the gates that looks familiar. Puzzled I continued past it, and it is only when I get to the physio room that I realise the rubble use to be the retaining wall which had Mahali’s boxes stacked behind it. Without this wall these boxes are now precariously balanced in the corner. “Hey what happened to the wall,” I ask Mahali I ask as he comes in. “I don’t know,” he smiles brightly “the men just took it down.” I decided to seize my chance for more space, “do you think it would be a good idea to put your stuff in the container?” Unfortunately, there’s no deal, Mahali says there’s no room in the container. 

   

The morning continues and by the time the kids go for lunch there is a distinct buzzing sound, accompanied by a growing posse of bees in the room. “What’s with the bees Mahali?” I ask him as he passes by “I don’t know, he replies cheerful, “I’ll fetch the Doom.” He arrives back with a can of Doom which is empty. He squirts it anyway just to pacify me, as I’m getting a little hysterical about the bees. By now there must be over a hundred in the room and the focus of their attention is Mahali’s padlocked wardrobe, which he opens several times a day to get things out of.

“They’re building a nest in your wardrobe, I tell him.” Mahali denies it and opens it to show me I am wrong. I point out where they are entering a hole in one of the boxes, and insist he takes it outside. Mahali open’s it to show me they are merely interested in some bees wax he has stored there. He agrees to hang the wax in a bag in the trees and the bees gradually start leaving, following the intoxicating smell of the wax out into the garden. By the time children come back there is only a dozen disorientated bees flying around the room and the only person who’s been stung is me. I mention this aside to show how quirky life can be here, and how you just have to roll with it.

On Monday morning, I spend a ridiculous amount of time getting cross over one of the few remaining wheelchairs whose seat won’t fold out. I haven’t got the right size alum key for it and resort to my hammer. Even this technique does not bring results and it is only when Nelson brings some calm to the situation that I notice two supporting bars that should slide, don’t, and some grease greatly improves the wheelchairs behaviour. The moral of the tale being that brains frequently trump hammers.

On Tuesday I walk some of the children to school and then go down to house 8 to find Keneoue is sick again. Mamello says she must go to hospital as she has a chest infection and diarrhoea and is not feeding. I go and do some physio until disturbed by the sound of horns and ululating. The noise announces the arrival of a convey of trucks stacked with wardrobes and cupboards and a ceremony of thanks giving. I go over to watch the ceremony where the school choir are singing in the midday sun and the principle is in her best orange dress, so it’s a serious affair. The man in charge of the wardrobes gets up to give a speech which goes on for so long if the children hadn’t been African they would have all have passed out with sunstroke.

I decide to go and see if Keneoue has gone to hospital and find she is still waiting. I notice a small boy who looks very sick lying on one of the beds and who I haven’t seen before, and when I uncover him to find he is desperately thin and has a fever. Upon further investigation, I find he has come from the baby house where three children have died in the last few days, possibly from the measles vaccine, but it is not clear. They just suffered fever, rapid weight loss, went to hospital and died soon after.

This boy had only been at Phelisanong a couple of weeks. His mother evidently went mad and ran off with him and didn’t feed him, which is why he has malnutrition. He was deemed too sick to have the measles vaccine, which might be a blessing for him, but he has still come down with fever and now is in house 8, waiting to go to the hospital with Keneoue. 

I am concerned because who knows if he is contagious or not and he’s lying in the middle of a packed house surrounded by two dozen children. I go back to see Mamello and find the wardrobe thing still going on, which is a very difficult occasion to interrupt.  The wardrobe man has evidently decided to become a politician and seek election, and is practicing his skills on a captive audience. Eventually the message does get through to Mamello and she comes to house 8 and the boy with malnutrition and fever is taken outside to wait outside on the door step with a house mother.

I manage to find a packet of rehydration salts and mix them up with some water. He gulps down a couple of cups full. I try to get Keneoue to have some in a baby’s bottle, but she is coughing too much to drink anything. We are told the car is on its way to take them to hospital but this doesn’t give much of a clue of when it might arrive. The wardrobe people leave and the children are given left over snacks while they wait for a late lunch. Someone has put two biscuits in Keneoue cot and I don’t know whether to laugh or cry, trying to imagine her suddenly start munching on a biscuit. The taxi finally come at three and feels like it’s already been a very long day and fortuitous that I am doing hygiene training tomorrow.

At the training the next morning there are care parents from each house, and representative from the school and kitchen. I start by asking if the children get sick very often and they all say “yes often.” I ask them why they think this is and how they think sickness might spread between children. They suggest bad water and bad food, but there is no mention of germs or how they might be caught.

