Sunday 26 February 2017

Blog 13 : Under Pressure


I’m not sure how I have got to the age of 55 without meeting a priest, so when Justice’s mother was keen to introduce me to the local Father, early in the week, I decided to take the opportunity. The possibility of divine intercession, in trying circumstances, can never be passed by.

I was expecting to be introduced to a black Father, but instead find a white Italian, South African who enjoys brass bands. I decide to play him the beginning of John Coltrane’s Spiritual on my soprano sax. He looks puzzled and I wonder how anyone can not have heard of the 60’s Jazz icon John Coltrane. I decide a quick switch to Amazing Grace is necessary and when I finish offer to look at the fathers aching neck. I show him some exercises to do, which he says he adhere to, but thinks he will still need the medicinal whiskey to keep the pain in check.

My soprano playing goes down better with the pre-school children who have no inhibitions about getting on down with James Brown and Jaco Pastorius. I feel I have slightly redeemed myself in their eyes, having baffled them on Tuesday with the story of the three little pigs. This totally mystified them, even with the aid of finger puppets. The pre-school is just across the corridor from the physiotherapy room so I see quite a lot of their activities and have already had two children brought to me with extremely bowed legs. It is unclear whether they have Rickets or Blount’s disease (I have never seen either before) and I try to make a sensible plan of action with the aid of the internet.

I come across a lot of medical conditions in Lesotho that I have never seen before and am currently following up Lorato from the adjoining primary school (see blogs 5 and 10) who has TB of the hip. When I last saw Lorato, in April 2016, she was in a great deal of pain. She had been in a wheelchair for 6 months, unable to walk, had massive abscesses on her buttock and leg and the left hip had contracted to 45 degrees. I suspected osteomyelitis and she finally got the X-ray, I had been demanding, just before I left Lesotho. This confirmed osteomyelitis due to TB of the bones. Lesotho has the highest rates of TB in the world, due to poverty and HIV. TB of the bones is much less common than in the lungs, and unusual in young children. 
  
Since her diagnosis Lorato has been on antibiotics and has improved to a much better level than I had hoped. She is now on crutches and back at school. When I examine her, the left hip is still contracted and her pelvis rotated to compensate for the shortened muscles in her back. She has a cord tied round her waist which Christine (the volunteer social worker) tells me is a charm against witchcraft. Lorato’s parents have no concept of TB and believe her condition is “deliberate” (a curse). The conflict between Western medicine and traditional Witch doctors add to the many problems of healthcare in Lesotho.

Lorato herself, has been turning up regularly to do physiotherapy with her little gang of friends from the school. She’s a spunky kid and tolerates me stretching and grinding her hip, with a grimace. She has much more fun stretching herself on the physiotherapy ball, and has already become an expert in this skill. Justice arranged for a doctor, with a special interest in TB, to come and see her this week. I talk to Dr Johnson about the possibility of Lorato seeing an orthopaedic specialist and having an operation to reshape the femoral head. This would improve the movement of the hip so she can grow in a more normal posture as she approaches puberty. Dr Johnson promises to pursue this and how much such a procedure would cost.

He is just about to leave when Kats crawls through the door. The ever-smiling Kats who sometimes comes to physiotherapy several times a day with his great friend Rets, who never stops laughing despite his trousers continually falling down his spindly, stiff legs. They both love to play floor football and Kats has asked whether he can go to Bloemfontein to fix his legs. Bloemfontein is in South Africa and the nearest big hospital where the kids can go to have major procedures.  

I get Dr Johnson to take a picture of Kats flexed knees in view of asking a specialist about the possibility of Botox injections to relax the hamstrings. Even if such a procedure is possible I don’t know how long it would last as Kats has Cerebral Palsy and his brain will keep sending the same messages which tighten his leg muscles. The procedure would cost thousands of Maluti and it is unlikely that the Lesotho government would pay for the operation, or the ongoing follow ups he would need.    

Kats goes and cheerfully smiles and waves to me in his wheelchair as he passes by the window, unaware that he has further added to the banging headache that has plagued me this week. Trying to make the right decisions for the children’s health care in areas which I have little experience in, with no specialist guidance, is proving stressful. Added to these concerns are two meetings I have arranged to try and effect longer term changes at Saint Angela’s, which could improve the future well being of all the children.

Before these meetings, I have more minor decisions to consider on grab rails in the children’s toilets. The wonderful men and women of Ireland, who have fixed a basket-ball net to the physio room wall, put a grid for noughts and crosses on the repaired floor, made a large contribution to the water bill debt, built the pre-school a playground and put a disabled shower into the dormitory block, have grab bars left over from their endeavors and ask me if they can be used in the toilets. In the UK, such decisions are taken by an occupational therapist and I decide the best thing to do is to get the kids to demonstrate how they get on and off the toilet. With a variety of disabilities, they approach this task in different ways, including two boys who pull themselves forward onto the seat by pulling on the toilet cistern. How the cistern hasn’t fallen off the wall I don’t know and the result is grab rail on the back wall as well as ones on the side.

