Blog 35: Counting my blessings

Manyanye picks me and the equipment up from Saint Angela’s and it fits perfectly into the back of the Buckie. In the two and a half hours it takes to get to Phelisanong Manyanye manages to successfully negotiate four police check points by brandishing his warning triangle and driver’s license at the officials dressed in bright yellow jackets. The Buckie may look old and battered but it has all the right paperwork, good tyres, decent suspension and doesn’t give the disappointed police any cause to make a spot fine.
Malineo, the physio assistant who I have trained, is outside the physio house when we arrive and grabs me excitedly to show me all the progress that has been made since I was here in November.  At that time the physiotherapy dormitory block was still not complete, and I wasn’t sure how the ramp connecting to the physio room was going to work, or if there would be enough space once they’d put the beds in.
It’s all working a lot better than I hoped and was worth the huge headache the ramp gave me on my last visit (see blog 32). The ramp is acting as an extra piece of physio equipment. The hand rails, running down the side of the ramp, which I recycled from an old abandoned bed frame, can be used by the children who need balance support. Holding on they can  get up and down the ramp and along the bottom of the beds. It’s great physio for them. The children that can crawl can access the two rooms independently and sometimes use the ramp as an extra piece of furniture to sit on.
Mab has fixed the ceiling, the leak in the roof and the outside cladding, which all suffered in the great storm (see blog 32) and the room is now warm, cosy and easy to heat, a blessing with winter coming on. It would be great if one day the physio room could also have a ceiling and electrics to make it more user friendly during the cold months. Meanwhile the space it offers and all the equipment it now houses make it a great asset for the children with disabilities at Phelisanong.
The evidence of these benefits is the astonishing progress some of the children have made. Josh is now walking. I always knew he would but it’s heart-warming to see him standing at the door entrance with a shy smile on his face. Tula is also taking her first tentative steps while Mothimokholo can stagger right across the room with his wide ataxic gait.
As its Easter relatives are visiting for the day. While the children are occupied, Malineo and I unpack all the equipment and sort the physio room out. I have over 100 pairs of special orthopaedic boots, most of them brand new, casts off from the NHS, unable to use them again once they have been ordered and rejected by patients for whatever reason. I also have some more frames and special seating and a heap of Lego and Duplo and various other toys to stimulate the children’s minds and hand skills. This is the second load of equipment that Action Ireland have brought out to Lesotho for me. Collecting it and organising its transport to Ireland has proved highly stressful. It’s a relief to see it arrive at its destination, unpack it and finally  use it.  
The next day besides catching up with the children I already know, I start assessing some of the new ones. I see a couple of boys with hemiplegia’s  and one with spina bifida  and club feet. This is the third child I’ve seen here who has an operation for club feet but no follow up treatment.
Without special boots and bracing bars the feet just revert to their old position, meaning the operation is a complete waste of time.
I give him some new supportive shoes from my stock, put them on the wrong feet and tell him and the house mothers he must wear them every day like that to try and correct the position of his feet. He is only 6 years old and is the sweetest of children, smart, with a huge smile and desperate to do all he can to overcome his disabilities. At the end of the day I find him in bed and he quickly removes his blanket to show me he if still wearing his shoes on the wrong feet. What a star !
Less up lifting is the little 2-year-old girl, Bokang, I see in another house. She is an orphan and severely disabled, both physically and intellectually. Her whole body is rigid with the high tone of her muscles, her head and fascial features dysmorphic and her eyes don’t focus on anything or turn towards the brightly coloured toy I am holding. I fear she may be also be fitting as occasionally she jerks, and her eyes roll. The house mothers say she doesn’t have swallowing difficulties and are feeding her with a small spoon. Since she can only weigh a few kilo’s I don’t know how much nutrition she is getting.
She is not taking any medication and there is no medical monitoring of the children here, except those which have HIV who go regularly to a clinic, or those who develop emergency symptoms and get taken to hospital. I feel overwhelmed with where to start and what realistically I can offer her to improve her life. I decide to see what tomorrow brings and think on it for now.
Going back to my hut on the hill I feel a bit down, the weather and my living conditions don’t help. It’s now heading into winter, it’s cold, with lots of thunderstorms and thick red mud everywhere. Ironically, despite the amount of rain, the outside tap doesn’t work. The roof and the door to the long drop toilet have blown off, my hut roof leaks and there is no light. There is occasionally electric, when it’s not knocked out by the thunderstorms but there is only one plug and I simply haven’t had the time to go to town and find an adapter to try make life a little easier.    