I think something invisible is difficult to explain. The glow dust on the doctored pen and paper that everyone signs their name on, helps illustrate the concept of how diseases might be spread when the UV torch reveals its trail. From our discussion, it is agreed that that hand washing is a good thing and I give out the last two plastic water containers I have for a hand washing facility for the outside toilets. The teachers and care mothers also say they will supervise lunchtime hand washing and I will do some further training with the children in school next week.

The following day I am in house 8 helping with the feeding. Once again Keneoue is back as the hospital said she was too complicated for them to admit. She returns to defy the odds with paracetamol, multi vitamins and another batch of antibiotics. The boy with malnutrition and fever remains in hospital. Malineo has had to stay with him and Sylvia has had to go home for the week so I have lost both physiotherapy assistants for the time being.

On the bright side, it is now possible to open and close cupboard doors in the houses, without them falling off, since the advent of the wardrobe man and his gifts. I am also pleased to watch the able children diligently washing their hands before lunch. After lunch I am called upon for the placing of the water containers for hand washing for the outside toilets. The ground around the toilets is a mess of rubble and junk, and as it turns out shit, which I discover as I try to assemble the water containers on a pile of rubble, an old tin can and table with broken legs. Surprisingly these feats of engineering work quite well and the children are soon using the taps. I flick away the encroaching piles of poo so nobody walks in any while they are cleaning their hands.

When I go back inside and watch from the window the house mother standing next to me assures me the water containers will survive less than 24 hours.  Well, we shall see but you have to start somewhere. Hopefully all the training I did on the hygiene and feeding will not be lost, as notes have been made and will be translated in to Sesotho to make a short training video which can be used to induct future staff.

Mostly the work I am doing here is building on a long term accumulation of consistent input, things do not change suddenly, however on Friday I am blessed with a moment where a simple thing brought an immediate result. It actually goes back to Monday when I was walking up the track with the social worker, Nthaza, and she stopped to talk to a teenage girl who comes up behind us. The girl was upset and spoke with her hands in her mouth, Nthaza was also stressed. The conversation finished and we continued, leaving the girl standing on the track crying.

I ask Nthaza what the problem is, she explains the girl is an orphan, very poor and lives with her grandmother. She is a good student, but has had to change schools and has no school uniform. Without school uniform, she can’t stay at school and will not be allowed to return after the Easter break. She has begged the social worker for a uniform several times, but all the bursaries have been used up and Nthaza has no money left to buy her one.

I tried to imagine what life must be like for this girl with no one to support her. There are probably thousands of children like her in Lesotho, but only one of them standing on the same track as me at this moment. It’s a no brainer, I tell Nthaza I will buy what is needed. It is such a small price to pay to give this girl a chance of a future. Nthaza goes to town and gets all the necessary things and on Friday the girl comes to get them and puts on her brand-new uniform, and yep, the look on her face... priceless.

I wish all fixes were as easy, but they are not. I watch Garry’s film the same morning, and the ten-year struggle that Mamello has dedicated herself to at Phelisanong. Against all the odds she has built something here that gives disabled children hope, a community and a chance of a better life. It’s been a long road, and with a bottomless pit of need, there’s no end in sight.  I walk out the gate, past the pile of rubble that use to be a wall in the physio room, and back up the track. Tomorrow’s another day.               

Blog 18: It's all about the micro

So, Keneoue has bounced back with the help of Amoxicillin. The diarrhoea and sickness has stopped, and she’s even been quite feisty in her demands for food. Encouraged, I decided it was time for her to have a proper square meal and Sylvia blended her some rice, fish and vegetable soup. It’s amazing that with all the hazards Keneoue has faced she’s made it this far on milk and porridge. She’s a tough one for sure and seemed to enjoy having something a bit more substantial for lunch, if a little surprised by it.

She still fighting some flu, virus thing, which is going around, and many of us have fallen victim to. I have been trying to encourage the children to cough in their hands, or their elbow, but since many of them can’t control their hands, arms or heads, this is a major task for them to achieve. Lesojane has had a terrible cough and been off school all week, and is unable to bring his arm to his mouth, however much he tries. He has still been keen to come to physiotherapy, and tries so hard to accomplish the small tasks he is given, that I have brought to physiotherapy to him and had a few sessions in house 5. I realise how much it means to him when I come to the house and find him trying to use a washing up bowl, which has been left on the floor with clothes in it, as a therapy ball. Laying across it with his limbs waggling about in the air, doing some sort of swimming strokes.

