Blog 32: Ramping up the pressure

The Canadians go on Friday morning and by the afternoon I am already running into problems and concerned about the ramp joining the two physio rooms. Two doorways confluence at this point, the outside one and the one between the two rooms, so the top needs to be flat for a wheelchair to negotiate between the two doors. I discuss it with Maboleka and leave him to build the outside ramp, the top section and the run off into the dormitory.

I return later in the afternoon to find the run off is way too steep and Mab has already run out of cement. Mab extends the shuttering for the inside ramp and I go to find him more cement. I see if a driver can take me to London in the Buckie, only to find the Buckie is dead and there is no transport available. I remember the Chinese shop on the hill sells cement so ask Mahali if he can get some guys to come up the hill with me to carry back three bags of cement. Mahali thinks that is possible and that there are even a couple of wheelbarrows to assist us.

Mahali says  “Ntate who hits himself” will help. This reference follows a conversation we had last week when I was very alarmed to see the man who lives in the hut opposite mine, viciously beating himself up. He clearly has a mental illness, although normally he is very passive and just sits  looking into the distance talking to himself. Mahali assures me he is harmless and the right man for the job. He also ropes another man in “Ntate who grinds the porridge” and our procession makes it way up the hill to the Chinese shop.

We stop off at the huts, so I can get money and Ntate “who hits himself” can change. He usually wears a long black coat and gumboots, but today is curiously dressed in a tweed waistcoat. He changes into his black coat and we make it to the top of the hill. The Chinese lady is very happy to see me again, after I was here in March and brought half her stock of chillies. I assure her I am not after chillies this time, but three bags of cement and three bottles  of pop for the guys.

We get back down the hill, drop off the cement and I give the guys some Maloti. “Ntate who wears the long black coat” (as I call him in his regular attire), likes to collect coins even though he doesn’t spend them. Mahali tells me he has a store of hundreds.

I consult again with Mab that he is happy that he can continue the ramp. Unfortunately, he has now run out of rough sand and fine sand. The thought of going to London, three miles away, on foot with the wheel barrows to source supplies does not appeal. Mahali says maybe tomorrow the Buckie will work or maybe we can ask Mamello if we can take from the piles of sand being used to build another hut  outside where I’m living.

In the morning I go down to Phelisanong  and neither Mahali, Mamello or the Buckie are around. I ask Mamajoan, who is in charge, whether she can call Mamello to ask if we can take from the piles of sand being to build the hut. The answer is “Yes” which only leaves me the problem of how to get it down the hill. The only person around is Ntate who wears the long black coat, who is happily washing his gumboots, his favourite activity.

Feeling I had bonded with him, a little, after yesterday’s cement expedition, and having now found out that his real name is Thabang, I try to mime to him what I want him to do. There is a little confusion when he brings a steel bar out of his hut, with two giant weights of cement attached. I shake my head and go in his hut, which he shares with four other guys and a wheelbarrow and extract the wheelbarrow and a spade. I show him what I want him to do, then hand him the spade to continue.

He follows me down with the full barrow to the physio building. We repeat three times with the rough sand and then make then transition to fine sand. The last run he does by himself, then I follow him up again and point to the broken wooden bed lying outside my hut. The wood is good enough quality to make rails for the ramp and we pick it up together and take it to Mab to recycle.

By now I have been up and down the track eight times. It’s early morning and already must be 30 degrees and I am sweating cobs. Thabang has done the same number of journeys, pushing his loaded barrow and wearing his long black coat, a woollen jumper and a shirt. He is also sweating profusely but does not remove his coat.

I am hoping we have now got supplies sorted, but Mab shakes his head. There is no water to make the cement. I go to ask Mamajoan it she can get the village higher up to turn on the water. They do occasionally, but it has become much less frequent in the current drought and you never know when its going to happen. She rings but its in the hands of the Gods and I ask Mab to explain to Thabang to go down to the stream with his barrow, water containers and scope, to bring back water.                     

He does so and for the moment we are sorted. I go back up to the huts with Thabang and give him some coins to add to his collection. I go into my hut to get some shade and a few minutes later I can hear bangs and shouting and know that Thabang is beating himself up again. Eventually he stops and returns to quietly washing his gumboots.

After lunch I hear a Buckie approaching, it is Mr Chabalala, the builder of the first physio room. He leaps out and tells me off for not telling him I am here. I side step the issue and tell him I like the path he has built. We josh each other for a bit before he disappears in a cloud of dust to do more deals. 

Later I hear the joyful sound of running water and realise the outside tap has come back on. I and the lads in the other hut, run out and fill every available container and count our blessings. I drink a litre and feel I have enough energy to get up the hill to buy Mab and the guys some pop and see how they are getting on.    

I find that although Mab is building the mother of all ramps it is still way too steep, and that he has run out of sand again and is nearly out of cement. I can’t see any way around it but to get Mab to further extend the ramp into the room and for me to try and track down further supplies for him .

