Sarah McRae
Seeing Salmon Raj standing straight and walking about with his crutches, it is hard to believe that one year ago he was crawling along like a crab and then spent many months in hospital in traction. He is truly remarkable and has such drive and determination. It was an unbelievable pleasure for me to go to Tuni and work with him. As I said, he is now walking with crutches (with no callipers!), climbing stairs, taking a few steps completely unaided and even playing cricket. So were the operations worth it? A big resounding YES and Salmon Raj is so pleased with his progress, so much so that he told me he now wants to become a Doctor.
And so where did I come in then, as a physiotherapist? Just before I left I wondered that too, because at this time Salmon Raj was walking about with help, attending a physiotherapist at the local hospital and really doing pretty well. So I was a little apprehensive as to what my role would be and if I was going to step on anyone’s toes. When I arrived Salmon Raj’s physiotherapy consisted mainly of stretches to maintain the movement in his joints and this is where the differences between physiotherapy in India and UK, in my opinion, became evident. Indian physiotherapy seems to me to be all about doing things to the person and not so much about empowering the person and getting them to do their own exercises. I felt that it was important that Salmon Raj became as independent as possible and did exercises to help strengthen his muscles, improve his balance and also work on his walking pattern. So this is what he is doing now, three times a day under the supervision of Chinta Rajesh, known as ‘Ch’. Ch is one of the workers in the home, who is doing a great job with the boy’s physiotherapy. He was always keen to help and to also learn some simple techniques. He is very disciplined and enthusiastic and followed my instructions to the letter almost too much!
Salmon Raj also has marked curvature of the spine which means that he stands bent double and has to wear a brace, which causes him a lot of pain, to stop the deformity getting worse. I think that his back will hold him back, because it is very difficult to balance when you can’t stand straight. Salmon Raj is very keen to have surgery in the future to correct this, but this is obviously a risky and painful procedure, again probably requiring prolonged hospitalisation and lengthy rehab. I suppose it will require careful thought and consideration from all involved and of course Salmon Raj himself, but as I said he is an amazing young man who wants to walk tall and is prepared to do almost anything to achieve that.
The support the kids have for each other is incredible. The older ones look after the younger ones and so on. There is so much camaraderie between them and I don’t think I ever saw any evidence of bullying. I suppose that it makes it even more amazing that the kids all immediately trust us “white chickens” and welcome us to be their friends, or “Aka”, which means big sister in Telugu. But for me, as a physiotherapist, helping proved sometimes to be a hindrance. Helping it seems, is a big part of the Indian culture. They want to help each other and so for me, as a physiotherapist, trying to explain in a foreign language that it is better for Salmon Raj if they don’t help him and he gets used to moving himself was in itself quite a big challenge! I also feel that this will be a challenge for Salmon Raj in the future, as he strives to regain his independence because he is so popular with all the kids, such that they want to do everything for him. I asked Salmon Raj what his goals are in terms of his functional ability for the future and he said that for one, he wants to be able to walk by himself and secondly, he wants to be able to dance with “Gillie Amma” when she next visits.
Now I have to mention Simon. He is a 15 year old boy (although, like many of the children he is not sure when his birthday is), who was brought to the orphanage just before Christmas. He had been curled up underneath a tree in a ball for two years, after having some kind of infection and then taking some Aruveyic medicine. At some point during this time he suffered some damage to his brain. So now he can’t easily move his arms or legs, get around and has difficulty speaking, although mentally he is sharp as a tack. He is pushed around in a very ropey looking wheelchair which is far too big for him. I spent a lot of time with him because he does not attend school and he has never had any formal schooling. We practised simple numbers and letters, and did some speech exercises, as well as most days doing over an hour of physiotherapy.
Simon is absolutely amazing and has a huge amount of potential. In the short time I was in Tuni, he worked really hard, learning to drink himself and use his arms a little. He loves music and now during prayer time he always bangs on his tambourine and sings in a much clearer voice. The problem for me was trying to set up a rehab programme for him whilst not having the resources that are available in the UK. He has a simple programme, but would benefit from a more structured one delivered by trained professionals – but this would be very costly and also things are done differently in India. I think even a wheelchair that fits him, has footplates, a table and a proper cushion will make a big difference. The challenge at the moment is getting Simon to see a neurologist so as to get a diagnosis and getting him a decent wheelchair. But as I found out India is often frustrating, particularly when it comes to timescales and making appointments! Maybe the NHS is not so bad after all!
When I knew that I was going out to Tuni, I thought about what I might be able to offer. I thought I could do some physiotherapy to help Salmon Raj and Kumaraja maybe, but I also thought about what I would get back. It was a challenge unlike anything I have ever undertaken before, professionally and personally. It has given me a huge amount of confidence because you have to draw on all your resources, professionally, emotionally and physically. It is very humbling.
So now, to sum up there are so many words to describe India and my experiences in Tuni, but if I was to chose just one, I think it would be “incredible”. Because at times it is incredibly difficult and frustrating, but at the same time it is incredibly inspirational and the kids are so incredibly full of life. So a big thank you to SLA for the opportunity to share this incredible experience with the children of SLA.
