the global village

With jobs in short supply for UK physio graduates, could looking further afield make all the difference to your prospects at home? Jane Hobden finds out

Summer is here and with it for the latest batch of newly qualified physios concerns about finding work. With many of last year's graduates still not settled, competition is fierce. This is forcing some to look abroad for opportunities. But is working overseas a way of building skills and experience to maximise your UK job chances or simply marking time? The most likely overseas opportunity at this stage in a physio's career will be volunteer work. Mark Chillingworth saw it as a way of consolidating the skills he learnt during training. 'It really meant a lot to be doing physiotherapy at a time when I had trouble obtaining my first post. I gained so much confidence.' His 10-week stint in Bangkok, Thailand, followed graduation last summer from Glasgow Caledonian University and four junior post interviews. The placement - organised through For Life, a charity working with disabled children in Thailand - was based in an orphanage in Bangkok, home to 2,000 mentally and physically disabled children. Much of his caseload consisted of boys with cerebral palsy. He worked largely independently, assessing and treating his own patients. To overcome the language barrier, he used sign language with both staff and children. It was a chance to experience physiotherapy at its most raw. 'You're completely out of your comfort zone, with few resources and almost none of the equipment available to physios working in the UK. The key thing is to make the most of what is around you. Your main tools are the most basic: your hands.' Working at the orphanage enabled Mark to build both his clinical reasoning and his manual handling skills - 'the sort of skills that can only be worked on through day-to-day contact with patients'. The skills and confidence he developed have played a big part in helping him to find a junior position in the UK, he believes. He is now the full-time physio junior at Monklands hospital, Lanarkshire. At his interview he was asked about his experiences in Thailand. 'This is something that raises you above what, at junior level, is a very level playing field.' Mark adds: 'Volunteering can be expensive but For Life is a charity whose administration fee is modest and also the cost of living in Thailand is very cheap.' Mark paid for the flight and living expenses during his stay, including accommodation in a volunteer house, which cost £50 a month. A TRAGIC WASTE CSP student adviser Jamie Mackler agrees that gaining physiotherapy experience abroad can help to develop resourcefulness, flexibility and cultural awareness, but he abhors the situation that is driving unemployed graduates to look for overseas work. Given that the government and NHS employers identified in 2001 that more physios were needed, and expanded training places accordingly, 'it seems a tragic waste that now some of the brightest and most competent UK-trained graduates are being forced to look abroad to put their skills into practice', he says. Nevertheless, many graduates prefer to take their chance abroad than stay at home unemployed or forced into a job that does not use their specialist training. Last September, Marc Holl took up a five-week placement as a physiotherapist volunteer in Ghana, having graduated from an MSc physiotherapy programme at the University of Essex. He is convinced the experience helped to land him his first UK junior post at Norfolk primary care trust. He says: 'Working as a physio volunteer overseas helps to boost your confidence, to develop your clinical reasoning and to use initiative in developing treatments. You also learn to be much more culturally aware - all important skills to take into work within the UK.' TREATMENT IS A LIFELINE Organised by Gap Sports, an agency supporting development projects in Africa and Latin America, he was based at the Korle Bu hospital in Accra. Working in musculoskeletal outpatients, orthopaedics and neurology, he assessed and treated patients with a range of injuries. 'There were loads of hand injuries from people chopping fruit from trees and using machete knives. Given that something like a hand injury usually means no compensation and no income, you are aware that the treatment is a lifeline for them,' he adds. While another qualified physio was available for guidance, Marc mainly worked independently. He was also himself asked for advice by staff on areas such as soft tissue skills and UK stroke rehab programmes (in Ghana a high-salt diet and low intake of fruit and vegetables results in a high incidence of stroke), and trained third-year physiotherapy students in basic musculoskeletal assessments. Because Ghana is English-speaking, communication was straightforward - a factor he took into consideration when choosing a location. Would he recommend this sort of package? 'Definitely. While it may be cheaper to go independently, Gap Sports took care of the placement and provided shared accommodation with other volunteers, so it felt very secure.' EXPENSIVE EXPERIENCE Jessica Mitchell had already accepted her junior post with North Somerset primary care trust when she took up her voluntary placement in Ghana last year. The PCT was supportive, agreeing to keep the post open until her return. She also had a five-week placement at Korle Bu hospital, based mainly in outpatients musculoskeletal, neurology and respiratory. It was an experience she feels has helped her in her subsequent UK job. She says: 'In Ghana, I had to be adaptive in communicating with different patients and very creative with assessment and treatment skills. Back in the UK, my first rotation was community and I think my ability to use my initiative and work independently was only due to my experience in Ghana.' Jessica sounds a note of caution, though. The agency she used promised an all-inclusive 9am-5pm placement in a hospital working with qualified physios, plus accommodation and meals. 'Once I got out there, things were slightly different. The placement was for mornings only and we hadn't been told about things like bringing our own uniform. It was also self-funded, including travel costs to the hospital, which turned out to be 1.5 hours across town. It all ended up costing me over £2,000 including the flight.' Despite this, the experience was positive. 'I learnt a huge amount and am a better physio for having gone to Ghana.' MAINTAINING SKILLS In different vein, Leeds Metropolitan University has set up a scheme that offers graduates from its fast-track MSc course the opportunity to work in a Malaysian hospital at the local rate of pay. The internship was set up by Mike Holmes, professor of health psychology, who built on existing links between the university and the Pantai group of hospitals. The graduates commit to 0ne to two years, and have usually completed a placement abroad during their training. Course leader Sue Smith says the scheme 'maintains the practical skills of possibly otherwise unemployed graduates and it helps fill vacancies in Malaysia'. Ben Farrelly and Chris Drake are four months into their placement with it. Based on the island of Penang, off the coast of Malaysia, they are working in Gleneagles Medical Centre, a private hospital run by Pantai rehabilitation services. As junior staff, they work on inpatient/outpatient three-monthly rotations. One of the most rewarding aspects has been increased cultural awareness. IMPORTANT LESSONS Support from colleagues is excellent, they note, and sharing different assessment and treatment techniques has been an important part of their learning, says Ben. Taking up a paid position overseas has to be an option worth considering for new graduates facing unemployment within the UK, says CSP's international officer Liz Carrington. 'The pluses of employment in a developed country are that you are being paid and are developing a similar skills set to the one you would be using at home.'  Parts of the developed world currently short of physios include New South Wales, Australia and British Columbia. To work in Canada, the United States, Australia and South Africa physios must sit exams, says Liz, adding. 'There are opportunities out there, and they can add significantly to the skills that you can offer UK employers.' FURTHER INFO For Life GAP SPORTS 0870 837 9797 info@gapsports.comChecklist for working overseas
  • Ensure you are registered in the UK with the Health Professions Council.
  • Join CSP as a full practising member. This covers you for professional indemnity for temporary work abroad, excluding Australia and North America.
  • Contact the International Support Group for Chartered Physiotherapists (ISG4CP), which supports physio work overseas. A study day is being held on  25 September at CSP head office. Further details available from ISG4CP secretary Jean Lowton at
  • Check out the registration requirements in your host country with the agency you are applying to and call the CSP enquiry handling unit for information packs on different countries.
  • If an agency is arranging your placement, clarify arrangements including accommodation, hours of work, travel costs to and from work, level of support available and uniforms or equipment needed.
  • Look for the right project for you, for instance being aware of whether you want to go to an English-speaking country.
  • Take a CSP professional portfolio with you and fill it in so you can provide the HPC with evidence of ongoing learning and for prospective UK employers.

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