His reach and grasp control has improved a little, but it’s going to be a long road if he ever is to control a spoon and feed himself. Masela can now do that with the aid of a special spoon with a large handle and an anti-slip mat (thanks Helen for another daring raid on the ward). Unfortunately, this morning I discovered that Masela can’t use a pen. Inspired by the spoon idea I thicken a pen by wrapping string around it, but it doesn’t work too well. I find that she is unable to identify the letters of the alphabet, or which ones make up her name. Such are the hazards of overcrowded classrooms.

I task Sylvia with trying to teach Masela some basic letters. Sylvia is the young albino lady who is helping me as a physio assistant. She is smart and speaks good English, but like myself, is not blessed with patience. We are both improving in this area with the fortitude needed to work with some of these children and constant repetition of tasks. It’s a working progress.

There are a number of albino staff and children at the orphanage and their skin colour can make a tough life even harder. Stigmatised in Lesotho, and in many parts of Africa, albinos suffer abuse, attacks, and are even murdered. If that wasn’t enough to endure, they are vulnerable to skin cancer, many can’t afford to buy protective cream and they usually have poor eyesight. Mamello has helped to set up Albino link as a support system and a community that provides employment and schooling for them at Phelisanong.

Anyway, Sylvia has done such a good job helping to feed Keneoue, I’m sure she can cope with the alphabet and Masela. Both she and Malineo probably didn’t realise how all-encompassing being a physiotherapy assistant would be, from being a teacher, building furniture, feeding children with swallowing difficulties, being a care giver and all round entertainer, besides all the usual stretches, strengthening exercises and use of mobility aids. With few resources, it’s all about multi-tasking and using your ingenuity. Having two willing assistants has made such a difference in the number of children we have been able to help and hopefully will sustain things after I have left.

Regarding the more traditional physiotherapy elements, the kids are going great guns. Kolosoa and Tokiso’s first hesitant steps on the posterior walkers I brought out with me, have now evolved into all out wacky races down the path. Both boys determine to overtake the other, shouting and laughing as they engage in Ben Hur type tactics, trying to win. Thanks again to those who gave donations towards the frames and helped in adapting the wheels.

Tokiso has also achieved his dream of walking to school after only two weeks of training. It does take quite a few rests and the assistance of one to guide his frame over the rough stones and down the hazardous slope between the school blocks, but he gets better every time he does it. I think the only way he could manage it independently, would be on crutches. There is an older boy here who is diplegic and uses this method, so I am encouraging Tokiso to strengthen his upper body, and improve his balance, so that one day he might be able to do the same.

Other children have also joined the walking brigade, up and down the path between their house and the physio room and across to the school, holding the assistant’s hands or using the small children’s Zimmer frames sent down from Saint Angela’s last year. They are all making progress in their own way and it’s amazing what they’ve achieved in such a short time.

I wish I could say the same for the health of the country, but there has been a serious setback in the vaccination program over the last couple of weeks. When I was at Saint Angela’s I was impressed one day when all the young children, with their mothers, queued for hours to get their measles vaccination, as they did all over the country. However, it turns out this vaccination had not been tested and has resulted in serious side effects. The hospitals have been over flowing with extremely ill children from this life-threatening event. It has been a tragedy for the children and families effected and caused a huge political storm. After this who would trust their child to be vaccinated again, or put their faith in the ministry for Health.

Sometimes when you are faced by such mal practice, and laid low by a virus yourself, it’s hard to hold onto the conviction that your efforts are worthwhile, or will help change things. The government here has been a disaster since the last coup and caused many aid organisations to withdraw from the country. However, as my Canadian friends tell me, there are good things happening, and Phelisanong is one of these, building a community with a skill base, which hopefully can become a hub for spreading ideas into the surrounding area.

The week ends with goodbyes to Christina and Jeff, who have done such a great job helping the school with supplies, sorting out the chaos in the library and running music workshops. We are privileged to watch the children put on a show, singing and dancing, the boys kicking up a storm with their traditional gumboot dance on the dusty red earth. I feel reinvigorated by the ceremony and more able to focus on all the positive things that are happening around me. You just have to keep the faith and move forwards, one small step at a time, it’s all about the micro, not the macro.   

    

   

Blog 17: Building headaches, miracles and prayers

When I agreed to try and come up with a proposal to spend some bequest money left for Phelisanong, I did not anticipate the epic proportions this task would involve. I had some idea of a physio house, instead of the cramped corner I am trying to operate out of, with maybe a playground in front of it. I was surprised last week when I was told the builder had come to see me. I presumed that I just needed to point out where this building might go, the chosen spot being the site of the old broken swings.

