SGAA Activities in 2004
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SGAA believes that the life of
every disabled child can be improved in some way. A boy
suffering from polio can be made a pair of callipers that will
help him to walk to school. A girl with cerebral palsy can be
made a wooden chair to help her sit up straighter and learn to
feed herself. A boy with juvenile arthritis can be given
physiotherapy treatment to reduce his pain and discomfort.
Families of the disabled child can be counselled on what
exercises to do at home.
SGAA's health educators also work closely with children in schools to promote awareness of disability. If a child knows of someone who is disabled in his family or street he can suggest that they be taken to a doctor or a rehabilitation centre for a diagnosis. Often the parents think nothing can be done and leave their disabled child in a corner of the house. Early detection and treatment can help reduce the severity of many disabilities.
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Orthotics and Prosthetics
Patient figures have continued to rise this year in both departments in the orthopaedic workshop in Jalalabad. Over 110 patients a month receive callipers, splints or spinal braces made for them by a team of 12 orthotic technicians. The fabrication process has been speeded up with the arrival of a new plastics oven at the beginning of the year and extra workbenches for 5 trainee technicians. In addition over 40 patients a month come for a new artificial leg or a repair to their existing one, produced by our three prosthetic technicians who make up the prosthetic department. There are also three artisans, two cobblers who make special shoes and leather buckles and a carpenter who makes special wooden chairs for children with cerebral palsy. The workshop and storeroom remain very squashed and despite discussions with the hospital director, there seems little available space in the hospital to provide us with more storage space or a larger room for our carpenter.
Component Workshop
The component workshop makes 30 - 35 wheelchairs a month and more than 500 other items such as crutches, rubber feet, walking frames and calliper joints. This year the technicians have been testing different proto-types of a hand-propelled wheelchair, due to the many requests for this type of wheelchair from the disabled living in Jalalabad. This has led to an exciting new project beginning in December 2004 in which SGAA provides 10 amputees every month with a hand-propelled wheelchair, the possibility of training and a loan to start their own business in the bazaar. Each applicant has to come up with a plan of action which is vetted by a committee made up of local disabled businessmen and SGAA staff. The project is sponsored by the generosity of the American NGO, Adopt a Landmine, which works in many countries to raise awareness of the danger of landmines and the plight of mine-victims. We hope to see some real success stories from this project in 2005.
A survey of the rubber feet made in the component workshop revealed that they are too heavy for some users and some of them break too quickly across the toes. The problem of weight can be partly solved by finding a lighter wood for the keel and SGAA staff have been scouring the bazaars in Afghanistan and Pakistan for the right kind of seasoned wood. A different type of elastic has also been inserted inside the foot to reduce the risk of breakage across the toes. It is difficult to produce a rubber foot that can stand up to the durability that Afghan amputees require. Recently a young man of 23, a double amputee, came into the workshop to replace his artificial legs which he had been wearing since he was 17. Since he walks 4-5 hours a day in the summer to collect firewood in the mountains near his home it is amazing they have lasted so long, although in the winter he works as a tailor. He is married with 2 children and said that his disability did not impair his life at all.
Nazir Jalal is a double amputee who lost his legs fighting in the war. He has been using an SGAA 3-wheel wheelchair for 5 years. He recently had the opportunity to try out one of SGAA's handle-propelled wheelchairs. This can go faster than a normal wheelchair and is thus highly coveted by local amputees in Jalalabad. In the annual wheelchair race on Disability Day there is a special class for competitors using SGAA wheelchairs.
Physiotherapy Programme
The physiotherapists remained very busy in 2004. As well as treating many different types of patient that come to the male and female clinics in Jalalabad the mobile teams continued to visit various clinics in the surrounding provinces. A change came mid-year when four male physiotherapists, recently graduated from SGAA's two-year training programme, started working in 3 district hospitals in Nangrahar, Laghman and Kunar provinces as locally based employees. This meant that the male mobile team from Jalalabad no longer needed to pay weekly visits to these hospitals, going only twice a month to supervise the new staff. In October, motorbikes were bought for these junior physiotherapists so that they could start visiting local clinics round the district hospitals, thus widening access to patients. Unfortunately, the women who graduated from the same course did not take up job offers in the district hospitals. The main problem is that unless they have family in the area they cannot live there alone and SGAA does not have the means to provide daily transport to and from the hospitals. This is a recurring problem in rural areas in Afghanistan where there are few educated women able to take up professional roles and educated urban women will not work in rural areas because of the lack of facilities.
