February 10, 2022

Quarterly Report – 2021 Q4

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This quarter, with the help of all our amazing donors, supporters and volunteers, we made exciting strides as we continue to grow and expand our scope as an organisation. We significantly increased the prosthetists and hospitals in Europe and North America that know about our recycling service. We have developed our partnering and review processes for community-based organisations and ASNU are getting off to a flying start with their new project.

This report also contains some invaluable insights from Morrow Fofana on his experience at the OTC, as the first graduate of a full prosthetics and orthotics qualification funded by Legs4Africa, having now returned to the Gambia to put his new skills to valuable use. We’re very excited for what the future holds for Legs4Africa’s part in training Africa’s future prosthetists and ensuring quality care for amputees.

4 friends who have received limbs from OTC, Nsawam, Ghana

What you will read about:

1. African partners – STEFANIE HADLEY

2. Global recycling – tom williams

3. Delivering legs – Stefanie Hadley

4. Community Projects – Bethany Elgood

5. Training Bursaries – Stefanie Hadley

6. Morrow Finishes his course – Chris Ingram

7. The Gambia – Chris Ingram

8. Ghana – Chris Ingram

1. African Partners – Stefanie Hadley

Amputee peer counsellors attending a meeting led by our partners’ Smiles of Hope, Accra, Ghana

As we have approached the end of the year, we have focused on planning ahead for the new funding cycle commencing 2022, and ensuring that the purchases and installations of the year have been successful. In Quarter 4, our first ever pallet deliveries containing donated prosthetic routers and a vacuum machine have arrived safely in Benin and Liberia, and next quarter we will be ensuring that the centres have all the parts and electrical supply fittings to safely and efficiently operate them. The pallet received by A2D Services also contains requested PPE items such as an automatic hand gel dispenser.

We have also begun trialling our new developing partnerships processes, starting with the Ganta Centre, so that we can develop new partnership agreements that are based on a more thorough understanding of the needs of the centre with a plan for future upgrade purchases to – in Ganta’s case – help move it towards the status of a centre of excellence.

COVID-19 has unfortunately continued to cause delays to international travel plans, so the Diabetic Foot Management training we have funded for Nsengiyumva Magogwa at St Joseph Hospital in Tanzania has been delayed, but we anticipate this will go ahead in April.

Finally, we have continued to provide mobile data for the team at Mulago Orthopedic Workshop to increase the ease of communications.

2. Global Recycling – Tom Williams

A collection of legs being made from Wolverhampton Limb Centre UK

We focused on building and nurturing a prosthetics technician audience on LinkedIn, as this seems to be the most effective method of targeting an audience dependent on their profession. Engagement with messaging and posts is generous as people across the sector are interested in a rescuing legs solution. By the end of December, I had 1,734 connections which is up from 0 at the beginning of the year; with this trend, I intend to continue growing this audience and hitting them with motivational content to inspire them to get involved.

We collected 555 legs in the quarter, which was almost half of what we did in the previous, and my only conclusion is that it’s a busier time for staff to deal with donations. The most generous quarter was the third, suggesting that staff have more time then and are more likely to engage in non-role-specific activities.

The Collection Coordinator volunteer role onboarding process has been ready to launch. We’ll aim to do this at the start of the new year cycle in April once we have a better grasp on managing comms and have it fully aligned with a revised version recycling strategy.

The most significant event has been the pallet Ossur Germany donated to us, consisting of 120 feet and many more valuable components.

3. Delivering Legs – Stefanie Hadley

Tom and Phil with partners ‘Nav Solidaire’ when they visited Bristol to learn how to collect and dismantle prosthetic legs

The most exciting update from our previous quarter is the arrival of our collection ambassadors Nav Solidaire in The Gambia, who in November set off on their intrepid adventure to sail two boats from France to deliver components to make about 200 legs to the Banjul Mobility Centre. Although the customs process was lengthy, we have successfully completed a low emissions and low-cost delivery from an international partner, and are looking forward to many more in the future through our fantastic partnership with Nav Solidaire.

