Thursday 19 March 2020

Blog 41: Should I stay or should I go ?

I am advised to leave Lesotho as restrictions on movement grow tighter around the world and the boarders between South Africa and Lesotho start to close. Since last week I have felt increasing surges of panic as I get updates on the coronavirus and the travel situation and try to decide what is best to do. Sometimes I forget about it for hours as I am totally immersed in work, and then an update comes through and I start to panic that I’ll get stuck here, or panic that I am not panicking when the whole world around me seems to be panicking. I am committed to running a training program on Monday and Tuesday so wish to stay, at least for the next few days. 

Monday mornings panic is added to by the stresses of running the training course, trying to find flip charts, note pads and pens and suddenly realising that I have no certificates, which is an absolute crisis when running courses here. It’s the minimum people expect, along with free refreshments. Mamokhosi has the refreshments covered while Justice has a friend who sorts the certificates. A volunteer from Australia picks them up from town and drops them off. He only arrived a few days ago and now has to go back to Australia, along with a host of other volunteers who are all making their way back to their own home countries. Everyone is leaving and I’m beginning to feel like I’m last man standing.   

I try to stay focused on the course, which is ‘Physiotherapy with children with disabilities. On the first day we will be looking at the physiotherapy exercises and programs the children are doing at Saint Angela and then on the second day looking more at the environment and attitudes and how they affect activities and participation for people with disabilities. The candidates on the course are some staff from Saint Angela, local teachers and volunteers. Amazingly everyone turns up and nearly on time, it’s already a triumph!

After some background talks on physiotherapy and basic conditions, the afternoon session is a practical on the principles of exercise. Everyone gets enthusiastically involved, whatever their shape of size and it’s a riot. Sister is going for the burn with a medicine ball and seems to have incredibly strong biceps for a lady who has spent a lifetime in prayer. The floor football becomes ultra-competitive and social distancing is forgotten. It’s been a good day. 

Night is not as good as coronavirus lockdown around the world continues and by morning, I have slept little. I receive a trail of emails from other volunteers and the High Commissioner of Lesotho, who are all making to the boarder. The High Commissioner is going back to the UK and will be working from home. Jon from Wales for Africa thinks he can get me a flight out if I leave in the next few days. I ask him what the implications are if I stay, he says worse case scenario is I might get stuck here for the next 18 months. I can feel the panic bubble rising in me, mixed with a wry smile as I imagine the dust trails left by everyone hot footing it to South Africa. 

We start the second day of the training course. Thato gives a talk about the outreach program and what we have done so far, I pick up a message from Jon who has managed to book me a flight on Friday if I want it. I crumble. I am not due to leave Lesotho for another three weeks, and while I don’t mind being here a bit longer, the thought of a whole year is too much. I was due to leave Saint Angela next week and at least have achieved most things here I set out to do. Even if I leave now the trip has been a great success, but it means I won’t be going to Phelisanong children’s centre for the first time in four years. 

I press the send button and accept the ticket and turn my attention back to the course. If it had been left to me, I don’t think I would have had to energy or presence of mind to book a flight. Things have been going so well here and I have felt very unclear about what is the best thing to do. Without a crystal ball I can’t see the future and I am grateful for the ILO for making the call.  

In the afternoon a couple of the lads come in to share their physio dairies and demonstrate their exercises to the course participants. I am nearly in tears as I read out their introductions at the beginning of their diaries. They are both wheelchair users, Rets, with his tightly twisted legs, wants to be a soldier and protect his country, while Thabelang, who has only just started school at the age of 12, wants to read and be a businessman. Everyone should have dreams and these boys have the determination to achieve them. 

We go out for a walk in the grounds using crutches and wheelchairs, trying to scale badly built ramps and make our way over potholed paths.   It takes a huge amount of effort even for fit healthy bodies and staff are beginning to have some appreciation what it must be like for the children with their disabilities. We get back and we finish things off with a discussion with the teachers and the importance of education and attitudes. There’s a long way to go in this country when it comes to equality and reducing discrimination for people with disabilities, but the schools are a good place to start.                  

The last two days I spend seeing as many of the children as possible and trying to pass as much information as I can to Thato. She’s absorbed a huge amount of information in the last few weeks and its amazing her brain hasn’t exploded. I don’t know when I’ll be back, it’s hard to predict the future with the spread of the pandemic, but I am confident the work will carry on. A young lady on the course, Julia, has already been doing voluntary work with the physiotherapy sessions and will be there to continue to support Thato, it would be a huge undertaking for Thato to do it alone.

