Memorial Service for John Andrew Fixsen, FRCS, 1934-2014

The recent memorial service for John Fixsen, our urbane and distinguished consultant who carried the flag for SGAA in Afghanistan for many years, was a fitting tribute to a remarkable man. Modest, unassuming, and softly spoken, John bore his great medical knowledge lightly. There was often a mischievous twinkle in his eye, but he was deadly serious about his mission: for John the patient came first and last.

John FixsenJohn Fixsen

John Fixsen tests these baby boys for developmental dysplasia of the hip (DDH).

A pilot project in Samangan Province found 16 babies out of 80 sent for testing to have dislocated hips.


When we began working in Afghanistan in 1986, there were after years of revolution and war many hundreds of thousands of amputees and other disabled patients. Since then, year in year out, we have treated literally thousands of amputees, providing them with artificial limbs [prostheses]; and many more thousands of children suffering from polio, cerebral palsy, club foot and spina bifida - a disease of the spine. Our main activity now is to send out regularly our highly experienced consultants who were led by John. The work they have done, often in difficult conditions, without complaint, has been enormously valuable. We are immensely grateful to John, who would have been 80 this year. His companion on many trips, a leading physiotherapist, Mrs Jeanne Hartley, currently representing SGAA in Afghanistan, sent this moving tribute, read out at the service by her husband, Peter, in the 11th century St Bartholomew the Great church in the City.

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Chairman's Letter

December 2015


Dear Friends,

When Nancy Dupree, the American doyenne of Kabul's once-glittering international set, says of the current situation in Afghanistan, 'it's dire', you know it must be pretty bad. She has seen it all, over the years, and fondly recalls the old days when the British gave such good parties at the Embassy that the gardeners had to sweep up the drunks from the bushes next morning.

I spent nearly a month in Kabul last September and soon knew the litany of complaints from her, my driver and everyone else by heart: no jobs, no money, corruption worse than ever, and all the young people want to leave. 'Even the son of my chowkidar [watchman] wants to leave,' Nancy said with horror. 'I told him, no, you must stay and help the country, but he didn't want to know.' Afghans are now the second largest refugee group in Europe, after Syrians.

The wider picture is equally disturbing. Up and down the country the Taliban are on the warpath, inflicting unsustainably heavy casualties on the Afghan army and police, while the government in Kabul dithers, apparently incapable of appointing, of all things, a defence minister. The man they nominated months ago was turned down by Parliament as too inexperienced, which most observers think was true. To make matters worse, the extremist Islamic group, ISIS or Daesh, is also making inroads in the Jalalabad area.

The failure of the government, cobbled together by John Kerry, the American Secretary of State a year ago, to defuse a dangerous squabble about who really won the Presidential election, now dominates the political scene and the country's future. There is no common ground between Ashraf Ghani, the American-educated technocrat who became President and his rival Dr Abdullah, once number two to the famous mujahideen commander, Ahmad Shah Massoud, assassinated by al Qaeda just before 9/11, who became CEO, or prime minister. As the Government lurched from one crisis to another in the space of a few weeks, Kunduz fell to the Taliban in October, although the Government retook it; followed by the loss of much of Helmand, the poppy-growing heartland, where, in the past, the British and the Americans also took big losses; and most recently, the Taliban attack on the former British 'capital' of Lashkar Gah, 'the place of the soldiers,'.

So I am extremely proud to be able to announce a ray of real hope from SGAA, in one word - Ponseti. Ponseti is the name of a Spanish doctor who invented a revolutionary method of treating Club Foot, known as the Ponseti technique, or method. Instead of relying on surgery, as in the past, the Ponseti technique depends on a skilled physiotherapist straightening a small child's malleable bones by manipulation and then plastering the feet to keep them in place. After a week or so a further adjustment is made to correct the position of the feet and they are then re-plastered. After 10 years of Ponseti, our technicians have become highly expert.

