01 February 2015

A Shepherd Needs His Shoes

Using an inner tube and foam from his mattress, our
patient rigged up a 'shoe' to cushion his steps.
A few weeks ago, I saw a young man -- maybe 16 or 18 -- limping through the hospital.  I was walking behind him, analyzing his gait pattern.  On the left foot, he wore a DarcoShoe which we had given him a while back.  His right foot wasn't visible as the leg of his pants encircled what remained after a midfoot amputation.

I didn't think much more about him, until a couple hours later he and his father showed up at our gym.  He didn't want the Darco any more . . . the wound where they had removed his left big toe, was all healed and the wedge of the sole made his limp worse.

Walking, for this young man, isn't just a form of transportation . . . it is his source of income and identity.  He's a shepherd, and his life is spent roaming the wide open spaces of Niger, leading his sheep and goats out to pasture.

As we asked him some questions in order to best gauge our intervention approach, he began to sling a little rubber disk around the ring finger of his right hand.

'What's that?' I asked.

'My shoe.'

'Where'd you get it?'

'I made it myself.'

I've been in Niger for four years now.  One of the phenomena that happens after about a year or so of being here is what I call The New Normal.  Things that used to stand out and surprise me . . . things that I used to notice and would blow my mind . . . but now, they are just part of the scenery.

As I looked at my patient's 'shoe', I realized that African Ingenuity has become a New Normal.  Don't get me wrong . . . I was super impressed!  I just wasn't surprised anymore.  Necessity is the mother of invention, right??

He needed a shoe to walk . . . his flipflops wouldn't work anymore, considering he didn't have any toes . . . the rubber closed-toed shoe he wore on the left wouldn't stay on since they had no means of tightening around his ankle . . . and he couldn't afford another option.

JN (our new physio, here for six months!!!), B. and I chatted about making him a new shoe . . . with the spare parts we had lying around, surely we could figure something out.  But I confess, I wasn't in the mood to scrap together a shoe . . . and we've been looking for ways to reduce our workload, not increase it.  Besides, there are cobblers in town, surely we could explain what this guy needed . . . and maybe we could collaborate more with them in the future, especially once we start the prosthetics clinic.

We organized a rendez-vous for that afternoon, and B. led the way to the nearest cobbler.

Hailing a left out of the hospital, we took Main Street just into town and over the second little bridge and followed B. down into a ravine.

'We're here!' B. announced.

As we stood under a hangar roofed with rotting millet stalks, I noticed a wooden 'workbench' and small tarp on the ground.  It was clear he saves a lot on overhead.

We went through all the greetings with the two guys who had been sitting there.

Thinking it was going to take a few attempts to explain what we needed, I began to describe in French why we had come and I thought B. was translating.

'So, this guy only has half of his foot and he's a shepherd and he needs to be able to walk all day long, every day.'  I paused to let B. interpret.

'Slkvaj lka lskjvoir jglkvsklljapwouglknslkmvaqpw9tj gk alkfmuanw984utj egkdsvmka vsldfkvaoirjg alkf mvjalk voaei lisdklvm kaowigjvlkjafmlnoi v argm i jl akslkflnov ij  amoiao ini nwoj wim409wj lkaniugbqaog aoi joidfn lma goiw4n aldifg aowijb lfkqoagjr oiw alsdj  aljwojavi a v uwiuvan  woijav lijia vi mak nuernf imv aoim vkmlkx vj,cmvhwueoriut 8ut k sfnaf  jslfkvaj isjogjroigjalsjavnaoer jnoau of qoirg oij av joiajg r0j gaijoigf jgaqreg ge gr ijg gjgafigji gfgafgrqp rgpjgr90uega0u3 jl avklvcaf ia[pia9j er.'

The man gave a very short answer.

B. turned to me, 'He'll do it.'

'Great, here's what we want--'

B. cut me off.  'Oh, he understands, he makes shoes like this all the time . . . for cows.'

'COWS?' my jaw dropped.

'Yeah, if a cow steps on a thorn or something.'


'Don't worry, D├ęborah, he knows what he's doing.

From that point on, we just had to sit back and watch.  Clearly a cobbler doesn't need an OT to tell him how to do his job!

Recycled car tires, thick plastic tarp, and leather were quickly transformed into amputee mens' fashion.  Using homemade scissors and modified needles, the cobbler snipped and stitches and produced a rather remarkable shoe . . . significantly better than we could have ever done!

The cobbler's 'shop'

Using scrap cardboard to size the shoe

Those scissors were homemade out of scrap metal

A rubber motorcycle tire is trimmed for the sole

And then shaved down with a homemade knife

Nail on recycled rubber tubing for the body of the shoe

Flatten the nails into the rubber sole

Leather trim for the laces

And, voila!  A shoe!


elisabeth said...

Rather like the a boot for a syms amputation, but we did not allow any nails in the shoeshop, so used the cobler would use impact glue and stitched it together. The handicap international bk has some ideas in it which can be adapted. Inner car tube is a flexible matrial and easily available.

Joyful said...

I'm always amazed by African ingenuity. They have an ability to repurpose almost anything. It really is true that necessity is the mother of invention. I'm sure the shepard will now be very comfortable.


Deb. said...

Thanks Elisabeth! I'll have to check out the book. They ended up adding a chunk of sole from a flip-flop on the inside to provide more cushioning. He's coming back in a month or so to check in and make sure nothing else needs to be modified.

Bethany said...

i love that shoe!! thank you for sharing. i love hearing your stories and seeing glimpses into your life. miss you dearly, friend.

P the Wichitan said...

That is awesome