In 2016 I came to Lesotho with the Welsh Government International Learning Opportunities (ILO) Program to work with children with disabilities. Somehow, I am still here in 2025 as a volunteer physiotherapist and team lead of the Physiotherapy and Outreach Program (POP Lesotho). By the miracle of What’s App I am chatting to Tina who is currently on placement with the ILO for a month in her capacity as a special education teacher. On a previous visit she started a little school for children with special needs but is having problems sourcing appropriate chairs to help them sit up. The children she is working with have cerebral palsy at quite a severe level and lack the postural control needed to sit in a normal chair.
“Don’t worry Tina we have
just the thing” One of the things POP Lesotho does is make bespoke supportive
seating out of recycled cardboard and newspaper, known as Appropriate Paper
based Technology (APT). Currently we have supplied over 150 of these chairs
with slide on tables to children across three districts in Lesotho. Such a
simple thing, but life changing for the many children who need them. Without
them so many of the children we visit in the community are left lying on the
bed or the floor, unable to take part in the most basic activities of daily living
or go to school.
“I’ll come to your school
on Friday and bring some APT chairs with me that might work, and we can measure
up the children that need new chairs”. Tina sends me some details and pictures
of the children that I’ll be meeting, and I confer with the Malamulele Onwards
(MO) ladies I work with in the district. Tina tells me one of the children
cannot attend and that he has been sent away by the granny he stays with, and
she doesn’t know where he has gone. “I’m so worried about this boy” she tells
me. She sends me a video of him when she visited in April, a happy healthy
looking teenage boy playing with a ballon, a big smile on his face. Then she
sends a picture of him as she found him last week. Half the weight he was,
filthy and in rags, purple bruises around his face, sitting broken in the dust,
the light gone from his eyes, more dead than alive.
The contrast is sickening,
“What happened?” I asked. “I don’t know”, Tina replied, “but when we went to
see granny, she said she had sent him away to an aunty, and that he couldn’t
come to school anymore”. I message the MO ladies and ask them to find him. This
might sound rather optimistic, but they have an amazing network on the ground
and by the next day they have tracked him down, living close to town. We will
go and visit him on our way back from the school on Friday.
I pick the MO ladies up
first thing in the morning and we set off for the mountains, up gravel rutted
tracks, the boot full of APT chairs. The car is a Hillux Raider and has been donated
by Glasswaters Foundation Canada for just such missions. It has massive wheels
and such a high ground clearance I nearly fell out of it the first few times I
stepped out of the driver’s door. It is built for the rough terrain of the
Highlands and is heavily loaded with equipment and people. We pick up one of
the children and his father from his house. The boy has a wheelchair which doesn’t
fold so we put it up on the roof rack. I only have some APT belts to attach it
with and hope it will be okay for the short distance we have to go. After about
10 minutes on the bumpy road there is a squeal from a passenger in the back seat,
and I turn around to see the wheelchair riding shotgun at a jaunty angle next
to the side window (Note to self I must buy some heavy-duty roof rack straps
and tie equipment on properly).
We stop briefly to pick
up the bukana (medical book) of the abused boy from granny, who the MO ladies have
contacted and told her to bring the book to the roadside. We don’t leave the
car as granny comes towards us. I don’t greet her and grip the steering wheel tighter;
it is granny that is getting the grant from social development to care for the
boy. She is a robust woman and even if she didn’t beat and starve the boy she
must have stood by while someone else did. The boy can only crawl and use one
hand, so he would have been utterly defenceless.
We arrive at the little
school and meet the parents and children along with Tina’s daughter who has
joined her for this part of her trip. Ellie has just qualified as a speech
therapist, a professional rarer than hens’ teeth in Lesotho, and I banter with
her that next year it will be her turn to come to Lesotho with the ILO. She seems a little startled by the thought but
also excited. I feel it would be of great benefit to her and POP if she could
come back and help us with some training. Many of the CP children we work with
have speech and language problems and swallowing difficulties. We do our best
but having a specialist in this area would be a great bonus for everyone.
Ellie helps me measure
up the children at the school who all need support to sit up and have severe
physical and intellectual disabilities. The Department of Social Development
are supposed to supply equipment to children with disabilities in Lesotho, but
we rarely find any devices given out by them, and if we do it is usually
inappropriate for the individual and environment. Few children with
disabilities ever get the opportunity to go to school in Lesotho and one of the
barriers they face is having the appropriate equipment to help them access
schools. Trying to fill this gap is one of the things that POP has excelled at.
Since building a workshop at Abia High School in Maseru in 2023, we have made
nearly 200 APT devices, purchased 80 appropriate wheelchairs using donations
from friends of POP in Wales and recycled over another 30 wheelchairs. The workshop
maintains and services all the wheelchairs the children use at the local high school
and primary and makes new APT devices for the children as they grow.
