awestruck again at more life-changing interventions

Today we headed into South Sudan, it will probably take us 3 hours to get to the town of Kajo-Keji, just over the border.  The purpose is to fit some artificial limbs.  A previous visit 3 weeks earlier had taken measurements.

En route we had some good banter, some of which was about the border guards.  And lack of formal price structure.  And so it proved.  The first hurdle was that our visas were single entry, and so we could not afford to do this properly and get stamped, on either side, in either direction, so 4 hurdles in fact.  Some of the team were actually South Sudanese, who had fled from the conflict.  And in fact a few of them were actually from Kajo-Keji themselves.  So these things helped at the border crossings.  There was still the ritual negotiation (due to the aforementioned lack of formal price structure), and at one point we were at an eye watering $3,000 USDs!  We got down to acceptable prices in the end though which I think was around $20 USD for the Ugandan / South Sudanese contingent (though the drives were around half that) and about $200 USDs each for the two “Mzungu”, as whites are affectionately known.  And despite my earlier preconceptions and prejudices, we paid in Ugandan Shilling (remember that Independence thing?), not USDs as is so often the case at the border.

Back to the visa issue, it was quite comical when the guy on the Ugandan side said, “well I suppose you have paid me now, so I have to do as you ask”.

Of course, we also ‘took care’ of the guy at the physical border.  Which was a rope (string really) between two three-foot tall wooden stakes in the ground.  At both border posts, of course, but only once each, thankfully.

The real purpose though was absolutely incredible.  Fitting prosthetic limbs and so changing lives.  The measurements had been taken, and the limbs prepared.  Today was final fitting, adjustment and aesthetics.  We had six people to attend to; I say “we”, of course I really mean “they” – I was just in charge of power and being awestruck.  So what was achieved?  Five legs, both above and below knee, for primary (first time) users and secondary (subsequent / replacement) users, and a lower arm.

So the pre-prepared limb is fitted and adjusted, tested, readjusted, refitted and tested again, and again until just right.  We brought some parallel bars to help familiarisation and training, but also erected at set outside the venue for ongoing support and training.  Did I say the venue was a church?  A wooden framework with grass thatch roof and trimmed branches for walls.  The floor was just earth.  Not unlike a big old garden gazebo you can get at B&Q.  Two open doorways and a simple lectern fashioned from a couple of pieces of wood.  Church, community centre, meeting place.  Landmark.  Legend in my mind.

We brought a generator, water, machinery (including an oven) and a whole heap of equipment and materials.  From a hammer to a cordless drill, talcum powder to foam sheets, vaseline, bandages and shoes.  Yes, shoes.  Every prosthetic leg needs a shoe to protect it, so we also have a shoe-maker.  No not the Timpson’s guy, or even a cobbler, but a bona fide shoe-maker.  He obviously makes pairs, one for the leg, one for the person.

After the fitting, the finishing is a process to behold.  Foam sheets are glued around the titanium rod (tibula & fibula if you like).  The foam is then ground down to the natural form of a leg.  And its not just a skill, but an art and a genuine labour of love.  The team take their time to try and get a really natural shape.  When finally content, they wrap it in a skin toned rubber sheet, and here is the baking bit.  Warm through the rubber sheet to make it really pliable and then stretch it around the leg, whilst still warm.  We had forgotten the oven gloves so when it came to my turn, no honour, to get involved in this last part it took all my resolve not to wimp out and say “ouch, hot” when stretching the rubber sheet around the leg.  When I say warm, I mean bloody hot, but it barely registers; I feel so proud to have been part of the process.

Along the length of the leg, there is now a seam where the edges of the sheet have been mated.  Again this is ground away.  The finish is perfect and reminds me of a pair of stockings with a seam down the back of the leg.  Final cleaning and refitting and there is some training and familiarisation again with the prosthetic.  All for free, of course.

And all of this at the side of the road in what remains of a war-torn border town in East Africa.  No power, no water, no formed roads.  No welfare, no social care, and absolutely no disability care, without Hope Health Action and its partners.  A fully functioning Prosthetics and Orthotics workshop, utilising state of the art technology to change lives.  Once again during my introduction to East Africa, I find myself awestruck.