The final day and we are in a frenzy of physiotherapy programs and assessments. All the students understand why they are doing physiotherapy and busting a gut lifting weights, doing stretches, trying to balance and strengthen their core muscles and filling in their diaries with their achievements. I couldn’t be prouder of them.         

I feel the work at Saint Angela has taken a giant step forward with the outreach program taking it into the communities, and the physio diaries getting the children and families more involved and making the work sustainable. Staff training has added to this and increased local contacts and understanding of what is trying to be achieved. Hopefully the work will have a ripple effect and spread out the from the families and communities and help to bring about greater equality and opportunities for children with disabilities in Lesotho. It’s the least these children deserve.

Tomorrow with great sadness I will try and leave here and see whether I can transit Oliver Tambo airport and get back to Heathrow. As always its been an emotional roller coaster ride but totally worthwhile. Of all the scenarios I thought I might face out here coronavirus was not one I had prepared for. The children’s endurance, spirits and smiles of triumph have made all the stress and sleepless nights worthwhile and hopefully I be back again next year to see how they are all getting on.       

               


Sunday 15 March 2020

Blog 40: We must hope for better things

On Sunday we go to visit another family on the outreach program. I have been on a visit to this home once before in 2017, not long after the children’s mother died. At that time only the brother, Teboho, was at Saint Angela and his two sisters were living with the father in a small broken-down hut, with a leaking roof and black soot walls. We came to bring them some bedding and build a ramp so that Teboho could get in and out of the hut independently. 

Next door was a far better house and the auntie was persuaded to let the family use that. Since then Teboho’s two sisters have come to Saint Angela. The three siblings all have Osteogenesis Imperfecta, OI, also know as brittle bone disease (see blog 39). There are differently levels of severity, and in Teboho’s case he is a wheelchair user. The girls can still walk but they have bowed legs, the youngers sister’s femur impossibly curved, her pelvis tilted, the older sister has a scoliosis. 

Although the sisters are teenagers, they are only about a metre high, due to their poor bone growth. Both are a tour de force, with bright engaging smiles, always in the middle of any fun and games going on at Saint Angela. It is my fear that unless they get treatment they will also end up in a wheelchair like their brother.  

Before I came out to Lesotho Thato messaged me that the sisters were unable to pay the boarding fees at Saint Angela and Teboho his school fees, because the father is illiterate and can’t fill out the forms for the government grants, further complicated by not having a death certificate for the mother.  With donations I have covered the 13,000 rand that is needed to pay the fees. However, as I tell Mamkojo, this will not happen again and by the end of the year the paperwork needs to be sorted for next year’s fees. 

The other reason the paperwork is required is that if the girls have a chance to see a specialist in Bloemfontein, they can obtain a passport to get there. The paperwork starts with getting a death certificate for the mother and with no social worker to try and sort out these complex family situations, I can feel a journey of epic proportions coming on. It begins in the form of a grand expedition as the three kids, the care father, Mamokojo, Mamokhosi, me, Thato, the driver and two wheelchairs, somehow cram into the van. Fortunately, we do not have the health and safety regulations of the UK to be concerned about as we bump joyfully along the rutted roads of the countryside.   

I wonder how the ramp we built in 2017 will have fared in the last 3 years, not very well I suspect as we only used half a bag of cement and some earth and stones. I also wonder if the family are still living in the same house as the auntie didn’t exactly embrace the idea of them living there, even though she wasn’t using it.  We arrive, they are still using the same place and the father greets us from the open door. Unsurprisingly the ramp has broken, but it shouldn’t be too difficult to fix with a decent mix of concrete. I decide to investigate the toilet situation. 

I ask Teboho where it is and his points towards a small corrugated construct leaning at about 45 degrees. I am a bit puzzled and push him towards it over the grass. It far worse than the leaning tower of Pisa and I arrive unclear how anyone can get in or out of it. Everyone starts shouting at me pointing back the way I came, and I reverse about 10 feet.
“Where?”
“There” they all shout as I stare stupidly at a concrete breeze block laying on top of the grass. 
“Yes here” Teboho confirms pointing at the block

I am not understanding how the block with its two small holes a toilet and Thato and Mamokojo come across to explain. 
“There is a pit dug underneath and you sit on top of the hole in the block” There is a pause while Teboho demonstrates this neat manoeuvre. 
“Well I can see it’s a good height for small people to sit on but there’s no privacy at all and how do you take a crap down such a small hole?” I ask bluntly
“It takes some planning” Thato says laughing at me
“Okay, well something more comfortable and private needs to be sorted out in the future. For now, do you want to try and find out why there is no death certificate for the mother after three years?” Thinking to myself, thank goodness I can’t speak Sesotho and thus am able to avoid this conversation. 