Happily, Mamello is onsite and I get a lift with her and the driver takes me to London where the cement is a 20 percent cheaper than the Chinese at the top of the hill. Its tea time and in the shop the Chinese are all sitting at their tills eating noodles and are still open for business. We get the cement and drop it back with Mab. The old Buckie is available to collect the sand but unfortunately the “Fat Ntate” who has the keys is not. Thabang is not around to push the wheelbarrow but the lovely student Thapello, who is one of the lads who lives in the house with Thabang, says he will sort it.  

It is now dark, and I hear him going up and down the hill with the wheelbarrow six times which takes about an hour and half. He hasn’t eaten, and I make him some food while we talk. He is nearly 18, a year younger than my son, but his story is very different. He is at Phelisanong as he is an orphan. He walks 12 km a day to go to school, loves acting and dreams of becoming a TV presenter.

He lives with four other boys and Thabang in a hut, about the same size as mine. They all sleep on the floor and look after Thabang when he has his nightmares and try to calm him to stop him harming himself. He says he is glad Thabang lives with them, as the care mothers shout at him and don’t understand his mental illness. He tells me all these things in beautifully spoken English with no self-pity. I am humbled by his positive outlook and his care of Thabang.

He leaves, and I fall asleep, waking a couple of hours later with the heat of the night and anxiety about the wheelchair ramp, how much space it is taking and how safe it will be for the children to negotiate. In the morning I go back to review it and test with Palesa in a wheelchair. Its no good, despite Mab’s extension it’s still way too steep and unsafe.

I must stop guessing and take measurements. We have already wasted two days, and goodness knows how much concrete, on something that doesn’t work and is taking a lot of space up in the room. The drop off is 18 inches and UK regs for a ramp for self-propelling wheelchair are one inch of rise for every 12 inches of length. This would make the ideal ramp 18 feet long and nearly the length of the room.

Its already 7 feet long, five foot six inches wide and too difficult to smash the concrete to try and make an L shape. Anyway, that would only reduce the bed space further. I stand in the middle of the room stressing, while trying to entertain Palesa, sort out crutches for the Albino gentleman who is hobbling around, fend off Teko who wants petrol money, talk to Mab with the power saw going and What’s App Steve in Germany to bounce some ideas off him.  

The ideal solution would be to raise the entire floor, but that’s a huge amount of work and not going to happen. I need to work with what I have. I decide to abandon the concrete ramp and make a wooden ramp. Wood should be much quicker and easier to work with and allow carpet to be nailed to it. This will hopefully give enough friction to make the steeper than ideal incline safe. I pray that transport is available to go to Leribe and get the necessary materials and this compromise solution will work.  

The good news on Monday morning is that transport is available. The bad news is its full of other people doing lots of other errands and therefore its going to be an epic with lots of waiting around in the suffocating heat. Mab has given me a list of materials, but I still must make decisions on how to make the ramp safe. I get the things that Mab needs but they don’t fit into the Buckie, so I pay for transport twice on top of everything else. 

I got back and forward between shops, trying to find carpet and something to hold it down. No one understands what I need and try to sell me everything from fluffy rugs to kitchen Linoleum. I go back to Cash and Build to consider painting options and even roofing rubber. I think the assistant senses I am about to have a breakdown in the middle of the shop and is extremely kind and tries to help me as best he can. I must get the decision right if the children are to access the building safely, but everything is a compromise and the pressure is huge.

In the end I go for textured paint and pray I’ve made the right choice. The assistant brings me a bucket of water, so I can use the toilet, and then a plastic chair , so I can sit down, before I fall down. Teko eventually picks me up and after driving around Leribe for another hour, picking up people and dropping them off, we finally leave. There is now less than two and a half days left to make the dormitory accessible and habitable and I want to get back to see if the ramp will work.    

We stop on route again, this time to get milk, but everyone has apparently gone to lunch, even though it is 2.15 pm. I am drumming on the dash board with steam coming out of my ears. Teko wisely decides to abandon the milk idea and we finally get back to Phelisanong. Happily, the materials have been delivered and Mab builds a quick mock up to see what the incline is like. After yesterdays demo with Palesa he could see how big the problem was and is completely onside.   

The angle looks much better, even though it is steeper than it should be I think it will work. It will dominate the room, but I think some of the children can use it as part of their physiotherapy, for balancing and assisted walking. We will just have to make it a feature so everyone will want one in their homes!  

I relax a bit and get little Josh and Palesa in to do a bit of physio amidst the concrete and dust. They are two of the 45 children left here who have no relatives or homes to go to when the others go home for holidays. It’s the first time I’ve had the time to do any physio in the last three days and feels quite calming, that is until Josh does a smelly poo in his nappy and big fat tears roll down his cheeks. He waddles off pushing a small frame in front of him. I’ve said he will walk independently next year. No pressure then Josh!  

Feeling the ramp crisis is well on its way to being sorted Tuesday stats well. Mab quickly helps me get the wall bars and parallel bars fixed and its amazing to see them finally in situ having raised the money for them and sent them on their way, via Ireland over a year ago.

