Two Nations: One Large, One Small

by Martin Nafukho, Occupational Therapist

Mumias Educational Assessment Resource Center

One day, Bea Staley, my close friend and workmate for the last four to five years out of the blue simply said "Martin, can you come to the United States next November for the American Speech and Hearing Association convention?" My immediate and instinctual answer was "no." 

Back in 1998 after writing an abstract and being accepted to present at the World Federation of Occupational Therapists conference in Canada, the roadblocks I met in trying to get approval to attend, then the support for air fare and accommodation were many and steadfast. Back then I could not even get a passport as I did not have money to bribe someone to get it fast. They were the days when getting a visa for nations like America or Canada meant living on the precincts of the embassy, lining up every dawn for interviews that never seemed to yield fruit. This was back when only Nairobi managed to offer fax services at exorbitant prices and I recall spending 3 quarters of my 3400 ksh salary just trying to fax my abstract to the conference organizers! When Bea mentioned a US trip, my initial reaction was a chill through my spine, and thus my immediate "no."

I had ultimately ended up in the office of my chief occupational therapist who said, "son you will never get support for that kind of thing. How can we send you to a professional conference when here in Kenya we do not even  have Malaria medicine in local dispensary?" Beaten, I shelved my abstract rightly named 'Tackling the Global Handicap' that had earned a 15 minute scientific slot with  the programme organizers, as it dawned on me that the need of that Kenyan handicap was perhaps much larger than the Global handicap I anticipated to show the way of tackling.

So it is 2012, and it has been 10 years since the conference abstract debacle, where I had returned from Nairobi with a fresh determination and concentration for Tackling the raw Kenyan Handicap at home. In those years since Kenya has changed drastically in many many ways. Technology for one, the ability to connect for another. We are no longer as isolated or as far away as our small town had seemed a decade ago. 

In these past years, I have been working along side volunteers from other nations with a variety of skills and calling. The Speech Language Therapy professionals of late have become my closest allies and friends and together we have formed a team with visiting volunteers from Australia, England and the United States helping to develop our protocols. Training assessment teachers and the community in Mumias, Western Kenya we have managed to make progress in the identification and treatment of children with communication disorders. We have built this community focus making it possible for many young children who were born with disability to receive assessments. We have also counselled, established school programmes and shared lots of key health information.

In a society where disability has been a secondary thought, where prioritizing the well being of children with disabilities due to stigmas is difficult, we started by supporting surgeries for children with cleft lip and clubfoot. This was done by encouraging  individual sponsorship both in Kenya and abroad, which could be as little as $10 for fare to reach a surgical camp at Nyabondo or as much as $150 to pay basic hospital hospitalization for a week. As people were able to see significant changes in specific children for the better only then did they start to have hope and believe that their disabled children had finally found a place to be and receive rehabilitation.

This kind of seeing is believing is good but as a professional occupational therapist, to still have to try and convince my community of hidden disabilities like sensory awareness is an ongoing battle. The inability for many children to survive independently in  a society where it has been normal to rely on relatives for activities of daily living puts them at risk for poverty, abuse and neglect. Often small children are hidden or sheltered so  one would never know a child had serious social, communication and/or physical needs as long as they stayed home among relations. The day they go to school however, and the teacher notices that child is not communicative, cannot go to the toilet independently then the concerns arise. Often when the child’s hidden disabilities are revealed, the child is too old and it can be too late to effectively intervene. The precious and critical early years when the language centers are malleable and stimulable have long passed. 

Have transgressed much from my theme, in which intended to show what are my learnings after visiting the USA by the support of my friend Bea Staley, Chris Merkley, Lauren Bienek and Joanne Fry, let me return to my initial point. The trip  that seemed the unattainable dreaming of a rural OT back in 1998, became real in 2012 and here I was in one of America's largest universities with a student population of 80,000. Here I was, poor me, armed with long years of experience of struggle to influence my community to see that a child's development must be shaped in the formative years of life and these formative years require the participation of the whole family if not whole community.