Our pallets destined for A2D Services and the Ganta Centre also arrived safely in Benin and Liberia, containing parts for 30 legs for A2D and 180 legs for the Ganta Centre.

We also sent a pallet containing 300 legs to Mulago Orthopedic Workshop in Uganda, which should be arriving within the next few weeks. Thanks as always to our friends at Navigator International Logistics for their help with shipping for these.

Over this quarter, we continued to receive reports on the use of our components; we logged 52 new recipients of prosthetic legs made from donated components who visited our partnered centres from July to November, who came from project countries of Tanzania, Uganda and Liberia, but also from Guinea and Cote D’Ivoire. These service users paid an average of $256 for the labour of their prosthesis, with all of our parts being provided for free. The primary cause of amputation for these recipients was road accidents, followed by diabetes and congenital limb difference.

4. Community projects – Bethany Elgood

UGANDA: The quarterly peer support camp was hosted in October themed “Empowerment to Reduced Inequalities”. The forty people in attendance benefitted from forums hosted by guest speakers – a rep from a Ugandan wealth management app, The Uganda Youth Association who promoted their current road safety campaign, a prosthetist, and a surgeon. The surgeon and the prosthetist (Henry from Mulago) did a group and one to one Q&A sessions where folks could ask about their recovery and self-care.

The event attracted some new members, some of whom learnt about it through social media, others who had met Charlotte, Alex and Jared at the eco rally last year, so from this we can see how ASNUs increased visibility is allowing them to reach more people and meet these particular project targets. In December, the ASNU team participated in a road safety awareness walk as part of National Road Safety in partnership with the Uganda government, further promoting the project and work of ASNU more broadly.

In this quarter, ASNU employed a part-time project administrative assistant, Paul, to support Charlotte in her role as Project Manager. Paul has experience working with Kampala City Council Authority (KCCA) and has been working alongside the rest of the ASNU team for almost a year now.

One of the challenges this quarter came in the form of a possible safeguarding concern. A client that Charlotte had met on the ward had been going around claiming to be an ASNU volunteer peer supporter. Charlotte has informed the hospital this isn’t the case, and the hospital have requested that photos and information about the ASNU peer support team are sent to mitigate this risk. Charlotte offered this client additional support to learn more about her motivations. It was fortunate to have happened in an environment where hospital staff members were able to observe and report but we know now that identification and clear communication with clinical staff is an absolute must.

Stats this quarter: Secured 5 new clinical partnerships to visit newly amputated patients. Made 9 media appearances to advocate for people with limb loss or promote their work. Attended 3 professional networking events. Were keynote speakers at a national conference discussing access to mobility services in Uganda. Registered 47 new members

GAMBIA: This quarter, we have been working on a framework for developing partnerships and strengthening capacities with community-based organisations (CBOs). Using this framework, we have been conceptualising a series of workshops to be held in person with three CBOs – Gambian Amputee Association, Gambian Amputee Football Team and a grassroots ladies interest group.

The workshops we have planned centre around guiding these groups in undertaking an organisational capacity self-diagnosis which comprises of a number of in-person workshops looking at the following areas:

We will explore the organisation’s journey so far, spending time mapping out its development to date and identify clearly what its aspirations are.

Then we will look at the organisation’s vision, values and mission to nail down what is important to the organisation and its community, and the fundamental beliefs that drive its work. We will also explore Legs4Africa’s values, vision and mission to establish where there are areas of strong common interest to focus our work on.

At this point in the process we will begin to assess how people feel about the status of the existing partnership. During this quarter I developed a new baseline matrix which allows us to compare and contrast how the relationship is perceived by our two organisations to make sure we are singing from the same hymn sheet.

Next we will spend time discussing the organisation’s capacity to deliver on its mission based on another self-assessment tool developed in this quarter, from which we will be able to prioritise strengthening those capacities as part of our work together.

We will also spend time working out how best to capture data and measure impact using the CBO’s priorities to set realistic targets. All of this information will be brought together to form a tailored work plan for each group and create the foundation for a new partnership agreement for each group.

These workshops will be running throughout January and February in preparation for funding to begin in August 2022.

