Being in Cape Town for the WCPT congress made Katrina Kennedy reflect on her childhood in Africa and what lessons we in a more affluent part of the world can learn from those living in harsher settings
When I was last in the city, I was 18 months old. My parents, who were in their early twenties, had left Bristol and set off to start a new life with their two young daughters. What courage! My family left the UK 48 years ago to sail to Africa, when there was little global communication. My sister and I travelled back and forth to boarding school from the age of eight, and stayed until I was 14.
Cape Town is now a vibrant and cosmopolitan City. The sounds, smells and taste of this huge continent were re-awoken in me during the Congress's spectacular opening ceremony: the drumming, colours, vibe, and beat! Tasting guava at breakfast reminded me of my childhood in Warri, Nigeria, picking fresh fruit from the trees.
Healthcare in southern Africa
We heard that the South African government's healthcare system is used by 80 per cent of the population. Speaking with the impressive physiotherapy students who acted as volunteers at Congress, I discovered that physiotherapists are relatively well paid and that people are often reluctant to move as a result. Most graduates end up in private practice.
I had a fascinating talk with a CSP member who works in the northern part of Western Cape. She told me that nurses, rather than doctors, are the first point of contact in community clinics. She works in a secondary care hospital, which has three wards (one partly private) and serves a population of 100,000.
The member is a 'deep generalist', being able to assess, treat and manage any patient with a physical problem. She works in a farming community, which has an influx of people during the harvesting season. The healthcare system relies strongly on local community workers, who have been up-skilled. They deliver long-term rehabilitation and understand their patients' culture and social networks.
In a session on Zambian health care at Congress, I learned that the Catholic Church runs community rehabilitation services. Through church activities, needs are identified early on and health care is delivered through discussions and people taking action locally. Factors such as political priorities, people speaking different languages and having contrasting cultures, all have an impact on healthcare delivery. Though clinics operate in rural areas, some patients still require home visits.
An evaluation run by researchers from Zambia and Ireland focused on the patient's experience in community-based rehab. They found that functional outcome, networking, peer support, and quality improvement were the most important factors for service users.
They may have nothing but they give everything - whereas we have everything and give nothing! We have much to learn from their culture.
In many parts of Africa, there are still very strong family ties and a culture of care giving. People will give up work to support and care for others. They may have nothing but they give everything - whereas we have everything and give nothing! We have much to learn from their culture.
However, for me, the most transformative stories came in the 'humanitarian' session. Imagine being a child with cerebral palsy who benefited from having high-quality, well-funded care in your home city in Syria. Then the war started. You and your family were displaced, ending up in a refugee camp with no equipment, schooling or health care. In these situations, those with disabilities lose the most, which often includes their independence.
We heard that physiotherapists have trained and empowered refugees to undertake surveillance of people's needs in camps so they can identify those at most risk of health and functional deterioration. Elsewhere, physiotherapists have set up makeshift spinal injury and disability units in camps from nothing. We also play a role in preparing for an earthquake disaster and reducing risks after a disaster. We are an amazingly resourceful profession!
What struck me the most? The horror of hearing that nobody with a disability reached a refugee camp in Sudan and about the high proportion of disabled people who died in the Japanese tsunami because they couldn't run away.
As a profession, we have the skills to empower people with the knowledge to assess their own risks and plan their own escape strategies. If we reflect on the recent tragic events in Manchester and London, what provision had been made for disabled people to escape from a burning building?
While we physios have a huge amount to offer in terms of emergency planning and first response triage, it is in the redevelopment and restorative phase that we can excel and collaborate to support a sustainable national response.
I hope this gives you a flavour of my first 24 hours! My next blog will focus on leadership. I have been impressed by the amazing passion of early years physiotherapists but have found that they lack support.
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