The other three huts around me are full of orphans and the rubbish they have dropped litters the ground everywhere, trodden into the mud. A little Albino girl, holding a baby on her hip not much younger than herself, tells me there are nine children in her hut, a hut which is smaller than the one I’m living in and has no electricity at all. I feel guilty about my extravagant living style when they have so little and will live in these conditions all their young lives.
Later a gang of half a dozen cheeky boys come calling at my door to parade in a couple of Basotho blankets and see if I have some tools to dismember a bike they have been given. They stand there in the rain bantering with me and not feeling at all sorry for themselves, so why should I ?
It’s food time and they run off down to the centre with their plastic bowls to get some pap. They have the security of regular meals, shelter, friends and a bike to share between them, life doesn’t get much better. These kids and their great ability to squeeze whatever joy can be found out of each day give me a reality check. I smile, wash the mud off my hands and find the electricity is on and I can make a cup of tea. I  count my blessings, life is good, it just depends on your outlook.   
The next day the rain is unrelenting and there is a large pool of water which I need to negotiate outside my door. There are torrents of water pouring off the hills, which at least mean I have easy access to washing water. Down at the centre there is no sign of Malineo, and I decide to put together the two Panda seats I have brought. These provide special seating for children who need postural support, one was given to me, obsolete from stores, and one I brought off eBay. They are very expensive to buy new with all the attachments.
It takes well over an hour to work it out how to put them together and once they are fixed, I go to the house next door to find Kananelo to test drive one. He has no control over any of his limbs and they all wave around excitedly as he recognises me. I pick him up with some difficulty and place him in the smaller seat which has a chest harness and head rest which hold him firmly in position, the best thing for children with his condition.
It’s the first time I’ve seen him able to sit still, and he appears to like the sensation. Later when food comes the house mother takes him out of the seat and attempts to feed him on the floor. He gets very distressed. Once back in his seat he calms down and feeds well. If only for his sake it was worth getting the Panda seats out here.   
I attempt to feed the baby Bokang a bowl of milk and lumpy pap one of the house mothers gives me. Bokang makes heavy weather of it, no wonder she’s so small. I have a blender to try and make the food smoother, but there is no electricity. The house mother resorts to the dreaded Weetabix, which I was so familiar with in 2016. I wonder how Bonkang has made it this far.
In the afternoon the weather continues to be shocking, but I have two special treats for the children. I play them a film off my laptop and give them all a chocolate lollipop to suck on while they try to follow the Disney classic, Finding Nemo. Bokang and Mothimokholo both lovingly cuddle up to me and dribble all down my trousers. It doesn’t matter because I haven’t been able to wash my clothes since I got here, and the stains blend into each other.
Whether a fish with a disability rings any bells for them I don’t know but the kids seem to enjoy the film and the lollipops go down a storm. After the film is over, I give Tokiso my old laptop, which he is completely thrilled with. He is the only one with the manual and intellectual skills able to make use of it, but the others sit around him absorbed with what he is doing.
There’s no internet but I have downloaded some games from him to play on it which hopefully will entertain him for a while. Sure enough the next morning he is still playing on it. I do physio with the younger kids in the morning and the older ones in the afternoon. The older ones are the crew that I’ve been working with since I first came here in 2016, how times have changed since then. 
I play various games with them to get them to stretch and strengthen without it being a chore. There is plenty of room for them to roll up and down on the crash mats and be chased around on the floor by me in a game of tag. After that everyone gets a walking frame and we set off to make a complete circumnavigation of the centre on the wonderful flat path.
They are all using posterior frames of the same spec that kids would use in the UK. We pass the old physio room, which was just a corner of a hut and was also used as the clinic. It had no facilities except some adult plastic chairs. We breeze past the school, remembering Tokiso’s first epic journey to walk there in 2017, taking him more than 20 minutes to negotiate a few hundred meters on the rough stony path. Finally we arrived back at our lovely on suite physio room, which I never would have envisaged back in 2016.
It’s time to go home and I walk back up the track to my hut. It’s finally stopped raining and I risk doing some washing in the torrent that is gushing down the hill. The outside tap has miraculously come on and I have drinking water. The electricity is also on and I have an extension cable so I can charge my laptop and heat up some beans at the same time. I also now have some candles which brighten up my dark hut as I write this blog.
Outside the orphaned kids are running around screaming and chasing each other. The boys are half wild while the young girls are already responsible adults, collecting water and nurturing the toddlers. Tomorrow school opens again after the Easter break and they will become school kids again. I guess in the UK we would call them young carers, here with so many thousands of orphans, it’s just what happens. Later I hear a group of the girls singing completely unconsciously with beautiful harmonies. It’s been another day well spent and my blessings are many.   