Somehow, as we tramp around the site at Phelisanong it becomes a two-phase plan. Phase one consisting of three different projects, in an attempt to make Phelisanong a flat, wheelchair friendly, site. Presently, the access to the school building is probably most suited for skilled motor cross riders, with the path an interesting slope of about 60 degrees, between two of the classroom blocks, with a brick wall straight ahead for those who lose control. Not surprisingly most of the wheelchairs have disintegrated while trying to negotiate these perils and only a few battered specimens remain.

“Make it flat” I say to Mr Chalabala, the builder, at least hundred times as the scale of the hazards becomes apparent. At the end of tour the brightly smiling Mr Chalabala agrees to make three separate quotes, for the three different projects of phase one. When this comes back the next day, it is one large quote for all the labour costs, none of the material costs are included and there is no mention that the physiotherapy house will have any doors or windows. He returns at the beginning of the week and we go through the whole process again in the midday sun.

The quotes and ambitions of the project ebb and flow, until finally we agree we should keep it simple and limit it to just a physio house and a bit of path for access. I feel a great sense of relief and there is a photo call on the patch of land where the physio house will be. The smile on my face freezes when Joel (the finance officer) says that Mamello has asked if we could move it to the right, to give her a view down the valley from her office. Such a move would greatly increase the cost, as it would entail levelling the slope which tails off on that side.

As the finance officer, Joel, can fully appreciate that views come at a price and I leave him to break to news to Mamello. So, the next day I am due to meet Mr Chalabala in a hotel in Leribe to get his quote. It’s a very hot day, added to by the fact I am sitting next to a pizza oven, but I am too hot to move to somewhere cooler. Mr Chalabala arrives without the quote and says we should go to the builder’s merchant to get the prices of materials. I tell him this is not a good idea and I have never had any interest in bags of cement or sand.

I buy him a beer instead and we go through the list of materials again and add various items which might be useful like lights and door frames, until I lose the will to live. Mr Chalabala finishes his beer and goes to the builder’s merchant without me and my lift arrives to take me home. 

On the way back we pass by Mr Chalabala's two story house, built by him and still standing, which I feel is a good omen. He returns the next day with an itemised quote, three pages long, for all the materials needed from Hard Ware City. I am impressed and start checking through the list and immediately spot a discrepancy on page one, “Four double sinks? I said only a single was needed.” Hard Ware City seems to have got a little carried away with the plumbing of the physio room, while forgetting to cost the sand or concrete at all. We finally come up with a definitive list which Mr Chalabala takes away again for Hard Ware City to amend.

The last building project I was involved in was over thirty years ago, in the North West Territories of Canada, when I was helping a builder construct a log cabin (it’s a long story). Unfortunately, he had to go to Winnipeg and never returned, leaving me to learn how to use a very large chain saw and build a dozen walls on jigs, 15 logs high. Good job I had the whole summer to do it. With that experience in mind I have now gone for a much cheaper option of upgrading the present physio room and bought hammer, nails, sandpaper and cups in an endeavour to achieve deluxe status.

I already have a saw with me and decide to use it, along with my other tools, to strengthen table legs, bang in the nails that stick out, sandpaper the splinters away, raise the plastic table, which is too small for the older children to get their legs under, using the cups, and reorganise the space so I have at least an area the width and length of a small child, in which they can lie down and do stretches. Before that I turn my attention to House 8 which has the most disabled children in.

The most powerful weapon I have in my arsenal is my new hammer and put it into immediate action to hang the colourful ribbons that I have brought to hang from the roof of House 8. Even armed with my hammer there is still a problem with the central hanging point for the ribbons, which is eventually solved with a large piece of bubble gum to stop it coming off the nail. I amuse the care ladies for about an hour with my decorating efforts, but the final effect is quite pleasing. 

In the afternoon, the physio room get the DIY treatment. The cups I brought are too small for the plastic table, but Malineo and Sylvia improvise with peanut butter containers, earth and carboard, producing an instantly height adjustable table. I relinquish my hammer to Mahali, a man who will turn his hand to anything, and has made a small table for the Lecky corner seat, out of rough pieces of wood hammered together with a stone. Together we improve on its rustic appearance and texture, producing something more stable and almost Ikea like, if viewed in a certain shadowy light.

Who needs 250 bags of cement, 3 loads of rough sand, 3 loads of fine sand, 6 aluminium windows, 2 double doors, roofing sheets, bricks, tiles, pipes, wiring, blah, blah, blah… Anyway, I don’t have to meet Mr Chalabala until Monday so can turn my attention to all things physio until then. Friday morning starts in House 8 as usual, helping with breakfast. It is in this house that Malineo has performed a miracle with Lithapelo, the most difficult resident to feed in the whole of Phelisanong (see blog 6)

For 25 years, this girl has been fed on her back. She gags and splutters as her jaw goes into extensor spasm and her tongue thrusts out. She has flexure contracture of her limbs, windswept hips and a rotated trunk. Last year I decided the best way to feed her upright was  in a large pushchair, which has a bolster between the knees. With additional padding this arrangement was just about able to retain her spasms. However, there has been some backsliding on this method and once again I catch the house mothers feeding her on her back, covering her mouth with a rag to avoid getting sprayed with the food she spits out.

