Names have been changed or deliberately not used to protect confidentiality and privacy in this article.
Some remarkable work takes place at LAMB and I do hope to get round to a fair number of departments and areas to explain what goes on here during 2012. I’ve mentioned teaching quite a bit over the months but the primary work that LAMB exists for is actually the community. Basically, LAMB is here to give development to the poor – specifically in health care and education about nutrition, family planning and so on.
One department that deals with the poor in this way both inside the hospital and outside in the community clinics is the Rehab/Disability department run by my wife. Although trained as an Occupational Therapist, she has had to adapt to a much more holistic work taking on Physiotherapy as much as Occupational. I could go on all day trying to explain the differences and detailing all the work that goes on there but I think it would be quicker – and certainly much more interesting for you – if I tell you the stories of two young people who have benefited from different aspects of the work carried out by the Rehab staff.
Adif Adif is 11 years old and has both club feet and club hands. His arms don’t work and just hang limp though his fingers can grasp. He also has one knee that is fixed at a 90 degree angle – it won’t straighten beyond that. He comes from a village and his father is a day labourer farmer. He has no land of his own and this makes him all but penniless really.
Adif’s family brought him to the hospital for two reasons. First, he is now too big to carry. He can ‘walk’ but only by using his knee on one side and a straightened leg on the other – very lopsided and cumbersome! The second was because they had heard about a baby with club feet which had been fixed by the Rehab staff. The hope was that they could fix their son’s too.
LAMB works in partnership with Walk for Life, an organisation set up with the aim of eradicating club feet in Bangladesh. Statistics are always difficult to confirm in Bangladesh but, on recent estimates it would seem around 5,000 babies are born here every year with clubfeet. It is a big task to try and get what is known as the ‘Ponseti method’ implemented in enough hospitals in the country so that the treatment is accessible to all. But the work is growing at great speed. This method is cheap and does not require major surgery. The feet are manipulated and then plastered to be held in place. This is carried out over around 6 weeks with one small incision at the Achilles tendon to enable it to lengthen and a period of time in braces (a key aspect to the treatment) – resulting in successfully corrected feet in the majority of cases (96% internationally). LAMB was the first clinic to be set up in Bangladesh and, with limited resources and personnel, had 150 children on its books alone within 18 months. After the first year 1040 children had been treated nationally and, currently, over 6,000 feet have been fixed in over 35 clinics around the country. It has been a great success but there is still a long way to go to succeed in making sure no baby will have to grow up with unusable feet again. My wife, as well as doing the work here at LAMB, is also part of the team responsible for checking and auditing the work in these clinics and making sure training is given where needed to the national staff.
In Bangladesh, disability is a huge problem to the family unit. A child who cannot walk is a young boy who cannot work or a girl who cannot be married. This makes them a financial burden on the family and local community who often cannot afford to keep those that cannot contribute in any way. To give a child his or her feet back is, in a very real sense, to give them back their life. The title, Walk for Life, was perfectly chosen.
Adif’s feet could not be fixed. He was too old and corrective surgery would be likely to increase pain significantly and a knee replacement operation would have been far too expensive for his family ever to afford. They hoped a wheelchair might be possible for him. To give this, my wife needed to assess his ability to function. If function in his arms could be improved then a tricycle (a bike where pedals in the middle enable the pedalling to be done by a hand) could be a possibility. The assessment showed just how resourceful this young lad is. To write, he holds the pen in his hand and then puts a leg on the hand to hold it steady and move the arm! His writing is neat and accurate. Adif goes to school and sits on a high bench to write like this at a table. Remarkably, he has a fine mind and is keeping up in his class studies. He feeds himself by, again, gripping the spoon in his hand and then using his leg to push the arm up to his mouth.
Incredible to see but it became obvious he was never going to increase movement of his arms significantly. Not good for the use of a wheelchair. They tried him in it anyway and were astonished to see that, by using his body weight to push back and forth, Adif could get around in the chair. This remarkable young man was beating the odds stacked against him. He needs practice and exercise, but the wheelchair was his to take – assuming that the Poor fund committee agree he can. There is a limited fund at the hospital to pay for treatments for those that cannot afford it. With 5 million Bangladeshis in the catchment area for LAMB this resource has to be carefully managed. There is never enough. He left though, looking like a kid with a new bike, beaming from ear to ear.
The Rehab department deals with people like Adif daily. Even though he is too old to have his feet treated, just simple access to mobility eases burden on his family and increases the activity he can do in the community. Maybe even one day he could taking on simple work and earn a wage? Who knows? Inshallah, as they say here.
In part two, I will tell you about an equally remarkable young lady who I will call Lucky. She certainly was – in many ways.