Saturday, July 3, 2010


This is a post I initiated in March but never finished. Now that I've gone again, I realized I need to get it out. Hope you enjoy.

I just found the coolest flickr photostream about Sierra Leone from a guy named Adam Cohn. This is more what it looks like than my very amateurish photographic attempts. I hope this link works because its captivating. Unfortunately, my camera battery died out here so I have very few photos from this leg of the trip.

For the last 6 months we've been getting reports about the excellent work being done out in Bo where three of 2009's trainees live. One of them, Musa Mansaray, is the Director of Rehab at the Bo Rehabilitation Center (BRC). Bo is Sierra Leone's second city, located about a 3-5 hour drive east and a little south of Freetown. Fortunately, the Italian government has recently built a paved road, making travel far, far easier.

Madonna is huge here. Or, at least these huge stickers of her are all over their taxis and buses.

This part of the country was very hard hit during their horrible civil war. The reason so much conflict happened here is that this is one part of Sierra Leone where Diamond mining is prevalent. Without dwelling too much on the specifics, the people of Bo suffered immeasurably during the war, leaving many with amputations and amplifying endemic polio. Therefore, the need for wheelchair services is as great in Bo as anywhere in the world.

Fortunately, the people of Bo (and the rest of Sierra Leone) have been steadfastly supported by Handicap International, one of the most effective organizations for helping people with disabilities in the world. One focus for HI in Sierra Leone has been in support of the Rehabilitative Services, strengthening and supporting the clinical programs country wide. As in Liberia, many of the clinicians here are 'mid-level therapists' or former nurses and social workers trained by European HI staff for up to 2 years. There are likely 3 or 4 Physical or Occupational Therapists in the entire country. Musa Mansaray, the director of the BRC is one of them.

We were able to work with Musa and his staff to gain an initial feel for their skill level in context of the wheelchair distribution process. So far, so good. Coming from the US and knowing what we have, I must say I was impressed by the vibe and hard work going on in their rehab center. The heat and conditions aside, it felt like any rehab gym in the states. People where working hard to improve their motor function. They have the basics and use them to get the job done as best they know how.

We assessed one of the wheelchair users, a 16 year-old refugee from Liberia. When I first viewed him in his chair, I felt something was very wrong. Either he had grown 5 inches in the last year since he had the chair, or his chair did not fit him. If a chair is too small for a user, their weight rests almost completely on their sitting bones, placing them at risk for a pressure ulcer. That said, the seat length, depth and backrest were appropriate and the chair was in good order. He uses it every day as his primary source of mobility.

As I assessed the fit of the boy in the chair, I realized that in addition to the infection they were treating he has all the symptoms and movement patterns of Duchenne's muscular dystrophy (undiagnosed). He lives in a refugee camp on the outskirts of town and had to travel several miles across a bumpy trail to get to school. With great relief, I realized the staff had trained the family how to adjust the footrests of the chair and raise the footrests so they wouldn't high-center the chair. This tells me the clinicians had measured and fit the chair appropriately and the technicians had built it correctly. Most importantly, the family had received correct instructions for adjusting and maintaining the chair. This is a very good initial case study for the BRC!

It is important to note that I was aware of my own bias coming into the situation. It would be easy to believe that, "Yes! they are doing it correctly and I'm so very happy to have gone!" However, Ike and I realized that catching a glimpse of one small part of the rehab center's week and transposing that across the entire wheelchair program in Sierra Leone would be dangerous. We had many, many long discussions about the need for an objective evaluation of the program. The need to truly analyze the skills of the clinicians and technicians we trained and the people they have since trained.

More to come about the Mobility Sierra Leone workshop soon.