MALAMULELE HOSPITAL AND MHINGA CLINIC, LIMPOPO PROVINCE
In September 2005, four therapists (Estelle Brown, Andrea Fraser, Marga Marloth and Gillian Saloojee), all from Johannesburg, were joined by Louisa Lowe, a physiotherapist working at Elim Hospital, about 140 km from Malamulele, to assess and screen children for the pilot project. Sonto Nhlabathi, a research assistant and mother of a child with CP in Soweto, also joined the team and assisted with the parent interviews and assessments. All the therapists volunteered their time.

The team spent three days at Malamulele Hospital in September 2005 where they:
1. Explained the project to the rehabilitation staff at Malamulele as well as the parents and had face to face discussions with everyone involved in the project.
2. Screened and assessed 30 children – formal testing and outcome measures (the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI) and a parent questionnaire for each child. established what equipment the children needed and took the necessary measurements so that the correct equipment could be ordered
3. Worked out the logistics for the intervention phase of the project.

The rehabilitation staff at Malamulele Hospital who were directly involved in the project included one physiotherapy assistant, two occupational therapy assistants, and two community based rehabilitation workers. Twenty-nine children were assessed. All the therapists taking part in the screening visit were struck by the enormous needs of each child. It was really difficult to see what happens to children who have received little or no therapy intervention – they are really stiff and “stuck” and many had developed contractures and deformities which could have been reduced if the children had been treated regularly from an early age. Many of the children were also very asymmetrical and it was very difficult to try and position them in a sitting position. 95% of the children could not walk and less than 20% of the children were able to sit by themselves. Few of them can talk and almost all of them needed help with eating and drinking.

The team took with them a newly designed and locally manufactured standing frame to establish which children could benefit from it. This was a huge success and had amazing results. Children who could only lie on the floor could be positioned in a standing frame and they were transformed – they were more alert, they started to hold their heads up, and some even started to use their hands. The children’s caregivers were overjoyed - they never thought that their children would ever be able to stand and hold their heads up.

In November 2005, a group of ten volunteer therapists traveled to Malamulele Hospital for the intervention phase of the Project. The therapists included Gillian Saloojee (project leader and physio), Estelle Brown (physio), Faatima Ebrahim (occupational therapist), Vanessa Rademeyer (physio), Dianne Zeller (physio) - all from Johannesburg; Diana Novotny (speech therapist from Cape Town), Jane Merber (physio from Nelspruit), Louisa Lowe (physio from Makhado) and Shelley Broughton (occupational therapist from Durban).

Twenty-seven of the twenty-nine children assessed in September each received a week of daily intensive therapy. One child had died since the September visit and another child was too ill to complete the week of therapy. Apart from “hands on” therapy, each child was provided and individually fitted with the equipment and splints he or she needed. The splints and some of the equipment were made by the therapists during the week. The therapists worked closely with the local rehabilitation staff and the children’s caregivers and this was a way of informal training. By the end of the week, each caregiver had been taught how to continue working with their child at home and how to use and care for the equipment.

In January 2006, Estelle Brown, Gillian Saloojee, Sonto Nhlabathi and Lydia Ngwana, returned to Malamulele to re-interview the caregivers to identify which, if any, aspects had changed; to reassess the children and establish whether the home programmes given were still appropriate and still being done; and to check on the equipment. This visit also included several unannounced home visits to some of the children. This was an informal way of assessing whether the equipment issued was appropriate and was being used. The children all showed significant improvements in their motor function – these changes could be measured using the Gross Motor Function Measure, the gold standard for measuring change in motor function in children with cerebral palsy.

Following the success of this pilot project, a second visit was done a year later (Oct/Nov 2006). Word of the project had spread and double the number of children arrived for the screening visit. Many of the children were unknown to the hospital rehabilitation team – by word of mouth mothers of children with CP had heard about the project and came looking for help for their children. The project doubled in size and twice the number of NDT trained therapists volunteered to treat the children. Once again, evaluation of the project revealed that the therapy intervention, training of caregivers and provision of equipment had a significant impact on the lives of the children and their caregivers.

Malamulele Hospital now has two physiotherapists and an occupational therapist. Recognizing the value of therapy services for children with CP, the hospital management sponsored the occupational therapist to attend the full time eight week basic NDT course. This means that the project has been sustainable as the hospital rehabilitation team now has the skills to continue with the programme. Therapists from Malamulele Onward, the Section 21 Company which was founded as a result of this initial pilot project, continue to support the rehabilitation staff at Malamulele Hospital through two – three day annual visits to the hospital. Malamulele Onward has now moved onto another hospital in Limpopo and the occupational therapist and community rehabilitation workers from Malamulele joined the team of Malamulele Onward volunteers – they are now in a position to assist children with CP in other areas of Limpopo.
Our plans are reliant on funding and volunteers.

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