5. Female Bursaries (plus Ebrima)- Stefanie Hadley

Female Bursaries

I’m delighted to announce that last quarter, our brand new cohort of scholarship students commenced their study towards the Certificate in Lower Limb Prosthetic Technology at the Tanzania Training Centre for Orthopedic Technologists. The continuation of the project this year is down to the belief of our funders in this project and the hard work of Mr Davis Shirima – the head of TATCOT – to work with us and within his own network to create a scholarship process that would allow professionals working within the P&O community to identify suitable candidates within our criteria of women with experience of limb loss, who would also pledge their support to their future careers with an offer of employment following their graduation.

This year’s students; Bernadette from Burundi, Solange from Rwanda, Emmaculate and Damaris from Malawi, Cindy from Kenya, and Hawanatu from Sierra Leone, have varied backgrounds and passions, and have a place of employment secured at workshops and hospitals in their home countries when they finish their studies. Last quarter they had their first exams in skills such as IT and started their first project to fabricate wooden prosthetic feet.

And we are of course not forgetting about our 2020/21 cohort; Judith, Molline, Ophia and Winnie, who are currently halfway through their supervised clinical placements in their home countries. They have gained a useful range of skills and experience so far, such as orthotics and pediatric legs, and are now knowledgeable enough to be making and improving their own prostheses! The next step is to evaluate their placements and start discussions about their future employment options.

Ebrima Krubally Leaving for Short Course – Prosthesis Technician Ebrima Krubally is prepared to leave for Tanzania on the 30/12/21 to undertake a short course in prosthesis at TATCOT. Topics include new techniques in transfemoral, transtibial and knee disarticulation related prosthesis. We wish Ebrima all the best in his travels and are excited for all the new skills he will bring back to Banjul on his return.

6. Morrow Returns – Chris Ingram

In October, Morrow Fofana returned to The Gambia after completing his three-year course in prosthesis and orthosis at the Brother Tarcisius Prosthesis and Orthosis Training College. His return was highly welcomed as it meant there are three staff at the centre now able to make prosthesis and orthosis using new expertise.

We asked him some questions about his time the school and here are his replies in his own words:

The course really help me, because it helped me to improve my skills in P&O. I have learned how to make Transfemoral Sockets (Above Knee Sockets). And how amputees behave, especially fresh amputees, before they start using prosthetic leg. The methodologies I learned is how to made a Sach foot for children with wood. Because now am also a trained prosthetic and orthotics. If my boss goes for retirement I can take over the workshop. With confidence.

My main challenge was, I was not a science student. Because I did not do science at my secondary school. I enjoy my stay at BTPOTC, Because I meet new fellow students and my Lecturers were very kind to me. They did not see my short comings. They really give me support till I finished my three years course.

My time at BTPOTC was nice and enjoyable, everyone respect me. Both Lecturers and my fellow students other staffs of the college But, they should try to improve some of their establishment. Better known to the college management. But now things will change. Because O.T.C should be taking management of the college.

In the future, I wish to further my training on Prosthetic and Orthotics making. Because In BTPOTC you have limited time on working on the device marking. In the future I can specialise on the making of a devices.

The primary socket making method learned at BTPOTC. Is taking cast of the limb with pop bandage, you fill the cast with pop power, and you modify it, after you check your measurements if the measurements is correct you can then you can be prepared for the lamination.

Mobility Centre Gambia – Chris Ingram

Nav Solidaire arrive at the port with their cargo

Nav Solidare/Tom visit- The recent Nav Solidaire trip provided an opportunity for Technical Director Tom to catch up with our partners and staff to understand any needs they might have relating to prosthesis and orthosis manufacture. Following this, additional equipment and repairs have been ordered to be delivered in the new year in follow-up visits, items include stockinette for socket making, sanding sleeves and multi-tools which are difficult to source in-country.

Site Hardware Supplied – Thanks to the team at Aid2Gambia and our partners at Edinburgh Mobility Centre, two ovens and vacuum pumps arrived in The Gambia for use at the Banjul Mobility Centre, these items will go a long way in helping in the delivery of prosthesis and orthosis services.