Blog 34: The last roll of the dice ?

Less than 5 months since my last visit in November I’m back again in Lesotho. Events have conspired in a certain way that mean I am standing at the airport at the end of a long que where one official is hand writing various details from everyone’s passport and then scanning their eyes with a hand held thing which looks like a laser gun. It takes an age but doesn’t matter because it takes the ground staff the same amount of time to unload the plane, wheel the luggage inside and chuck it on the floor.

I grab mine and am thankful that somehow my bag has managed to negotiate Paris and Johannesburg and arrive unscathed in Maseru. The next hurdle is to get through luggage search, and I decide to act innocently and see if I can avoid it, and head straight out the door. A plane clothed security man points crossly back to the baggage search, while another man studies my passport. He sees all the previous Lesotho stamps and the word “voluntary work”, decides I’m legit and finally I get the all clear to leave the building.

Outside I look for the taxi driver, Sabbath, and find him standing on the pavement looking rather magnificent in a day glow green shirt and beret. “Mme Jan how are you?” he says with a big beaming smile, giving me a hug.

“Great thanks, I love your outfit. What happened to your car?” I ask him, staring at a rather battered grey vehicle he’s piling my luggage in.  Sabbath fills me in on a rather alarming episode he had in Bloemfontein when he was chased by potential hijackers trying to steal the former flash taxi he owned. After that he decided discretion necessitated getting rid of his stand out car and to seek the safety afforded by grey anonymity. I can’t say I blame him, and his clothes certainly make up for the motors drab appearance.

After some shopping for some supplies, we pick up Justice from town and head back to my accommodation at his guest house. It’s undergone a revamp and now has all mod cons and is a very comfortable abode. I have a meal with Justice and his wife, Thato and discuss the state of the nation, the state of his family and the state of Saint Angela’s.

Since I first came here in 2016, I have been disappointed with the organisations ability to sustain the work I have done. I am now going to run a 3-day training course, with a follow up day in May, called “Introduction to working with children with disabilities in the community”. The intention is to try and instigate some community support for Saint Angela’s and look at ways the community can become involved and contribute towards the children’s welfare. I feel it’s the last roll of the dice in trying to sustain physiotherapy here.   

It’s a small pilot course with 4 teachers, a local parent of a child with disabilities and Thato, Justice’s wife, who has qualifications and previous work experience in the community. I’ve been trying to organise it from back in Wales with pre course questionnaires, schedule and reading. The course starts the following afternoon and I spend the morning running around trying to organise the set up and check the arrival of the equipment which I sent out with Action Ireland last November. It all seems to have arrived safely, except  a filing cabinet, which I suspect is still back in the warehouse in Ireland.

The course starts, nearly on time. We are two teachers down but have gained a retired physiotherapist, the first physiotherapist I have ever met in Lesotho! She tells me she thinks there are probably only 7 qualified physiotherapists in the whole of the country, mostly based around the capital Maseru. The two teachers that have turned up are from the adjoining high school, and one is the Principle. The other two candidates are Nka, who is the mother of a child with disabilities and Thato. I am happy, better to have 5 enthusiastic candidates than 20 indifferent ones. Workshops are a bit of a culture in Lesotho, normally with nothing to show at the end except the consumption of a free lunch and refreshments.

At the end of an afternoon of classroom teaching we go across to the physiotherapy room to look at the facilities and meet the children. There are 32 children at Saint Angela’s and most of them are trying to get into the physiotherapy room at the same time…its chaos! At one point there are 3 children balancing on therapy balls in the parallel bars and 6 sitting astride rolls, another 6 on the floor building Lego, while others are lifting weights and playing floor football.

