I am happy
to get back to work on Monday and see the children. Back home you might see a
patient once a week, or once every few weeks, to monitor their progress. Here I
see them every day and am much more closely involved with their daily routines.
Phelisanong is very muddy after the recent thunderstorms. The weather has
increased the hammering the walking frames are taking as well as the daily use
of them to negotiate the rocky ground to school.
After all
the cost and effort to get them here I am concerned that they last and decide
to clean and grease them. They are built for off road conditions in the UK and I
doubt if the engineers had the African terrain, sun and dust in mind when they designed
them. In the NHS we have stores that deal with the cleaning and maintenance of
equipment and it is often scrapped with the slightest of cosmetic damage. Here there
is no NRS sores, its DIY, and I have brought tools and grease with me to help.
I am not
very good at this sort of thing but am getting better out of necessity. There
is one tap, in the middle of Phelisanong, and we take the frames there to wash
them before greasing. In her enthusiasm to help Malineo has taken all the
wheels off, which seemed like a good idea at the time, until I realise that all
the numbers have worn away showing which wheels go with which frames, and on
which side … Oh crap!
You would
think that there is a limit to the mathematical variations of the combinations
of wheels and frames, but the possibilities seem endless and it takes an hour
to sort it out. I blame the sun beating down on my head for limiting my ability
to follow a rational process. I decide to use it as a training opportunity and suggest
to the physio assistants they follow a less haphazard approach next time.
If there was
disabled access between the houses and the school the frames and wheelchairs
would be under less mechanical stress. There has been a new consignment of
wheelchairs since I was here last year, but they are already breaking up. Presently
the concrete path is a semi- circle, if the circle was completed, with sprigs
off to the classroom blogs, then the children who use wheelchairs and walking
frames could access the school with ease. It’s a few hundred meters of concrete
path and I don’t know if, or when it will ever happen.
Just below the
school classrooms a school hall has been completed, built by World Vision. A
steep rocky slope leads down to it and I join the infants on the first morning
when they get to use the bare concrete rooms, instead of sitting under a tree.
I think sitting under a tree is pleasanter, but not so great in the pouring
rain. There is a wheelchair ramp at the door, but there no path for the
disabled children to get there. Hopefully there is a future plan to rectify
this, for now it’s just one of the unfathomable things that that leave me
perplexed every day.
Meanwhile
the physiotherapy building is going up at an extraordinary rate. I ask Mr
Chalabala about it as he gives me a lift into town. Evidently the builders are
paid by the square metre, so its up to them to decide how much money they will
earn and how quickly. They are tough men
and very strong, they have to be, there’s no machinery, it’s hot and its hard
work. Most of them wear balaclavas, despite the heat, and look like ninjas as
they go about their tasks.
The head
ninja for the physio build lays the concrete blocks, while his mates mix the cement.
He seems to be doing it all by eye and he has a good eye, as his lines are
straight and true. Now the walls are up I can see more clearly how things will
work and I think it will be okay, if the promised path is built to it. There is
scope to develop it in the future, and hopefully it will be a great resource
for the disabled children here.
Mr Chalabala
drives the truck up the rough track from Phelisanong while the ninja’s stand in
the back, holding on as best they can. You can tell Mr Chalabala is the boss
because he wears plastic hard hat, rather than a balaclava, and shouts a lot
down his cell phone. We reach London and he escorts me to the liquor store to
get Maluti beer. A can of it is my one
treat every night, but it means running the gauntlet of the dodgy side street leading
to the liquor store. I have been hassled here a few times, which is probably a
factor of drunk men and being the only white woman in town.
Relieved to
escape this time without anyone telling me they love me, I get my beer and jump
into a taxi heading home. While I wait for the taxi to fill to capacity, a
woman offers me fish cooked in batter from a batch she is carrying in a plastic
bucket. I weigh up the risk of E. coli against a break from the staple diet of
peanut sandwiches. I decide to risk it, but take the precaution of incinerating
it on Mahali’s gas stove when I get back. It proved delicious and thankfully
harmless.
