Rehabilitation Centre Gambia
Ongoing Service: Ramadan in April saw a slowdown of service, but over the last quarter the centre has engaged 44 patients, with 52% being for repairs and the other 48% for the supply of new prosthesis.
Course Completion: Prosthetist Ebrima Krubally completed his short course in lower-limb prosthesis at the start of April at TATCOT, Tanzania. This is the only ISPO-certified institution in Africa so Ebrima’s time there was really useful in terms of developing knowledge of best practices in prosthesis manufacture, learning about teamwork and workshop management and building connections within TATCOT and our female amputee scholarship students.
Ebrima has already put his knowledge to good use and provided plenty of exciting and important suggestions to help develop the workshop in Banjul, from technical development of the service to increasing the female amputee workforce at the site, so that patients are given the best possible services moving forwards.
Inland Trek Planning: With the peer-counselling and home maintenance teams the Rehabilitation Centre has been moving into the final stages of launching their first upriver trek, which aims to deliver services to people inland who are unable to easily travel to Banjul. It’s hoped that the team travelling will be able to work through existing networks of the Department for Social Welfare, linking up with inland social work teams to organise activities.
Site Development: This quarter saw works to change the organisation and day-to-day management of the workshop, focused on organising tools and components whilst the site is being refurbished by the Department for Social Welfare. Workshops were also organised to discuss ways to work better as a team and coordinate services.
This was led by the senior staff at the workshop with the support of Paul Martin from the USA. Paul has extensive experience in working in workshop environments, correct tool usage, storage and maintenance processes, so his knowledge was invaluable in supporting the staff to enact changes to the centre. It also saw the completion of works to refurbish the workbenches and the installation of a bespoke made metal cupboard, funded through our work. Looking forward to seeing how the centre looks when we get back later in the year!
Gambian Peer Support
This quarter our fantastic peer support time provided:
- emotional support to 28 new clients across our existing hospital network
- prosthesis servicing and emotional rehabilitation visits to 57 clients in the community.
Building New Connections: Whilst our service covers the large public hospitals in the Greater Banjul Area, not all amputees come through these wards. To increase access to services our team visited numerous private hospitals and diabetic clinics which are now agreeing to notify us when our services are required; helping ensure we’ll be engaging more of those in need.
Social Work Training into Final Term: Both our counsellors and a candidate with ambitions to join the service are presently in the final term of their diplomas in social work at SOS Village. Building on their certificate study, modules in mental health and community development aim to develop knowledge of how services supporting vulnerable people should function. We wish them well for their exams next term! Our counsellors are also required to undertake research projects, for which they have chosen to focus on the increasing issue of diabetes-related amputations in the area.
Future Plans: Following the end of Ramadan, we moved on to reflect on the direction our services could take in the years to come. We built on the workshops organised earlier in the year and solidified further our plans moving forwards. These aim to focus on developing a larger peer-counselling team to support existing staff as well as extending services access through working inland, developing telephone counselling further and trialling group rehab meetings. It’s hoped we’ll work closely with partners in Ghana and beyond, to share experiences and develop services based on best practices with adaptations for the context.
Ghana Peer Support
Our peer support team:
- Met with 18 new clients in four key hospitals across the Greater Accra Region
- Provided 253 counselling or peer-support sessions over the phone or in the community.
- Organised community meetings within Greater Accra and at the OTC in Nsawam, introducing new speakers from the Ministry of Gender, Children and Social Protection who spoke about services available to amputees and how they can access them as well as the ongoing syllabus.
New Candidate Training
April and May saw the recruitment and training of four exceptional new candidates to join the peer-counselling team. The candidates spent eight days with Equilinks founder May Cullen Wulff-Caesar, who led training sessions on topics such as unconditional positive regard, rapport building and client-counsellor relationship. This training aims to provide a foundation of understanding to complement their lived experience as amputees, so they’re equipped to counsel those in need.
With the training complete, workshops were then organised with the existing counselling team where questions and discussions could be had around current processes and the practicalities of delivering the service. Following this, we’ve agreed that trainees will be paired with existing counsellors for more than a month, to see firsthand how clients are engaged. Wish them luck!
