‘It was a chance conversation in a bar over a bottle of wine at the end of last summer that started the ball rolling. My friend Emma Jones told me of her plans to go to Zambia for her elective physiotherapy placement. My sports related placement had fallen through and I was back to square one, looking for a suitable elective. How could I make the most of this opportunity?
Previous travel to South Africa had stimulated my interest in working in a developing country. So when Emma explained her idea of working for the charity Leonard Cheshire, it wasn’t long before we were planning our trip.
We flew to Zambia at the start of February this year bound for a paediatric Leonard Cheshire home in the capital Lusaka. With us were textbooks and an ultrasound machine, requested by the clinical educator there, Sister Margaret Mweshi, after we suggested taking equipment out with us.
Raising money to buy the ultrasound machine involved a lot of teamwork. A simple car boot sale was the initial idea and friends and lecturers cleared out their homes to generously donate items for our sale. Three boot sales later we still needed more funds and with the help of PhysioMed we managed to purchase one.
Our arrival in Zambia was another learning experience, especially when customs would not allow us through with the ultrasound. It took a return journey to the airport and an exchange of cash before we were allowed to bring our ‘gift’ into the country. Seeing the physiotherapists’ faces light up at the sight of the new machine and how much it was used in the four weeks we were there made it all worth it – including the cold early mornings at car boot sales.
We were based at a Leonard Cheshire home that opened in 1973 as part of a national network in Zambia. It is also part of the worldwide network started by the founder Captain Leonard Cheshire after the Second World War. This particular home is in partnership with an Italian-Zambian orthopaedic hospital where children have surgery. The home was residential: providing schooling and physiotherapy for children aged between five and 12. We helped run rehab sessions for children with a range of conditions such as cerebral palsy, epiphyseal dysplasia [abnormal development of bone or cartilege], osteogenesis imperfecta, talipes, post-burns contractures and amputees.
One six-year-old girl called Judith had been in a house fire when she was a baby and was the only family member to be rescued. She was undergoing continuing facial surgery due to the extent of her burns and had one amputated hand and no fingers on the other. However, she threw and caught a ball better than any of the other children, and her beautiful colouring, with a felt-tip pen between her well healed stumps, was simply inspiring.
Some children wore wooden prostheses and others wheeled each other around in oversized wheelchairs, but smiled and worked hard during intensive rehabilitation sessions. I am proud of the extra pair of hands we gave for the short time we were there. Often the rehabilitation sessions involved one physiotherapist treating 12 children. Most treatments were performed with the whole group, which varied greatly in presentation of disability. Emma and I were able to take one on one sessions, in particular with the more severely disabled children.
I particularly admired one colleague, outreach physiotherapist, Rose. Outreach therapists travel into communities to ‘find’ and assess children. In underprivileged communities the birth of a disabled child is more common due to poor birthing methods, the parent’s health and the lack of medical care. However, families do not just seek help from hospitals or GPs like in the UK, but hide their babies away. The outreach service looks for these children.
Rose had incredible enthusiasm when looking for children. Seeking out babies and children is a difficult task and we often found ourselves trekking across fields, asking for help at market stalls and giving talks to school children about the free medical help available through Leonard Cheshire homes. When looking for one child we searched homes, garden sheds, hiked across fields and asked at street stalls all in search of the family. Nothing got in Rose’s way. She had an incredible amount of motivation, and as well as having five children, she had previously spent time abroad studying to further her career and knowledge.
My time was shared between the children’s centre, community work, outpatients and palliative care at a local hospice. Palliative care demonstrated the extremes of care in Zambia: at one end was the new church funded hospice, Our Lady’s Hospice, at the other was the reality of visiting patients in the poorest areas. Mud and rubbish lined the paths, flies swarmed around market stalls and dark rooms with hard floors and blankets provided family beds.
Probably the hardest part of my work was at the local hospice. This treated young HIV-positive and AIDS patients. Most were scared and I found reassurance difficult when patients were seeing me in uniform and gloves. Although the hospital was new and had lovely grounds, most patients sat or stayed in bed all day with sad faces and few visitors. This was emotionally the most difficult part for me, especially because of their young age.
There are many differences between physiotherapy in the Zambia and in the UK. Initially I noted differences in resources. When working in Zambia we had to adapt our assessment and treatment skills to work within these limited resources. For example, the treatment beds did not move up and down, which made us really think about health and safety issues – particularly our own bad backs.
Compared to the UK, I felt everything happened at a slower pace. I am not suggesting this is negative, but it allowed me to realise the importance of accepting different cultures and individuals all work in different ways and at a different pace.
Physiotherapists practice after a three-year diploma. They can progress on to a degree, but only if they can afford it, and further training is limited. The degree programme only recently became available in Zambia. Previously students travelled to South Africa to train, however, they rarely returned due to better job opportunities.
I found Zambian physiotherapists were required to work without medical help and the support of a multidisciplinary team. This stretched their scope of practice to the limit. While visiting one school a young girl was brought to us with a large facial abscess that had caused her face to twist to the right, leaving her nose and mouth abnormally positioned. In my eyes this said GP, referral and specialist consultant yet the physiotherapist had to work on her own, doing her best to assess and make notes in order to relieve the mother of some worry, and also attempting a doctor referral. At times I felt uncomfortable pushing the boundaries of my competence yet on reflection it has broadened my enthusiasm for looking at the wider picture and providing a holistic approach to management.
My trip to Zambia has allowed me to further my placement profile, gaining new skills and improving existing ones. Language barriers and disabilities allowed me to learn how effective and important non-verbal communication is. I learnt to use smiles, facial expressions, touch, and body language to gain a patient’s trust. I also grew to value the importance of fun in communicating with children.
In addition, I realised I needed to adapt my professional skills to prevent disturbing the good work already in place, but made suggestions and helped with individual staff teaching in order for them to take steps towards advancing their practice. Having a friend was a great support. I feel Emma and I gained hugely from daily discussions and reflections, both personally and professionally.
We allowed ourselves some free time and went to the Victoria Falls. After much persuading from Emma, we were brave enough to do a bungee jump over the Zambezi River... what an adrenaline rush.
Returning home, I graduated from the accelerated physiotherapy course at Cardiff University. Searching for junior employment in the current job climate can force my Africa memories to the back of my mind. Yet in reality working in a developing country has given me a unique experience, extending my profile and cv, and allowed me to appreciate the NHS.’ FL
Tips for organising an elective placement
- Remember travel insurance does not cover you for working in another country. You may need more than one insurance policy for your trip.
- Organise a visa (if required) before you leave the UK as this makes entrance by air or land a much swifter process.
- Apply for sponsorship to help fund your trip. Your budget quickly escalates with unexpected costs.
- Leave plenty of time to get necessary vaccinations (and expect to pay for a yellow fever inoculation and malaria tablets).
- Prepare a well-stocked first aid kit including a mosquito net where necessary