Adventures in hand rehab – Cape Hand Clinic comes to the wild

A post by Kate Sherry - Occupational Therapist in Chief

More exciting news from the rehab department!

I don’t think I ever posted something entitled “They Knew We Were Nuts”, that I started writing in February. It was all about how 5 of us therapists from Zithulele and Madwaleni got up at 2h30 one morning to drive to George to attend a one-day course. Presented by Karin Weskamp, head of the Cape Hand Clinic (and remembered by UCT graduates for her totally-impossible-to-take-notes-from but fascinating lectures on private practice and human occupation), the course was on splinting hands with neuro conditions. Wired from no sleep and Vida coffee, we sat riveted for the day, shocked the ordentlike George OT tannies, and collared Karin afterwards to invite her to the Transkei.

Persistence coupled with Karin’s adventurous spirit paid off, and a few weeks back we were blown away to host not just Karin, but two OT friends and colleagues – Tammy Williams (hand therapist, ex-Uganda IDP camp worker and soon-to-be second-ever-OT-in-Ethiopia) and Ruth Watson (highly esteemed former prof of UCT OT and one of my heroes). What was initially planned as a Wild Coast holiday coupled with some hand therapy training and consulting became a 5-day adventure in rural rehab.

Between the three visitors, we were in the presence of a wealth of experience in practice, research, community work, and service development (not to mention Tammy’s expert Ugandan 4x4 skills and Karin’s budding potential as a bootlegger). As we trekked over the hills, hiking, crossing rivers on ferries (or not), driving up and down eroded cliffs and picnicking in the wind, discussion ranged from clinical problems and the patients we saw in their homes, to broader issues of rural disability, the challenges of poverty, the power of occupation and the privilege of being here.

After 2 days of home visits from a base at Bulungula backpackers (how many of your university professors would you invite to a place with compost toilets and psychedelic frogs painted on the walls? J ), we moved on to Hole in the Wall, where Karin and Tammy got into teaching mode and gave us an intense day of hand rehab lectures and skills practicals. What they brought could have kept us busy for weeks, but the taste was enough to reinspire us and get us thinking again – they will have to come back for the rest…

This whole trip was inspired partially by the Cape Hand Clinic’s vision for education, and by the conviction that private practitioners and rural therapists have much to offer each other. An incredible thing we’re finding about the OT profession is therapists’ willingness to share skills and ideas, and we have benefited so much from the generosity of not only these three visitors, but many others as well (notably Theresa Lorenzo, another UCT prof, who visited us in August and gave us a fantastic workshop on community-based rehabilitation). A huge thank you to all of these wonderful people, some of whom first inspired us at university, and now continue to do so in new ways. We hope we can contribute to the general sharing and growing going on in the rehab professions – and warmly invite any therapists with skills to share and an adventurous spirit to come and visit!

PS A special thanks to Karin’s friend Nigel, who arranged for them to borrow a Toyota Hilux 4x4 double cab – the dream rural rehab vehicle – from contacts in East London. We couldn’t have done it without him!

Super Volunteer

Our super volunteer, Becky Chappell (wife of one of our doctors, Simon), has been at Zithulele since January 2008. She is volunteering full time for the Jabulani Foundation and has been a complete blessing and allowed us to make amazing progress in so many areas. She is fast becoming an expert in the community structures around Zithulele and has made friends all over the area with her fun and positive approach and incredible work ethic. She thinks she is leaving at the end of the year…we have different plans, possibly involving tyre slashing!

Elijah Paul Gaunt – born 3rd August 2008

The latest addition to the Zithulele team is a new Gaunt. Welcome, Elijah!

Circle of Friends

A group of American ladies who call themselves ‘Circle of friends’ and get together regularly to make an assortment of beautiful quilts, dolls and teddies have now sent us 2 boxes of goodies. Each bed in our paeds ward has one of their patchwork quilts and plenty of our sick kiddies have gone home with their own toy (big smiles all round).


We have also managed to send quilts home with some of our maternity patients.

Zithulele Staff HIV Awareness Day – 12/08/2008

The Zithulele ARV programme has really grown in the last year, but we have been disappointed by how few of our staff have tested and sought help at the hospital. We have lost 3 staff members to HIV-related illnesses in the last year.

Last week we had a staff awareness day with a side splitting role-play by our ARV counsellors and a motivational talk by one of our doctors (Tindile Booi….see pic of lady in red) and some of the staff already on ARVs. It was encouraging to see a good turnout and quite a number of staff members testing on the day. We hope to repeat the occasion regularly from now on.

Team spirit

We talk a lot about how much we enjoy working as a close knit multidisciplinary team, but it is moments like this that are what a rural team is all about: (see multidisc team pic in theatre)

Dr Karl, Claire (Irish physio student), Karen (physio), Lulama (nurse) and a patient who needed a tendon repair.

Homes at last!