Luckily we have been blessed by having on our staff some exceptionally skilful practitioners, led by a senior physiotherapist, Ahmad Shah, who took to Ponseti like a duck to water. Great credit also belongs to two of our expert and dedicated consultants, Philip Henman, a paediatric orthopaedic surgeon with the NHS in Newcastle who originally suggested we adopt Ponseti; and Jeanne Hartley, former head physiotherapist at the Great Ormond Street Hospital for Sick Children in London, now our senior consultant, who has ably backed him up.

All of them, Afghan and British have made the programme an outstanding success, treating more than 7000 Club Foot patients in the past ten years, and changing the lives of all those children. We are now working on another similarly prevalent disability in Afghanistan, displacement of the hip in newborn babies, known as DDH.

I conclude by wishing you all a Very Happy Christmas and [what they call in Scotland] a Prosperous New Year, and by quoting Philip Henman's account of how we launched Ponseti in Afghanistan.

'Teaching the Ponseti method in Afghanistan was something like lighting the touch paper of a firework. At the first lecture in Jalalabad the physiotherapists and orthotists came back with robust and searching questions and concerns about the procedure. From the first description it was clear that they fully understood the ideas behind the technique and were anticipating the possible complications and difficulties. This was very exciting, even challenging, and a much more vigorous, engaged response than I was used to when teaching medical trainees in the UK. Almost immediately the numbers of children being treated was impressive. In future months and years the local therapists developed the method according to the local resources and environment taking into account the sort of patients who came to them - which is a very different mix of children to the ones that we, the ‘teachers’, encounter in our regular work. Their skills as trainers in their own right is evident by the way that the method has been adopted by other centres, where the therapists have been taught the technique by Afghan clinicians not by expatriates. Over 10 years the Ponseti method has spread to all the main cities of the country and has been adopted by the main health care providers for children largely due to the enthusiasm and commitment of the Jalalabad therapists who accepted the challenge of a new way to tackle the problem of childhood foot deformity.


sgaa sig

Sandy Gall, Chairman SGAA


According to the 2005 National Disability Survey of Afghanistan, one in every five households in Afghanistan has at least one family member who is disabled. This is a result of 30 years of war, landmines, disease and poverty.

Since 1986 Sandy Gall's Afghanistan Appeal (SGAA) has trained Afghan professionals to provide artificial limbs and other mobility aids for more than 25,000 people with disabilities and provided physiotherapy treatment for over 60,000 patients with temporary and permanent disabilities.

Activities were initially based in Peshawar, Pakistan where there were over 1 million Afghans living in refugee camps in the 1980s and 1990s. SGAA gradually moved its activities inside Afghanistan from 1991 onwards and set up two main centres in Jalalabad in 1993 and Kabul in 1996.

Since 2006 SGAA has signed a partnership agreement with Swedish Committee for Afghanistan and its activities are now merged in a community based disability programme which works in 13 provinces.

This programme both treats people with different types of disability and offers them a range of services including home-based training, physical rehabilitation, education, skills training and business loans.

Physiotherapy Consultant’s Report. April 2013

The Chairman and Mrs Gall visit Kabul and Jalalabad March 2013

MahpekaiSGAA staff from the Component and Orthopaedic WorkshopsSGAA staff from the Component and Orthopaedic Workshops
Malek swimming raceMalek swimming race


Top left: Mahpekai, senior prosthetist-orthotist, and double amputee, showing a drop hand splint she has fabricated.

Top middle, top right: SGAA staff from the Component and Orthopaedic Workshops

Bottom: Malek, who is a double amputee, winning his race in Kabul.


Hashmatullah’s story

The boy in the picture is Hashmatullah. He and his father were walking through Darulaman (a suburb of kabul), Hashmatullah in front, when the father shouted: 'Look out, there's a mine !'

The words were no sooner out of his mouth then there was a terrific explosion right beside Hasmatullah, wounding him in both legs and seriously injuring h

is father who died two days later. By some miracle, Hasmatullah survived but he lost almost the whole of his leg. It was amputated just below the


hip and half of his leg, amputated above the knee in what is known as an AK.

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