The next day
I check up on the girl with the infected club foot. I am concerned because her
Bukana does not say she has had a swab taken. This does not necessarily mean it
hasn’t been taken, Bukanas are not the font of all knowledge. Since the brief
note of made in 2015 of an “operation to left club foot” nobody has written
anything about it or seems to have noticed that the wound remains unhealed. The
clinic man hasn’t read her Bukana and doesn’t realise that she has spina bifida,
or know any of her past medical history.
The house
mothers were supposed to be bringing her to have the wound dressed, but he has
only seen her once. I bring her to him and he dresses the wound and I ask him if
he will go to the hospital clinic with her to check on the swab. He agrees and
for a few hours I feel I have a handle on the situation until he approaches me
at the end of the day with a sad face.
“Mme Jan, I
have bad news” (my heart sinks) “I am leaving” (I look at him in disbelief) “I
have just had a call and I am going to a new job. I won’t be coming back after
today” (exit clinic man who is never seen again)
And that’s
the way it rolls here. It’s another unfathomable and I still don’t know whether
Nthofela will ever end up having the right antibiotics to cure her infection.
She is the sweetest of children, uncomplaining. as she sits quietly humming to
herself while playing with the Duplo blocks.
My fear is
that she will end up like one of the teenage girls here whose club foot is
shoot to pieces. All the ligaments have ruptured, such that the foot has rolled
over, points backwards and she now walks on her ankle joint. She has a Zimmer
frame and walks to school over the rocky ground with only a sock protecting her
poor foot.
She walked
past me in tears last week accompanied by a house mother. I wonder if there is
anything I can do to help, maybe provide some protective footwear? The house
mother laughs and says the girl is crying because she has tooth ache. How
stupid am I to think that walking over rocky ground, with only a sock on,
dragging your foot along at 180 degrees the wrong way could possibly be
painful?
I pick her
foot up and it dangles uselessly. I can turn it the right way around, but that
seems to distress her even more. I guess she is used to the way it is. There is
nothing I can do, and she goes on her tortuous way. I don’t know why she must
endure this horrendous journey to school every day and isn’t taken in a
wheelchair. Maybe the reason is because she can walk she has to, or because she
has no wheelchair, or because that’s just the way things are. For me it’s just
another unfathomable.
Over the
last 2 years I have now worked in Lesotho for nearly seven months and often
feel I know less about the way things work here then when I started. It is
impossible to explain the complexities of what it’s like to anyone, unless they
have worked on the ground and seen it up close.
As I stand
in the physio room, tying a piece of pipe insulation onto a drum stick, so
Lesojane can hold it, I wonder what my colleagues back in Powys would make of
it all. I am covered in mud, as is all the room and equipment, a large box of
condoms adorns the window sill along with some dirty lunch boxes. I am standing
next to a kitchen cabinet, which is actually a filing cabinet for the Bukanas.
Each house has a designated shoe box for the children’s Bukanas with the room
number written on the lid. While this might not look very professional, it’s a
lot more user friendly than the WICCS electronic notes system that I use to
find patients back in Wales.
I fix the
drum stick and Lesojane beats hell out of the Irish drum I brought along with a
box of musical instruments in the container consignment. He has to do it with
straight arms as he can’t control bending his elbows. I totally admire him for his grim determination to overcome his flaying limbs and do the
things that most children can do without thinking. Flushed with success of
hitting the drum he moves onto his next ambition, “I want to kick the ball” he
says with a glint in his eye.
The best way
to help him achieve this is to strap him into the baby chair, which is too
small for him, but grips him tightly and gives him some control over his legs. In
physio speak this practice is known as “key points of control”, but I doubt if
you will find this particular technique on any Bobath course. Malineo holds his
head steady and I try and calculate the best moment to throw the ball, so it
will contact his foot. It takes quite a few attempts but finally it connects
and the ball sores gloriously into the air. Lesojane laughs ecstatically and
its one of the many moments that light each day with a touch of magic. I’ll try
and figure out the unfathomables another time.
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