With the input of a friend on the early development of human life, these musings formed our presentation (with Bea) at Columbus convention Center…and of course the reason that made it so easy for me to seek permission from my government and employer and was given, because as it turned out the Malaria  problem of the late 90’S and early 2000s has left big scars, worrying scars of about 5 percent of Kenyan children with disabilities warranting the need for recognition for rehabilitation professionals.

To be continued... 

  

This October Martin Nafukho joined us in the United States for three weeks of conference talks, visits to organizations that work with children with disabilities and workshops. We will post a reflection from Martin soon. Meanwhile, his talk for the American Speech, Language & Hearing annual convention can be found at http://www.youtube.com/watch?v=8SlO_XD2kvQ&feature=plcp. 

Dear Yellow House,

RE: MY TRIP TO THE UNITED STATES OF AMERICA-ATTENDING A CONVENTION ON CRITICAL LEARNING INITIATIVES & COMMUNITY ENGAGEMENT 1^ST – 21^ST OCTOBER, 2012

I am grateful for your support that enabled me to travel for the above conference at Ohio State University in Columbus (USA).

I appreciate Yellow house children’s organization and friends for making my stay in USA very comfortable. I had a chance to share Kenyan experience in rehabilitation to Occupational Therapy, Speech & language therapy students and their faculty members courtesy of student organizations at OSU. Professors Michelle Bourgeois and Howard Goldstein threw a social dinner for  a few of us participants at her house giving all of us a further opportunity to build networks and share both academic and cultural niceties across the world. Valerie Kinloch, Director of Service Learning Grant at Ohio State University threw a wonderful cocktail party that meant I was able to meet many learned people from a wide variety of disciplines. There are great things we all can learn from each other and I am happy to have been accorded this chance to represent the people of Kenya in this conference.

The High lights of my trip culminated in presentation of a paper on 19^th October, 2012 “Obulala na amani”, [unity is strength], showing how to engage and work with service consumers in order to initiate long term solutions to their needs.

In the opening key note address, Professor Dan Butin, Founding Dean of School of Education at Mermick College and Executive Director, Centre for engaged democracy summed up this way paraphrase. - “If the people we serve don’t realize measurable gains, then probably we did not serve them”. This means we need to constantly have innovative approaches to engage service learners/consumers.

Dr. Cornel West the guest speaker on 19^th October 2012 re-echoed his motto throughout his speech “you can’t save people if you don’t serve the people”.

In Erie, Pennsylvania I had a rare chance of meeting with disaster response team in the city who was training primary school pupils in fire detection, evacuation in case of emergency and first aid drills. The unique thing is emergency preparedness teams are run by volunteer health workers and police with support from local community and government.

I also had an opportunity to visit United Cerebral Palsy (UCP) of greater Cleveland where a program initiated by parents in 1950s has grown and is now one of the two major programs in Ohio state serving people with cerebral palsy in Children’s development services, Adult vocational services and assistive technology provided at various levels with research support & very engaged teams have greatly reduced the effects of C.P in mobility& independence limitations among the C.P population of Cleveland.

In the 2^nd week I visited Adena Health Services sites and got opportunity to spend 26 hrs with rehabilitation team of various specialties, pediatric physiotherapist, speech therapist, trauma therapists and Occupational hand therapist. Here I got new skills of critical neurological, orthopedic, traumatic & congenital disorders team assessments and planning for management leading to a smooth health, social and industrial placement based on clearly realized rehabilitation programs.

It did not escape my sight to notice the level of consciousness the American people have in waste disposal, emergency preparedness, safety measures in homes, roads, and the importance of good health promotion information prominently displayed for caution, warning or instruction.

I learned that a law written on a man’s heart is better than a caution pasted on a man’s face.