With Malineo’s help, I began the whole procedure again, it needs two of us to feed Lithapelo’s and assist her jaw to close. After a few days I left Malineo to battle on with the help of a house mother, while I dealt with other children. I noticed at the beginning of this week that Malineo was feeding Lithapelo alone, and go to help her. Lithapelo opens her mouth and automatically I use my hand to support her closing it. Usually this takes quite an effort, but hardly any is required. Puzzled, I do it again, using just one finger, then realise that Lithapelo can do it without any assistance at all, and has also  stopped gagging and spraying her food everywhere.

Malineo doesn’t need any help at all and I stand back and watch. She has found a screw on table, which comes across the front of the chair, stopping Lithapelo from squirming out of it. She also has the patience of an angel and lets Lithapelo go at her own pace, anticipating her spasms, and constantly adjusting the support padding to get her head in a good position. This gives Lithapelo more control and consequently she is more relaxed which reduces the spasms. I try to tell Malineo what an amazing thing she has done. She smiles embarrassed and carries on feeding Lithapelo. I am left to marvel at this unassuming lady and the transformation she has made to one girls life.            

    

After Friday I am feeling that things are going quite well, the boys are getting much stronger with their walking and Marsala’s reach and grasp and head control has come on miraculously in two weeks. The only blip is both she and Lesojane have been sick the last couple of days and because they and the more able children go to school I can’t do as much physio as I want to with them during the week. When I come in on Saturday it’s an opportunity to do a lot more, but first go to House 8 to see Keneoue, who was not so good on Friday, coming down with a cold and diarrhoea.

I struggle to get her to drink any milk and when I change her nappy find she has had more diarrhoea and her skin is paper thin, drawn tightly across her sunken belly. I don’t think her body can weigh more than 7 pounds. I manage to track down some rehydration salts, detail Sylvia to go to the kitchen, get some boiled water, sterilise a bottle and make up the salts. Over an hour passes to achieve this feat and cool the water down, in which I over ambitiously try to run a physiotherapy session with and Malineo half a dozen children.

It is completely bonkers, but what can I do when I go into house 5 and they are all desperate to come. Mthimokholo is standing at the door as I go in, balancing precariously with his arms and legs akimbo (he is ataxic with learning difficulties). “Mme Jan” he shouts with delight, falling into my arms and dribbling all over me. By the time Malineo I have staggered up the path with the children to the physio room, with the various walking aids they use, most of them need to go back to the house again to go to the toilet. Anyway at least they achieve a fair amount of walking.

The water cools and I go to try and get Keneoue to drink some. It’s impossible, she is coughing with all the might her fragile body can manage. After half an hour of getting nowhere I ask the head house mother to come and tell her Keneoue must go to hospital and go on a drip. She is dangerously dehydrated and simply too weak to cope with diarrhoea and a cold. Keneoue is lying motionless with frothy white saliva on the pillow and the house mother calls Mamello, who immediately sends a vehicle to take her to hospital.

Little Keneoue with the misshapen head, who nobody wants, not even the hospitals, which is why she has been brought to Phelisanong. Here though, there are hazards all around, germs that her weak body can’t fight. I’m amazed that she’s made it this far and pray that she will win this latest battle she faces.             

Blog 16: Heads

There are around 180 children at Phelisanong and amongst these, a great variety of head shapes and sizes. I thought I’d seen every kind there was to see, until I came across Keneoue. This little girl arrived a couple of days before I did and when I peered into her cot I was shocked. All I could see was a spherically shaped skull with a bulbous forehead which looked like it had been crushed with a meat cleaver, a furrow going right down the middle of the crown.

She was obviously very sick, with weeping pink bed sores on either side of her head. Apparently, she had spent nearly all the 19 months of her life in hospital, until last week she was discharged and sent by the ministry of Social Development to Phelisanong. Her poor health resulted in her being taken back to hospital and put on antibiotics. When I heard that a child had died on Sunday I felt sure it had to be her, but I wasn’t. She returned at the beginning of the week looking much better. Her brown button eyes were open and seem to be amazed at the world she now found herself in.