UK Visit: After two years of not travelling to Ghana, the UK team were finally able to see in flesh what we’ve only heard about through WhatsApp calls, pictures and project data. Throughout June, Director Phil and Project Manager Chris attended hospitals, the Orthopaedic Training Centre, amputee community meetings and workshops with counsellors and community meeting facilitators to learn more about the activities being delivered, success and challenges.
It was a really amazing visit, as the scale of the work being undertaken was great to see and the impact of consistent emotional support and informed meetings with experts could really be felt. Workshops gave us all an opportunity to come together and think about new directions and what to focus on as we move into new project activities in the coming months, with ambitions to expand services into new regions and organise more community meetings in new areas of Accra. Also, meetings with key stakeholders stressed the importance that using the data we’re collecting could have on policy level discussions around long term rehabilitation.
Care4Legs Content Development: Whilst providing emotional support in the main, the peer-counselling team also provide support in terms of information and signposts to services using the Care4Legs digital resources, which the team distribute and advise on during sessions. We’re expanding the content to include detailed information on phantom limb pain, diabetes management and the importance of physiotherapy. The current content is also being translated into Twi, Ga, Hausa and Ewe: the four main languages used in Ghana to address the literacy issues amongst certain populations.
Community Network – ASNU
During this quarter we were delighted to get back to Uganda for our first project visit since the start of the pandemic and hold some face to face workshops with ASNU. We also marked the 6 month milestone of the project with a project review and a temperature check between Community Partnerships Manager, Beth, and ASNU Project Leads Charlotte, Paul and Jared, which concluded that we are happy to continue as planned with no need to make any amendments to the planned activities or results framework, and a broad consensus that ASNU is very pleased with the nature of the partnership. Jared said that they attribute at least 80% of ASNU’s development in the last 6 months to the partnership.
ASNU’s achievements this quarter include:
- 6 hospital partnership brokering visits
- Securing a new clinical partnership agreement
- 6 media appearances to advocate for the amputee community
- Attendance at 5 professional networking events
- Submitting an independent application to the David Weekly Family Foundation Acceleration Portfolio, with our support
The team have also been working on a number of high level documents to officially register as an NGO and to plan a peer support camp in the west of the country at the beginning of Q4.
Wellbeing Assessments:
We have also been able to analyse the first set of wellbeing assessments for ASNU members – marking the first wellbeing assessments run at Legs4Africa!
Of the thirteen sample group participants who were asked about their wellbeing between their second and third consultations and given a score:
- 2 people’s overall wellbeing improved by a score of between 12 and 20 points
- 8 people’s overall wellbeing improved by a score of between 6 and 11 points
- 3 people’s overall wellbeing improved by a score of 5 or less.
With the understanding that we don’t need to aim for a perfect score by the second consultation, we can translate the assessment scale score to a RAG system which gives us the necessary detail with the understanding that wellbeing is a holistic journey.
Community Partnerships
Ladies Gambian Amputee Association (LGAA)
In June, following the hugely successful project workshops in Q1, we began discussing some of the final project considerations such as what type of tech the LGAA might need, what is required to get the group a bank account set up and planning of a meeting to review project documents and sign a partnership agreement in July.
Gambian Amputee Football Association (GAFA)
This quarter, GAFA has utilised £1500 of unrestricted funds received from Legs4Africa to speed up operations. Notably the players lobbied from an elective congress to refresh the technical committee in late May. Many of the new committee members are well connected within Gambian national sports which provided the current team with an opportunity to play an exhibition match at the National Stadium during halftime of the Scorpions (the National able-bodied football team) match in June.
There have also been discussions between Dawda Danso, secretary general, and Turkish clubs this quarter regarding short term contracts for GAFA players which would give them the chance to play in one of the best amputee football leagues in the world. The technical committee and players see this as having the potential to significantly improve the game in Gambia.