Thato and Mamokojo go back to speak to the father and the auntie, who has now turned up from her nearby house. I look at the distant hills, the small mounds of sad earth next to aloes plants, underneath one of which the mother must lie, the breeze block on the grass and the crazy leaning town of Pisa long drop toilet. 

I walk over to the old hut which has now nearly completely fallen down and the father comes up to me talking excitedly in Sesotho. He takes me by the hand and pulls me along to show me the cracks in the walls of his present house and how that is also falling down. I emerge from the dark interior and the auntie greets me like a long-lost friend, and then carries on her conversation with Mamokhosi. 

Thato fills me in on what has been said so far. “The problem is that the mother was not taken to the mortuary so there is no death certificate. The auntie has to write a letter confirming the mother is dead and some of the people that went to the funeral must also confirm this and the chief. The letter has not been written as there is a family dispute over property and land. 

At this point Mamokojo enters in the fray and the auntie carries on forcefully putting her viewpoint while Mamokojo answers her in quiet measured terms. I wander around to the back of the bus where the kids are. Then quite suddenly we are going, and everyone piles back into the minibus. I hurriedly hug both the auntie and father, unheeding of the advice that neighbouring South Africa has given its citizens, that they should not to hug anyone because of the coronavirus. My diplomatic hugs are necessary to show I do not favour either side, maintain relationships and hope everyone has sorted out their differences. 
   
“So, what happened?” I ask Thato as I get into my seat
“The auntie has said she will write the letter by Easter” Thato replies
“Wow!” I say stunned. “What changed her mind?”  
“Sister said she had no choice and that the children would suffer and not be able to continue at school if she didn’t write it”
“Yes sister!” I turn to congratulate Mamokojo, mightily impressed this nun who has a twinkle in her eye but is not to be messed with. 

We arrive back into Maseru where a large political rally is taking place with people wearing yellow shirts. “The good guys or the bad guys?” I ask Thato 
“I don’t think we have any good guys,” she replies ruefully, “these are the prime ministers’ supporters.” 
It turns out there was no vote of confidence this week in the prime minister as he said he will retire in June, although as yet he hasn’t specified the year. All the people in yellow shirts look very happy. We are just happy to get back to Saint Angela with the prospect a letter might be written to confirm a mother died three years ago and her children might in future be able to prove they are entitled to the government grants they need to continue their schooling.   

The problems the children have combined with their social situations, poverty and lack of resources, feel overwhelming. Many have HIV as well as conditions like cerebral palsy and to get to school, which is only next door to Saint Angela, they are trying to propel heavy, broken wheelchairs, across rutted ground, which gives them back ache and tightens up all the muscles we are trying to get them to stretch. New wheelchairs and a proper path and ramps to school would cost thousands of pounds, and I don’t know where such money can be raised.  

We go to visit the principle of the high school to ask permission for a couple of the teachers to come to the physiotherapy training next week. I take the opportunity to ask whether there are any grants available for infrastructure improvement. The Principle is sympathetic but doesn’t even know where she is going to find the money to pay for the private teachers and ancillary staff who haven’t been paid for months. 

It’s a depressing story I won’t go into. The principle is trying to get an audit done to remove “the problem”. Meanwhile she can’t sleep at night and wishes she had retired. “We must just hope for better things” she says, and I know how she feels. We leave and try to stay focused on doing assessments in the afternoon, which we have scarcely touched on because of all the other things we have been doing.