The ramp still needs some wood and the wall needs painting  where the corridor was knocked through. I leave Mab cracking on with shelves and the toilet wall while I go to London to get the bits. It’s starting to look like we can get the beds into the extension block before me and Mab are out of here on Thursday. I can’t find anything I need in London and by the time I get back to Phelisanong the mother of all storms has hit. I am stuck in the hut that used to be the old physio room for fear I will get hit by lighting or washed away if I try get across to the new physio room. 

A house mother is madly mopping the flood that’s coming in under the door while the children stuff a blanket in the gap to try and stem the tide. When there is slight lull I make a dash for the physio room. It’s dark, even though its only 3 pm Mab and the guys are wearing head torches as the electricity is down. The roof of the extension room is leaking, and part of the ceiling is down where the wind has lifted it. Holy crap!

With power off the guys can’t do anymore work and anyway the priority has now changed to fixing the roof, which can’t be done while there is a gale and hail stones the size of marbles coming down. Sitting here in the dark writing this, wondering how the hell we can sort this mess out, especially with the weather against us. After all this time with drought the rain is coming down in buckets and even super Mab has been stopped in his tracks. 

In the morning there is calm, and the sun comes out. There is damage everywhere where the gale lifted off tin roofs and rivers of water swept down the hill. I go to the physio room to find it still standing but the outside cladding has blown in various parts where the water has caused the wood to expand and pop out.

Mab goes up on the roof with a giant gun of filler, to sort the gaps under the top ridge and bang wood around gaps in the side. He doesn’t have enough filler to do the job, so I go to beg the admin staff to get some when they go to Leribe on Thursday. Both gentlemen are from Zimbabwe and have not been at Phelisanong long enough to know how violent the storms can be here. They were caught out in it yesterday, trying to get home and found themselves blown off their feet and attacked by the giant hail stones.

In their traumatised state I get them to agree to buy the filler that Mab needs to finish fixing the roof. Mab has agreed to stay to the weekend to try and sort the extra work that now needs to be done to make the extension habitable. I return to the physio room to meet Mr Chabalala to get a quote for the physio room which has no ceiling, is freezing in winter and mind numbingly noisy when it hails. I meet Mr Chalabala wife, who is waiting in the Buckie, and tell her she’s a lucky lady making everyone laugh. They drop me in London, so I can get some beer for the guys and money to pay them till the end of the week. 

When I get back to Phelisanong everyone has gone for food. The ramp is finished, bar a set of rails down one side. I’m glad I brought the bed down to use the wood, because it’s the only wood smooth enough to use for rails and we don’t have a sander to improve things. Unfortunately, the guys carpentry skills are very limited, the joins are crude and there are nails sticking out, not great for kids who are crawling.  

I bash nails in where I can and prime the wood. Hopefully with another two layers of textured paint it will be safe enough to use. Manyanye is picking me up tomorrow to take me back to Maseru and I have to leave Mab to make good. By the time I’ve finished its dark and I realise I am utterly exhausted by the stress of the last week. The moon has risen as I slowly make my way up the track to my hut. The mountains are black silhouettes in the night sky and it’s beautiful and peaceful. I reflect on the words of the lady who found me stressing out about the building problems a few days ago. “Don’t worry Mme Jan, it will work out fine” and I guess it will in an African kind of way 😊      

         

Blog 31: The beat goes on

The kids all love music, and so do I. As usual I have brought my saxophone and I have been blessed on this trip with a gifted drummer, a boy called Thapelo. He is one of a gang of kids who like to hang out in the physio room and was there when I was trying to sort out the battered collection of musical instruments that I have manage to accumulate. Amazingly the tambourine is still in one piece, but the Irish drum (bodhran) has a hole in it from Lesojane's exuberant banging. Its easily sorted with some gaffer tape, although several other wounded instruments are beyond repair. The drum sticks are all still here and some of the shakers, and I improvise with various containers, bottles, tins and gravel, to make a larger rhythm section.   

Thapelo immediately picks up the bodhran and tambourine and places them against the blue plastic box to make himself a drum kit. He instinctively starts a contagious beat and we are off. I can’t think what possessed me, but for some reason I have brought four recorders to help restock the instrument pile. These are grabbed by the kids drawn into the room by the music, who blow them as loud as they can and out of time with the beat. It’s a terrible racket and I stop them several times and try to get them to blow gently and listen to the drummer, however as soon as we start again chaos resumes. 

They are having a great time but in the end for the sake of my sanity, I decide we shall be a recorderless band and to just try and concentrate on the beat. Everyone grabs a piece of physio equipment and bashes it with their hand or a stick. Malineo has brought in an old plastic storage container to use as a large drum, some kids hit the table, some hit the floor, some clap and Thapelo holds it all together with his homemade drum kit. It sounds pretty good in parts and we play for about an hour before I shoo all the interlopers out and have a physio session on the gym mats for the sensational six, except Tsilensang, who is in his standing frame.

Its been a high energy morning and in the afternoon I wilt a little and look around me. There are kids and toys everywhere, one kid is having a pee in a bucket, one care mother is asleep sprawled across the beds, one is stripped off in the corner washing herself. There’s a pile of building materials and tools stacked in one corner, which the builders need access to along with their food and drink. Another corner is stacked with bedding and clothes, while physio equipment,  tables and chairs line the rest of the walls.