Gambian Amputee Association (GAA)
This quarter we terminated our partnership with the GAA due a breach of the partnership agreement. The GAA has posed significant challenges to us under its current executive committee and we have offered to reconsider a new partnership in January 2023. The withdrawal of L4A support has prompted the members to demand an elective congress, which was being stalled by the existing committee. Whilst we didn’t come to the decision lightly, we are nevertheless pleased to see GAA’s members holding those in charge to account and understanding more clearly what qualities they wish to see in an executive committee.
Federation of Uganda Amputee Football Associations’s (FUAFA)
During this quarter’s project visit, staff from the UK team spent six days with FUAFA’s executive committee workshopping a theory of change, project planning, independent fundraising, partnering with other local organisations and how satisfied they are with L4A as a partner. The project planning drafts we created and the knowledge shared in the fundraising workshop have provided the springboard for executives Paul, Alex and Lawrence to spend June developing their own fundraising strategy.
FUAFA also implemented three amputee football events this quarter in three districts – Kampala, Mukono and Iganga.The events were well attended with over a hundred spectators attending the outreach in Iganga in early June, and Gulu will be the fourth and final location. Pending narrative and financial reports will give a better sense of what we can learn from this project.
Kenyan CBO Partners
During our visit to Uganda we facilitated the attendance of our prospective Kenyan CBO partners. We welcomed Emmily Aketch and Isaiah Muchoki from Universal Lighthouse and Global Foundation respectively to Kampala for a three day meet-and-greet and peer learning experience. Both Emmily and Isaiah joined ASNU for their Safeguarding workshop led by Stef as well as meeting some of ASNU’s clients in the community. We also worked on Global Foundation’s Theory of Change and a quarterly project implementation schedule, and are hopeful that project implementation will begin in the upcoming quarter. Following the visit, we were pleased to learn that Emmily used the format of the workshop we did together to run a session with her team in Kenya.
Stakeholder Social
Finally this long awaited visit gave us the opportunity to show gratitude towards all our partners in Uganda. We did this in form of a stakeholder social which was attended by the Mulago Hospital Orthopedic department, ASNU execs, FUAFA execs and players, Emmily from Universal Lighthouse, Isaiah from Global Foundation, and a few people who had expressed interest in supporting some of the CBOs. It was a really nice celebration of all the amazing work they do and provided a rare opportunity for everyone to socialise.
Shipping
In the last quarter we made deliveries to our partners in Tanzania: AJMA Orthopedic Services, Harowin Rehab Clinic and St Joseph Hospital Kagondo. We’ve also shipped out barrels of legs bound for the OTC in Ghana which should arrive in the next few weeks. That’s 449 legs in total either received or en route this quarter.
It’s been an exciting period of development as we enhance our impact measurement and develop stronger systems for our partner prosthetists to let us know who’s being helped by these parts and their hard work, and that data is currently showing that 107 people have gotten walking again with our components in the last quarter. As always, road accidents continue to be the leading cause of amputation in our service users, followed by rising levels of diabetes as well as other accidents. We’ve also been able to speak to some service users in Uganda on the recent project visit and hear their amazing stories of how they have turned their lives around since receiving a prosthetic leg – such as Joseph, a single dad who injured his leg chasing a robber and spent the entire lockdown in hospital, finally having his leg amputated and feeling hopeless about how he could care for his 2 year old son. Now he has finished his gait training, is walking strong and able to play with his little boy, who loves his dad’s new leg!
And even more good news from Mulago Orthopedic Workshop: productivity has shot up since they received their pallet of legs, and the average price of legs has dropped way down now that the workshop has a healthy stock of everything they need, with almost half of services being provided for free! The attached charts show the difference in the last year.
Rehabilitation Centre Upgrades
One happy update for Project Upgrade this quarter has been the completion of electrical installations at A2D Services in Parakou, Benin, which we funded to help the workshop accommodate their new machinery by upgrading the electricity from monophase to three-phase. The Ottobock prosthetic router donated by our friends in Edinburgh is now working great!
Having identified that the materials involved in fabricating a prosthetic socket often present as much of a financial and procurement challenge for workshops as components, we’ve agreed to provide some funds for materials such as polypropylene and resin while we also assist with sourcing better value providers. The Ganta Centre has received their first installment of these funds to help keep prosthetic legs free to their patients.
