Between two and three children out of every 1,000 live births are estimated to have cerebral palsy (CP) – a permanent disability caused by brain damage that impairs movement and posture. The prevalence of CP is thought to be higher in resource-constrained settings: in many African countries, for instance, the limited access to healthcare and to early intervention strategies that could minimize the impact of the disability still represents a huge challenge. Children with CP living in such areas tend to have more complex problems, and the high prevalence of HIV makes their lives (and that of their families) even harder. Most children are raised in single parent households, often with grandmothers as their primary caregivers.
Children with cerebral palsy will be disabled for their entire lives, and often have other CP-related impairments (cognitive, visual, sensory, to mention but a few). Because of its multifaceted nature, the condition is difficult to treat and manage, and newly-qualified therapists feel woefully unprepared to work with the large numbers of children with CP they encounter in public service hospitals. The situation is even more challenging in rural areas, where inaccessible terrain, poor roads, inadequate or non-existing public transport, poor infrastructure and a scarcity of therapists mean access to healthcare and rehabilitation services is, at best, infrequent. Most rural children only receive 40 hours of therapy over their lifetime – a scary number when one considers that in well-resourced environments, children with CP receive nearly double the amount of therapy in one year alone. Additionally, less that 30% of rural children with CP will ever get to school or a day care center.
At Malamulele Onward, we work to provide access to therapy to as many children with CP living in the rural areas of South Africa as possible. We want to enable parents and families to feel equipped to deal with a lifetime of caring for a severely disabled child and we want each child to thrive in a supportive environment.
So, what does lean thinking have to do with all this?
Let me tell you, it’s become essential to everything we do here. We are applying it by ourselves, trying new things out, making mistakes and learning from them. I was first introduced to lean by Terry O’Donoghue from Halfway Toyota [a chain of car dealerships in South Africa – you’ll hear more about them on Planet Lean in the coming months], who encouraged me to read more about it. And read, I did – whether it’s a book by Michael Ballé, Dan Markovitz, Art Byrne, Jim Womack or Karen Martin, or an article on Planet Lean. I also watch a lot of YouTube videos on lean. And each time I read something, I understand it a little bit more. Something I found incredibly helpful was when Terry and Dave Brunt (the CEO of the Lean Enterprise Academy) invited me to follow them at the gemba at several Halfway Toyota dealerships around Johannesburg. Lean was a new language for me and it was very useful to see its concepts and tools in practice: that’s when I began to understand the jargon (value streams, pull systems, flow, eliminating waste, and so on) and how to possibly apply those same ideas at Malamulele.
Each of the lean ideas we have implemented stemmed from problems that we had to solve across all our programs, and from our desire to build a system that prevents them from re-occurring. You can’t be reactive all the time, and we have too much to do here to waste our time taking care of things that should normally run smoothly.