The retired physiotherapist looks in shock and even I am a little taken back as I realise I’ve never met half the children before. Anyway, I roll with it and at least the course delegates get to meet most of the children and get an idea of the range of disabilities the children have at Saint Angela’s. It’s been a day of learning for us all.  

The next morning, I call on Nka and meet her daughter Khothi and her aunty. The three of them share a typical Lesotho one room shack, with a tin roof. Everything the three of them need to exist is piled high around the walls of one small room. Their home is just around the corner from Saint Angela’s and aunty looks after Khothi when Nka is away.

Khothi has an engaging smile and can crawl and sits outside with me on the step enjoying the sunshine and watching the herdsman tend his cattle. She can’t talk but can understand what her mother says. Nka prepares some food to show me the problems she has feeding Khothi. Before she eats Khothi presses her hands together, indicating we should all pray before she eats her meal.

I am amazed how Nka has overcome so many problems to provide for her daughter over the last 25 years. As a single mother living in poverty the quality of care she has provided is astounding and something I doubt something I could provide living in her circumstances. There is little professional advice I can add to what she already provides, except to tell her what a great job she is doing.

We meet up again for the afternoon  training session which is mostly physiotherapy orientated. Two more teachers who were supposed to be on the course turn up, but I tell them they are a day and a half too late and there is little point in them joining us, especially as one says she must leave early to go to the bank!

We carry on without them and have a rather amusing session with me trying to teach basic core stability, joint range of movement, and stretches, before the trainee’s test drive their knowledge on a few students. Over a dozen disappointed students wait hopefully outside the physio room, but I simple can’t let them in while I am trying to concentrate and teach. It’s such a short time to pass on a lot of knowledge but the trainees are enthusiastic and picking up things fast.  

The third day dawns and starts with a brief look at epilepsy. It turns out the teachers sometimes have children fitting in the class but don’t know what to do. People have heard theory’s ranging from putting a spoon in the child’s mouth to calling a priest. It’s not uncommon in Lesotho to  think someone having a fit has been cursed.

We go through simple do’s and don’t and everyone practices the recovery position. I suggest to the Principle that she does   training with her teachers and every class teacher knows who is epileptic in their class and what to do. Also, that the children are encouraged to tell their teacher if they feel a fit coming on. It is very useful that the Principle is on this course and can train the rest of the school. She is very grateful to have the information, as she is supposed to be the lead on this matter, and up to now hasn’t known what to do.

After this we take the hazardous journey to school using wheelchair and crutches. The ground is very rough and the ramps too steep and everyone is amazed at the hard work  the children must do every day, maybe several times as they have to go back to Saint Angela’s if they want to use the toilet.

The Principle  thanks me for the experience just before she has an accident and tips backwards out of her wheelchair and hits her head on the ground. It could have been a lot worse but fortunately she is wearing a thick hair piece which absorbs most of the impact. After lunch and two paracetamol she’s ready for the afternoon session.   

I decide to go easy on them and do some diaphragmatic breathing and relaxation therapy. A ten-minute chill and its back to working with another student, trying to assess her difficulties and come up with a plan. It’s a tough one as the girl said she could walk up to the age of 12 then had a fall, broke her arm and can no longer walk. The doctors say its arthritis, which I doubt, but I have no idea why her ankles are fixed, and someone has operated on both her achilles tendons.

We come up with a simple plan and then I call it a day. It’s been a course of information overload which is why I won’t review it with them until the follow up date of the 14th May. In the next few weeks I challenge them to action their knowledge and run some physiotherapy sessions. For now, I’m happy with the way things have gone and the candidate’s response. In May I’ll find out if they’ve learnt anything and what happened after I left.

Now its time to pack up because I’m going to Phelisanong tomorrow.  Another children’s centre, another challenge.     

Blog 33: Final week reflections

Manyanye picks me up Thursday lunchtime and drops me in Maseru at the hotel where we are having the board meeting for Saint Angela’s. Facts and figures are not available, so we adjourn until Monday. The Irish help me out with hotel fees for the night and I have the glorious experience of going for a swim and fully immersing myself in water after three weeks of making do with a bucket. Later they also take me out for a meal and I feel thoroughly spoiled. God bless the Irish!