Keneoue means gift, but that name can’t have been given by her parents as she has been abandoned. There are hardly any details about her and it is unknown whether her ailment is an accident of birth, some genetic defect, or an operation that has gone horribly wrong. The staff are reluctant to pick her up, and feed her by squirting milk from a syringe into her mouth as she lays in her cot.

I look into the cot as I pass by one morning. I have taken to starting the day in the house with the most disabled children, where Keneoue now lives. Somebody has put a bottle by her side which she can’t possibly drink as her hands are tightly clenched into fists and she is unable to suck. I take a deep breath and decide to pick her up. Her head must weigh nearly 50% of her body weight, making it hard to support. Her body is ridged and only the size of a small baby, and slowly I manage to bend her knees and sit her on my lap.   

I can sense everyone is watching me, waiting for something calamitous to happen, and I try to appear more confident than I feel. I pick the bottle up and slide the teat into her mouth and gently press her chin with my finger, closing her lips, trying to stimulate her to suck. She makes a few attempts and then pauses, this continues over the next twenty minutes or so, and slowly she drinks a little milk. One of the house mother’s hands me a small bowl of porridge which I gradually get Keneoue to eat with the aid of a small spoon.

I wonder if anyone has ever cuddled this child or taken the time to feed her in their arms. Later that day Mamello (the Phelisanong manager) comes to the physio room with Keneoue in a push chair and asks me about how to hold her. It’s amazing that despite all the children at Phelisanong, nothing ever happens without escaping Mamello’s attention. She holds Keneoue comfortably in her arms, and we agree that with some TLC, Keneoue will hopefully have a chance of a better life than she has known up till now.

Despite her terrible start to life, Keneoue has already achieved more than some of the children here, in that at least she can swallow. Her next physical milestone will be head control. There are a number of children that have no head control, and the reasons for this vary. Presently I am working with two children, Marsala and Lesojane, who can hold their heads up, but they can’t keep it in the midline. They have a type of cerebral palsy called atheotosis. This means they have fluctuations in muscle tone, involuntary movements, and find it difficult to control and grade the movement of their limbs.

Lesojane is worse than Marsala, he is usually spoon fed by the house mothers while he sits on the floor, bracing himself with his arms. Marsala sits at the table and feeds herself using her hand, lacking the control to use a spoon. Neither child can walk, as when your head and arms are always writhing around, it is impossible to balance.  However, when these children’s heads are held in the midline and their arms fixed they can achieve all sorts of things. Now they both come to the physio room at lunch time, and when Marsala’s head is held she can use a spoon to feed herself.

Lesojane has also been able to sit at the table and feed himself, but he needs two people to help him, one to hold his head and one to guide the spoon. He can also sit at the table with the other children when they play, instead of watching from them from the floor, and he can fix his own head, using his elbows on the table. The picture I take of him and Marsala may seem unremarkable, but you can’t imagine how difficult it is for them to keep still and for me to get a shot of them both motionless at the same moment.  

He and Marsala can both walk with the assistance of two people, one guiding the head, the other the arms. If these children’s bodies get enough of the right input and feedback, they will both eventually achieve more independence. I just don’t know how long it will take and it is certainly very time consuming and takes a lot of patience and effort. Fortunately, I have been blessed with two helpers this time, Sylvia and Malineo, which makes my life a lot easier.

Even with two helpers I can only see about a dozen children a day, because the work is so intensive, and it’s totally new to me. Until I came to Lesotho last year I had never worked with children with cerebral palsy before. The work is complex, every child has different problems and needs. Upper motor lesions are out of my comfort zone, I normally work with adults in outpatients with musculoskeletal problems. However, most of the children I know from last year and I am better prepared, having had time to research their difficulties.   

There are more people around to help as well this year, not only do I have my two assistants but there are five people here from Canada and Nelson from Lesotho, who are involved with HIV education, music workshops and all manner of other business. They often pop by the physio room and the next moment are holding are holding an arm or a leg in position, or just simply playing with the children.

With so many children here the need for physiotherapy is a bottomless pit. I am trying to engage the house mothers as much as possible but it’s difficult. There is a high turnover of care staff as they do back breaking work seven days a week, are paid little, live in cramped conditions and have no training. They tend to do things in a way that makes their life as easy as possible, which is not always best for the children. I’m only going to be here five weeks so it’s easy for me to bust a gut for that time. I will be going home to my own house, van, and a three-day working week.

Things are not helped by the poor facilities here and lack of help from the Department of Social Development. The ministerial head of the department graciously pays a visit this week, as he did last year when I was here (blog 6). There is another election coming and the madness of around 250 million maluti being spent on this event by one of the poorest countries in the world. There are dozens of parties for a population of about 2 million, each party trying to grab a share of the money and power. The consequence will be that eventually another coalition government will be formed and the squabbling and infighting of the Lesotho government will continue.