After almost 2yrs of living in a hospital ward for some of the longest-standing Zithulele professional staff and numerous shifted deadlines, it was with great jubilation that we finally moved into the brand new hospital accommodation on the 29^th of June. It was a weekend affair with much scrubbing, lugging and sorting of long-shared stuff but the feeling of ‘I-have-a-house-so-nothing-you-do-can-possibly-bother-me’ lasted well into the weeks that followed complete with silly grins as people settled back into having some personal space at last!

The units are small but well designed each with a stoep and braai area. We look out onto the neighbour’s mielie field complete with cows and sheep and beautiful hills and sea in the background. It is so wonderful to come home to one’s own space whilst having friendly neighbours close by if the need to socialise or borrow something arises.

We are so happy here. Visitors, you are welcome anytime!

Malamu-what??

Good news in the Transkei, people!! Last week, Malamulele Onward came to Zithulele. Or at least, to Madwaleni, hosted by the (increasingly influential, watch out for us) Zithulele-Madwaleni Rehab Coalition.

Malamu-what?

An NGO run by physios and OT’s who are specialists in working with kids with cerebral palsy (CP), which began its work in Malamulele, Limpopo – hence the name. The concept involves taking a team of volunteer therapists, all NDT-trained (NDT = neurodevelopmental therapy), to a rural area, to provide intensive therapy for local kids with CP for a week. The idea is to work together with existing services, like ours, so that the families can be followed up and supported by local therapists (who are generally not exactly experts – and CP is hard). The team continues to visit every 6 months or so follow up for the next 2 years.

It looks a lot like a circus actually, when it happens. We took over the church at Madwaleni hospital, and in the hall set up 8 therapy areas, a play and practice area, a workshop area and a waiting area. The therapists arrived in a convoy, laden with colourful blocks, wedges, standing frames, chairs, bikes, tinsel, jelly, cheap Chinese toys that flash lights and play inappropriate songs, plastic farm animals, balls, cars, power tools, tins of glue and paint and rolls of foam rubber, and every other imaginable piece of paraphernalia needed to change the lives of 32 kids and their moms in a week.
Everything is either a donation or bought with funds raised by Gillian Saloojee, the (powerhouse) ringleader, and almost everything either goes home with the kids or is given to the local therapy services. Total Christmas.

From Monday to Friday, each kid gets at least an hour of therapy (physio, OT and speech) per day, and by the end of the week, their moms/grannies have been trained in a basic therapy program for home, as well as how to use all their new furniture. They even get a laminated set of photos as a reminder.

There’s no magic for kids with CP, but there were some serious miracles in this week. A child who never spoke before started talking. Some who have never done more than lie on a bed in the back of a hut, started sitting up and actually seeing the world. Kids learnt that they could feed themselves, and a few took their first steps. Moms who never believed their kids would ever be able to do more than cry and be carried saw them as “normal” kids for the first time.

We’re all too used to seeing our patients get “second best”, but in this week we experienced what it was like to work with a dynamic team of specialists, who made sure 32 of our kids got the ultimate treatment. It was a huge privilege and an amazing learning experience, and we are more than grateful to Gillian and her team for making it happen. Here’s to the next one!

Zithulele in the South African Medical Journal

It's not a scientific article - those will come in time - but we were profiled in the January 2008 SAMJ. If you have a fast link, check it out at http://www.samj.org.za/index.php/samj/article/viewFile/860/399 (the download is about 5.6MB)



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IT’S A HARD LIFE

Couldn’t resist sharing this after-work pic taken a few weeks ago. Such are the joys of working rurally with friends. It was a gorgeous sunset, so we enjoyed it (and the green rolling hills with sea in the background) eating mussels on crackers, while our city friends were sitting in traffic.

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Team Conference

We started 2008 by setting aside a weekend to strategise and set some goals for the year. Sometimes the challenges are so big we’re not sure where to start, but at least now we know where we want to end! We’ve got exciting plans for HIV, management clinics for malnutrition follow-up, hypertension, epilepsy and diabetes, we learnt more about occupational therapy and spent time discussing the Jabulani Rural Health Foundation and how to link in with it. We also had some great meals and conversation.

Picture (L-R): Back: Ben & Taryn Gaunt, Shannon Morgan, Karl le Roux, Simon Chappell, Riana Dippenaar, Becky Chappell.

Front: Kate Sherry, Sally le Roux, Honey

So long,farewell

After a really good year, December was a month of many goodbyes. First to go were Ali (our com service dentist) and Mich (our com service OT). Those of us left behind for Christmas enjoyed yet another excellent Jamie roast and then the Beach Bums (Jamie, Lyndall, Brad, Sam & Jules) departed in dribs and drabs on their various exciting adventures around the world.

Top left to bottom right -
Sam (dr); Jules (computer programmer); Brad (dr); Jamie (dr); Lyndall (physio)

Mich (OT)

Our community service colleagues have been out of the top drawer this year: hard working, competent, reliable and a whole lot of fun. We are going to miss them loads. Thanks for a good year, you lot. God bless for what lies ahead and feel free to come back any time!

