Community visits are an incredible way to see village life. And to keep fit! To reach many of my patients houses I have to climb the hills on either side of the valley and wind my way through banana plantations.
The houses themselves can differ greatly from being small, basic structures with a few rooms, built entirely from mud and wood, to slightly larger, solid brick houses. Most houses have their own land for farming which means despite the area being poor, it is rare for people to go hungry, as generally crops are plentiful.
Everyone in the community is friendly, if ever I get lost trying to find a patient (which is frequently!) I just have to ask and someone will either point me in the right direction or show me the way. If I am with a patient, often other villagers will walk in and out and that is how I have come to gather a small community caseload, someone knows someone else that needs therapy.
The first patient I met was suggested to me by one of the staff at the lodge. He is 24 and since the age of 15 has struggled walking due to increased tone in his legs. He has never had a medical diagnosis and as far as he and his mother are aware has no clear trigger before the onset of symptoms. He is a fascinating case and as well as providing rehab, one I want to look into further. I am hoping that before I leave we can get some medical tests completed and maybe have a clearer idea of what is causing his symptoms. At the moment there are lots of differentials but it is important to rule out anything causing immunosuppression as if this were the case, in Uganda, he would be entitled to free healthcare.
Whilst I was with this man a lady stopped by and recommended going to another house just up the hill. When I arrived at the second house I met a gentleman struggling with arthritis and his son, completely immobile and without any speech. He was sitting on the grass under the shade of a tree and unable to maintain independent sitting balance, yet despite this he was laughing and giggling appropriately as I moved his arms and legs. Again, this child has no diagnosis but unlike my first patient, he has never been able to walk and therefore a definite diagnosis is less likely to change his treatment or long-term medical management. Often children here if they are disabled are still kept hidden away as they are considered ‘cursed’. Many people still rely on local witch-doctors for medical care and given that this boy is now sixteen years old, he is actually fairly healthy. He has minimal contractures, is alert and engaging (even if unable to follow instructions/ commands) and has adapted to maintaining sitting balance by fixing with his right arm.
I’m currently in the process of getting an amazing Swedish volunteer and a local carpenter to help me make supportive seating for this boy which hopefully will help reduce his tone a little and allow him some comfort and relief.
Madrass=Mattress (Swedish code)
The main difficulty with my community work here will be sustainability once I have left. Many of my patients I can get to continue exercises independently and they know how to get in contact with our nurse at clinic if they have any trouble. The harder patients will be the younger children, particularly those with neurological conditions. Last Wednesday I met a little boy at baby clinic who is 6 months old, yet presents as a 2 month old. He is the first child of a young mother and for the last week I have been going up to his home to visit him but I am concerned about when I leave; I also have far more concerns related to his breathing which I want to look into further this week.
Luckily, since my arrival I have made contact with a physiotherapist who teaches at the University of Mbarara, the only University in Uganda teaching physiotherapy. She has put me in contact with another physiotherapist based about 30 minutes from where I am who works at a school for disabled children and is looking at setting up a physiotherapy clinic alongside this. I am aiming to meet with her next week and hopefully any of my paediatric patients with more complex or long term needs can be referred onto her to review after I have gone.
If you want to support my work, please follow the link to my just giving page. Any additional money raised will be spent funding medical tests and imaging for patients that need it and will help pay for the adaptive seating we are making.