Every wheelchair is precious
for the mobility and independence it offers the children. The APT devices are
used both at home and to help children access school. We also give out other donated
assistive technology to support children’s needs, like specialist walkers and
some children can now walk independently without them. Once a child no longer
needs a device, we pick it up and pass it on to the next child. POP now works
with over 450 families across three districts empowering caregivers with
physiotherapy training and health care knowledge and supplying appropriate
assistive technology for children that need it. The stats for such a small
project are impressive and the impact stories for individual children equally
so. Since that first visit with the ILO in 2016, it’s been a journey, as they
say.
Some of the APT chairs
fit the children and we leave them at the school and measure up the children,
so they can have two chairs, one for school and home. I then leave with the MO
ladies to find the abused boy, while Tina goes to report his situation to the
village chief. These children are so vulnerable and defenceless, especially
those children living in remote areas. Obviously, a grave crime has been committed,
and it must be reported, but it is unlikely the chief will go to the police,
and even if he does it’s doubtful the police will follow it up.
We find the boy who is
sitting on the floor at the Auntie’s home trying to eat a bowl of samp. Due to
some dental issues half the food spills from his mouth as he tries to spoon it
to his lips. The purple bruises on his face have faded a little since Tina sent
me the picture. The boy is clean, but his body is emaciated, his spine and ribs
clearly defined. It seems likely that if Tina hadn’t found him when she did,
causing granny to panic and send him away, he would have probably be dead by
now, beaten and starved to death. I examine him and he flinches as I gently try
to establish his injuries. I give him his favourite toys, that Tina has sent
with me, and he manages a small smile, it will take some time for the physical injuries
to heal and much longer for the psychological scars to fade. I give Aunty large
bags of samp, beans and pumpkins to feed the boy up until the grant from social
development is transferred from granny to Aunty. We leave promising to be back
to check on his progress in a few weeks.
I drop the MO ladies
off and then call in to check on the build of our second Assistive Technology Center
(ATC) at the Technology College in Leribe. It’s being built through a grant from
Glasswaters Canada and is a huge investment to supply the children of Leribe
with assistive technology, currently all supplied by our small workshop at Abia
High School. When I arrive, the builders are lifting a massive steel girder onto
the roof, weighing tons, to make the apex of the building. They are ingeniously
using a system of winches and a man up a ladder, to achieve this feat. It looks
a very scary operation but I’m sure they know what they are doing. I silently
thank POP co director, Joel, for coordinating the build and securing supplies
because it requires much more financial dexterity and patience than I have.
I go back to Maseru to do
some training at the workshop with our latest batch of new recruits from the
Lesotho Defence Force (LDF). I have had many surreal experiences in Lesotho but
probably near the top is standing with a cardboard chair in the board room of
the LDF in early January this year asking the Commander in Chief and a dozen of
his most senior officers for help. The LDF is mandated not only to defend the
country but also to serve the people. It is my experience that they are
fulfilling this promise.
The Commander in Chief
understood the need for the work POP is doing straight away and gave it his
blessing, also telling me there was a great need for POP to go to the Highlands
and reach out to the children and families there. I agreed and said I would put
it on my very long list of things to do. By June we had purchased the Raider
and by August were visiting the Highlands. By February the first two soldiers
were on placement, and now the next two have started and will be with us for
four months until December. They provide valuable staff for POP and in return they
get training, tea, coffee and sugar and make POP more sustainable.
As well as making APT
and learning to repair wheelchairs the soldiers are learning about working with
children with disabilities, of which they have limited experience. Along with the
theory I am trying to get them to understand the importance of play and fun
when working with children. I well remember on the ILO in 2016 asking the
children at Saint Angela residential home what they knew about physiotherapy,
and they mimed people torturing them. The physiotherapy room I set up then is
still in operation and we use it 2/3 times a week as well as doing outdoor games
and sports. We go across for Monday’s session and I’m not sure the elderly
sergeant is buying into today’s dance and movement session but the younger
private is certainly getting into the groove and shaking his hips with the
kids.
For the kids these
sessions are a chance to get fitter, have fun, build confidence and do
activities that other kids take for granted. These children all go to school at
the next-door mainstream primary and while education is supposed to be
inclusive in Lesotho the reality is somewhat different. POP has put a great
deal of effort into improving the practicalities of inclusivity from sporting
activities to the supply of appropriate wheelchairs, to putting in pathways to
make school more accessible. It was POP that built the first pathway at the
primary so that the girls could access the disability toilet that UNICEF had
kindly put in but somehow had forgotten to build a pathway so that wheelchair
users could get to it.
Working with the ladies
from MO in the community is another way that POP operates to make the project
more sustainable. MO is a South African foundation that trains mothers with CP
children to train other mums with CP children in the basics of care. They give
invaluable practical and psychosocial support in an environment where
disability often carries stigma, and the children are hidden away. I link up with Mme M the following week who
covers Maseru district. She is an absolute diamond, ever resourceful, calm and
reliable, and manages to stay upbeat whatever situation we find ourselves in.