We have only just started when Mamokhosi comes into the room to ask if I remembered about the girl who needs assessing to come to Saint Angela because Mamokhosi is unsure whether she is independent enough to cope. No, I hadn’t remembered because it was over a week since she mentioned it and a lifetime ago. It turns out the ministry of social development is putting a lot of pressure on Saint Angela to come to let this girl attend. Mamokhosi succumbed to the pressure and said she could stay a couple of weeks to do physiotherapy with me to see if she improves. I think it’s called passing the buck 

We dismiss the lovely Bokang, who is an absolute joy, and the girl, Eliza, comes in with her auntie, Deedee. Elizas problems are immediately obvious as she sits there in her wheelchair. She has a very bad scoliosis, can barely lift her arms against gravity and has no muscle power in her trunk or lower limbs. She is 12 years old and must weight 70 kilos. I have to get two strong men to transfer her into a chair. There is no such thing as a hoist here and at home her older brother, has to lift her.  

I can see the desperation in both Eliza’s and Deedee’s eyes but there is no way that Saint Angela has the capacity to help her without compromising the safety of the staff and impacting on the other children’s care. I have to say no, she cannot come to Saint Angela and I cannot do physiotherapy with her for the next two weeks. 

I feel absolutely wretched, but it’s much worse for them. They both have tears in their eyes as their hopes for a brighter future are smashed by my decision. I search desperately for something positive to come out of their visit and suddenly remember Majubil, who also has a very bad scoliosis and uses some very useful form inserts in her wheelchair to support her spine. 

Majubili comes to the room and lends Eliza her inserts, which work really well. Deedee takes some pictures so she can make some at home. She also takes some pictures of the exercises I suggest, and I reassure her that all the things she has done up to now are beneficial for Eliza and she is a good therapist. She is in tears and I hug her and Eliza and wish I could have done more for them. Majubili saves the day, instantly befriending Eliza with her infectious giggle and playing catch with a bean bag. They go off to spend the night at Saint Angela before Eliza and Deedee have to return on their long journey home.  

Thato and I collapse in an emotional heap but agree there was nothing else that could be done. Tomorrow is another day and we must pick ourselves up and try to assess the children here and do what we can for them. I get back to the guest house exhausted but get no sleep as on top of the days trauma I find out the Lesotho government has banned international travel and I could be here indefinitely. After today, the prospect is not one I relish.

The next morning, we finally make some progress with the assessments and setting up individual physiotherapy diaries so the kids can be more independent in running their own programs. I get back feeling more positive and am just going to bed when I get a call from Jon, the head of Wales for Africa, asking if I want to get out of Lesotho while I can. Obviously, I don’t want to get stuck here, but it feels a bit feeble going home when there is so much I need to do. 

Jon gets in touch with the Lesotho High commissioner, who wasn’t aware that the borders had been closed. She finds out it’s a badly worded government note, not intended to imply that the borders are closing, just that there are restrictions on Government travel. Phew! For the moment I am saved, and even have 3 toilet rolls and a packet of pasta to see me through the crisis. 

The next day we go to town in the morning to secure supplies for ramp building. Things are going well until we end up until we end up in a junk yard looking for the gravel man. The gravel lady says they only sell gravel by the lorry load and only the gravel man has the paperwork and the authority to sell it. She is very vague about where he’s gone, how long he might be and whether she can phone him to find out the answered to these questions.  

We cross the road for the second time. The junk yard spreads either side of the road and there seems to be confusion about which side the gravel man resides in. Then suddenly a gravel lorry appears, then disappears, then reappears and the gravel man arrives! Some girls want diamonds, I just want gravel and buy a whole lorry load of the stuff. Amazingly we are back at Saint Angela in time for lunch. We have an entire afternoon of physiotherapy, only interrupted when the gravel man arrives with his precious load. It’s just like Christmas 

Boxing day follows with the arrival of cement and supplies but there has been a miscommunication and we end up with a hatchet, instead of a pickaxe and a huge piece of shutterply. Its Friday afternoon and we must brace ourselves for Maseru traffic and a renegotiation of the invoice at Cash and Build. Once this is achieved we then go to Alex’s home to make a plan and take a load of heavy gravel, seriously compromising the clearance of the Saint Angela van. 

The logistics of the ground we have to build the ramp on are complicated and the best way to do it appears to run the ramp alongside the house, rather than straight out from it. The skills of our collective are Lebs, who is strong, the driver,Tsotetsi, who seems to know something about making cement, myself who has built an indoor wooden ramp in 2018, which proved to be a very traumatic experience, Thato who has watched a dozen different videos on ramp building with me on You Tube and Alex’s dad, who has brought a small amount of rocks and earth to the party and seems to thinks that will suffice. Praying that tomorrow will bring some inspiration we depart into the evening traffic. 