Meanwhile Phelisanong has only a few broken-down wheel chairs left to try and transport the children over the over the rough ground to school. I meet the minister as I am coming out of the physiotherapy room. I am holding Tokiso under his arms, taking nearly all of his body weight, as I take him out to his walking frame. The minister offers me his hand and I stand there holding Tokiso, wondering if the minister expects me to drop him on the ground, so I can take his proffered hand.

Eventually I manage to sit Tokiso down and then shake the ministers hand as one of his entourage holds an umbrella over his head. I can’t think of anything to say to him, and tell him that I have go to walk Tokiso back before we both get drenched. The minister leaves in a hurry as the hailstones start. He has surely already spent enough time with poor people and orphans to win some crucial votes. Earlier he had visited the house with Keneoue in and asked who had bought her here. He is surprised to learn it is his department and promises he will try and find some more information out more about her. This week has been all about heads, strangely shaped ones, ones that won’t keep still and ones that I feel need uncomplimentary prefixes in front of them.                      

Blog 15: Goodbye/ Hello

My last few days at Saint Angela’s pass by in a blur of report writing, training Christine and handing over as much detail as possible to her, so she can continue to run the physiotherapy as the newly qualified physiotherapy assistant.

The girls put on a marvellous display of traditional singing and dancing for me in the physiotherapy room. They wear skirts made from shredded maize bags and underneath have belts made of old bottle tops. When they flick their hips the skirts flare up and the bottle tops jangle. I have no idea how a girl with no feet, one with cerebral palsy and another with hemiplegia are achieving this feat. I can’t get near it without any disabilities.

The boys are huddled in a corner playing chequers, but Christine is having none of it and insists they join the girls in a courtship dance, facing each other in two lines. There is lots of squirming and embarrassment from the boys and several bids to escape, but there’s no getting out of it. The ever laughing Rets drags himself across the divide, but is rejected by his potential partners. Tiger and Phaz fare better and eventually the girls are whittled down to the last one.

Somehow you always know in these situations who the last one to be chosen will be, and sure enough its little Sadi, with only one eye, a withered arm and shortened leg. Life can be so harsh at times. The lines are redrawn and the girls pick boys. Christine pulls me up to join in and I do my own version of Saturday night fever and pick Rets. Fortunately, he accepts and I tell him I am looking forward to him cooking my tea tonight.       

         

Finally, it’s time to go home, but there is on last treat and Christine and Lucky sing a duet. They both have extraordinary voices, and sing a mesmerising gospel song together. Christine has a beautiful soprano voice, while Lucky is an incredible Baritone. You would never guess the sound came from a young man in a wheel chair with brittle bones.

I wander down the dusty road as the sun sets, pondering on the highs and the lows at Saint Angela’s. They have been as contrasting as my last visit here, some of the lows unbloggable. However, when you witness such talent and beauty there is always hope that things will get better. I feel I am leaving the physiotherapy in much better hands than on my last visit and I’m very glad I came back. Even in the last few weeks some of the children have improved and have noticed their own progress. With a lump in my throat I bid them all goodbye on my last evening and move on to the next challenge.

As Manyanye drives me to Phelisanong I feel a mixture of excitement and anxiety. Excitement at the thought of seeing the children again, anxiety about what Tokiso will think about me returning. This was the young boy who had a big dream to walk to school, whose face lit up with joy when he had a chance to walk on a small green zimmer frame that I sourced from Saint Angela’s, and who cried inconsolably when I left, taking his dreams with me (see blog 8).

I couldn’t even promise him that I’d be back, as I didn’t know what the future held. He won’t know how much I’ve thought about him, how hard I’ve tried to find a frame that will best help him. His legs on weight bearing turn into stiff pillars, the feet pointing downwards and in inwards.

It’s a huge effort for him to walk and the more effort he puts in the stiffer his muscles in his legs become. That’s why I’ve brought him a frame with a flip down seat and off-road wheels. The wheels had to be specially made for the frame, to hopefully endure African conditions. I wonder if he’ll be suspicious of me after I raised his hopes a year ago and then left him. It was so difficult to explain my departure to a nine-year-old boy, whose had such rough breaks in life and whose second language is English.

I wonder how the others will be, the children with swallowing difficulties who were being fed on their backs. I taught the care mothers how to feed them upright (see blogs 6,7,8), but what happened when I left? The drive to Phelisanong takes forever and its dark by the time we arrive and bump down the rough track. The surface is worse than ever after all the thunder storms this year.