Yours Faithfully,

Martin W. Nafukho

Interesting read:

http://africasacountry.com/2012/11/08/how-to-write-about-children-in-africa/

For more information.. see these short videos

Speech Language Pathology in Kenya

Speech & Language Therapy in Uganda

Yellow House

A volunteer's reflection by Isis Cooper

I loved everything about my time in Mumias. It's a beautiful rural town full of wonderful people. It may be a lot quieter than places like Kisumu and Nairobi, but that's all part of Mumias' charm - quiet but not uneventful! I didn't bring enough books - but was able to buy some from the local bookshop (ones that were on the secondary school curriculum!) or swap with others. There are plenty of places to visit at the weekend, like Kakamega and Kisimu. 

The Mumias EARC is the embodiment of a community. The EARC welcomes everyone - children, parents, families, volunteers, and other professionals. Working with the team at the EARC was inspiring. The staff really work tirelessly to provide a good service to the region. Martin Nafukho, in particular, is such a wonderful OT and amazing person. People like Martin are rare, and I feel very lucky to know him and to have had the opportunity to work with him. 

My days involved seeing children at the clinic, visiting schools in the region (Mumias/Butere) and providing training for teachers/parents. Trainings included language stimulation, using visuals in the classroom, supporting children with ASD (including PECS). I also provided some training to the staff at the EARC in basic assessment and therapy for children in a variety of areas. The caseload was varied - you never knew who was going to come in the door in the morning, which meant that working at the EARC was never boring. The children I saw had CP, language delays, ASD, learning disabilities, language difficulties post malaria/meningitis, and hearing impairment. I also spent some time at the Butere EARC with John, the Co-ordinator there. I ran a training afternoon for staff at the Butere hospital near the end of my time there, and I wish I had made the contacts with the staff there sooner; it would have been great to do some more work in the hospital. There are so many areas of need that it was hard to narrow my focus down, but I think working with schools and children and their families was the best use of my skill and current knowledge/experience. 

I stayed at St. Angela's Secondary School. My house was in the middle of the compound, and being surrounded by students all the time made sure I didn't feel too lonely! Because I was a heavy sleeper their 5am rising time didn't bother me. It's something a light sleeper would have to consider!! I loved having my own space, particularly to cook my own meals (especially since I'm a veggie), which was something that isn't really available at St. Mary's Guest House. Halfway through my stay the running water stopped, which I didn't mind. There's something satisfying in using water that's taken some effort to get - and it was a good daily workout. Aiyuma at St. Angela's was so lovely and really helped me with getting settled there. It was unbeliavably reasonably priced too - 4000KSh a month. 

Of course it wasn't all a walk in the park. It was tough, especially at the beginning. Some of of the difficulties children and their families have are heartbreaking. But, they face these challenges so admirably. I knew there were things that I could help them with that would make their lives a little easier, and that's what I tried to focus on. 

When I look back at my time in Mumias, I realize it was much too short. If I could, I would have liked to stay for much longer. It wasn't an option for me at the time but it is something I would like to do in the future. I hope that my time there made a bit of a difference. 

I would recommend that future volunteers allow a little extra time to travel around the country a bit. Kenya is so diverse. 

Surgeries in Nairobi, July 25-Aug 4, 2012

FYI: Coptic Hospital in Nairobi, Kenya is offering surgeries between 25th July 2012 - 4th August 201 due to the arrival of consultant surgeons from the United States of America. The Consultant surgeons will perform *General,eye, Obstetric and Gynecology surgeries.

Among the surgeries that will be performed by the surgeons are:

Obstetrics and Gynaecology Surgeries
Both Laparoscopic and Open Surgeries

- Cancer and Advanced Cancer Cases
- Hysterectomy and Myomectomy
- Ovarian Diseases

Eye Surgeries

- Comprehensive Eye Check-up
- Cataract Surgery
- Glaucoma Surgery among others

General Surgeries
Both Laparoscopic and Open Surgeries

- Gall bladder stones
- Appendicectomy
- Hernias
- Gastric & Abdomino-pelvic operations
- Thyroidectomy
- Mastectomy

The consultations fee is Kshs.1200. There will be no surgeon fee charged for all the surgeries that will be performed. Booking and Screening is ongoing. Please refer any families that might be appropriate... For more information and Booking, contact 0735 408 903, 0739 642 699 or 0735 558 862

(thanks Lynne Masaki for spreading the word)

Moving...

