Chair antics

IMG_2010A blonde, a Swede and a partially blind Ugandan attempt to make a chair…. it sounds like the start of a bad joke doesn’t it?

Well, this is reality.  I’ve commissioned a Swedish volunteer to help me make some adaptive seating for a disabled boy in the village and we have roped in the skills of a local carpenter who has lost the sight in one eye and has provided some rather questionable chairs to the lodge we reside in.  His name in Mandev, which isn’t actually his name at all, more a nickname which abbreviated in Ugandan, means man with a beard.  He is in his 70’s, has a 20 year old wife and lots of children that attend our school.

The initial idea was to make some supportive seating for a boy without sitting balance which may help reduce his tone and give him some comfort.  My initial sketches, although not great, were quickly adapted by Jan our Swedish volunteer into something completely different but looked like it may work.  Given that Sweden has a reputation for high class products and of course is home to the infamous IKEA, which if anything shows how well the Swedish can put together furniture, I decided to run with it.

Many people in Uganda still resort to witch doctors and are under the impression that if they have a disabled child then they have been cursed in some way.  This young boy was identified to me by a neighbour and his parents were more than happy for me to meet him.  Unable to sit independently or talk, he has the most beautiful smile and I instantly wanted to try and help in some way.  At 16, it is unlikely rehabilitation will make any huge differences, especially if no-one is able to carry on my work after I leave.

The best solution therefore was to make him a form of adaptive seating to help reduce his tone, improve his strength and hopefully improve his quality of life.

The question was how to do this.  Jan decided that Mandev was the best option and we handed over his above plans… inevitably what we got given was nothing like it.

Needing to then adapt the plans I had a little help from Jessie, another physiotherapist I had made contact with who works at a disabled school.  We began to change the design to ensure that at the very least, he had some more flexion at the hips to stop him from sliding out and falling onto the floor.

The other very obvious problem was that the chair was wonky (a common theme with Mandev’s chairs!).  Hardly surprising, considering he measures the legs from a different point each time and his tape measure is so old that it no longer has numbers on…

IMG_1791.JPGIn addition to the chair, I also asked him to make a table which we could fit on top as the boy has enough upper limb activity to feed himself.

Five attempts later, with some measuring help from another Swedish volunteer, Jutta, we finally had something that was beginning to look like it might actually work.  Lucky, as I’m not sure Mandev would have been able to handle it if I’d have sent him back again to make more changes.

On the way back from town I bought a mattress to provide the additional support the chair still lacked.  Coming back from town, sitting three on a motorbike, holding a pair of crutches and a mattress I realised how much I have become absorbed in Ugandan life.  It also cemented the fact that I have very little regard for health and safety.

IMG_1967The chair looked great, such a good effort and I began cutting up the mattress to provide the chair with more postural support.  That is, after a photo of the carpenter with his goods of course.  Also, it turns out Mandev’s real name is Nathan… suits him far better I think!

IMG_1974.JPGAs the mattress was thick and I only had a small, plastic pair of scissors I had to resort to a knife to cut it up.  Although not ideal, I appeared to do a fairly good job.

IMG_1994.JPGAfter some battling to get everything back together we finally had a chair that might actually do the job.  I was buzzing!

IMG_1997.JPGTried and tested by our very own Pats…

IMG_2007.JPGThe next problem was how to get it up the hill.  On a good day, without carrying a huge wooden chair, it takes about 30/ 40 minutes to reach their house.  After trying my sweetest persuasion techniques, I couldn’t entice anyone to carry it up for me, except for one of the cowboys who then got called away milking.

So, what else to do in Uganda other than call a boba boda?  I have seen everything from goats to bananas to coffins on motorbikes so I was pretty confident they would be able to help me with my chair.  Laurence called in some friends and within 10 minutes my chair was being loaded onto one of two motorbikes – the other to take us up the hill.

 

Bumping up small dirt tracks and through banana plantations, on a motorbike, is an unbeatable feeling.  We passed the local villagers attending a service outside the church and I smiled and waved at some of my patients and the people I have come to know over the last two months.  It is such a wonderful community and I have loved being a part of it.

When we arrived, the boy, P, was on the floor outside and smiled at the sight of us (his dogs were slightly less friendly and did their best to inflict fear).  On previous visits he has generally been outside but when I have turned up unexpected he has been lying on the floor, in a small hut and I believe this is where he usually stays.