Mama Jo opens the gate, some boys unload the equipment and we leave, it takes less than five minutes. Manyanye drops me off at the guest house and I find myself staying in the same room as last year. I see myself in the mirror, for the first time in a month and look ten years older than I remember. Maybe the strip lighting doesn’t help.

I barely sleep and am up early the next morning. I pack a small rucksack and leave the house to walk up the track and on to the road, where I flag a taxi down. Soon I am walking down the track to Phelisanong, a beautiful backdrop provided by the Maluti mountains and clear blue skies. I go through the gate and the first person I see is Tokiso, being pushed to school in a wheelchair. It’s an amazing coincidence and he looks at me in disbelief. I crouch down and hold his hand and tell him I’m really pleased to see him and will meet him later for physio after school. He’s wheeled away still looking stunned.

I go to the hut that I was using part of for last year for physio, sharing it with the clinic and social worker’s office. The space I was using is filled with metal fruit driers, a washing machine, drier, a wardrobe, tools and boxes of apparent rubbish. There is up roar as I insist it all goes. A battle ensues with Mahali, the man who organises the sports here, says the boxes are full of football stuff. Some of them are, some of them not.

“Look rubbish” I say pointing at empty plastic bottles. “Yes rubbish” chorus the social worker, clinic lady and care worker, taking up the cry.  Eventually there is a compromise, the wardrobe and football kit get to stay and everything else goes. The social worker, Nthaza, helps me unpack all the kit I have brought, frames, crutches, a corner seat, bowls, soap, water containers, blenders, cutlery, cups, toys, books, games, therapy balls, tools. I had no idea I had so much stuff and assembling it and clearing the room takes the best part of the morning.

I then go with Nthaza to look round the houses and decide which of the many children I will pick for physiotherapy over the next month or so. The setup of the houses has changed since last year and children have swapped rooms. I start in the house which has some of the youngest children in and most disabled. I have already decided that I will be continuing to work with Lineo (blog 7) and Malafane (blog 8). Last year I got Lineo standing and beginning to feed herself and want to continue her progress and get her walking. I’m in for a surprise, the staff have beaten me to it and she has been able to both feed herself and walk for some time.

Lineo waddles across the room and gives me a friendly thump. It’s lunch time and I can’t believe what I am seeing. Not only are the children being feed upright, but Malafane is managing to feed himself. This is the child who last year was being fed on his back, the house mothers forming a trough under his chin and scooping the food into his mouth before his large tongue could push it out again.

He looks at me triumphantly as he manages to get most of an entire spoonful of food into his mouth. I have tears in my eyes at his incredible feat. I feel that teaching the house mothers to feed the children upright and them continuing to do this and progress it, is one of the most worthwhile things I’ve ever contributed to. Feeling rather emotional I move on to the next house.

In the afternoon, Tokiso, Marsala and Kolosa come to the physio room. After Malafane’s amazing exploit I am eager to see how they are all getting on with their walking. It’s a big disappointment. They all seem worse than I remember, the boy’s muscle spasm and Marsala’s uncontrolled movements make walking terribly difficult for them. “Look Mme Jan I am training,” says Tokiso excitedly as he struggles a few yards down the path. I try to smile and encouraged him, but can’t see how he will ever be able to walk to school. His legs are so twisted they wrap around each other as he tries to move them.

The afternoon finishes on a brighter note as I go back to their house with them and read all the children the Three Little Pigs, with Nthaza translating and using the finger puppets. Florence rises to the occasion and the children laugh delightedly as we run around pretending to be the wolf with our bottom on fire. I say goodbye to them all and that I’ll see them all tomorrow. Tokiso has shyly told me it’s his tenth birthday, so of course I won’t be missing it.

Saturday dawns and I manage to find some pens, a note book, a bar of chocolate and a car building set, like the one I gave Alex, with a screw driver and spanner. I go to Tokiso’s house and give them to him. He clutches the plastic bag to his chest without even knowing what’s in it. I think it’s unlikely that he, or the other children, have much experience of receiving birthday presents.

It takes him the best part of a couple of hours to patiently screw the vehicle together and he is delighted with it. After he has had lunch I go to his house with Ashton, who is here doing some voluntary working teaching the children to hand sign. She on guitar and drums and I’m on sax. Some pretty wild dancing ensures from the children who are able to stand and ear splinting screaming from one of the children who can only lie in bed, who joins in the only way she can.

I walk back up the track with Ashton and we catch a taxi being driven by a man in a red plastic builders hat. He tells me he remembers me from last year. I don't remember him and wonder if I should be wearing a hat like his, but he delivers me safely to the guest house without the need for it. Hard hats are sometimes necessary on the emotional roller coaster ride Africa can throw at you, but I got away with it this week.