On Friday I meet up with Justice for our weekend hiking trip to the village where his mother was born. Unfortunately, we find ourselves in the middle of the chaos of Black Friday and we give up trying to get near any shops. It takes the whole afternoon to secure transport and food and we don’t leave Maseru till after 6.30 pm, and even then we must backtrack for petrol. There are seven of us in two cars winding our way up the high pass towards Semonkong. By the time we stop to meet the herdsmen with horses and donkeys who are taking us to the village, the moon is high in the night sky.   

The village where we are heading is called Ha Sekantsi. It’s about a two-and-a-half-hour hike along a rough path and from its position you can see Thabana Li Mele (the mountains with tits). The name is obvious when you see view! Our path is well lit by the moonlight and we arrive after midnight to be greeted by the ferocious barking of the village dogs. Some of our group have a couple of tents and the rest seek shelter in a hut with a mother and her children. I find the hut too hot and claustrophobic and decide to spend the night outside, settling alongside a dry-stone wall. Its cold and uncomfortable but the beauty of the night sky and dark silhouettes of the mountains make up for the discomfort.   

Morning comes early in the village. As soon as the first tinge of dawn comes, everyone is stirring. The clonk of goat bells ring, donkeys bray, dogs bark and soon the herd boys are taking the flocks out to find grazing. Some of the herdsmen wear the traditional grass hat shown on the Lesotho flag, each having their own unique take on the basic design. With the ground parched the herders spend most of the day tending their flocks, foraging for grazing, before returning their animals to the safety of the corrals at night.

They are a tough people and the herd boys as tough as they come, looking after the flocks when most boys are in primary school. Those boys fortunate enough to have a family with a horse ride them bareback with a swagger. Horsemanship and horses are highly prized here, both as a surefooted means of transport and for the thrill of racing and betting on them at the big meets held during the year, especially at the nearby town of Semonkong.   

Smoke starts to lazily rise from the village as the cooking fires are lit and the first pap of the day is prepared in the fat black cooking pots resting on the flames. The ladies poke small pieces of brush wood under the pots to feed the fires, while the children sit around hunched in their blankets wrapped tightly around their shoulders.

We spend some time absorbing the morning atmosphere, taking photos and making breakfast in the open walled kitchen alongside the hut. Justice films me while I play my saxophone, much to the amusement and bewilderment of the villagers. They are kind and peaceful people and seem pleased to meet us and find out more about Justice and his family. Justice’s nephew is with us and it turns out is the rightful chief of the village. His fathers second wife presently reigns but the people aren’t happy with her and feel that the heir should claim his throne.

As the only person who can’t speak the language, plays a saxophone, and sleeps outside, the villagers seem to find me a curious and hilarious phenomenon. One of the village elders keeps coming up to me, laughing and shaking my hand. I don’t know what he is saying, I like to think it is along the lines of “You go girl!”       

Later in the morning we decide to seek out a waterfall we are told is nearby, where the locals say a snake lives in the gorge. When we set out the day is still cold, but its soon sweltering and I regret bringing a woolly hat, rather than a sun hat. We are accompanied by a local guide, protecting us from the dogs who guard the flocks and homesteads and naturally see us as a security threat. We get to the steep drop off into the gorge and I decide not to go down as the lure of some cold water is not enough to compensate for the hot climb back up again.

I wait by a few huts watching the ladies make pap, admiring the Basotho ponies they keep and trying to find some shade to hide from the sun. The ladies fuss around me, bringing me a log to sit on, a blanket to make me comfortable and pap and peas to eat. The stiff skins of two wild cats hang from the trees and twirl around in the slight breeze as a warning to other predators.

When the others return we watch a bird of prey hover on the up drafts rising from the hot ground below, a slight flick of its wing tips holding it effortlessly in the sky. Two village girls walk by with piles of brushwood balanced on their heads, their skills as effortless as the bird of prey we have just watched .

We make our way back to camp. The village has a tap and I get a bucket of water and try to wash some of the dust off me. A small brown calf with big soft eyes follows me and attempts to get in the bucket with me. A puppy also joins us and the two of them trail around the village after me. The rest of the group laugh, but I tell them it’s obvious the animals know I am a vegetarian I am the only one amongst us that won’t eat them!   

