In both Medellín and Montería, the children we first visited in their homes and then assisted in the workshops lived in poor neighborhoods and squatter communities on the fringe of these cities. However, where I have most experience—and where I most enjoy working—is in the rural area: small villages, farmlands and forests where the natural and human environment still inter mingle. This being the case, long before departing for Colombia I’d asked the SLF national coordinators if I could have a chance to visit some of their rehabilitation activities in the rural area. So on completion of the workshop in Montería, the coordinators for Stichting Liliane Fonds (Sister Teresa and Marina) took me to a village area called Cerro Vidales, where the population is almost entirely indigenous.
In Cerro Vidales and the neighboring pueblos de indios most people are very poor—but there is a strong sense of community.
Families live off the land and often supplement their income through local crafts such as basketry and the weaving of sombreros. The rustic houses are made of poles—sometimes covered with mud—and have roofs thatched with palm leaves.
The people tend to live simply, growing most of their own food and collecting building materials and firewood off the land. They are very friendly.
In Vidales we stayed in a Catholic convent where the nuns assist the needy—often mak- ing home visits on motorcycle to outlying communities. Across the road from the convent Stichting Liliane Fonds helped with the building of a “Center for Attention for Disabled Persons.” The Center is very well organized. Records and photos of every child assisted—complete with diagnosis, goals, assistance provided, and progress achieved—is meticulously laid out in a loose leaf notebook. More detailed files on each child are kept in a file cabinet, color-coded according to the different types of disability.
The Center has a therapy room which includes, amongst other equipment, adjustable parallel bars. Unfortunately the bars were far too wide, and much too high—even at their lowest adjustment—for most of the disabled children needing to use them. (This is a common problem seen in many programs and countries.) The coordinators have agreed to adapt the bars for lower adjustments (simply by sawing off the tops of the fixed uprights) and to add new, closer bars for small children.
I was able to join with a number of mediators and concerned people, and visit some of the indigenous villages in and near Cerro Vidales. There we were able to make some assistive devices for children.
The Children of Cerro Vidales
Domingo is an attentive eight-year-old boy with spina bifida. He has a pressure sore on his butt. It is now healing, but the scarring shows it was much bigger Not surprisingly, when we asked Domingo what he wanted most to be able to do, he said, “To walk!” We thought that he might be able to begin to walk with a parapodium, such as we’d made for León Darío in Medellín. So we needed to test if this might be possible. Since walking will depend largely on the boy having sufficient arm strength (to walk with crutches), we asked him to try to lift his body weight off the bench with his arms. With pride, the boy easily lifted himself into the air. His arms were strong from all the crawling he did. And his balance was excellent.
Next we tested Domingo for hip, knee, and foot contractures, which can be obstacles to walking. Unfortunately his knees didn’t straighten quite enough to use a parapodium. We taught him and his mother how to do stretching exercises. But that would take a long time. His legs were more likely to straighten using night splints that would gently stretch them for long periods of time. We decided to make the splints out of PVC tubing. A man brought some very thin walled PVC drainage tube, about 3 inches in diameter.
Because the thin plastic is so pliable, we decided to leave tabs projecting out from the brace to help hold it onto his leg. Then strips of rubber inner tube were bound above and below the knee, to provide a gentle but steady stretching action. Because the inner tube wraps tended to slip away from the knee, we decided to use a single piece of inner tube with a hole in the middle for the kneecap, and 4 long strips to encircle the leg above and below the knee.
Domingo said he could feel the brace stretching his knee, but that it didn’t hurt. We advised the boy and his mother to use it at night, but only for as long as it didn’t cause much discomfort. They could start with short periods, and gradually leave it on longer.
After seeing that the new night-splint design worked, we set about completing it—and making one for the other leg. To prevent the ends of the splint from cutting into the backs of his legs we needed to round them to avoid a sharp edge. To do this we heated the edge of the plastic with a candle and then bent the edge outwardly by pressing the hot plastic with a large spoon and holding it in the desired position until it cooled. The result was a gentle outward bend at each end of the splints.
Most important, everyone learned a new simple technique for helping solve a common problem. (Knee contractures often develop in children with cerebral palsy and other disabilities, and can be a big obstacle to walking.) I have previously used thicker, non flexible PVC pipes. But this was the first time I had experimented with this very thin, bendable PVC tubing, and it worked very well, easily opening wider to fit the child’s upper thigh, without need to heat and bend it.
Pressure Sores from Inappropriate Seating
** Sores on buttocks ** on either side of center (from sitting)
It finally dawned on us why Domingo has a pressure sore over his tailbone. It came from sitting in an oversized wheelchair—as well as in large hard-plastic chairs. In such big chairs his body leans backwards, putting pressure on the base of his spine. The risk of such sores is yet another reason for making sure disabled children have seating and wheelchairs adapted to their needs and size. We emphasized the importance of sitting on a soft cushion—and on chairs that would help Domingo sit upright.
On the road outside the Rehabilitation Center we happened to meet a 6-year-old boy named César and his father, walking by. The local mediator explained that she had helped arrange surgery to correct the boy’s clubbed feet, two years before. But evidently the problem was not only in his feet, since the boy’s knees and feet still turned inward when he stood or walked. A doctor had recommended below the-knee leg braces, but since in-turning of his feet and knees appeared to originate mainly in the hips, is was doubtful the braces would help. Besides, it was unlikely that he would wear them, since he walked quite well without them.
So we decided to make a nighttime foot twister out of an old plastic 2-liter Coke bottle, to hold his feet angled outwardly at night. The hope is that this will gradually stretch the tight ligaments and tendons which turn his legs inward, thus helping him to stand and walk with his knees and feet in a more outwardly rotated position.
We inserted César’s feet through the hole in the plastic bottle. Although the thin plastic bent quite a bit, it held his feet widely open. César didn’t see seem to mind—and much preferred the idea of wearing this device while he slept than having to wear braces during the day. We advised him and his family to start using the device for short periods at night, and to remove it if it began to hurt. Little by little he should get used to it.
Orlieda is a 25 year old woman who lives in the Vereda de Salihal, near Cerro Vidales. She appears to have a slowly progressive form of muscular dystrophy. Muscles in her arms and legs began to grow weak in her early teens, and now she has trouble walking. Orlieda supplements her family’s income by carving wooden flowers, birds and animals, which she paints colorfully.
Orlieda’s legs are now so weak that she has trouble lifting them. Her right foot drags on the ground, causing her to trip and fall. We found her foot-dragging is due to her left leg being shorter than her right. We experiment ed a shoe lift—which we made with layers of cardboard—under her left shoe.
With her leg length equalized by the lift, Orlieda discovered she could walk without her right foot dragging so much. She felt more stable and self-confident, with less risk of falling. She will ask a cobbler to add a permanent lift to her shoe. This small modification may increase her ability to keep walking for additional months or years. Orlieda and her family were delighted.