Blog 30: The simple life

I RV with Richard the builder without a problem and we fly to Johannesburg via Dohan. It’s a rather indirect flight so there is plenty of time to enjoy the inflight entertainment, including being able to read the Koran. I make sure I follow the gentle reminders to remain seated when I pray, and we arrive safety in Joburg where Richard picks up a hire vehicle. Twenty-two hours after leaving Wales he has dropped me at Phelisanong.

It’s dark and my first job is sorting out a hut on the hill to sleep in. There is electricity, via a strand of wire coming across the grass outside, but no water. Mahali informs me  there is a bad drought and that although we are supposed to be in the rainy season it hasn’t rained since the beginning of September. The outside tap that serves the small collection of huts hasn’t run for weeks and the only water available is the one tap in the middle of Phelisanong which serves over 200 people.

Mahali gives me some water out of his bucket and I will see what tomorrow brings. The good news is the long drop toilet doesn’t require water and Mahali has fixed the door to give some privacy.  As long drop toilets go its not a bad one, but I find it best to time the call of nature to begin and end in no more than 30 seconds. After this period the heady fumes emitting from the pit below and the constant buzzing flies can become rather overwhelming.

In the morning I skip down to the Phelisanong to find “the miracle of the paths” has been performed. I know Jesus performed a few miracles in his time but finding a complete circular path at Phelisanong trumps all miracles previously performed on this planet. Not only is there a flat path going to the physio room but there is a path from it which leads directly to the school. As I approach the physio room Tokiso is coming out of the door with Malineo, the physio assistant, and is walking to school using his frame. He makes the short distance without a rest and it takes him about two minutes.          

This is the boy who had a big dream to walk to school in 2016. When I returned here in 2017 with a suitable frame with a seat and off-road wheels for him to negotiate the rough track, it took him over 20 minutes at least 10 rests to complete the journey.  It is unbelievable the transformation this new path has made and the access it gives him and all the other children with disabilities to the school and physio room.  

I walk along the beautiful flat path and enter the double doors of the physio room, which was completed a few weeks after I left at the end of March. It’s a bigger space than I thought, but is full of beds, an enormous settee and all the physio equipment. I have been joined by a new physio assistant, Mamothonyana and immediately set her and Malineo the task of cleaning the room and equipment and throwing away the odd squares of stuck down carpet. I ask Mahali to get rid of the settee and within 10 minutes it’s gone to a new home. 

It takes a couple of hours to sort out the room and find tables and chairs for the children to use. Sitting up and using hand skills is all part of their daily routine and physio. With the beds pushed up to the end wall and the settee gone a large area of floor has been revealed. I can finally unwrap the gym mats I brought at the beginning of the year and the children can play floor football,  do their stretches and use the gym balls.

Most of the children have tightened up since I last saw them in March, so I want them to get back into a good physio routine. Having fought so hard to get them this space I would like them to get its full benefit. Mamello decided it would be good if the children I have worked with live in the physio room to take advantage of the facilities. Richard and his team have come to finish the adjoining dormitory block to make this happen and move the beds next door.

Some of the hard-core physio crew have gone home early for the Christmas break as they have been ill. This leaves only six children  sleeping in the room. I decide to dedicate the entire weekend to them, before I see any of the other children that need physio at Phelisanong. In the past I have spread myself too thinly and it is probably better to give more input to a select few and try to get them up to speed.

Before physio the first thing I must do on Saturday morning is wash my bedding, which looks and smells very unsavoury. I would normally use a bowl of water from the tap, but it’s a resource too precious to use for washing. There is a mere trickle coming out of the tap at Phelisanong and the ladies have to que all day long to fill their buckets.

I go down to the river, which is now a pathetic dribble, and join the ladies trying to wash the clothes and bedding for 180 children in a muddy puddle. We share some banter and I think my washing came out muddier than it went in. I leave it to dry in the intense sunlight in the hope it will smell better by the end of the day. 