When I step back and look at everything happening it can sometimes seem a little bonkers, but the physio room is the kids home, so the daily business of life continues all around us. Anyway, physio is not a separate business here, it needs to be as functional as possible and part of everything the kids do.

The kids go home in five days’ time, I need to keep going and cram in as much as possible before they leave. Now there is added pressure as I have decided to do a small presentation for the builders and get the kids to do some music, what was I thinking? Most of the kids struggle to hold anything in their hands and apart from Tokiso they all have speech problems and therefore find singing difficult.

I rally some more troops, some of the kids that push the wheelchairs and assorted house mothers. One amazing thing that happens here is that when people start to sing they naturally harmonise and produce the most beautiful sound, without even trying. However, I still need to do a rehearsal as I can’t really expect anybody to perform without even knowing the songs we are doing.

Tuesday’s rehearsal suffered a setback after the invasion of the babies. I arrived at the physio house to find two dozen over excited toddlers cannibalising the toys. I don’t know why they are here or where they are from, I just have to roll with it. With a tin roof and no ceiling, the noise is incredible. Poor Kolosoa arrived back from school feeling ill and had to tolerate a baby continually bashing him over the head with a cardboard tube extracted from the building rubbish.

On the other hand, Kananelo had the time of his life sitting in his special seat on the floor, desperate to join in, although with his body wracked by spasms and uncontrolled movement all he can do is wave his arms around excitedly. The babies looked at him a little confused, then just carried on creating mayhem. In the end I decided to outgun them with my sax. A stunned silence followed for the next 5 minutes, then I stopped, and the baby chaos resumed. At last they went to lunch and thankfully did not return.

As the week goes on the building activity reaches frenetic levels as time runs out. Despite their incredible work rate there is so much to be done to put a building up in ten days; walls roof, interior, electrics, insulation, cladding, toilet, plumbing, floor, ramps. Its built to a high spec and on top of everything trying to track down the materials needed has been a bit of a nightmare.   

Richard has been totally heroic in his efforts sourcing materials and driving the project forward. He’s nearly seventy and has the stamina  of a guy twenty years younger, although he did admit to me today at one point his legs went from under him and he couldn’t get off the floor. Like everyone he was covered in fine red dirt from the dust storms that hit today. Half blinded from the powdered dirt blowing around us, burnt from the unremitting sun over the last week, these guys have been an unstoppable force, I take my hat off to them. 

Richard leaves on Wednesday morning and Paul continues to drive the pace. Another unsung hero, I know he has done a lot of fund raising to make this all happen. Like the rest of the team he has funded himself to come over here and to work like a horse every day. No time off and sightseeing for these guys, so when Wednesday afternoon comes, and its presentation time, I want to pull everything out of the bag. I give a speech and get all tearful, which I find rather frustrating, but I manage to stagger to the end. Here’s how it should have sounded … 

   

A warm welcome to everyone that has joined us here today. We asked you to come to a small gathering to say thank you for the collaboration between Africa’s Gift and the Pemberton Lions for building the extension to the physiotherapy house and being part of the journey of physiotherapy at Phelisanong.

None of this journey would have been possible without the support and vision of Mme Mamello and her belief in the benefits that physiotherapy gives disabled children. It is recognised by UNICEF that “Children with disabilities are one of the most marginalized and excluded groups in society. Facing daily discrimination in the form of negative attitudes, lack of adequate policies and legislation, they are effectively barred from realizing their rights to healthcare, education, and even survival.“

A child’s disability is not only determined by their impairment and function but by the environment and context they live in. Here at Phelisanong great progress has been made in improving the environment that disabled children live in. There is a complete circular path at the centre which gives the children using wheelchairs and walking frames access to the school and houses. There is a community hall where they all can eat together and be part of an inclusive society and now there is a now a physiotherapy room and equipment to help them exercise and stay mobile.

I believe that Phelisanong is showing the rest of Lesotho what an inclusive society should be like and I am proud that the physiotherapy team is part of that. I would like to thank Mme Mamello for her support and vision, Malineo for all her support and help with the physiotherapy over the last two years and for Mamothonyana for joining us these last two weeks and working with the children.    

Three years ago, the physiotherapy room was a bare space in the corner of a hut with no equipment. Now we have this room and all the equipment and the beautiful extension that you have built for the children to sleep in. Your building is going to make their lives so much more comfortable and help them achieve even more with their physiotherapy. Thank you for making such a wonderful space for them and all your care and kindness during your time here.

On behalf of the Physiotherapy team at Phelisanong and the children I would like to thank Africa’s Gift and the Pemberton Lions for all your hard work, time and funding to build the extension to the physiotherapy house. We have seen you out there every day in the hot sun and wonder how you managed to carry on. We are amazed that nobody fell off the roof, got sunstroke or cut their fingers off. We are also pleased to see some feisty ladies’ builders in your crew putting in a hard day’s graft.