Later I settle down by the wall again for another night under the stars. The village children are perched on top of the wall giggling at me and daring each other to go a bit closer to the strange white woman. They finally go to bed and I drift off for a short while until there is an indignant squeal and I leap up into the air. The village pig has escaped and walked straight into me. I’m not sure who is more surprised, me or the pig. The pig runs off squealing with the shock, and blunders into a pack of excited dogs. There is a huge racket and a battle ensues which sounds like the pig is outnumbered and losing.

I am genuinely pleased when I find in the morning the pig looks to have escaped unhurt and is tied up in its usual place grunting to itself, none the worse for its night time adventures. The donkeys and horses arrive to carry our bags, and we walk back out to our transport, seeing the stark beauty of the mountains in daylight in contrast to our moonlit journey on Friday night.

I feel the weekend has felt a genuine encounter of the Basuto village people living in the remote mountains. They have no roads, shops, clinic or school here, but they do have a life uncluttered by superficial materialism and desires of modern living. It is not a utopia, but it is a life stripped back to what really matters; having the basics of food, water and shelter, and being surrounded by a close-knit community. Friendly people who have time to talk and take pleasure from the simple joys that each day brings. It’s a reality check and I silently contemplate the lessons as I walk back to so called “civilisation”. 

…

Monday lunchtime and I walk down the dusty track to Saint Angela’s. I bump into Kevin and Martin, from Action Ireland, who are trying to find out whether they can refurbish the broken water pump, but it’s been taken away. I leave them looking down the empty hole and go to find the kids. They have all gone home for the holidays except three of the new ones who I met back in March. They bound up with big smiles like long lost friends.

We get the key to the physio room and open the door. I know its going to be bad but its still hits me like a punch in the guts. It is thick with red dust and all the wheelchairs have been left in the middle of the floor with boxes and equipment piled up around and little space left to do anything. If it wasn’t for the expectant look on the faces of the three kids with me, I would have turned on my heel and walked away.

I take a deep breath and start to fold the wheelchairs and put them in the toilet block, then I shove as much of the boxes and equipment as I can out the way to sweep and mop the floor. Star tuts at my efforts and stands with her hands on her hips, “Mme Jan, let me help you”. She eleven years old and has the most bowed legs I’ve ever seen which she manages to walk on in a rolling gait defying all normal laws of biomechanics. She never seems downhearted about anything or the unfair hand life has dealt her.

After an hour or so we manage to make some improvement to the room and I tell them I will come back and see them tomorrow. I need to go to the Saint Angela board meeting part two which is in town at the hotel. Some fact and figures have now been obtained and things are looking bad in terms of balancing the books. With government funds not available anytime soon, the only source of more immediate income is 250 laying chickens that have been ordered for December.     

The board meeting descends into a chicken crisis meeting of how many eggs 250 chickens can lay and what profit can be made after all costs are accounted for. There are four people madly punching numbers into their calculators and adding up the figures. For a while it looks like the chickens might solve the more immediate financial problems until someone points out the numbers of daily trays of eggs it is assumed that the chickens will lay works out at two eggs a day. “Two eggs a day?“  “Yes that’s right, but they are small eggs!” In my books a chicken that can lay five eggs a week is a good layer. Clearly Lesotho hens are super heroes when it comes to the production of eggs.

The figures are rehashed several times until everyone loses the will to live and the calculators start to smoke. We adjourn with some sort of action plan and for the moment Saint Angel’s financial gaps are plugged by the Irish and we pray to a kindly God for salvation.

I go back to Saint Angela’s the following day and the enthusiasm of the fabulous three is undiminished. I set us all the task of going through the boxes of toys and sports equipment that have been donated to Saint Angela’s and lie unused in huge boxes. Many of the toys are broken and useless and we find bizarre things like inflatable rubber rings and unicorns floats used for assistance with swimming. What were people thinking when they donated these things? The children of Saint Angela’s are as likely to go swimming as they are to the moon, with the added irony that the water has been cut off and is unlikely to be turned back on again.

The kids have great fun blowing the inflatable toys up and sigh when I say they might as well put them in the rubbish box. I relent and say they can take them back to their bedrooms and do what they like with them. I leave them bashing each other over the head with the unicorns which seems the best use for them.         