Ongoing Prosthesis Manufacture – Staff at the Mobility Centre attended to 30 amputees over this quarter, providing 11 repairs and manufacturing 19 new prostheses.

Digitising Data and Improving Patient Processes – Presently all patient data is collected through the use of paper forms, so we’re working with staff and partners to trial the use of digital tools to make data more accessible and patient processes more organised. Using KoBo Toolbox and KoBo Collect as well as sending some briefs through to the team for discussion, we’ve begun testing out the use to understand if it works and understand how it could be incorporated into their work moving forwards.

Gambian Peer Support – Chris Ingram

The Gambia Amputee football team

Hospital Counselling Sessions – Our peer-counselling team have continued their work at Kanifing General and Edward Francis Small Teaching Hospital meeting with 14 new clients across the locations, providing them with acute counselling whilst inpatients. There has been some slow down this quarter due to Christmas and elections in The Gambia.

Home Counselling Visits – Our peer-counselling team engaged with 14 amputees in the community also during this time. Owing to our other community staff travelling to Tanzania with the amputee football team, the community visits were undertaken solely by the peer-counselling team.

Home Maintenance – Our Community Rehab Support Officer organised 32 home maintenance visits during this quarter, where they checked over and assessed the quality of prosthesis and made adjustments where feasible.

Community Check-Ups – Our Community Rehab Support Officer met with 9 amputees over this reporting period to provide information on physiotherapy for newly amputated people and advise them on available services.

Gambia Amputee Football Make it to Tanzania – Our Community Rehab Support Officer Bubacarr Jabbie is also the manager of the Gambia Amputee Football Team. Thanks to his hard work as well as the players and other supporting staff, the team were able to attend their first official international tournament this year, travelling to Tanzania to compete in the Cup of African Nations Amputee Football.

Owing to funding not being available from the Gambian Government, Legs4Africa and other private donors linked to the charity funded international travel expenses to Tanzania totalling £11,000.00. A squad of 17 players, support staff and delegates attended where they beat Nigeria, Zanzibar and Uganda (through a no-show) to reach 9th overall; this was top of the teams who didn’t qualify for the knockout stage and an amazing achievement. Not only this, but executive members were able to engage in discussions around the future directions for international amputee football in the coming years, with Gambian delegates being elected to decision making and coordination positions during the interim negotiation cycle.

Ghana Peer Support – Chris Ingram

Community Meetings – This quarter saw a continuation of meetings in Nungua and OTC, with the final winding down of the sessions for this iteration of meetings at Adenta being completed. Themes covered in this quarter’s meetings included discussions around preparing for a prosthesis and understanding its workings, managing health after amputation and a review of the sessions content.

Peer-Counselling – Peer-Counselling and Peer-Support continued over this period, with 46 amputees being met with and 183 sessions being provided.

Outcome Level Feedback Collected – Owing to the completion of the second period of our two-year project, we have begun to collect outcome level information from people involved to understand any longer-term benefits they may have received as a result of being involved in activities. Through the peer-support team we’ve organised two surveys that look at individual peer-counselling and group community sessions.

Safeguarding Issue – One of the peer-counsellors was receiving calls at unsociable hours from one of her clients, this was reported to the safeguarding lead and followed through the appropriate channels. The client was then transferred to another counsellor.

Information Hub/Toolkit Trials – Following feedback from peer-counsellors on any changes the information hub/toolkit might need before they’d use it in their community work, it was adapted to suit how it might be deployed. Following that the peer-counselling team have been sharing the information via paper, digitally or through the chat-bot to people they’ve been supporting.

Christmas Activities – Our community group partner Smiles of Hope organised special Christmas themed community meetings this quarter. Initial planning to organise a Christmas celebration for the groups following discussions with some beneficiaries they decided to organise Christmas packages instead which included essential foodstuffs to help cover costs for attendees of community meetings.

Thank you

Together we are getting amputees in Africa walking, working and dancing again

Our warmest wishes

Phil Tunstall – L4A Director