Action Ireland has been a revelation to me this week. I was unaware of all the work they do, besides the kid’s entertainment with the Irish students they bring over each year. I meet with the director of the Charity and explore the possibility that Saint Angela’s might benefit from some more sustained input and support from them over the next five years. I meet with Sister and the board of Saint Angela’s and tell them that opportunity knocks, not only with Action Ireland, but in engaging the volunteer social worker as the employed social worker and physiotherapy assistant. I have been very impressed by her and feel she offers a chance to engage someone with the necessary skills and aptitudes in both areas. 


I hope I’ve said the right things and presented a compelling case for Saint Angela’s to consider taking advantage of these opportunities. The pressure has felt huge as I try and pick my way through the surrounding politics. Ultimately you can take a horse to water … Perhaps when the priest has recovered from the shock of John Coltrane he will offer up a prayer  

Saturday 18 February 2017

Blog 12: Back at Saint Angela's


I rendezvous successfully with Veronica at Heathrow and somehow, despite the last-minute addition of a Lecky wooden corner seat, all 5 pieces of luggage come in at under 23kg. We dispatch them safely onto the Virgin Atlantic flight, but any feeling of smugness soon evaporates at Johannesburg airport when only one piece manages to turn up in fragile handling. After a minor panic the other bags are all found and stuffed into the hire vehicle, with quite a lot of heaving, mathematical calculations and the addition of Veronica’s husband and his luggage, who arrives on a later flight.

We make for the border, wondering if Lesotho officials will let us through without slapping us for custom duty. Arriving there at 5pm on a Friday afternoon, in thunder, lightning and rain, nobody is interested in us. We breeze through and are soon in the Lancers meeting with Manyanye, Dolen’s man on the ground in Lesotho. Manyanye looked after me last year too, and we have barely greeted him before Joel turns up from Phelisanong orphanage, together with a bunch of people I have only met on Facebook up till now.

Drinks and catching up all around and I become engrossed in a political discussion with my new friend, Nelson, about imminent return to Lesotho of the political opposition exiles, after the failed coup of 2014. It would be nice to think that this event will begin to disperse the clouds of political fragmentation and corruption that hang over the country, but I won’t be holding my breath.

Justice arrives and my luggage is repacked into a taxi which takes me to his mother’s guest house. The roads, already rutted and potholed, have been made even worst by frequent rain and thunderstorms over the past 3 months. When I was here last year there had been 9 months of drought and it was a lot hotter and drier, and I am already regretting not bringing any warm layers, or a rain coat.   
On Monday morning I walk the short distance down the dusty road to Saint Angela’s and it feels like I never left. My arrival has coincided with the annual Irish visit to Saint Angela’s (see blog 3), and the first day of a volunteer social worker, Christine. Of the previous senior staff, the social worker has left, the marketing officer has died and the finance officer has left and then mysteriously returned. Funding has been cut to a shoe string and Sister Augustina remains the only consistent figure at the helm, sailing bravely on in the troubled waters surrounding the orphanage.

I meet Christine and Sister and show them how to assemble one of the water filters (having already watched the assemble video and practiced back in Wales). I hand over the second one to them for them to do and Christine does it twice as quick as me while wearing high heels (the girl has style and is obviously a veteran of the Krypton factor).

Sister gives me the keys to the physio room. I open the door to find it still contains most of the equipment and has also gained a huge set of therapy stairs. The rails haven’t yet been fixed on the stairs and I contact Paul, a local handy man, and ask him to sort the rails and a dangerous hole that has appeared in the linoleum floor. I have received some generous donations from people back in Wales, some of which I have already spent on equipment, but I still have plenty of money left. It is such a relief to be able to pay to get things done straight away, without having to prepare invoices for Sentebale and wait to see if they will be accepted, which was the situation I was in last year.    

Myself and Christine spend the rest of the morning cleaning and organising the physio room. Feeling rather pleased with the results we have time in the afternoon to do some impromptu physiotherapy training. In the middle of this Irish Tom turns up, announcing he is also a physio. He looks around at the torn mats and unusual parallel bars and says “I guess it will be okay when you’ve got the room sorted”.

Irish physio Tom may be a well-built man, but he is in danger of being punched on the nose. He uses some of his Irish charm to win me over and I show him some of the films I made last year. It doesn’t take long for him to become enthused by the kids and their potential and he promises to come back next year with equipment and his skills. This would be a brilliant opportunity for more physio input at Saint Angela’s and I hope it works out.
The Irish are here dancing, entertaining and building, putting in disabled showers, which will give the children in wheelchairs much better access for washing. Irish Tom is helping with the showers and I ask him if he knows that the water has been cut off. He looks puzzled and shocked, but miraculously the water comes on later in the week and for the moment the builder’s efforts have not in vain.

The kids turn up for physio after school and I feel quite overwhelmed to see them all again. Some of them look thinner and more ill than I remember, but the smiles and resilience are the same. The good news is that now many of them have much better wheel chairs than on my previous visit. The bad news is that they have done little physiotherapy in the last year and have spent most of the time sitting in these wheelchairs.  Consequently, some of the children’s contractures have got worse and its definitely time to do some exercise.