I am in the midst of moving. It is a task filled with mixed emotions. Moves always mark a change and this move too starts something new, leaves something behind. In packing, I find myself unearthing all kinds of wonderful things that are symbols of past adventures, past loves and past stories. Many of these objects representing other times must go. I sometimes feel swallowed by the heady memories and need space in life for the future possibilities.

As the days gather between now and my years in Kenya I wish to get back there. Not physically in any sense, but to be back in that emotional place where my experiences seemed ripe and fresh, my friendships delectable and work only one thin slice of my life.
   

A time in the life of a Yellow House Speech Therapist

By David Rochus

It does not work nicely unless there is a child or parent seen or talked to.

Its remoteness is one thing, but the naivety of its people about speech, language, and communication difficulties makes it an undeniably a fresh ground to break. Yes, I'm talking about Western Kenya.

I am one of those early risers who seem to forget too quickly the sweetness in that last morning snooze; by about six am I'm up, 50 minutes after, I am good to go! This has nothing to do with my bed or home, situated in a safe haven which I love calling 'The Compound'. Enclosed by a fence of both chain link and vegetation with one way in and out secured 'geti mbili' as the locals branded it, which literally means “two gates” in Swahili and which simply means that I don't have to tell a pikipiki (motor bike used for public transportation like a taxi) rider hired from Majengo (a 3 minute ride to my house in Vihiga) where the house is.

The compound comprises of eight houses including the mother of all, a tiled mansion. Of the advice doctors give, there is one thing I try to keep to each morning: get a good breakfast and this usually means a bowl of oatmeal with nuts, a pinch of cinnamon, the occasional banana and sometimes even ginger. Fair enough for a guy who wants nothing to do with cooking and eating, I’m still working on food preparation skills though.

Normally work begins at 9 am at the Vihiga Education Assessment Resource Centre (EARC) where I asses children who otherwise come in for school placement or via community referrals. The ones specifically referred to me usually come by way of the volunteer community workers, schools or Vihiga District Hospital Occupational Therapists.  It is here that all my administration work is done usually in between schedules or on Fridays.

Not all days with the EARC are the same. Some days feel like expeditions between a school or a home to see a child, distances which stretch out to other districts like Hamisi. Other days are spent in hospital working along side others or doing trainings.

 My work varies and it spreads out nicely to cover almost all areas that a Speech Therapist is trained in, not to mention those you may have dreaded. Monday is set to work with schools, working with teachers and it is then that I may schedule another day of follow up; most of the times a Thursday later that same week when I will see specific children for individualised therapy. This is only if time permits. Often times, things come up at the EARC and those activities need to be slotted into the week's programme making those return mid week visits impossible.

If I'm talking about a normal Monday, once started, time flashes by like a 'shooting star'. It's ended in planning for the next busy day - Tuesday, code named 'CP Clinic' but actually we see all children regardless of their underlying conditions. The nice thing about this day is, we get to having a multidisciplinary team or as close to it as seen in Western Kenya. On the team there are always two Speech Therapists (myself included; both courtesy of Yellow House), an Occupational Therapist (again courtesy of Yellow House), an assessment teacher, and of course a parent - on a few occasions, we are honoured with the company of a father but normally it's a mother or grandmother. We also plan for a cup of uji (porridge) for the children and here I extend an invitation to you who is reading this just for one purpose which I present as a challenge; I dare you to come on a Tuesday and finish a full cup of the uji! I've never been able to even do a quarter! Hint: citrus.

I'll admit my work comes in an all-in-one package. In it I get to work the mental faculties - really work them! Both in the clinical aspects of my job, and in learning Swahili. My physical capabilities are not left out including balancing on a speedy pikipiki (motor bike) while on very rocky, steep inner roads, and bravely supporting the weight of a well sized, adult woman by the knee ends in a matatu (public service van/taxi) carrying 26 passengers instead of the licensed 14.