The rest of the morning is dedicated to individual physio sessions for each of the six children living in the physio room. It’s fantastic for the children to have the physiotherapy equipment and the space to use it in. It’s less than three years ago that I started in the corner of a small hut with nothing. Now I even have my own physiotherapy plinth here that I use to use in private practice. Both myself and my  plinth have been on an incredible journey since then.

My plinth and the rest of the physio equipment has travelled over 5,000 miles via Ireland and South Africa, to get here. I have given up private practice and changed jobs in the NHS from outpatients to the paediatric and 14 + service. All these changes and the building of the physiotherapy room started from working in Lesotho in 2016 on the Wales for Africa program and the subsequent support for me and physiotherapy in Lesotho given by the Dolen Cymru link and Action Ireland charities.  

The infrastructure and modem of operation of Phelisanong has also changed beyond recognition in these three years. Not only is there now a well graded path that circumnavigates the centre, but a large community hall where the children can all eat together. The more disabled children are no longer fed on their back or spend their days lying in bed. The World Health Organisation recognises that disability and function is a ‘dynamic interaction between a person’s health condition, environmental factors and personal factors’ and Phelisanong has made real progress in improving the environment and context that these children live in.

After lunch I decide to venture outside as the children don’t get much sun or opportunity to play outdoors. With Malineo’s help I get them to the swing and spread a carpet out for them to sit on. Obviously, the next thing to follow, in my mind, is to get them on the vertical tyre that serves as the swing. This turns out to be a rather hazardous process as the top of the tyre is very slippery, and they risk a head injury if they fall off.

At this point, back in the NHS, I would have to do some dreary risk analysis form and undoubtedly wouldn’t be allowed to do the activity. Fortunately, here I can skip this process and weigh up the potential risks myself. My conclusion is that all the children have such high muscle tone that their hands will clamp on to the chains that hold the tyre and therefore they won’t fall off.

Lots of screams and laughter follow, attracting a large audience of house mothers and children. I could do without the audience, but I am glad they can see that disabled children can play on a swing in the sunshine and do the things other kids do. We go back to the room and play floor football and do a bit a dancing. It’s been a great day and pleasure to spend it with these kids.

More of the same follows on Sunday and already the sensational six, as I have renamed them, have already shown me their enormous potential for improvement with a bit of input. Richard turns up with some of the building materials he has been collecting and we take the children outside to watch their bedroom being built. Fortunately, it’s being built of wood, as there is little water to make cement, and should go up very quickly as Richard had already put the floor down.

I finish the weekend encouraging  a group of lads to hurtle down the slight incline of the path to the physio house, bob sleigh style, aboard on a small plastic truck and trailer. On the fourth attempt they dramatically smash through the front door and there is carnage and bodies everywhere. It’s a glorious celebration of the flat path I have being praying for and I promise no one was seriously injured in the making of that movie 😊   

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On Monday the rest of the building team turn up. They are all part of a Lions club from Canada and very enthusiastic builders. The building is going up in sections of panel, like a flat pack, except they are making the flat pack on site. They are surrounded by an audience of school children every breaktime, all keen to watch and help and smuggle away spare bits of wood and building rubbish for toys.

While things on the building front are going well, the water situation deteriorates and the tap at Phelisanong finally stops. I go down to the steam with Malineo to source a bucket of water from a puddle protected by a bit of corrugated metal. It’s very muddy as the cows have been down there trying to drink. The puddle is so small the water needs to be scooped out with a cereal bowl to fill the bucket.

Once the bucket is full I can barely lift it. Malineo  laughs at me and puts it on her head and takes it up to the hut for me. She, like the all the other ladies that work here are tough, resilient and incredibly strong. They need to be, the work is very physically demanding and there is a lot of heavy lifting. There is no toilet in the physio room, so the ladies balance the children on a bucket when they need number two’s, you try doing that with a child who has high muscle tone and extensor spasm.