The need for a ramp at Alex’s home has been an issue for years. He has brittle bones, multiple fractures and is most comfortable in his wheelchair (see blog 39). He has been reliant on someone lifting him in and out of the house but there is not always someone there. I remember a sad tale of him desperate to use the toilet one day and managing to get out of the house, but unable to get back and having to spend the whole day in the rain. For the ramp to work it needs to have a big enough turning circle for him to get out of the door and ideally for every inch of drop a foot run off. It’s going to be a big job, 25 feet long, over 6 feet wide and needing a lot of infill.  

First foundations need to be dug and a retaining wall built, 
we run into problems immediately. We thought it had been agreed we could use breeze blocks from the new build next door to build the wall, but now that is not possible, and we must scrabble around to find rocks instead. Some uncles turn up, one very grumpy who says it will never work, while Alex’s auntie and step mum start having a domestic with his dad, saying he should have built a ramp years ago. Dad goes off in a huff, Tsotetsi and Lebs get started on the foundations while Thato and I try to find stones.               

Tsotetsi understands the logistics of the build very quickly and with both him and Lebs being real grafters, the idea rapidly takes form, so people realise what needs to happen. More uncles turn up and start working, even the grumpy one. Alex’s dad reappears with a wheelbarrow full of stones and works hard for the rest of the day. The construction takes about 8 hours to complete, has a decent turning circle, regulation drop and safety rim. It’s a proper job.

As the day goes by it becomes a real community build, the ladies make food for everyone, chat and become friendly with Thato. Various people drop by and as we are finishing up the old lady next door gives a speech and announces what a wonderful thing has been done. I agree with her, most of all it is a wonderful thing for Alex to have some independence, but it has also been a great thing in raising awareness in the community of the rights of people with disability. We can hope for better things, but we can do more than just hope and do something practical to change things for the better.      

Saturday 7 March 2020

Blog 39: Visas, viruses and outreach challenges

Four years ago, in 2016, I started this adventure when as a physiotherapist when I came on the ILO (International Learning Opportunities) program with Wales for Africa to work with children with disabilities. I am now coming back again on the same program as I enter my fifth year of consecutive visits to Lesotho. There hasn’t exactly been a five-year plan, as there have been some unexpected events on the way, but over the course of each visit the physiotherapy and care of children with disabilities has improved at Saint Angela and Phelisanong children’s centres and I am hoping to continue to build on the progress made. 

After battling through the floods of Wales and being kindly dropped off at the airport by the lovely Jean Louis, my next obstacle to continuing this work comes as I stand at Birmingham International trying to check in. 
“Have you got your entry visa?” asks the lady on the desk. 
“No, I’ve never needed one before,” I reply puzzled, “it’s always sorted out for me once I get into Lesotho.” 
“Well it says here you need one in advance,” she replied pointing at her computer screen, “I’ll have to call my supervisor.”   

“Yikes,” I think, as I answer the lady’s questions on where exactly Lesotho is. The supervisor comes over and agrees that the computer screen does say I should have a visa in advance but decides this is only advisory and waves me through. Breathing a sigh of relief, I breeze through Zurich and Johannesburg airports and arrive in Maseru on time. 

Moshoeshoe International airport is a small runway which receives a couple of flights from Johannesburg a day. As I get off the light aircraft and walk over to low grey brick building, it has taken on the appearance of a centre for advanced chemical warfare. A man with hand sanitiser and face mask stands by a plastic barrel with a tap. He squirts my hands with sanitiser and watches suspiciously as I turn on the tap and demonstrate my best NHS hand washing technique. Inside the building all employees are wearing a face mask.   

I get to the check in table and through her mask the lady asks me in a muffled voice if I have an entry visa. “Err no, but I’ve been here lots, of times before without one,” I say hopefully. I see her mentally calculate how many hours/days/weeks of paperwork this potentially may take her to sort out and she waves me through. Relived I get past the next lady with a computer screen who makes a joke through her mask, but I can’t hear what the punch line is.    

Moshoeshoe airport has had a makeover, not only are there two people sitting at desks with computer screens but there is a luggage carousel. The masked baggage attendants chuck the luggage on the floor as usual. Either they haven’t done their carousel training or have decided that two dozen passengers have no need to watch their luggage go around in a circle. 

