Helping to improve the lives of disabled patients.
Physical difficulty in Malawi poses enormous challenges for both adults and paediatric patients. Many children with disabilities such as Cerebral Palsy are marginalised and socially isolated because they spend most of their young lives on the floor, unable to stand or walk without support. Wheelchairs are unaffordable and even if patients manage to access tertiary facilities and receive recommendations, they are unlikely to be able to afford crutches or walking aids. Mothers carry their disabled children around if they can, but inevitably, the child grows too big and heavy.
Operated by the Blantyre District Health Authority, Zingwangwa Health Centre was opened in the 1970’s and serves a population of approximately 161,300 people. Located in the heart of Zingwangwa, 4km from the centre of Blantyre, the dirt access road to the health centre is appalling and moreover, the descent to the facility from the road is steep and unsuitable for elderly, infirm and disabled patients.
Patient access from the rough road down to the facility is very challenging; severely disabled patients must be carried, and wheelchair access is almost impossible. Moreover, the drainage from the top road is inadequate; in the rainy season this causes severe damage to the retaining wall, with cascades of water flowing down to the health centre.
AMECA was alerted to the plight of disability services for patients at Zingwangwa by the DHO Physiotherapist, Chindikani Mkandawire. Chindikani was instrumental in working with AMECA on the creation of the new physio clinics at Chilaweni and Chilomoni Health Centres.
Staffed by 2 physiotherapists and operating Monday to Friday, the physiotherapy clinic, located in a dark, gloomy, cluttered and ill-equipped room, was totally unsuited for the delivery of any meaningful physiotherapy services. Although structurally sound, it required new larger windows, new lighting, and structural alteration to move the entrance door to create more space and the addition of a patient toilet.
The challenges were as follows:
- Poor infrastructure, cluttered, narrow passages hindering mobility and no patient toilets.
- Poor lighting and ventilation.
- Poor patient retention rate due to poor facilities.
- Almost no equipment.
- Lack of assistive devices for patients to undertake therapeutic exercises.
As can be seen from the photo opposite, patient access from the rough road down to the facility is very challenging; severely disabled patients must be carried and wheelchair access is almost impossible.
It was apparent that, although modifications can be undertaken to create a clinically functional physiotherapy clinic, there is little point unless disabled patients can safely access the facility. The building modifications therefore included construction of a new ramp from the road, which will permit safe wheelchair access and ability of patients, and even the elderly, with mobility aids such as crutches to safely reach the facility.
Working with physiotherapists Chindikani and Blessings, AMECA asked architect Jan Sonke to re-design the room and create more light and space.
The room was totally demolished internally and the door re-sited to enlarge the available space. The windows were enlarged and a new store cupboard, a new toilet were created. Finally we asked our graphic artist,Young, to create some bright and cheerful murals.
The facility was then fully equipped with a ultrasound and Tens machines , and other physiotherapy aids. The wooden wall ladder, Boabub bed and standing frames were made by our local carpenter Gibson. We also brought in sensory toys for the paediatric patients.
Blessings reports that patient attendance has increased significantly. Patients with chronic issues have started reporting great improvement in their pain and function as well because of the electrotherapy equipment. The improvement in space allow patients to move around freely and exercise therapy has become easier.
Having sorted out the main physiotherapy clinic, we then began to look at the challenge of patient access to the facility. The obvious answer was to create and access ramp from the top wall down to the health centre, but the space for a ramp is very restricted and approval was needed from Blantyre City Council.
An additional problem, was that the drains on the outside wall were poorly designed and led to flooding of the facility in the rainy season. Moreover, in time, the flooding would have led to a total collapse of the outside wall.
Opposite, architect Jan discusses the situation with BM Contractors and with Davie from The Dossani Trust, who so kindly funded the project.
As can be seen from the photo opposite, patient access from the rough road down to the facility is very challenging; severely disabled patients must be carried and wheelchair access is almost impossible.
It was apparent that, although modifications can be undertaken to create a clinically functional physiotherapy clinic, there is little point unless disabled patients can safely access the facility. The building modifications therefore included construction of a new ramp from the road, which will permit safe wheelchair access and ability of patients, and even the elderly, with mobility aids such as crutches to safely reach the facility.