Therapy without drugs

There is a sense that some things are getting back to normal at Zithulele; normal being merely ‘hectic’ on the basis of the superabundant health needs and the finite, not to say limited resources. All health systems face this type of mismatch. In this environment however, unlike the UK, there are fewer people who come to hospital without a very good medical reason. People here are ill, often desperately ill, and they have frequently left things until very late until they decide that they need help. This is sadly often because of the simple lack of the wherewithal to get there.

There is now more than a trickle of drugs arriving thanks to MSF; we have ambulances (perhaps MSF could be persuaded to take them over too), and there are some green shoots of resolution appearing in the local situation. Notwithstanding this it will never be a lavish health system. A large discrepancy between need and supply is endemic and a striking disparity in resource allocation between rural and urban medicine exacerbates it.

The medical staff have been learning to do without investigations and drugs but this post is not about them. It is about the team of therapists here who perform minor miracles (and some major ones) on a remarkably frequent basis using devices, exercises, innovation, sheer know-how and ferocious dedication. They are so much an integral part of the health care team it is difficult to imagine how it could function without them but Zithulele boasts a team of diverse therapists which is the envy of other rural hospitals. In terms of their skill and achievements I do not think I have ever seen a team to beat them.

I am referring to them generically as therapists although they are individually specialists – occupational therapy, physiotherapy, dietetics, speech therapy – but the teamwork makes it seem like one multitalented multitasking unit. Day to day the interactions between us are busy. We get detailed physical analyses of neurological cases and accurate opinions on the likelihood of conditions such as spinal TB being the problem. The time they spend with their patients elicits vast amounts of information which we fail to. The real number of fits the epileptic is having; the practicalities of getting about in a rondavel on a remote precipitous slope; what the social situation is really like. The examples are legion. Watching them mobilise severely debilitated patients along the ward, the patient using their tray table as support, the wasted matchstick legs gradually getting more confident, is a small wonder in itself.

Their contributions to the community are also huge. Despite disruption (See ‘When you come out of the storm’) they triumphantly pulled off the Christmas party for 30 children with cerebral palsy and their mothers.

Recently at a morning meeting when the daily gloom about no drugs was at its peak the therapists presented us with a case of theirs complete with storyline and videos. This was an 18 year old boy with cerebral palsy whose mother had been sent away from hospital when he was much younger having been told there was nothing that could be done for him. He is seriously disabled and virtually immobile, needing to be fed, dressed, washed and toileted. His mother has been doing all of this and carrying him on her back for the last 18 years. He is quite large now.

He came back to medical attention as he is now 18 and as an adult he will qualify for a disability grant. His mother will more than merit a carer grant.

The presentation was spellbinding.

Firstly there was a demonstration of his life before he arrived at Zithulele, which was one of confinement to one area of floor in his house and virtually complete dependence on this rock of a mother.

He was booked in for a short intensive course of therapy. He was supplied with a rural wheelchair. These are amazing three wheeled devices with the front single steering wheel a long way forward from the rear two. This makes them both very manoeuvrable and extremely stable on rough surfaces like grass and dirt roads. His very limited movements meant that at first he didn’t seem to get the idea that he should propel himself forwards and we watched him on the video rocking back and forth, a few inches forwards and a few back. It was pointed out to us watching, what seemed like a frustrating performance, that the very movement was so novel for him that he was enjoying the to and fro movement and it was quite deliberate. Soon however with the encouragement of the team and this remarkable mother, he was wheeling himself around and got better and better. He was taught to transfer, bed to chair and back. His physical skills and dexterity were honed up by exercises such as sorting objects and he began to be able to feed himself. My recollection of all the various inputs of all of the team is incomplete (and probably inaccurate!) and there was much more. The signs of delight on his face spoke volumes and the sense of wonderment in the audience watching this transformation was palpably emotional. Seeing someone grow up concertinaed down from years into days was almost like time lapse photography.

Eighteen years carried on his mother’s back and in a matter of days a life completely transformed. Two lives completely transformed. Everyone watching in that room’s life transformed.

Humbling, and just simply glorious.

 

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