We’ve also bought a new laptop and printer for the Mulago Orthopedic Department in Kampala, Uganda to help with their data management, as well as funds for the extra data required for the increased internet usage.
We have also been working hard on the partnerships between L4A and all the different orthopedic workshops we work with, to make sure we have clear partnership agreements and goals that we are working towards through Project Upgrade. During our recent project visit to Uganda, we worked with the orthopedic dept at Mulago Hospital in Kampala to set clear goals for our partnership and agreed on a donation to the department to fund vital repairs to the roof and equipment. Following a meeting with the director of the hospital, we were informed that this pledge has motivated the director to provide £6500 towards socket making materials for the department – a huge success on all sides since the department has received no funds from the hospital for 6 years. We are optimistic that the successful functioning of this partnership can help to keep the attention of the director on the hospital and work towards sustainable investment into the department from the Ugandan government and away from external support.
Female Bursaries
Firstly in news from our first ever cohort, we were delighted to learn that both Ophia and Judith have been offered jobs as orthopedic technicians! Judith will be continuing on at Kenyatta National Hospital in Nairobi, and Ophia has been working for the last few months at Leonard Cheshire Disability, Harare, Zimbabwe. As part of Leonard Cheshire’s work, Ophia has been involved in outreach programs run in collaboration with Action Aid. We can’t wait to see what they do next! Both Molline and Ophia have been able to obtain their licenses to practice in Zimbabwe, and Molline is currently volunteering with Jairos Jiri, a disability organisation in Harare, as a prosthetic technician as well. This is another significant achievement as Molline is a bilateral transfemoral amputee for whom the activities of fabricating prosthetic legs present more challenges.
And over at TATCOT, cohort 2 have completed all of their modules, moving up the limb from foot to transfemoral prosthesis, and learning new socket techniques like ischial containment. They are currently preparing for their final clinical presentations before flying home at the end of August to commence their placements!
Planning is also underway for the third year of L4A prosthetic scholarships, so watch this space!
Recycling
This quarter we collected 476 legs from our various collection partners and locations.
This is an expected reduction from the previous quarter, as we haven’t been actively pushing collections in the last quarter in anticipation of the August Collection Sprint, as we want to focus collections around an annual sprint once a year. We’ve been using this time to organise the workshop and storage areas for smoother movement and processing of legs. We’ve implemented a live stock system which allows us to easily see what we’ve got in storage to help us make better judgments of what we can and cannot send to partners based on their requests.
Fundraising
Now we are in the heat of the summer, it seems like a perfect time for reflection and appreciation for the brilliant support that our amazing donors and volunteers have given us!
Q2 was expected to be a lower income period due to fewer significant campaigns this quarter, funding timetables and the current planning period for the rest of the year, leaving our overall income for Q2 at around £35,000.
As our UKAID funding is drawing to a close, we are planning a significant push for long-term support for our projects in West Africa – especially we are looking at doubling down on our work in Ghana. The Ghanaian peer support and counselling has been an incredible success, and we are looking for extra funds to spread it across the country.
We have also begun fundraising for Get Legs to Africa 2023, which will allow us to continue to collect, maintain and ship second-hand prosthetic parts to their destinations at our partner orthopaedic workshops.
We have also have a couple of campaigns heating up at the moment, ready to launch in the coming months. We are partnering with schools, with sports teams and with a whole range of community organisations which are helping us to get people back on their feet! I want to use this space to give a couple of shoutouts to two incredible fundraisers:
Rémi – Our pilgrim friend is currently on the home stretch of walking from Canterbury to Rome, trying to raise 1 Euro per kilometre for our partners Nav Solidaire, who manage collections across Europe and do low-emission sailing trips to deliver our components to West Africa each year.
Conrad – A doctor living in Norfolk who, despite playing for the Ghanaian national basketball team, had difficulties with his legs as he grew too fast. Conrad has raised hundreds of pounds for us by connecting with people’s hearts to help children walk again.
