Physical disability in Malawi poses enormous challenges for both children and adults; estimates indicate over half a million children are living with disability. Marginalised rural communities are more than likely unable to access orthopaedic and physiotherapy clinics due to distance and affordability of transport and many children continue to live with undiagnosed conditions.
Initial meetings were held with the District Medical Officer, Dr Jere and with Physiotherapist Chindikani Makandawire, who works for the Blantyre DHO. Meetings were also held with Belinda Impey, an experienced UK physiotherapist who happened to be volunteering in Malawi at the time. An equipment list was identified, this being naturally divided into the essential and the desirable!
AMECA commissioned a Disability Needs Assessment in the catchment villages to give an overview of needs and then approached the Blantyre District Health Office to request implementing a Physiotherapy clinic at AMECA’s Health Centre. The DHO funds a physiotherapist and AMECA funds the transport for these staff. Tens machines and Infra-red lamps were more cost effectively purchased from the UK, whereas locally made furniture is much cheaper to be made by a local carpenter in Malawi. We found a local carpenter, Gift, who constructed a wall exercise ladder and portable mirror. We transported the carpenter to Chilaweni village to fit out a room in the Health Centre that was identified as being both fit for purpose and secure.
Many children with disabilities are marginalised and socially isolated because they spend most of their young lives on the floor, unable to stand or walk without support. Wheelchairs are unaffordable and even if patients manage to access tertiary facilities and receive recommendations, they are unlikely to be able to afford crutches or walking aids. Mothers carry their disabled children around but inevitably, the child grows too big and heavy. The ability of a child to be able to stand with the aid of a frame or sit up with support from an adaptive chair, is simply life transforming for both mother and child. Patients are measured individually and a local carpenter is used to make equipment.
Aged just 4 years old, Tafazwa has Cerebral Palsy. Prior to receiving her new Adaptive Chair, she was unable to sit up and her mother had to hold her to enable any meaningful interaction with others. Tafazwa is pictured here, clearly delighted with her new adaptive chair and standing frame.
Pictured right is Leticia, a 3-year-old who suffers from Hydrocephalus, (excess fluid on the brain). The condition is being managed through a shunt, but her delayed development rendered her unable to walk. The donation of a baby walker is now enabling Leticia to be trained in walking. Her mother tells us that she can now walk more than 8 steps using her walker and we look forward to monitoring her progress at clinic. The walker costs around £7.50 and has changed Leticia’s little life.
AMECA continues to purchase further disability aids, including standing and walking frames, walkers, crutches and wheelchairs. The clinic also needs some dumb bells for exercise therapy, but these could be made using sandbags. Subject to affordability, AMECA intends to continue to support the physiotherapy clinic with patient equipment and to try to get a few walking aids, such as bars and stair rails, fitted to the homes of some of the elderly.
Staffed by DHO Physiotherapist Chindikani, Physiotherapy services commenced in January 2023 and have since been held once a week. The clinic experienced a setback in attendance numbers in February, following the main access bridge to the village being washed away. To date, the bridge has remained unrepaired. Physiotherapy Clinic patient attendance at the AMECA Health Centre has increased sharply and we are currently seeing more than 60 patients a month. Reports indicate that the vast majority of our patients are children with Cerebral Palsy, normally due to birth asphyxia, whilst elderly patients mostly present with arthritis or have suffered a stroke.
As physiotherapy consultations increase, requirements for orthopaedic equipment grow and we are currently purchasing wheelchairs, standing frames, walking frames, adaptive chairs and orthotics. We are really pleased to be working with Wilson Nanungu, the Head of the Orthopaedic Centre at Queen Elizabeth Tertiary Hospital in Blantyre. Chindikani, the DHO Physiotherapist, refers some patients from the AMECA Health Centre to the Orthopaedic Centre where some paediatric items are free of charge, due to funding from Friends of Sick Children in Malawi, a UK based charity.