The seasons also have their take on influencing how I work! When the rains start, they impose a kind of curfew on when my day should end and the extent of my work travels especially because I use a pikipiki or walk. Some roads become uncomfortably slippery and impassable being boggy with mud. At the end of the day, I meet up with a colleague to catch up on the frowns and smiles of that day; once in a while we have a drink in Guji, our local bar or have a chat with the friends generated over the time.

In my routine I work, meet, and mix with a variety of people many of whom are amazing and courteous; from District Education Officers (DEO) and their under staff, hospital heads, brave parents struggling to fend for their loved ones to children to whom, simply, disability just won't take their brilliant smiles away. It is the impact, (tiny or huge), that I have witnessed in giving an undisturbed and unrushed minute to a child who has been ignored for years that the opening line to this article was inspired "It does not work nicely unless there is a child or parent seen or talked to".

Here service becomes less of a duty and more of a sweet passion that changes ones perspective of life and livelihood for the rest of their life.

Although the Yellow House website (www.yellowhousechildrens.org) has become our main place for posting information online; informal thinking and reading and writing about issues of disability and Kenya and children and access continues. I have posted 2 recent "journal type" narratives written by Martin Nafukho, my wonderful colleague in Mumias. Martin's writing shed light onto the local issues of service provision in the disability sector. Beyond the rhetoric of large non for profit organizations, Martin's writings allow readers a glimpse into the complexities, frustrations and joys of work on the ground when resources are limited and local attitudes, fear and lack of awareness about disability set the tone for the lives of many of these children.

I thought I was strong! Not anymore
Martin Nafukho

Friday 13th April 2012.

It has been another happy week, and lots good things have happened ! Another occupational therapy student from Australia has joined our team on Placement. She got the nudge to come after reading an article by a peer that visited in 2009. The article spoke of an enriching experience of practice where you have to think outside the box to solve a myriad problems of health care provision in Kenya.

The week truly reflected the sentiment of Easter: renewed faith. The student is here and the rains have come to chase away the drought that seemed to extend beyond the time. The student was accompanied by her mother, a nurse specializing in epilepsy and movement disorders, added new impetus to our efforts of serving children with disabilities. Because of a looming airport strike the student’s mother had to cut short her stay to two days , but as a result of the limited time with us she offered to sponsor a child with a club foot, while her friend back in Australia committed to support a child Evan, who has had difficult raising boarding fee for basic primary education because the nearest school from which he could access free education had refused to accept him because of his lack of functional arms. Another burden carried off the shoulder of EARC and a poor father by a Yellow house friend.

The parent support group that has been making beaded products were also left smiling all the way to the bank as payment was received for the necklaces they recently completed. So far the group boasts sales of $900 after its inception just less than 5 months ago, not bad when you consider that many of these families still live on less that $1 a day, making payment for medical services and therapy for their special needs children near impossible.

Another surprise of Easter – we have finally managed to get 18 refurbished lap tops and the necessary accessories to Kenya. Unfortunately, they remain with FedEx as we look for the funds to pay the import taxes.

Fast forward to today and here we have Sylvia, the little angel who has been in Australia recently for extensive surgery for severe burn contractures which are the result of an accident she had 7 years ago. While she was recuperating she had been given this wonderful wheel chair she has not used since she came back as she has been using an artificial leg to get around. Sylvia and her family have known Ladin who has muscular dystrophy and also comes for therapy at the EARC and has been in progressive decline of function since 2008. Ladin is the first born of his teenage mother and despite all the efforts this young mother has been making to see doctors and come for therapy, there has been this fear and inability in all who care for him about his outcome of treatment.

Though Sylvia is not so well beyond wheel chair use as she is still in recovery stage, Sylvia’s family have decided to ease the pain and the struggle they have seen Ladin go through while he tries to get from one place to another and have donated Sylvia’s wheelchair to him.
The struggle to get around has been overwhelming Ladin. He first started to walk on tip toes, falling frequently. When he sought initial help someone thought he had convulsions and put him on anti epileptic medications! He sought another opinion and was put on ‘heat therapy’ twice a week for his weakening limbs. After the recent elections, the bus fares shot up and Ladin gave up the journeys to the general hospital and came to the Education Assessment Resource Center (EARC) in Mumias.