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We lifted P up into our arms (for anyone bothered about manual handling – TIA) and carried him to the chair.  It was instant gratification for the last few days stresses and exertions.  He looked perfect.  Yes, the chair was probably only just adequate but he looked so much better and it was definitely worth the effort.

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His mother, who had seen us passing, had ran up the hill from the evening church service to meet us.  Her kind words and blessings making it all the sweeter.

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That smile!

I haven’t yet mentioned by this was actually my last evening at the lodge and it could not have been better.  Leaving behind something so small, that will make such a huge difference, there is no better way to end a trip!

The only issues were that I burnt myself on the motorbike exhaust (basic error – and one I have avoided for years!), giving myself a second degree burn.  Fail!

I also definitely paid too much for the boda (to add insult to injury) and he wasn’t dropping his price, so I had next to no money for food or water for the next 30 hours until my flight!  But, it was worth it all for the sense of accomplishment.

Thanks to all the amazing people that helped make this a reality.

To donate to my projects so I can keep providing help where it’s needed, visit my just giving page here.

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Mountain Gorillas

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The beautiful hills of Uganda are home to the famous mountain gorillas.  There are around 850 wild mountain gorillas left in the world, habituating forestry between the borders of Rwanda, Uganda and the Democratic Republic of Congo (DRC).

Awareness and conservation for these incredible animals was made famous in the 70’s and 80’s through much of Dian Fossey’s work, the pinnacle perhaps being her book ‘Gorillas in the Mist’, an account of her thirteen years living in the rain forest with them.

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Recently the cost of gorilla permits have gone up in all locations and Uganda is now cheaper than Rwanda to do the famous gorilla trek.  DRC remains the cheapest but after the recent murder of both rangers and tourists in the area (2018), is not recommended.

There are two areas within Uganda to see the gorillas, the famous Bwindi national park and the lesser known but equally as beautiful Mgahinga national park, in South Western Uganda.  This is where we did our gorilla tracking.

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Mgahinga national park is the smallest in Uganda, covering the northern slopes of three volcanoes and bordering two national parks in Rwanda and the DRC.  The setting is spectacular.  At the base of the volcano is the town of Kisoro, the closest border town to the DRC.

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It’s impossible to go to the border town and not see hundreds of refugees who are making their way into Uganda, a country with an open-doors policy to refugees.  Mainly children, they wait near the border until they are transported to UN run camps.  The poverty of some of these children is extreme and their health poor.  The little boy trying to rub his face against me definitely had either oral herpes or a severe bacterial infection but I loved how happy they were to meet a friendly stranger.

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To track the gorillas you need to set off early and we stayed right at the base of the national park.  The guesthouse had only just opened and it was beautiful.  Half way up the volcano, the views across the country were stunning.

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The next morning we set off early to walk the remaining distance from the guesthouse to the rangers huts where we met the others in our group.  The biggest advantage of choosing Mgahinga over Bwindi is the groups sizes are generally smaller.  Although they only give a limited number of permits a day you can still have a group size of up to 8.  At Mgahinga we were lucky enough to have just 4 in our group; another volunteer from my lodge, an Australian couple and myself.

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It was a fairly steep climb from when we set off.  The trackers leave at first light to where they left the gorillas the night before and begin their tracking.  By the time you set off with the rangers, generally the trackers have either located the gorillas or aren’t far away.  It can take any length of time but most commonly between 1-4 hours.

We were lucky that we only had just over two hours of trekking until we found them.  Although this is actually more than many, the walk is stunning and having spent the majority of the previous day travelling in the car, welcomed the exercise.  For anyone thinking this sounds a struggle, the first sightings of the gorillas is worth the effort.

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Nothing can really prepare you for the first encounter.  It is absolutely fantastic.  The sheer size and elegance of these animals renders you practically speechless.

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It shows how well habituated they are they walk right past you without even acknowledging your presence.  In order for tourists to be able to visit the gorilla families, they first need at least three years of habituation by the trackers.  This means that everyday for 3 years they are monitored, observed and slowly exposed to humans.  Allowing tourists to visit ensures that the revenue comes in to protect the forests and the gorillas from poaching and deforestation.  As mentioned earlier there are only 850 mountain gorillas left in the world and tourism is vital to maintain their species.  To cause the least disruption to their normal behaviour the group sizes and time spent with the animals is always limited, as well as prohibiting any consumption of food and drink.