Outside I meet Veronica, who is visiting Lesotho as head of the Dolen Cymru charity, who have supported me in the past. Dolen also help coordinate the ILO program through Manyayne, who is away this weekend, so Veronica has stepped into the breach. We go straight to the mall to get a sim for my phone. On route Veronica fills me in on the current political situation, which is that the prime minister faces a vote of no confidence tomorrow as he awaits trial for conspiring to murder his x wife with the help of his current wife. I realise how much I have missed Lesotho politics and how boring Brexit has been in the interim since my last visit here. 

We arrive at the mall to find Vodacom has decided to shut at 3pm. Undeterred Veronica kindly offers me her second phone to use, which I politely turn down as it is an android from the stone age and I can’t even see the screen. We go to plan C which is to extract the sim from her android and hope it fits my phone. For some reason we carry out this procedure using a bin as a table top and watch horrified as the sim flicks into the air, does several summersaults and narrowly avoids disappearing down the rubbish hole. Having been saved from trawling through the rubbish to find it, we happily find the sim fits my phone and communication links with the outside world are restored.  

Next a visit to Pick and Pay for some basic supplies and then I transfer from Veronica’s hire car to the optimistically named Perfect Taxis and bump down the potholed roads to Justices guest house, a 5-minute walk from Saint Angela. I am greeted by his lovely mother, who is babysitting, as Justice and his wife Thato are away for the weekend. Restored by a goodnight sleep, I am grateful for a quiet Sunday to catch up with all the admin I need to do to try and start on the front foot on Monday. 

After being a participant on the training program l ran last year Thato has continued to work as the physiotherapy assistant at Saint Angela. As well continuing her training and assessing all the children and sorting out their physiotherapy programs, I am hoping we can launch a physiotherapy outreach program. This will involve visiting the communities the children come from and working with their families to improve the children’s independence and access to facilities at home. 

Disability is not only a factor of the impairment a person has, but the environment, context and attitudes that surround them. While the Lesotho government signed the convention on the rights of persons with disabilities (CRPD) in 2008, as yet it has done nothing practical to support those rights. The CRPD clearly states that limitations on resources is not an excuse to delay implementation and there should be strategies targeting low cost programs. I am hoping that the physiotherapy and outreach program can help the children at Saint Angela claim their rights to equality and independence in Lesotho and work with their families to support and encourage them at home.     

Monday morning starts with catching up with Thato before we go for a meeting to the new head nun at Saint Angela, Mamokojo and the Saint Angela coordinator Mamokhosi. My history of relationships with the nuns at Saint Angela has not been a glorious one. I hope for better things with the present incumbents, certainly some interest and help with the physiotherapy program would be good. Momokojo and Mamokhosi say yes to every request and we are off to a positive start. 

Next to the physiotherapy room where I am immediately distracted by the amount of equipment cluttering the room which used to be stored in the adjoining rooms, which are now being used as accommodation. Happily, we secured 2 unworking toilet blocks to store our equipment, unhappily they are full of junk and dust. A major reorganisation and cleaning program follow. In the midst of this the kids pile into the room and by the time I am out of the toilet block covered in dirt and carrying an obsolete computer, the kids are in a neat row doing high kneeling exercises lead by the head boy Kats. 

A few weeks back I had messaged Thato that we should have a head boy and girl physio helpers and she has already got the kids to choose a boy and a girl. I didn’t know they were leading sessions and I am quite blown away by what I’m seeing and how well the children are doing. It is a magnificent sight and I feel my physiotherapy heart fill with pride in all of them, particularly Kats, who I have known since I first came here. 

At the end of the session Thato tells me that Alex wants to speak to me, another boy I have known since 2016. He has Osteogensis Imperfecta, OI, more commonly known as brittle bone disease. He has the most severe form of it with broken bones badly set, deformed chest and spine, the muscles of legs wasted away dangling useless as he sits in his wheelchair. I have a kaleidoscope of memories of him doing wheelies in his wheelchair when I first met him and my horror of what might happen if he tipped over, demonstrating to me his Taekwondo punches and taking part in the Taekwondo lesson the following year, laughing as he dangled upside down from the therapy stairs, telling jokes, making complicated mecano models with his skilled hands. Anyone that has visited Saint Angela and has met him, will remember him. 