I have brought a large inflatable punch bag, which the boys love. The girls are fascinated by the carpeted therapy stairs, and go up and down them continuously, perhaps having not experienced such a thing before. Alex, who has brittle bone disease, decides it’s more interesting to hang upside down from the stair rails and I try not to think of the consequences should he fall.

Alex has deteriorated since I saw him last year. He appears tired and more crumpled in his wheelchair. He has the worse form of brittle bone disease and I suspect struggles to get enough oxygen into his crushed lungs. To try and boost his moral I decided to action a plan I’ve had in mind, to get a Taekwondo teacher in to run a session at the orphanage.  

Last year one of the first things Alex said to me was “Mme Jan, I show you my Taekwondo,” while fiercely punching the air. I tell the children that the lesson is open to anyone, but don’t expect them all to turn up on the appointed evening, together with the care staff and kitchen lady.

The black belt teacher, Mefane looks a little taken back by the rows of wheel chairs and wobbly children, but soon recovers to lead a wonderful session. All the children are punching the air, screaming at their imaginary enemies and venting their frustrations. The sweat streams down their faces, which are etched with painful exhilaration, and for short while they believe that they are as invincible as Bruce Lee. Christine tells me how excited they have all been about the Taekwondo and that they have told her that now the other children at school won’t be able to tease them anymore. I hope they are right. It has certainly been a glorious event and at least for one night the children at Saint Angela’s can dream of fighting back and taking on the world.                  

                

Monday 6 February 2017

The Return to Lesotho. Blog 11: The Final Count Down




So just over a year after I touched down in Lesotho, I’m getting ready to return, this time supported by the Dolen Cymru Link. I’m going back to work at the two main orphanages I worked at last time, Saint Angela’s and Phelisanong, and the last few months have been spent trying to source appropriate equipment to help the children. At times this has proved to be a challenging operation, due to cost and finding equipment that is suitable and will survive the rigours of Africa.

Finding affordable posterior paediatric walking frames and off road wheels has been particularly testing. One frame has had to have its wheel’s purpose made (thank you AJ and JT), while the other one still had its wheels in a German warehouse last week. Meanwhile I have accumulated 9 pairs of special supportive paediatric boots (thank you Ellen), crutches, sticks, assorted toys, books, hand hygiene and cleaning materials, UV torches, gel and powder, punch bags, a floor mat, blenders, a Lecky corner seat, special cutlery and cups, for the children with swallowing difficulties, and a tool kit to maintain equipment and build anything else I need.

The purchase of equipment has been supported by generous donations from Machynlleth and Tywyn Rotary Clubs, as well as private individuals (thank you Tilde, Elaine, Lesley, John and Di, Martin and Angela). To help with carriage I am flying with Veronica German, the head of Dolen Cymru, and have a large part of her luggage allowance, giving me a total of 5 loads of maximum 23kg each bag. Every kg is precious and I have had to think very carefully about what I am taking and unfortunately turn down some kind offers of donated equipment. It was all coming together reasonably well, until I spoke to Justice on a What’s App call on Tuesday morning.

Justice is on the board of Saint Angela’s and my main contact there, and informed me that the water had been cut off at the orphanage due to a huge unpaid water bill, caused by leaking pipes. Now they are relying on roof water collected in water butts, and using one small kettle to boil drinking water for over 30 disabled children. Justice asked if I could bring some water purification tablets with me.


After putting the phone down, and going slightly dizzy trying to calculate how many water purification I would need to take, I decided to look at water filtration units and do some research to fill in the vast gap in my knowledge on this subject. I spent the rest of the day trying to find something that was robust, would remove harmful bacteria and produce enough water. The stainless-steel gravity filter I thought would be suitable cost £200 and a spare set of four filters £133.

The company I was dealing with were not very helpful, or easy to contact, and by Wednesday I had lost patience with them, despite their offer of donating 2 spare filters. I got home from work and searched for another company. At 5 pm(not usually a great time to talk to business people), I found myself taking to the very helpful Mark of Osmio water, who told me they had a charitable fund and to drop him an email. I did and when I checked my emails the following morning Mark had replied to say they would be donating two gravity filtration units and eight spare filters, which would arrive the next day.

As promised, everything was duly delivered on Friday. A massive thank you to Osmio water indeed. The filters should provide clean drinking water for the children for well over a year. The only down side is I have lost one entire load to the water filtration kit and packing has become even more complicated. I now have 16 ceramic filters, which look like nuclear warheads, and I'm wondering how much bubble wrap they need to stop them exploding. 

Friends have lent me bags for packing, but none are large enough for the frames and walkers, so I have now decided to order a bike bag to carry them,  and hope Amazon will deliver in time. Then all I have to do is pack everything safely, get it to the airport (thank you AJ for offering to take me), RV with Veronica at Heathrow on Thursday afternoon, get the equipment on to the plane and sit back and enjoy the flight. Can’t wait to see all the kids again…



See you in Lesotho J   

Jan