Please can Paul step up as a representative of your group and accept a physiotherapy polo shirt on behalf of everyone. The logo on the shirt is the same as we wear in the paediatric service and 14 + service I work for in Wales, except instead of being in Welsh and English, it is in English and Sesotho. It simply says “physiotherapy team” in both languages. 

Thank you, Africa’s Gift and Pemberton lions, for being part of the physiotherapy team at Phelisanong, and making a difference to the lives of disabled children here. Thank you for being part of the community and we hope you will come again soon

Thank you, Kealeboha, Thank you very much

After that we break into a few short songs and Thapelo holds it all together with his superb drumming. My goodness this boy is talented ! Mamello gives a speech, and is even more emotional than me, and then I offer the builders some brightly coloured food snacks and sugary drinks. Wisely most steer clear, and as soon as they leave the children cram as many snacks into their mouths as they can and get high on a sugar rush .

Malineo and Mamothonyana have to go to a meeting and I am left alone with the children  and the fall out from the party. The heat of the day has gone, and I take the children to outside to sit on a rug while I brush up the crumbs and crushed food from the floor. I can hear them laughing and teasing each other as I work. The shadows lengthen, and the world seems a beautiful place. 

The following day relatives arrive to take the children home. I speak to the parents about their children’s progress and a father asks the dreaded question “Will he get better?”. I look at his son and try to think what to say. I want to hold out hope for him, without making false promises. This boy was born without any problems but after he had an operation to remove a foreign body from his ear in 2011 he was left unable to talk or walk. Now he can say a few words and walk with the assistance of one but its been very slow progress.

I tell the father he must stimulate his sons mind and body as much as possible and while he is still growing there is a chance for him to further improve. I’m not sure the father is satisfied with my answer and I move on to field a similar question from another parent wishing I had a magic wand. By the end of the afternoon most of the children have gone and the builders are ready to knock through the wall to join the two physiotherapy rooms together.

Maboleka,  the Lesotho builder, attacks the wall with a grinder and disappears in a dust cloud, before Paul takes a lump hammer to it. There is a glorious clatter of tumbling concrete and pictures all round as we jump between the gap between the two rooms. Afterwards we adjourn to the guest house where I am treated to a wonderful shower and meal.

In the morning the Canadians leave for Joburg to catch their flights home. Paul has paid Maboleka and John for the next few days to make good the ramp and connection between the two rooms and left them the tools to do it. After that I have some funds to pay Maboleka for some of the jobs I want doing before I go back to Maseru at the end of next week.

Malineo and I wipe the dust from the equipment and stack it out the way, the children won’t be back until January but the work continues. The last two weeks have been a kaleidoscope of dazzling images; sunshine, dust, Canadian accents, the noise of drills, hammers, drums, recorders, my saxophone, singing, laughter, and at the heart of it children who are defined by their spirit, not their disability.           

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 😊   

…

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.          

Blog 29: The Physiotherapy House at Phelisanong, three years in the making

In 2016 I worked at Phelisanong  for 3 weeks out of the corner of hut, using a small wooden bench, a few plastic chairs and some toys I begged from Sentebale. The only physiotherapy equipment I had were 3 small Zimmer frames that I asked to be sent from Saint Angela’s children’s centre.

In 2017 I brought more physio equipment from the UK, including 2 posterior walkers and began to aspire to a bigger and more suitable space for physiotherapy. Somewhere safe to store my growing store of equipment, somewhere big enough for the children to play and do their exercises, and somewhere to be a permanent focus for physiotherapy at Phelisanong, even when I wasn’t there.  By chance the opportunity came with a bequest made by the late John Ellis, a member of the Dolen Cymru board.

I made a quote for a physiotherapy house and the idea gathered momentum.  I returned to the UK to raise money and organise equipment  for the prosed physio house. By chance a charity I had contact with, Action Ireland, agreed to ship this equipment out. In February 2018 I met this equipment in Lesotho and travelled with it to Phelisanong.      

Once at Phelisanong, supported by Dolen Cymru I liaised with a Lesotho builder and the physiotherapy house was started. When I left the roof was ready to be put on and by the end of April, the exterior was finished, however it had yet to be turned into the physiotherapy house I envisaged.

Back in the UK it was difficult to keep the momentum going, then in one day in May, looking on Facebook, I noticed a British builder had turned up at Phelisanong. He was keen to help to help disabled children and started to build a dormitory extension on the physio house. Mamello thought it would be good idea if the some of the children most involved in physiotherapy could sleep in an adjoining bedroom to help them to do their exercises daily basis.

I contacted the builder, Richard, on his return finding out he was part of a small charity, Africa’s Gift, and would be returning at the end of the year with a small team of builders to finish the dormitory block. I asked if he could also finish the physio house for me and arranged to go back with him.

…and so, I am hoping to meet Richard next week at Manchester airport, flying with him to South Africa, jumping in his hire truck and then driving to Phelisanong. What could possibly go wrong ?

I’ve never met him but feel that its all meant to be and is a great opportunity to finish the physio house and get it up and running.

