A Working Week

Hiking up mountains on Monday morning was certainly a great way to get the week started and make sure there were no post weekend blues, but it was hard! The fact I was doing it to visit patients was a source of inspiration but occasionally that failed me and I had to rely on being encouraged (shouted at) by my colleague Abu (he took great pleasure filming my awful balance on the way down).

I already knew community physiotherapy in Freetown was quite the experience but this really was a shock to the system. I was drenched in sweat and even found myself being thankful that it had been a rainy day (if it had been sunny, I’m not sure I would have survived. I'd have become a burnt and dehydrated mess of a man). However, my complaints were put in to perspective when it was pointed out that the families living high up in the hills have to do this hike daily; they have to do it to get to work or to carry shopping back to their house. I witnessed pregnant ladies, ladies carrying baskets full of shopping on their heads, old grannies and children in flip flops all doing the hike and none seemed to be struggling as much as me (or struggling at all).


When I got back to the comfort of my sofa and put my legs up, it did make me wonder what people think I am doing here. Being asked why children in Sierra Leone need massage was a fun question to answer before I left the UK. In general I have found peoples perceptions of what a physio is can differ quite a bit. There is definitely a bias towards sports physio and also the giving of massage. Before training to be a physio that had been the physio contact I had, it was great contact and with my swimming it was a definite benefit. It wasn’t until I began getting work experience to apply for university that I became more aware of different areas, and this knowledge expanded further once I began studying.

So what exactly is it I am doing?

The simple answer is I am working for a charity called Enable the Children where I provide physiotherapy to children with disabilities. These disabilities include Cerebral Palsy, Developmental Delay, Acquired Brain Injury, Spina Bifida, Sciatic Nerve Palsy and other orthopaedic conditions. Alongside the disabilities, the children and their families, have to contend with a lot of negativity; often fathers abandon the family, money is scare and health care is expensive. In Sierra Leone there is also a belief that a disabled child is a devil or a witch and a community don’t want to support the family. Last year the Enable the Children team produced a song to highlight this problem.


The physiotherapy is provided either in clinics or in the community. We don’t have a lot of the equipment or interventions available in the western world, so this means we work on stretching, strengthening, loading and positioning. This has certainly thrown up challenges; how do I position a kicking, screaming, punching and sometimes biting child; how do I make the exercises fun and how do I ensure the family are doing the exercises with the child correctly and regularly. Honestly, I’ve not figured it out yet, but I’m working on it. I have found my singing of ‘Twinkle Twinkle Little Star’ seems to have a calming effect but ‘Three Blind Mice’ definitely produces screams and tears.


We do use frames, chairs and splints to help with the exercises. These are all produced by local carpenters, tailors and blacksmiths. Going back to the hiking I was told that the team have to carry these heavy wooden frames up the mountain to deliver them to the patients. I am very thankful that I didn’t have any deliveries to do!


I may be slightly biased, but I think the work Enable the Children do is amazing. As well as the physiotherapy work, members of the team provide occupational therapy support; particularly to children with behavioural problems and learning disabilities. They also provide family support and facilitate reconciliation to those who need it. They lead group support meetings, organise and run sport days and host a great big beach party. They are very proactive and really want to support families and break down the stigma towards disabilities that is present in Sierra Leone. Over 2,000 children have benefited from the work, and over 800 children are currently receiving active treatment

My own week has been reasonably structured since I have arrived

Monday is day out in the community. Where we split the team into smaller teams of 2-3 people and we go and see our patients in their homes. As a program we cover all of Freetown and some of the surrounding area. Freetown is a city with a population of over 1 million and like any city getting around is hard work. This is made trickier by the number of cars, motorbikes, kekes (imagine a tuk tuk), buses and the standard of roads (although one of the drivers did tell me there was no such thing as a bad road only a bad driver).

Tuesday and Thursday the team is split between community work and the Children's Hospital where we have a clinic room at the hospital to treat outpatients and inpatients; so far I have been in clinic on these days. On Wednesday we have a team meeting in the morning and then a clinic at a local health centre. Fridays are half days (whoop whoop) and they are for teaching and training. I have kept the training on anatomy at the moment, I thought my brain would be able to cope with that. I have had to work a wee bit at the weekend doing child sponsorship collection, sports events and support meetings but I have also made it to the beach almost every weekend (long may that continue).


To accurately describe what being a physio in Sierra Leone is like, but also what life is like here is difficult. It is so different to anything I have experienced before. There are so many things that I took for granted in the UK; like transportation, communication, street lighting, that I almost have to forget that these things even existed. I have also found that things just take longer here, some of it is time management but definitely not all of it! Accepting this is proving tricky, as I do enjoy things running efficiently and effectively.


The blissful escapes to the beach at the weekends have definitely been needed, partly to escape the noise and busyness of the city but also to unwind from the patients I have seen at work. The first couple of weeks flew by so quickly that I had no idea what was happening but now I am slightly (I really do mean slightly) more aware of what is going on that I have tended to mentally hold on to patients a bit too much. Not a good habit to get into and eating lots of rice is not the answer!

Finally, the thing that I find most exciting about Enable the Children is their attitude to put ideas into practice. As in most places, there is always a lot of talking and correct procedures and protocols to follow before change occurs. But to be part of a team that is looking to change mindsets, improve quality of life and do this through action really does make it easy to climb steep hills and be driven over bumpy dirt roads.


Thanks for reading, much love and God Bless x


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© 2019 by Iain MacMillan. Images World Hope International

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