It turns out that we have become the place of last hope, due to the kind of empathy and unlimited support that children tend to be given by staff and volunteers that have been constant since 2009. At the EARC we were able to make a toilet seat for Ladin and another small seat he could use while playing as it had become apparent that he could not get up from floor level to standing position. Ladin’s mother had applied for wheel chair from local organization but it has not come through for over a year. This has restricted Ladin’s attendance at school as he is so heavy and his mother cannot carry him on her back to from school every day. Ladin can crawl around, but as a 10 year old , there are so many places he wishes he could go and so many friends he wants to see. Now this is where I feel courage which seems to fail me as a therapist , yes we know he is just a good child with this terminal thing (Muscular Dystrophy) but when the mother starts to talk about the things her Mumias slum neighbors have done to her boy , I see a tear dancing in her eye despite the buibui she is wearing. She talks about occasions neighbors have literally shut their doors and snatched away their children whenever Ladin happened by crawling to his friends. Just to play and be happy with them, to be with friends he has grown up with and gone to school with in his better days. They are fearful of his disability, fearful of this crawling boy they don’t understand, fearful of his illness. He has not been “sick” or hospitalized yet he seems to be weakening day by day.

It is at this point that my tear shows up too in my eye, here is a whole homogenous community casting aside their own. Except for Sylvia and her family who understand the heartache of a child with physical disabilities. Sylvia and her family know the day her artificial limb will have a problem she too will experience restricted movement. It has only been a few months since her surgery.

At eight years old, Sylvia spent many months curled up her in hut with flies as her friends, school completely inaccessible. “While I can still walk please accept my precious little wheel chair” Sylvia says to Ladin. “It is all my family and I can do to atone for the community sin of rejection to you because of disability.” At this moment I hide behind my camera pretending to be taking a photo, as Francis, Sylvia’s father goes through the motion of explaining how this wheel chair works. But behind the lens I am as helpless, I am not strong like Sylvia and her parents , I am not strong like Ladin’s mother to live in such neighborhood and see my child crawl back to me in tears and shame because his friends’ mothers shooed him away and shut their doors to keep him out and away from them.

A Day in the Life
By Martin Nafukho ,

Occupational Therapist
Education Assessment Resource Centre, Mumias

It is Friday March 30th, 2012.

The night before has been hot and still with stars ablaze in the dark. I had been out many times to watch the skies for any signs of rain; the weather man predicted it would be pouring by now. It has been an unusual year for a rural community which is heavily dependent on Mother Nature for survival. The rains that form the main stay of farming in this part of the world have delayed, and the weatherman despite his advice to brace for floods by mid-month has been wrong again. He is now saying there will be no rains after all.

The new moon is already 4 days in the sky adding to the light of the stars. As I stand I can hear the quiet hum of the sugar factory. The quiet is broken by a cacophony of sounds that once kept an American volunteer awake on her first night in Mumias. These bats make a sounds that led her to wonder why someone was ringing bells all night. The hyenas that used to roam and moan in the nights are no more, just as our cows will be if we do not get any rains soon.

My day starts at 5.30 am as the children wake up to go to school. I have to be awake too to cuddle call ‘mbembeleza’ the family cow to give us 2 tea cups of milk for our tea. With this we are much better than the urban people who may have the money but the milk from the commercial dairy has disappeared from the shops. I think the prolonged dry season has not only affected the planting, there is no grass for the animals in commercial farms. I soon get my cup of tea and by eight o’clock I am nearing my work place, the Education Assessment Resource Center (EARC).

The last two days I have been away on integrated supervision encouraging our colleagues at health centers and dispensaries to forget the recent threat by the health minister to sack them after striking for appalling work conditions and do the best in spite of the deficiencies of the system they work in. As an occupational therapist and a community health worker it is never easy to plan my work day ahead of time. Rarely will I get a proper referral from the doctor on what to do with the clients who pass through my place of work.