Sitting in his wheelchair I notice he hasn’t joined in the session. He pulls up his sleeve to show me a bone in his forearm sticking out over an inch at his elbow, barely covered by paper thin skin. Then he pulls up his trouser leg to show me a similar situation with his lower leg. Below his knee is actually a Z shape it is so deformed. “He was wondering if we can get anything when we go to town on Wednesday to protect where the bones are sticking out.” Thato interjects.  We discuss options on what this might be as I continue to examine the sickening deformities.

I can’t quite get my head around what I am seeing and revert into physio speak as I wonder how Alex manages to cope with the pain. In physiotherapy we usually try and get objective measures when we assess someone. When dealing with pain we might use a visual analogue scale (VAS). This is a simple scale going from 1 to 10, 10 being top pain. I ask Alex if he can score his pain from 1 to 10, and what activity causes him most pain, he looks at me puzzled. I ask him again, thinking he didn’t understand me “10 would be like me poking your eyes out.” He gives a small smile before replying quietly “It just hurts all the time”

He winces, and I have a glimpse of the constant pain he is in which can never be measured on a VAS. Feeling rather stupid and insensitive I say, “I’ll see what we can find,” having little idea what that might be. The next day I am fiddling with an old back brace, wondering if I can adapt parts of it to help him. I decided to go a talk with him again, he is sitting outside by the chicken shed wearing a large green soft top hat. I examine his arm once more. “I want an operation” he says in a determined voice. “Okay” I say, having no idea how this might happen, who to ask, how it will be paid for, or if his fragile body can cope with a general anaesthetic, such is life in a country without the NHS. 

I add it to the list of things revolving around my head as I go to town with Thato for a meeting and to buy various items we need for the physiotherapy room. When we come out of the mall Thato greets a man and tells me he is a doctor. As they exchange pleasantries my brain ticks over and I smile at him and say, “I wonder if you could help this boy at Saint Angela?” and launch into the Alex story without further ado. I am totally shameless when it comes to taking any opportunity that might assist the kids. 

“Ah no I cannot help, you must go to the ministry of health and they will pay for him to go to Bloemfontein to have this operation, this is why I pay my taxes.” he says. By happy coincidence it turns out I am actually speaking to the former minister of health which is how he knows this information. Thato decides we must go straight to the ministry, which rather alarms me as I have a vision of an endless queue of coughing people trying to get through the door. This nightmare is quickly dispelled as we skip unimpeded through the revolving door and up the stairs. We stop to visit the ladies on route, as surely the best place to use a toilet in Lesotho must be the ministry of health. 

Neither cubicle has any toilet paper and in the cubicle I use the top of the cistern has fallen off. The sink does have an old water bottle with liquid soap in it, but the hand dryer doesn’t work. Still trying to dry my hands on my dress we exit the bathroom and walk into reception. 
“The minister is not here today” says the lady on reception. “Maybe you can help?” I say smiling sweetly “No I am not the minister she replies quickly dismissing my outrageous suggestion. Before she can turn her attention to the coffee her colleague is brewing up, I launch into the Alex story. She looks a little more interested and says we should go and see Dr M. 

“Do you have his contact details” I ask trying not to drum my fingers on the desk. There is a pause while she considers this and then says, “I will call him”. She dials, it rings for a while and she is just about to put the phone down when he picks up. After a short conversation she turns back to us. “He will see you with the boy at 9 o’clock tomorrow.” We walk out of the office and back down the corridor. “Yes!” I say clenching my fist and giving a small arm pump. Its minor triumph but an important first step in hopefully bringing about some improvement in Alex’s suffering.    

The next day we arrive in good time at Saint Angela to find the vehicle has a puncture and the driver must take it to be fixed in Ha Pita. It takes too long for the garage to sort, so we transfer into a taxi and only arrive 10 minutes late at the hospital. Hundreds of people are queueing outside and inside, jammed down every corridor. We get directed to a corridor and a door where our new contact, Dr K is in a meeting, Dr M now being somewhere else. We are pinned against a wall with a woman coughing opposite us and people with various aliments either side.                                         
We decided to use the time to have a catch-up meeting and make a plan of work for the next few months. An hour later, having reached the planning month of June, the door opens. Before it can close again, I get through the gap and establish who Dr K is, make eye contact with him and let him know we are here for our 9 o’clock meeting with Dr M, which is now with him. Looking a bit taken back he says he will be with us after his next meeting. “How long will that take?” I ask “About 15 minutes” he says. Amazingly it only takes 20 and finally the three of us are in a cubical with him. Result! 