DSC_1789.JPGDSC_1783.JPGDSC_1805 (2).JPGDSC_1799 (2).JPGDSC_1942 (2).JPGDSC_1874 (2).JPGDSC_1950 (2).JPGThe infants are undoubtedly the sweetest and spend their time scampering around in the trees with unlimited energy.  It is incredible.  It is also incredible just how the trackers can find them.  Often the gorillas come out to a clearing during the day but even so the forests are so densely covered it seems near-impossible to find them.  For our sighting they weren’t in a clearing but instead dispersed around the trees, in the picture below.  The fact that the rangers achieve finding the gorillas daily, in these conditions, is truly commendable.

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For anyone wanting a truly unique, once in a lifetime experience, this has to be it.  Tourism is still slow in Uganda and it is the most incredible country, rich in beauty and kindness, with so much on offer.  Tourism is important not just to protect these incredible animals but also those all over the country, including the incredible [Queen Elizabeth Park] and the captivating [chimpanzees].  If anyone is still looking for a reason to visit, the fascinating life of Dian Fossey (my namesake) would inspire even the least adventurous and last but not least, the Disney film Tarzan arguably has one of the most underrated soundtracks!

Ugandan Community Visits

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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.

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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.

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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.

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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.

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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)

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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.

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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.

DONATE HERE

Right to an Education

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I strongly believe that every child deserves the right to an education.  Having been lucky enough to be University educated in the United Kingdom, it is something I value highly.

One thing I have learnt since being in Uganda, is that things don’t often work out as expected.  After all, this is Africa.  Yesterday, my plans to start health screening on the oldest nursery school children, were knocked on the head.  We needed to print more screening sheets but as the power was down, we were unable to.

On my way back to the lodge to sort the papers, I passed a small boy.  Bare foot and dressed in rags, talking to the staff outside the gate, they were trying to round up enough money for a bus fare.  It turns out the boy had been found earlier in the morning, sleeping in a ditch outside the lodge.  He had spent the night there.  Visibly in pain, he limped towards us.

His name was Paulo and he was 11 years old.  With nurse Rosen’s help, we established that his father had taken him to his sisters, where he was to work for an old lady as her cow boy.  He walked there and back each day and after working two months, reasonably asked for some money.  At this request, the old lady ‘chased him away’.  He went back to his sisters, who instead of helping him, made him start walking back home.

It had taken him 4 days to reach here and he lives near Mburo, another 3 hours drive away.  There was no way, with any conscience, that I could have just let him get on a bus when he could barely stand.   Instead, I picked him up and piggy backed him to the lodge where he could shower and change.

This was very emotional.

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Outside the showers

This photo captures the moment perfectly.  Sitting outside the staff showers, waiting.  It is heart-breaking, in this moment, to see a broken child.

He stripped off his rags, torn and dirty and dropped them on the floor.  Standing malnourished, naked and vulnerable, he just looked at me.  He was placing all of his faith in a complete stranger.  More than that, in a white stranger, whom he could only communicate with on a basic level.

I fetched a bar of soap from my room and my towel and ran the shower for him.  I have no idea if he has running water at home, although it is still rare in our region, so I doubt it.  Despite his fears and exhaustion, it was obvious the pleasure he took as soon as he stepped under the water.

Naked, swollen-bellied and eyes closed, a small smile danced across his lips.  Despite his ordeals, he stayed in the shower and scrubbed every area of his body with the feverishness of someone who has not washed in days and the conscientiousness of someone much older than his years, who knew to take full advantage of this opportunity.

Dripping, he stepped out of the shower and I wrapped him in a towel.  I’d set Rosen the task of trying to find some spare clothes from the donations that may fit him but after holding a recent market to make money for the school, we had no children’s or men’s clothes left.  We managed to find an old shirt and school jumper but no bottoms would fit his tiny frame.  Eventually, Tony found a smallish pair of shorts with a draw string waist, some of his own, that did the job perfectly.

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Stepping out of the store room Paolo looked like a completely different child and I showed him a photo of how he looked in his new clothes.  Lifting him up onto my back I grabbed a banana from the kitchen and a large bottle of water from the bar.

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We got back to the others and little Paulo was unrecognisable.  Sitting down under the shade of the registration tent, I took a look at his feet and his left ankle was acutely sprained.  Very tender and swollen he was now struggling to even stand, so I grabbed our only bandage from the clinic and strapped it as best I could.

We grabbed him a soda and some bread and set up a mattress for him to lie on in the shade.  He tried to stay awake to listen to our conversation but eventually drifted off into the most peaceful looking sleep.