Meanwhile Action Ireland have agreed once again to give me container space to take out physiotherapy equipment. The last 6 weeks have been a frenzy of tracking down the equipment I want, begging for freebies and getting some great bargains off eBay.

I’ve added 3 more posterior walkers to complete the set at Phelisanong. Special supportive seating, including two Panda seats, each seat worth more than £1000, one came free from stores, one was £85 off eBay. I have more than a hundred pairs of supportive ankle boots, free from the NHS’s overflowing stores of redundant equipment. Splints, orthotics, toys and assorted physio paraphernalia.

The lovely Steve is taking it all to Dublin at the beginning of November when I am in Lesotho. I have no idea how he will get it all in his small van, but fortunately he is the master of packing and I am very grateful for all his help. Hopefully I will catch up with the container equipment sometime in 2019.

My more immediate concerns are my rendezvous with Richard (who tells me he is short, fat and bald, so will obviously stand out from the crowd at Manchester airport), and trying to fit a walking frame, crutches , boots and various other physio equipment into my luggage allowance, while still having enough weight left over for my personal kit. Watch this space to see how it all goes. See you in Lesotho …

Blog 28: Was it all worthwhile part 3

On Sunday it’s Tokiso’s birthday and I arrange a small party for him down in house 5. This is the boy who wanted to walk to school when I first came in 2016. He started a ball rolling that has gathered momentum over the last 2 years, resulting in bringing out a ton of physiotherapy equipment this year and the building of the physiotherapy house.

I have realised that you can’t just start something and walk away, raise hopes and then dash them, however I didn’t ever imagine the subsequent events that have followed from Tokiso’s dream. Yes, getting the equipment out here has been worthwhile. It has given the children the opportunity to do all sorts of activities, on a wide spectrum from walking, to being able to touch something intentionally.

Having some control over what your feet and hands do is massive progress for some of these children. The joy of being able to kick a ball or bang a drum can not be underestimated, We’ve even reached the stage where some of the kids can kick the ball to each other holding onto standing frames or strapped into a chair. Maybe one day Phelisanong will have a disabled football team.

Ultimately you want their progress and the physiotherapy to continue. Regarding that aspect I feel I have done what I can. Malineo has stayed the course from her training last year and continues to grow in statue as a physiotherapy assistant. She has now worked along me for 10 weeks in total and has proved to be an absolute diamond. 

The jury is out on Joalane, she’s had her moments but I’m not sure if she has the passion and commitment to last, time will tell. Other staff have joined in for various sessions, including Mamello, helping physiotherapy to gain a higher profile. Its impossible to avoid us as we are constantly blocking the pathways with the walking frames, taking the children to school or the physiotherapy room.

I have also met a number of the parents and relatives, this year and last, and spoken to them about how to maintain their child’s physiotherapy at home. Malineo leant out some of the physiotherapy equipment to use in the holidays to help the children do their exercises and get the families involved.   

I feel the new physiotherapy house will also help sustain the physiotherapy, giving it a base and focus. On my last day here Mamello asked me to do a presentation to all the staff on the progress of the physiotherapy, the importance of the equipment and the new building. It’s my third time at Phelisanong and every visit has been a building block improving the physiotherapy treatment for the disabled children here.

So, will I be back again? Well I would certainly like to come back to see the physio house set up properly, the children using the facilities and support Malineo. I would like to bring back more equipment as the children are growing all the time and need bigger boots and better seating. There is so much work to be done here but it really needs a team of specialists to give the best treatment. Two incidents illustrate this on my final day.

I am in the physio room with 3 children when Mama Jo comes in with an elderly couple and a young boy. Without any explanation she leaves them with me, obviously in the belief I am clairvoyant. At this point I get a lucky break because the gentleman speaks good English and informs me they are the child’s grand parents and have been told to bring him to physiotherapy. We all look at the boy as he wanders aimlessly about the room unaware of where he is or what he’s doing.

After some questioning I discover the boy is epileptic and was put on Epilim which controlled his fitting. All was well until the doctor said he could no longer have Epilim and would have to have Valex syrup. This does control the fits but has had drastic side effects and reduced him to his current mental state where he relates to nothing or anybody. Epilim is around 500 Maluti a month and the family can’t afford it. The doctor says he can only supply Valex.

The grandparents are between a rock and a hard place and look at me helplessly. I am used to thinking on my feet but have no idea what to say to them as their grandson continues to crash around the room. I decide to phone a friend and fortunately Owen picks in the middle of a training program for mental health somewhere in Lesotho. He advises me there may be other medication options, and the mental health unit at Hlotse hospital might be able to help if the grandparents take him there.

The grandparents gratefully receive the advice. What the boy really needs is an expert in mental health, or paediatrician, not a physiotherapist. At the end of the day the need for specialist care for certain problems is reinforced. The little girl with the festering club foot and Spina bifida is still in desperate need of a swab to identify the bacteria and get the right antibiotic. Not only that but she is doubly incontinent and has terrible diarrhoea. I write clearly in her Bukana that her faeces need to be tested for bacterial infection, possibly E coli (which she has a past history of) as well as a swab taken from the foot.