He does a though examination of Alex which take over an hour by the time there have been several phone calls and interruptions through the curtain. The bone sticking out of Alex’s elbow is at such a strange angle Dr K wonderer if it could be overgrowth of the lateral condyle. He asks Alex how much pain he is in on a scale of 1 to 10 and Alex once again unable to answer this question. He tries again and Alex decides that presently his level is 4 but goes up to an unbearable 10. Dr K doesn’t know whether it will be possible to operate but agrees Alex should go to Bloemfontein to find out and will try and get him there in the next few weeks.  

While Dr K is on the phone both Thato and I agree we are impressed with him and adopt a joint charm offensive immediately he puts the phone down, suggesting he should come and visit all the children at Saint Angela as soon as possible. By happy coincidence it turns out he first trained as a physiotherapist before deciding to become a doctor. We bond over his physiotherapy past and sympathise with his lament over the lack of physio’s in the country and lack of specialist health care. As there is no medical school in Lesotho most doctors do not return after their training and find richer pickings abroad. 

Dr K is a new breed of young enthusiastic doctors from the county who are returning to do an internship in Lesotho. He would now like to train as an orthopaedic surgeon to help youngsters like Alex. We hope to see more of him and finally leave the hospital at lunchtime and head back to Saint Angela. We got off lightly with only a morning spent at the hospital, with Alex now set to go to Bloemfontein, a potential useful contact established with Dr K and a productive meeting with Thato, its already been a good day. An afternoon of physio and fun with the kids follows and we are all set for our first outreach visit the following morning.  

As it turns our first outreach visit is to Alex’s home, on the outskirts of Maseru. We bump down a badly rutted road and have to park about a hundred and fifty metres above the house. A steep rocky path leads down to a basic brick build and the driver has to tilt Alex right back in his chair to avoid him falling out. When we get to the house there is a small concrete ramp leading to the door, which is too steep and broken for Alex to use. We spend some time trying to work out the logistics of how much concrete it will take to build a ramp that will allow Alex to use the ramp independently. His father turns up and we have a discussion on if we fix the ramp how will Alex get down the 50-degree slope to the long drop toilet. The father says they are going to put in a path, but even if they do it looks like a major engineering project to negotiate the slope safely in a wheelchair. 

We ask to see the toilet, which is a good height for an able-bodied person, but I can’t imagine someone of Alex’s stature being able to reach. The driver gets the wheelchair to the toilet and Alex does an incredible climbing manoeuvre called a mantle shelf, which I would have been proud of back in the day when I was climbing to a reasonable standard. There’s still no way a safe path can be built to the toilet so we revert to the original plan of trying to improve the wheelchair access to the house and then potentially building a toilet opposite which Alex can access. The driver thinks this will take 6 bags of cement and 6 bags of gravel and rough sand. Its looking like a much bigger project than I originally anticipated. 

Exhausted by the discussion we clamber back up the slope to the van where Thato, ever practical, suggests we visit Kats home which is only 10 minutes away. We arrive and find a fairly smooth, level, mud path to the door where we meet his father, mother and grandma who is child minding half a dozen small children on the porch. Initially access seems easier than at Alex’s home, until we realise that Kats has to get to the toilet by crawling about 40 metres down the path, covering in him in dust and mud when it rains and cutting his knees with small stones. The same happens when he has to crawl to get to the road to go to clinic. 

On top of these problems yesterday Kats mum was laid off from the factory where she works. It has closed down due to the coronavirus as they have had to stop importing materials from abroad. Kats father is disabled and hasn’t been able to work for years due to lymphoedema, which he believes is due to a curse from jealous neighbours. The only source of income now coming into the family is the grandmother’s child-minding fees, but this may also be affected by the coronavirus if other factories have to close where her clients work.   

I am used to the complications of working in the community as back home I travel all around North Powys visiting people’s homes. The difference is back in Wales there are whole teams of people and resources to help solve the problems I come across. Here, there is just me and Thato standing in the baking sun and the dark shadow of the coronavirus, whose implications are now reaching out to touch a people already stricken with poverty and the legacy of a much more deadly virus, HIV. Trying not to be crushed by the enormity of the problems we go back to Saint Angela to get Kats to work on improving his upper body strength so that he might, given time, be able to use a walking frame and lift himself off the ground. It’s a metaphor for everything we are trying to achieve here.