Helen Hyams’ Work in Ghana Back in 2015 with retirement looming I approached the Beverley based charity Jacob’s Well Appeal (JWA) about the possibility of using my skills as a Paediatric Physiotherapist on one of their projects abroad. A few months passed and then I heard from JWA that they had found through Sandra, their Project Worker, that there was an opportunity to volunteer at Tamale Teaching Hospital in Northern Ghana, to work alongside one of their Physiotherapists as I had experience of working with cerebral palsy patients. So, after various injections against yellow fever, rabies and other diseases, malaria prevention tablets, and getting my visa I was on my way to Ghana in October. My husband Steve drove me to Heathrow and I then flew to Accra, the capital city of Ghana. Sandra was at the airport to meet me. After an overnight stay in a guest house I went with Sandra to oversee the delivery of a JWA container to Ridge Hospital in Accra. We then took an internal flight to Tamale. My first night in the hospital guest house was a real eye opener, bed sheets were not supplied! Luckily I had packed a sheet sleeping bag. I also found the cooker had an empty gas cylinder so no hot food either. Then the water supply ran out. After three days I was moved temporarily into a small two star hotel until the conditions at the hospital accommodation improved, but remained in the hotel for the rest of my stay. On my first day Sandra introduced me to the Physio Department. Tamale is the largest city in Northern Ghana and has its own medical school and nursing college. Physiotherapy and more recently Occupational Therapy are degree courses at Accra University. Physiotherapy is a fairly recent profession in Ghana so many Heads of Departments are only in their thirties. I was surprised by how large the Department was. There were heat machines, traction bed, wax bath, parallel bars and static bars. I felt I had stepped back twenty years! Equipment such as crutches, sticks and walking frames had to be purchased by the patients themselves. The Children’s area was just at the end of the adult treatment area and consisted of two gym mats on the terrazzo concrete floor, and a small cardboard box containing a few rattles and picture books. I had taken some toys with me, mainly Fisher Price type stacking rings, shape sorters and rattles. These were a welcome addition. My main task was to work alongside Esther, a qualified Physiotherapist and show her how we use the toys in the UK to encourage increased function in the children. Ghanaian children have very few toys at home so the opportunity to play can act as an incentive to engage in active treatment, rather than the passive treatment which is more often used. Mothers are keen to bring their children for physiotherapy, fortunately in Tamale many are diagnosed with cerebral palsy at a young age so treatment can begin early. There is a lack of children’s mobility aids, standing frames and supportive seating, which we take for granted in the UK. Many severely disabled children spend a lot of time lying on settees or beds to stay safe and so have no sitting balance. On my return to the UK I contacted a Physio called Diane whom I had met previously at an “ADAPT” conference (Chartered Physiotherapists in International Health and Development). Diane had already taught an APT (Appropriate Paper based Technology) Course, in conjunction with the Cerebral Palsy Africa charity, for parents in Ghana. I enrolled on a one week APT course in Hampshire and learnt to make standing frames from cardboard and newspaper. We arranged to go out to Ghana in February 2017 and I visited Tamale in September 2016 to begin organising and informing people about the forthcoming course. Unfortunately, Diane was unable to come to Ghana in February, but arranged for Marian, a Dutch Occupational Therapist who has taught several APT courses in Africa and other places for Cerebral Palsy Africa, to come with me to Tamale. Marian and I set off for Tamale on 23rd February 2017 to run our first two-week course. Jacob’s Well volunteer Liz Lyle came with us as a helper. February 2017 Despite an extra day at Manchester Airport due to Storm Doris we made it to Tamale just 24 hours late. Marian had been on the last plane leaving Amsterdam so had stayed in Accra, thanks to Mandy Budge of Multikids School who also re-arranged our internal flights. The delay meant we had only a half a day to set up the course venue in the Physiotherapy Department at Tamale Teaching Hospital, visit the local market for essentials such as plastic bowls and wheat flour to make the paste and travel to the homes of two of our potential patients to assess their needs. Esther and a friendly taxi driver came with us to help with introductions and the language barrier. On the Monday morning we arrived at the Department at 8am and were in business by 9am meeting our course participants. They were from a wide range of backgrounds including nurses, a medical student, physio staff and Occupational Therapists, an art teacher and student from the King’s Village School, a Pastor, his wife and six week old baby, and a couple of mums. The CPA course to make chairs lasts for two weeks, but due to the Independence Day bank holiday one of the sessions was held on Saturday and we had a day off on Monday to watch the parade. Four chairs were made, one by each group of course students. On the last Friday afternoon (one of the hottest at 48°C) there was a grand presentation ceremony when the hospital Directors and Administrators, some in their best traditional robes, presented certificates to our course participants. The completed decorated practice stools and the chairs were on display. The hospital is happy to support the participants, now known as the Tamale APT group in continuing to provide chairs for more children. October 2017 In October Liz and I went to Tamale again to run the second part of the course with the group learning how to