The lady who takes the children to the hospital clinic arrives back and solemnly hands me the Bukana. I open it to find no swabs or samples have been taken, only the insane suggestion that Nthofela undergoes toilet training. I swear and only just manage to resist my desire to rip the Bukana to pieces and stamp on it. How I wish I could speak to a doctor that knows what they are doing and get the right treatment for this child.

I walk slowly up the track to my hut and share my last Maluti with Mahali. Yes, it was all worthwhile, but it’s only the tip of the iceberg.

https://www.youtube.com/watch?v=s_0qSioRnjg

Copy and paste the above link for Best physiotherapy moments and dance moves of Lesotho 2018              

Blog 27: Building progress and the unfathomables

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.       

Blog 26: Mental health, weddings and public transport

The week starts with our usual physio routine at Phelisanong. We walk the kids who can use the walking frames to school, and then for the rest of the morning we see the younger ones who don’t attend school. Children like Loreto, who loves sitting in the little supportive chair I have brought with me this time. I saw Loreto last year and am amazed that with the help of this chair she has progressed to sitting up, controlling her head and even having some direction over where her arms go. When she manages to spin some of the beads on the toy in front of her and make one bead move along the wire in the direction she wants it to go, both she and I are ecstatic.

After lunch we see the older ones who are back from school. We do more walking, use the standing frames to promote balance and strengthen joints, play with the toys to assist hand coordination skills, use the therapy balls for core stability exercises, do some general stretching, get the legs going using the static bike, maybe use some small weights to strengthen the arms, play catch with a ball to assist hand/eye coordination skills, dance and do anything we can think of to get the children moving and stimulate their minds and body.

Its sounds very dry when I talk about physiotherapy this way, but the reality is having lots of fun to achieve higher levels of function and independence. The children are very entertaining to work with and their determination is inspiring. Mothimokholo and Kolosoa can now take a few steps without using their walking frames, but its high-tension stuff. Mothimokholo is ataxic and needs to hang on to his trouser pockets to stop his arms waving about. He takes wide staggering steps and looks like John Wayne about to draw a six shooter. Kolosoa can’t straighten his legs and walks using a very quick Charlie Chaplin type of gait. I follow them along behind, holding my breath, waiting to grab them when the inevitable comes and they fall. Then I pick them up and when do it all again.       

This routine is broken on Wednesday when Owen, from Powys teaching health board (see blog 23), turns up late morning to do some assessments on the children with mental health issues. Phelisanong is the only children’s centre in Lesotho that accepts children with physical disabilities and learning difficulties  and suggested it might be helpful for Owen to see some of them and see if he could offer some advice.

I did say that he could only see children who had a Bukana, to give him a fighting chance of gleaning some background knowledge. This is the booklet children are supposed to have in which medical histories are written in. The problem is that half the children don’t have them and for those that do the information is of variable quality and use. Anyway, it’s something to go on and if you are lucky it might have their medication in.

There is such a variety of problems and so little information to go on its all very confusing. I make a fast exit and leave Owen to the confusion. There are many tragic cases here and it’s so difficult to know where to begin and what a country can offer with so little resources.

Owen bravely carries on with the assessments after lunch. Meanwhile, Ashleigh, who I met last year, has rocked up with her guitar and it’s too good an opportunity to miss. I fetch my sax and impromptu outdoor concert takes place outside the clinic window where Owen is trying to work. By the time about 80 kids are singing and dancing and generally having a good time, I think Owen concludes, “If you can’t beat them, join them”. He finishes trying to assess a boy who runs around making bizarre noises, which sound like a happy lap top on illegal substances and comes outside to join us.

Given the circumstances I think Owen has done very well. Trying to gather information from a Bukana and from carers who don’t know the child well is not easy. Even if you do manage to assess and diagnose a child what then? The reality is that in many situations that there is no support network for parents, no training and carers who are living in poverty, working all day long and cannot give the kind of input these children need.

Owen sees a girl who epitomises this problem and asks me to give my opinion on her.  She was hit by a car and then attacked by dogs, and now she can barely walk and is clearly disturbed. After the accident she couldn’t stop talking and she has been put on a high dose of sedatives to keep her quiet.

Her treatment is far from ideal but presently there are few alternatives available to her. She has not had any investigations or seen anyone able to prescribe more appropriate medication. One doctor has put in her Bukana the banal comment of “Doing well”, I think not. Understanding and treating mental health in Lesotho has a long way to go.

Leaving behind this depressing thought, I head to Maseru on Thursday. We all know there’s a very special wedding this year (which has nothing to do with Prince Harry), and I am lucky enough to get invited to it. First though, I must undergo the ordeal of public transport.

I drag my bags up on to the road and manage to flag down a four plus one taxi and get to London. From there I need to get a mini bus taxi to Hlotse. My heart sinks, I am the first on board and I must wait until it is fully loaded. It’s a precision job and fat ladies must get out so thin men, children and parcels can be wedged into the corners and maximise carriage.