Training
In February 20 physiotherapists graduated from their two-year course run by SGAA at the Institute of Health Science in Jalalabad. 10 men and 10 women. The course was taught by SGAA's physiotherapists and medical doctors using the curriculum approved by the Ministry of Health. Paddie Chanmugam, SGAA's consultant physiotherapist had initially set up the course in 2002 and came out for the final exams in January 2004. She was pleased with the standard of the students. It is especially difficult to find women who have completed their secondary education (12th grade) in many parts of the country because of the lack of schools for girls, especially during the Taliban era. Even before the war very few girls completed high school as they were taken away from school by their parents at the age of puberty. Tradition requires that women be treated by women in the health sector and girls be taught by women at school. Today SGAA technicians remind many of the parents of disabled girls how important it is that they should attend school and have a basic education especially as they are less likely to marry because of their disability.
Training seminars for our physiotherapists and orthopaedic technicians in May were held by SGAA's consultants John Fixsen (orthopaedic surgeon), John Lamb (orthotist) and Jeanne Hartley (physiotherapist) when they came on their annual monitoring visit. This was the second time that Jeanne had come to visit our project and we were delighted that she accepted an invitation to join SGAA as a Committee member. For the Afghan staff visits by our consultants are a valuable opportunity to find out about new techniques and ideas and bring their difficult cases for the "foreign experts" to examine.
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Topekai is a trainee prosthetic and orthotic technician. She previously worked as a nurse and then a physiotherapy assistant in a government hospital in Kabul before starting a 2 year training at the Kabul Orthopaedic Centre (KOC) which SGAA supports. So far Topekai has learnt how to take casts, rectify them to the correct shape and then drape the polypropolene plastic over the cast to make the appliance. As a woman, Topekai will be able to look after the women and girls who come to KOC.
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Health Education
The health education department increased its activities as a result of growing demand. Initially all eight of the staff were part-time workers but during 2004 the supervisor and two others became full-time so that they can visit patients in their homes in the afternoons to see if they need help with their appliances and also to follow up their teaching programme in local schools. The child-to-child programme in the schools is interactive and requires the children to identify causes of sickness and disability in the community. These can include blocked drainage ditches which attract flies and contribute to diarrhoea or unexploded mines lying in the fields. The health educators go with the children to help them activate the local community to solve its problems.
As well as many physically disabled there are also many Afghans suffering mental health problems. Some of this is due to the war and bombing and the stress of losing family members and loved ones or simply the result of the harsh life of poverty. SGAA's senior health educator followed a month's course in mental health run by a colleague NGO, HealthNet International, so that he can in turn teach SGAA's physiotherapists and health educators how to recognise symptoms of depression and anxiety in patients and what referral procedures should be followed.
Kabul
The physiotherapy clinic in Khairkhana, a northern suburb of Kabul has had a good year. The team of 4 women physiotherapists rotate between the clinic where they see women and children from the neighbourhood and a rural clinic in the Shomali Plain, north of Kabul. Here there are many patients who cannot afford the bus fare to Kabul to seek treatment. So successful has this clinic been that when SGAA planned to transfer it in October to the district capital, a delegation of community elders came to request that the clinic stay as their womenfolk had benefited so much from the treatment provided.
Four health educators also visit local schools and health clinics to talk about disability and hygiene in a programme similar to that in Jalalabad. The clinic in Khairkhana has gained quite a reputation as there are few physiotherapy services available for women in Kabul and has featured on national television and radio. Funding for this centre comes through the support of the Big Lottery (Community Fund UK) and when this funding finishes in February 2005 after 3 years SGAA will have to find alternative funds.
SGAA has been funding the Kabul Orthopaedic Centre (KOC) for the past 18 months. During 2004 the quality of the work improved greatly. Three qualified women physiotherapists were hired to boost services for women and three orthopaedic technicians were sent on six-month upgrading courses to improve their knowledge. More than 60 patients a month are now provided with orthoses and 50 patients a month with prostheses. Six physiotherapists see on average a hundred patients a day in the busy summer season and 60 patients a day in the winter. An outreach programme is planned for the beginning of 2005 to visit district hospitals and clinics to the east of Kabul where many poor communities live.
In 2004 the KOC was registered as an Afghan NGO (Kabul Orthopaedic Organisation) with the Ministry of Planning so that other donors could be approached to assist in supporting it. SGAA's funding ended in December 2004 and other donors are being sought to help carry on the good work at there.
Monitoring
During the year several visits were paid by SGAA's consultants and committee members to Afghanistan to monitor progress. Additional lectures and training were provided by Mr John Lamb (Orthotist), Mr John Fixsen (Paediatric Orthopaedic surgeon) Mrs Paddie Chanmugam (Physiotherapist) and Mrs Jeanne Hartley (Physiotherapist). In their reports they noted the severity of many of the disabilities they saw, due to lack of medical care and early detection. They also noted what an important role the health education programme plays to raise awareness and prevent further disability amongst local communities.
Funding
In the past two years a lot of money has been pledged to rebuild Afghanistan by the international community, but there are many competing priorities for this money: reconstruction of roads and cities, government reform, preparation for the elections, creation of a national army. Programmes for the disabled do not rank high on the list. This is why it is vital that SGAA continues to find new donors and to advocate improved services for the disabled.