At nine o’clock on this morning, I get a call from a special needs teacher that a colleague recently had a bad motorcycle accident that left them with a compound fracture of right proximal tibia. On February 14th his fracture was fixed by plates and his doctor advised him to see the paramedic to make a back slab, but when he went to the paramedic they said they had no plaster of Paris. As the teacher had no more money left to buy the plaster of Paris needed, he just went home. The next time he went back they were on strike. He then called the doctor who told him to find a knee brace. At the chemist it was going for ksh 3000 (around $40), a price still out of reach. He had a doctor’s appointment scheduled but according to him the doctor had said he will chase him like a dog if he showed up without a brace so he didn’t go. From my examination the right knee had obviously deviated laterally and without a brace, all the plates will soon be of no value.

Coming to see us at a centre for children with disabilities was a last resort. He will hear nothing about us being a pediatric clinic only. He begged for help and though it was a day we were planning to go out for community outreach, his plea made us reschedule. There had been some small sized knee braces once donated by one of the Yellow house speech volunteers. We find that volunteers often come with an assortment of materials after asking around their places of work for supplies that are lying around unused. Though we have had this brace for a year, today it has its purpose. Although small, it is all we have and it is better than nothing.

After we are done with him, the mobile clinic vehicle belonging to the Kenya Association of the Physically Disabled arrives from Busia, 35 km away. Today we are going south of Mumias another 35 km away to provide follow up to community outreach made earlier this month. It will be another 40 minutes before we reach our destination, the community health workers have been calling incessantly to confirm if we shall be there. By noon we arrive at the first point, Bukaya Health Center. There is a 15 year old with epilepsy from a nearby school and a 7 year old boy born without upper limbs. The parents of the girl reveal that at one time she used get medication for her epilepsy here at the health center but lately the medicines have not been available. When they heard a team was coming they thought they might get some, but they prepare to leave disappointed. We ask the nurse to counsel them and we refer them to an epilepsy clinic at St Mary hospital.

The boy we have been seeing since he was one month old. He has been referred to a special boarding school, because the local schools rejected him as he has no hands. His father however does not have the 15000 (~$200) for boarding fees. We think the local education office, has probably not looked at the EARC report we wrote when the family came to see us initially. We promise to follow up with the local constituency or social development fund to see what can be done.

At this time I start to feel very tired, thinking of Africa my mother land, so much hope in its people so little done to help. It is now 1pm and the physiotherapist , an orthopedic tech volunteer and myself, who make up today’s mobile team move to another station. Some clients got tired and left but there are still children and their parents still waiting.

There is also a five year old girl who cries the whole night according to maternal report. She presents with communication difficulties. Apparently she had malaria resulting in convulsions 3 years ago and the problem has been ongoing since. We agree that the family can come with us in vehicle today so we can take them to a pediatrician, but it is getting late. They promise that next Wednesday they will come to the EARC so we can help them as we have a visiting speech therapist volunteer. Another client is 4 year old boy with bilateral club foot who was identified early but after a series of visits to nearest hospital for casting , they gave up the procedure because the paramedic started asking them to buy the plaster . It is now so bad he will need surgery review . This one is lucky, Jess Medland an occupational therapist who knows of us through Yellow House Children’s Services has raised funds to help such cases.

So the day has not been in vain , one among these will live to say something changed. What makes changes happen? Money really. We have the skills, the materials are available, our families just cannot afford them. We need people to commit to help with transportation costs (usually bus fares) and surgeries. The money pays not only for procedures, but for the hope that may have been lost and can be restored for these kids. The hope that there is something better, that people do care.

The nagging thought as we head back to Mumias and Busia at 5pm is what can be done to help people with epilepsy, convulsions in the rural out flung areas, if they will need speech therapy like the 5 year old girl how can she access the EARC services 30 Km away, even if the parent were willing to help ?

My work day draws to a close. More questions than answers, more problems than solutions. I look forward to returning to my family, my home, to the blessings of my small children and their good health.