Eventually we leave, and there is constant rearrangement of bodies on route as we drop off and pick up more passengers. The cause is not helped by the sliding door which can only be opened by special technique and falls off every time it is opened. Once it is lifted back onto the runners we can continue the journey. We make it to Hlotse and happily I can join Owen who is getting a lift with Manyanye and make the rest of the journey in more comfortable fashion.

Yes, Justice and Thato are getting married and I am about to find out what a themed bohemian, exotic African wedding exactly is. I first met Justice when I came out to Lesotho in 2016 and he was such a great help to me when I was working at Saint Angela’s. I know Thato from a hiking trip last year and I am almost as thrilled as Justice’s mother, that they are getting married.  

On Friday we head out to the lodge where they are holding the event. It’s a beautiful venue and I’m up early watching the frantic preparations of tents going up, chairs being put out and hundreds of flowers being cut. The guests start arriving, dressed in their finest, the ladies in their beautiful exotic African prints. The ceremony takes place under two trees, it’s mostly in Sesotho and I don’t know what’s going on, but it doesn’t really matter as when a point of significance is reached their plenty of ululating, so I get the gist.

The bride and groom look radiant. Once the priest has said his piece and the knot is tied, there is more ululating and they are congratulated by everyone. The rest of the day takes the usual format of weddings, speeches, food, music and dancing. I have said I would play “The wedding” from the African suit by Abdullah Ibrahim, on my sax. When I was introduced to this tune last summer I felt I was destined to play it at Justice’s wedding, the only problem being I haven’t yet met the key board player or rehearsed it with him. 

We meet on stage and there is a hurried agreement on the arrangement and we agree to wing it. The singer kicks of proceedings with a series of love power ballads and has the mad idea that I join in with them, having not played any of them before. I wing it, fortunately the singer likes to hang on to notes for ages and fill in the rest of the spaces with lots of doo bee doo’s. I fill in the gaps when he comes up for air. Classic numbers by Celine Dion and Lionel Richie never sounded so good and playing “the wedding” after “Endless love” was a cinch.

We take a break for food and speeches and the day winds up with the evening venue at the bride’s house. I get a ride there with three UN workers and we spend the journey discussing such diverse topics as genocide and gender awareness in agriculture. It appears the UN has a department for everything, but when it comes to the big issues of genocide has proved to be totally ineffectual. The workers feel it might be a massive unwieldy bureaucracy, but at least it lays down the principles of cooperation … I suppose its always possible to put a positive spin on these things.

I get a taxi back to the guesthouse and we get snarled up an accident at a crossroads. Its chaos and its every man for himself. There are people shouting in the road and cars pointing in all directions as drivers try to get around the blockage. A mini bus daringly rides up a bank at 45 degrees while we join a group of vehicles going off piste down a muddy path strewn with potholes. Driving in Lesotho is always an adventure. 

We make it and I arrive back at the guest house and I can’t find the keys get in. I wait it out on a settee until Justice gets back. Despite not having slept for 24 hours he is positively glowing, and you would never know the stress he’s been under for the past few months with work, Saint Angela’s and trying to organise the wedding. Its been a beautiful day, with the usual moments of African chaos, topped with the happiness of two people I hold dear… and that’s what happens at a themed bohemian, exotic African wedding, should you ever be lucky enough to be invited to one.  

The following day friends, relatives and a sheep have been invited around to Justices garden for the final celebrations. The sheep quickly finds out it is on the menu and is slaughtered, butchered and its carcass hanging from a tree before it can protest. I was hoping to join the party but unfortunately my lift back to Leribe has fallen through and I must endure public transport again.

I get down to Maseru bus station to find a 100-seater bus with 4 people sitting in it and know its going to be a long day. An hour and a half later I think we’re finally off, but the bus driver decides if everyone standing in the aisle moves up more people can be fitted in. Two hours after I got on the bus we set off.   

Its baking hot, but everyone when is cheerful, even those standing in the aisle for hours. I try to adjust my mind set and chill, after four hours it’s getting hard. We have stopped at least a hundred times and taken a long diversion to the border post at Maputsoe, where we come to a complete standstill in a massive traffic jam. It’s now been six hours since I’ve been able to empty my bladder, its dusk and I’m facing taxi changes in the dark.

Happily, my luck changes when I get to Leribe, where I thought the bus terminated. It turns out the bus goes all the way to Phelisanong and I won’t have to make any changes. The heat from the day has gone and there are only a few people left on the bus. The sun is setting giving the mountains a red glow as we drive towards them. It’s very peaceful and the atmosphere puts a different spin on the day as I look at the beauty around me. 

I stumble down the track and get back into my hut. The piece of carpet is wet by the door, so I guess it’s been raining. A quick dash to the long drop toilet relieves my bladder from its 8 hours endurance test. I remove the beer cooling in my multipurpose washing up bowl and so that I can then use it to have a standing wash. Then I’m ready for food, … peanut butter sandwiches again, and a Maluti beer to celebrate. It’s good to be home, and sometimes you have to suffer a little to appreciate the small comforts around you. Only and week and a half to go so every moment is precious.