Meanwhile, not only is there no water but the electricity goes down too, due to all the thunder storms at the beginning of the week. These storms bring hail but no water to ease the drought. The inconvenience of living without water and electricity are a novelty for me. I challenge myself to see how many times I can recycle a cup of water and manage to wash my entire body with half a cup of water and a flannel. I imagine when you live your life like this the novelty wears off quickly. The crops are withering and there is little grass for the wandering herds that scavenge bare hills looking for grazing.

As I look at the mud and pond life at the bottom of my bucket,  which draws ever closer as the level of water goes down, I am relieved when the tap comes on again later in the week. It turns out a farmer had cut the supply pipe when ploughing his field and this has now been fixed. For the moment my pond dipping skills are no longer needed, and I use the muddy water to first wash in, then wash my clothes in, such is life here on the front line of recycling. 

I am pleased to report physiotherapy is going a lot better than the drought and some of the children I treated back in March have really progressed. When I last saw little Joshua, an orphan with delayed development, he refused to stand and spent most of his time crying. Now his bottom lip only trembles a little and he is standing and walking, pushing a frame in front of him. He can build a tower and throw a ball and is catching up fast. Teboho has also improved and enjoys walking with a frame and responds to music. The only problem is that he is rather attached to me and bursts into tears every time we take him back to his room after physiotherapy. I find this rather distressing so usually get one of the physio assistants to return him.

Kananelo can now tolerate quite long periods in supportive sitting and standing up in a standing frame. He needs to be strapped in tightly to try and control his writhing movements, but I’m sure prefers this to being left on the floor to roll around where he can see nothing. Unfortunately, I do not have such good news about little girl with the infected club foot and spinae bifida. Her problems are as bad as ever and I show them to one of the building team, a former doctor. She looks very worried and says she is out of her depth but takes pictures and says she will try to find someone who might be able to diagnose.

It can be heart breaking to see children who for the want of funding to go to South Africa could have life changing operations, but it’s often not that simple. I’ve seen too many children who haven’t had the after care and follow up treatment they need after their operations and end up even worse than before. To be helpful in health care out here it is necessary to be aware of the circumstances you are working in, the resources available, both in the short and long term and the needs and expectations of people living in poverty. There is never a simple fix.   

Having spent over 7 months working in Lesotho in the last three years I have learnt a lot. I have had to deal with things out here I would never see back in the UK and with little medical support it’s been a steep learning curve. The sensational six have all benefitted from my on the job experience and from my improved knowledge from in working in the paediatric and 14 + service in Powys in the last year.

One of the six, Tsilisehang, has such high tone and is so big and heavy, I haven’t known what I can do with him up till now. As soon as he tries to do anything his hand shoots up in the air, like he is asking a question, or goes around his back like he is trying to dislocate his shoulder. His posture is better in standing, but I hadn’t got a standing frame big enough for him… that is until Richard spotted a pile of redundant equipment in the storage container. When I investigated further there was a standing frame exactly right for Tsilisehang.

Once it’s cleaned up its perfect for him, and for me. Up to now I have been his standing frame, which was creating some manual handling issues for me in lifting someone heavier than myself. Now he can stand every day and improve his posture, tone, muscles and joints and look the world in the eye. The only downside is the worker assigned to extracting the frame from the bottom of the pile of twisted metal managed to pull the whole lot onto top of himself and give himself a minor head injury.

I think it’s only bruising but even after some medication he looks so sorry for himself I get him to lay him down on the plinth to give him some good old manual therapy whiplash treatment. It was not exactly what I wanted to do at the end of a long day, but here, as in most parts of the world, hands on treatment often carries more magic than a tablet.

I walk back up the hill to my hut and watch the sunset over the Maluti mountains with a Maluti beer in my hand. I have a bucket of water and a beautiful view. I think back over the week and remember all the smiles and laughter. Life can be complex but it’s the simple things that count. Sometimes you have to strip back living to the basics to feel that warm glow and appreciate what really matters.