Mind you even she goes pale, under her dark skin, as I nearly manage to drive
the Raider off a cliff.
I was just telling her
how much safer I feel in the Raider, compared to our other vehicle, an old X-Trail,
as we approach a very steep part of the gravel road we are driving on. No
problem I think confidently changing down gear, but the Raider starts to slip
and then goes into a wheelspin spraying gravel everywhere. It is at this point
I feel I should be using the diff lock, but I have forgotten where it is and
what to do. The car is sliding backwards towards a drop of several hundred meters,
and I decide to accelerate and pull forward using some dodgy clutch work in
first gear. We survive with a great deal of revving, and I arrive at the top of
the hill feeling slightly stressed. I call my friend at the local garage and
recount the tale, my heart still pounding. I find out where I’ve gone wrong and
make a note to self, that in future I need to stop the car and engage the diff
lock before tackling challenging terrain.
The children we are
visiting today all have severe disabilities and each case seems worse than the
last. We arrive at the penultimate house, find mum is not there and we are let
in by a neighbour. The boy has spastic cerebral palsy secondary to
hydrocephalus, and in proportion to his body he has the biggest head I have
ever come across. We have worked with him and the chaotic social situation mum
lives in, for a couple of years. We took him to hospital and paid for his treatment
when mums abusive boyfriend broke his leg, we supported mum to get him a
passport and paid for him go to Bloemfontein to treat his hydrocephalus, but
the medics said he was too difficult to treat. We have given mum food aid and
seedlings to grow vegetables, but mum continues to lurch from one crisis to
another dragging her children along with her.
I cast my mind back to
when we were called out over a year ago by mum to find her and her son and what
seemed like half the village, crammed into a dark hut. It didn’t take long to
establish that the boy’s obvious pain and distress was caused by a mid-shaft
shear fracture of the femur of his small leg. After stabilising the break as
best as possible we got him and mum into the back of the car. Before taking him
to hospital we had to go via the shops to buy nappies and food, so mum had
supplies to stay and look after him while he had an operation to fix the leg. The
long and stressful journey with the boy crying in so much pain in the back of
the car is still etched on my memory.
Today the boy is lying
on a filthy urine-soaked mattress pinned to bed by his enormous head, he
manages a smile as he recognises us. It turns out Mum isn’t here because she
has gone to court as her daughter, who also has a disability and we work with,
was raped by a villager in front of her brother, while mum was away trying to
find work in South Africa. I feel overwhelmed but Mme M, ever practical,
changes his clothes and together we lift him out of bed. I lift his head with
both hands and it’s like carrying a heavy boulder with the weight of the fluid
in it. There is a large dent left in the bed from where boys head has been.
We change the blanket and
lift him back on the bed leaving the neighbour feeding him something that looks
rather gross, found in a bowl in a bedside cupboard. Mum left the house at 6
o’clock this morning and we are the first people he’s seen since then and he is
probably starving. We drive past the airport on our way to our last visit and I
briefly consider jumping on a plane and flying back home. Days are not always
like this, and I know how life changing the project has been for hundreds of
children and their families, however sometimes the brutality of life here and
the suffering of these children gets too much.
Tina comes back to Maseru,
and we find time for a cup of tea before she flies out. She would like to spend
more time in Lesotho but presently can’t see how to juggle the logistics to
make it work. Looking back, I’m not sure how it all worked out for me. I was
drawn back every year after 2016 with the ILO and Dolen Cymru and then at the
end of 2021 took a leap of faith, landed and have been resident here since. It
was almost like the waves parted and it was meant to be. As I draw nearer to
the end of my fourth year of residency in Lesotho, there is still so much to do
to try and make the project more sustainable. There is the ATC center to launch
once the building is finished, training with local stake holders in Leribe to
sustain it, more training with the soldiers of the LDF, more outreach visits to
children in the Highlands, and we still live in hope of partnering with
ministry of Health, or Social Development or Education, or all three of them!
Co-Director Nelson,
more grounded than me, advises to keep expectations low and the fact that the
ministries are even talking to us is progress. Trying to work with the
ministries has been frustrating and not a very productive process so far. While
we continue to reach out to them, we have found a bottom-up approach with
parents, schools, the LDF, technical college and community groups on the ground
has yielded much better results. I get back from Tina’s and check in with the
soldiers at the workshop, make phone calls and try to gently nudge people into
action. We are building a better future for the children POP works with, and as
the ripples from that first visit in 2016 with the ILO continue to spread, I’d
do it all again. I wonder if Tina will come back and if her daughter Ellie will
embark on a new journey with the ILO and where that might lead.