Christmas Party - 29/11/07

Our annual Christmas party was held in November to avoid the big leave rush. The theme was ‘Smart with a twist’ which basically meant everyone came dressed in whatever they wanted! Jamie (Shelly, not Oliver) whipped up roast chicken with rosemary and lemon stuffing and everyone else contributed something to the feast (even Brad made a salad!). The evening was very festive with much banter, particularly around the Annual Zithulele Z’Oscars. One of the more noteworthy awards being: Karl, for the most-likely-to-breastfeed-if-he-could. We also had a great round of Dirty Santa (the game where everyone brings a present & each person gets to pick one; either wrapped or that someone else has unwrapped). The Christmas present bartering went on late into the night, with Brad desperately trying to get rid of his ‘Girl band hits’ CD.

Can you drink this?

I arrived in South Africa at the end of August to start a 4 month Public Health seminar based out of Durban. The program is run through an American university called the School for International Training. The school is based on experiential learning with an international experience. I am currently in my last year of undergraduate work at the University of Puget Sound (near Seattle Washington) studying Biology on a pre-health track.

After 2 months of lectures, homestays and field experience in Durban, we were able to design a study project to conduct over a month long period. Several of the lectures were focused on rural medicine and the public health sector. We were also taught about the consequences of sanitation, hygiene and water quality and their importance in the community. One of the Millennium Development goals, set by UNICEF, was to decrease child mortality by 2/3 by the year 2015. One of the major contributors to child mortality is poor water quality combined with sanitation as well as hygiene. About 1.7 million children under the age of five, die annually due to complications caused by diarrhoeal diseases. Of that number, 88% are attributed to unsafe water supply, inadequate sanitation and hygiene. South Africa has pledged to provide safe water to all by 2008 and adequate sanitation by 2010.

I had done a water quality study in Tanzania in 2006 and wanted to continue with the theme but I wanted to conduct the study in a rural environment where these issues are known to be a major problem. A study done recently at Zithulele Hospital found that only 20% of the population had access to piped water sources. The region is one of the poorest in the country. The unemployment rate is 77% and only 9% of the population has access to electricity. A non-profit Foundation, the Jabulani Rural Health Foundation, has recently been established to assist with development work in the community. Their emphasis is on health related interventions.

The first part of my project involved interviewing the mothers who came into Zithulele. I focused on the women in the Paediatric ward with their children, but also interviewed several from the outpatients department (OPD). With the help of a translator I asked them several questions about their water collection, feeding habits and sanitation issues. Based on the interviews, I was able to gain a greater knowledge of the issues at hand in the community. I found that out of the 80 women I interviewed, only 29% of them had access to a toilet facility and 71% were forced to use the forests. In the past, using the forest as a toilet, was not a major issue because the pigs would clean up the human faeces. However, because of a swine fever outbreak in 2005/6, the forests are left contaminated and the rain sweeps everything into the rivers and streams which is where 81% of the women interviewed go to collect their water.

Almost two thirds of the women said that the water that was collected was not clean and therefore unsafe to drink. Nevertheless, seventy-two percent of mothers do not boil their water or use any filtration methods. It seems that education would play a key role in decreasing child mortality in this area. It is possible that the mothers are not aware of the consequences that correlate to feeding their children water contaminated with bacteria. Another contributing factor may be the economic cost of fuel or time collecting wood.

I was also able to test the water of 17 different sites around Zithulele. I tested the two major rivers, several different tributaries, communal taps put in by the government, rain barrels, a pond, and two different sources in the hospital. Only two sources were fit for human consumption according to WHO standards. Both were treated by the hospital. The rivers were both contaminated with possible E.coli and total coliform levels that made the water unfit to drink. Both of the rain barrels tested had high levels of coliforms but only one of them had suspected E.coli. Of the five different communal taps, 3 of them had evidence of E.coli. The only tap that proved to be safe for human consumption was on the grounds of the church near the hospital. The church founded the hospital, thus this tap is supplied by treated water from the hospital. The Paediatric ward in the hospital is also okay to drink in terms of the microbiological aspects.

The Foundation hopes to develop an intervention to help the community access safe water. A cornerstone of this will be education; the community can learn about the dangers of contaminated water as well as the importance of basic sanitation. The simple process of washing your hands with soap has been shown to decrease diarrhoeal diseases in children, by 45%!

By Emily Clasen

Katie & Alice

Katie & Alice were our first ever volunteer nurses at Zithulele. They arrived from the UK in September and spent 3 months helping out, mostly in outpatients. It was a real challenge for them, coming from the first world and being confronted head on by the many challenges of rural medicine, but they got properly stuck in and managed to get lots of good stuff going in such a short time. It was really valuable to get their input and we enjoyed their unstoppable enthusiasm and wonderful sense of fun…Thanks you two. It was luffly having you! Please send us more nurses.