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When he woke, he finished his food and drink and, well rested, I carried him back to the road to wait for the bus. Along with bus money, we packed a bag with his rags, some biscuits, a few pencils and a letter folded in his top pocket explaining how we found him and that a bright young boy like him should be in school and not working.  We explained that as a school, we are able to provide bursaries and hope that the family will contact us to let Paulo continue his education.

He is the sweetest boy.  I’m so glad we were able to take him in and show him kindness, even if just for the day.  However, it is heart-breaking to know that once he gets home, we have no way of knowing how he will be received or if his family will agree to let him continue school instead of working.

There are so many injustices in the world and it is so sad when it happens to young children.  I pray that the letter we sent with him will be enough to change his future.  If he were able to return, I would pay his school fees myself without hesitation to keep him here, safe and away from child labour.  It is so sad to be in this situation as, despite all that appears best for him, the only option, the right option, is to send him on his way and return to his parents.  I guess all I can do is hope that they get in contact with our director when he returns.

If you want to contribute to my overseas work, then please follow this link below to my crowdfunding page.

https://www.justgiving.com/crowdfunding/diana-whiteside

 

 

Thank you and please share.

Uganda Lodge

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Believe it or not it has taken over 2 hours to write the title.  I am fully submerged into Ugandan life and finding any spare time to blog is as hard as ever.  I’m finally getting out my laptop and I have an excitable 11-year-old next to me who won’t let my concentration drift even for a minute.  We have discussed the reason for a belly button; worked out basic mental arithmetic and pretended to talk without teeth.  Needless to say, it makes writing a little tricky; when school term starts in a fortnight it may become a little easier, but I’m not too convinced.

Life in Africa is exactly as expected, everything runs at a slower pace, on African time.  The nearest town to where I am staying is Ntungamo, in Western Uganda, near the Rwandan border.  The people of Uganda are friendly and inviting and as area I’m working in is fairly remote, it is still rare to come across white people which makes everyone is excited to see you!  They point, stare and wave shouting ‘Muzungu’: white person.

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Local house

Whilst staying in Africa I’m residing at a guesthouse adjacent to a school and when not working at the local hospital or health centre, free time is spent renovating the school before term starts and rounding up and playing with the local children whenever possible.

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Sunday Funday!

In addition to a school, the guesthouse I am attached to has a medical centre over the road and a development building which has brick making, sewing machines, shoe making and a barber to teach local trades.  Much of this is still under development and they are hoping to set up more vocational style work for children to go into, that are unable to study at secondary school due to academic or financial reasons.

The whole development was started by a single, remarkable man named Denis.  As a child he did not attend school, along with many other children in the area and the at the age of 13, became a child soldier.  Now he is older, he still works for the Ugandan army but has started up this entire project with the aim to ensure that every child in his neighbourhood can get an education and access to health care.

The money Denis makes through various projects and volunteer opportunities is all reinvested into the community with any money being contributed to the school’s development and bursaries for the local children that cannot afford it.  All the government schools in Uganda charge for attendance about 35 000/ term, this is approx. £7GBP.  As this is a private school the fees are a little higher, also offering the addition to board for children from further away, however as this is heavily subsidised by charitable donations it generally works out at a similar price to the government run schools.  Any families that cannot afford to pay cash are often allowed to pay in goods, for example beans or bananas and as long as it can be utilised by the school they are happy to accept it.

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School Classrooms
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Classroom
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Boys Dormitory

As mentioned, fees can be heavily subsidised, children at the school can be sponsored to attend and bursaries given to poorer households.  Yet despite this, some children still cannot afford to attend.  The area I am in is predominantly farming land and this also contributes to the main conditions seen at the health centre.

Due to the poverty there are limited water supplies and water is collected by children and families from water sources often polluted with animal waste, this gives rise to high incidences of typhoid and H-pylori.  On my first morning at the clinic, every child that attended had one of these conditions and it is generally related to poor water access and not boiling water before drinking.

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A local house made from mud and wood, they last about 50 years

Other conditions common at the clinic include malaria and mosquito born pathologies.  To reduce incidences of malaria in Uganda the government have issued free mosquito nets to families however, despite this they are seldom used.  Often when visiting homes mosquito nets are found unused, for storage or even on occasion as fishing nets.  This leads to large quantities of people catching malaria, however, as it can be fairly easily treated if caught early, the locals treat it in the same manner as catching a cold in the UK.

If you want to read more about the types of medical conditions I’ve seen then read my posts on [The Local Hospital] and Ugandan Community Visits.