I cannot decide is there is any point in me being at Saint Angela’s. The ongoing management problems mean there is very little use of the physio room unless I am there driving it on. Most of the children have complex problems that require a lifetime of interventions and expensive treatment that cannot be provided for them. All I can do is to try and get them to stretch and exercise to try and keep them strong and slow down contractures from forming. This would be worthy enough but staff I train need the guidance and direction of management to keep things going and this has not happened in the last three years.  

I return on Wednesday to find only Majubili is left along with her friend that pushes her wheelchair. She is 14 years old and has the most horrendous scoliosis that winds her spine into an S bend. When I pick her up I need to lift her so her legs are folded tightly into her chest. If her legs were left dangling it would put too much strain on her spine and cause her a lot of pain. There is little I can do for her. She needs a complex operation to insert rods into her spine to stop it crushing her lungs.

Back in the UK she would have a motorised moulded wheelchair costing thousands of pounds. Here she has some pieces of foam shoved down the sides of the seat, to support the spine, and friend to push her chair around. It all seems to work well with the additional benefit of having a special friend she clearly loves and is far more interactive than a chargeable battery.

The girls decide they want to do some colouring and spend the next half and hour absorbed in their task and comparing their efforts. I take a picture of them proudly holding their pictures and then read them a story. The only book to hand is about a flying squirrel’s first day at school. A somewhat unlikely tale, I grant you, but ending with an uplifting moral to the tale when Sammy saves the day and the sinking school bus, and the other furry creatures recognise that we all have special and unique qualities that we can bring to the table.

The girls are enraptured by the story and I feel myself holding back the tears. Majubil has such a beautiful spirit and appears completely happy that she has been lucky enough to spend the last hour with her best friend colouring and having a story read to her. Such simple pleasures. She never mentions her scoliosis and the pain she must be in and completely accepts that’s just the way things are for her.   

Humbled I walk down the track. The months trip has been the usual emotional roller coaster ride. It’s been as crazy as the trip I make later in day with one of my favourite taxi drivers, Sabbath, who took a picture of me back on my first trip in 2016 standing on the roundabout playing with the statute of the man playing the saxophone. A lot has happened since then, but the statue of black man with the golden boots still plays his saxophone and gives me a friendly wave when I go by.    

Today when we pass the statue Sabbath is running late, through circumstances not of his making. We’ve come to stand still in rush hour traffic and he cuts across the dual carriage way and oncoming cars and rides up on to a bank on the opposite side of the road. We bump along the bank until he descends at the front of the que, cuts back across traffic and swerves around another couple of cars stranded in the middle of the cross roads so he can turn right.

I laugh at his outrageous driving. God, I love this country, the people, and the madness of it all, despite the frustrations I sometimes feel. Back in the UK being mindful and living in the moment is all part of a trend of mental health courses run by the NHS. Here you don’t need to go on a course about it, its an everyday reality. Whether it is the villagers of Ha Sekantsi or the children of Phelisanong or Saint Angela’s, they are all living in the moment and as usual have taught me far more than I have taught them. 

I fly home early tomorrow morning and will back in the UK for December, the cold wet weather and crazy commercialism of Christmas. Seems hard to believe sat here in a pair of shorts writing this. Yes, I will return  next year, the Irish are bringing in another stack of physiotherapy equipment in their container, which I need to distribute. The physio house at Phelisanong needs more work, Malineo needs more support and training and I still haven’t given up on Saint Angela’s and finding some way of sustaining the physiotherapy there.

It’s difficult to quantify the impact my visits have had over the last few years. Some of the changes are not tangible, relating to a change in mindset and outlook. Richard, the builder, who visited Phelisanong just before I arrived in 2016, said he couldn't believe the difference when he returned there in 2018, not only the in the infrastructure, but the way children with disabilities were treated. Staff taking a more proactive approach in supporting positive and independent futures for the children and the children themselves having greater self-belief in their ability and potential. 

I like to think that I have contributed to those changes, Richard said the way I work has rubbed off on the children and the staff around me, I hope he's right. In a country where people with disabilities are not supported by legislation and face daily poverty and discrimination,they need all the help they can get. Progress is slow and fragile, and I'll be back in 2019 to continue to work with the children and staff. For now, I would like to thank everyone that has supported Physiotherapy in Lesotho and helped me in many and varied ways. I could not have done it without you.  

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.