make standing frames for the children. This time CPA are sent two Physios, Diane Lyle (not related to Liz) and Diana Jackson. Diane and I reviewed six children (exhausting in 38°C heat and 89% humidity), four of which received frames made by the course participants, which will help them with developing control of their head and upper body. A high point was when Mandi and his Mum called in to the Physio Department to show us the fantastic progress he had made since receiving his chair in February. The course ran from Monday to Saturday, long days from 8am to 6pm, sometimes without power for the electric kettles needed for glue making, it was a long trek to the children’s ward in the main block which had a generator. Four children received custom made standing frames at the end of the course. Since the end of the first course three more children have had supportive chairs made for them by the group. Then it was time for the CPA Physios to head for Bolgatanga where they were going to catch up with the APT workshop at Sandema and visit Bongu on the Burkina Faso border. Liz and I went to stay at the King’s Village at Botanga about an hour’s journey from Tamale, where we had a busy three days. Monday was spent at the Medical Centre, a small hospital in the process of extending. I was called to the Emergency Ward to give Physiotherapy to an unconscious 3 year old being treated for cerebral malaria to try and reduce some of his spasticity. I spent time explaining to Mum, with a nurse interpreting, how to continue regular exercises. We later heard he was discharged home as his malaria had not responded to treatment. Many patients presented too late for treatment to be effective. Often local herbalists will have offered treatment first and patients and their families only seek medical treatment if they deteriorate and can access funds and transport to reach hospital. Tuesday brought a visit to Kapahli, a distant village, two hours bouncing in the pick up truck along rough tracks with the Nutrition Officer, Kristal, and John, King’s Village project workers, to allow me to see Musa, a tiny six year old boy with CP, club feet and malnutrition. He received one of the car seats sent out in the container that left Beverley in January. This had been tied into a wheelchair allowing his brothers to push him to school. I showed his father how to do exercises to move and strengthen his limbs. I then reviewed another child and a remarkable older lady with a cleft palate who had been disabled for many years, probably due to polio, who happily demonstrated to us how she could get in and out of her ancient hand propelled wheelchair. We measured it up for new cushions which John will have made up at King’s Village. Our next stop was a sit down in the recently opened Ghana Health Service primary healthcare clinic where the nurse, administrator/helper, patients and drugs were all cooking in the heat from the tin roof. We used some of the money given to us by the Soroptimists to arrange for John and Kristal to buy a freestanding electric fan to take there on their next visit. John then visited a mother who had refused further antibiotics and dressings for her infected finger and found that she had had a change of mind, the finger was healing and no longer in danger of needing amputation. Wednesday was a health education day for the children at King’s Village School. I gave talks about disability and inclusion to four groups from the smallest ones, who sang beautifully to us, up to the seniors aged 15. Liz repeated the disease prevention and public health messages as despite access to clean water, many of the health problems are linked to poor hygiene and not sleeping under mosquito nets. Some of the children had old untreated injuries and disabilities no longer seen in the UK. I saw two more patients before we left both of whom would have had fewer problems if prompt medical treatment and physiotherapy had been available. A farmer initially treated by a healer had nearly lost his arm to an infection, now after prolonged hospital treatment he was on the mend. I showed him some muscle strengthening exercises. Another man had made a good recovery from a stroke but had totally lost his speech. There are only seven Speech Therapists in Ghana, all in Accra. On Thursday it was time to fly back to Accra with the CPA Physiotherapists and renew links with Multikids Inclusive Academy, a very progressive private school for disabled children with Physiotherapists, Occupational Therapists and 3 Speech Therapists as well as Specialist Teachers, a whole different world away from Northern Ghana. We also visited the Physiotherapy Department at Korle Bu Teaching Hospital and met with three of the ladies who run the APT workshop there located in two shipping containers. There is the possibility of starting a second APT group in Accra at Multikids in Spring 2018. We were able to attend Sandra’s funeral held in the Central Region, three hours journey from Accra. It was a traditional Ghanaian Pentecostal funeral attended by members of her family and a lot of her friends. Some of the ladies from Wa in the Upper West Region had travelled for fifteen hours in a minibus. Pastor Ben from King’s Village, who knew Sandra, assisted in the service and conducted the burial. Sandra’s life and many achievements in Ghana were celebrated with joy. 2018 This year in September Liz and I are visiting Tamale Teaching Hospital again, to offer support with treating cerebral palsy to the Physiotherapist who has replaced Esther, catch up with the APT group and then travel up to the Regional Hospital at Wa in the Upper West Region. The plan is to see if they would like to start an APT group to make supportive seating and standing frames for the children with cerebral palsy that they are treating. Then we can make the arrangements for an APT course to run in early 2019. Hopefully on our return to Tamale there will also be time for us to visit the King’s Village.