As we celebrate Black History Month, Hannah Ajala charts the achievements and influence of three physiotherapists who qualified overseas
After 18 months of a global pandemic, which highlighted how Black people are affected in so many ways within society, it is more important than ever to showcase the excellence of our black members in the field of physiotherapy.
This year’s Black History Month edition shines a light on the great contributions of black physiotherapists in the UK, in a celebration of their achievements and influence across the profession.
With many qualified overseas, they will recount their journeys of joining the UK physiotherapy workforce and how they show excellence in their roles every day. Taking the plunge to move thousands of miles away from your usual environment to perform a demanding, yet rewarding job, takes a lot of character, strength, and bravery.
It’s having a gut feeling that your abilities have taken you far enough to not feel limited in the slightest by your circumstances. That’s what it has been like for Justine, Doreen and Sandra. These three incredibly hard-working and self-motivated Black physiotherapists have a wealth of experience through their ground-breaking work. In celebration of Black History Month we hear more about their journeys and experiences of what it’s like working overseas in the lead up to their dream profession as a physiotherapist.
A costly decision
Justine Musiime always wanted to be a doctor. She was born and raised in Uganda, and also qualified there as a physiotherapist. ‘We didn’t have as much equipment for our patients there,’ she recollects. They even had to replicate some based on theory and pictures using locally sourced materials. ‘I am a kinaesthetic learner so I always found this very interesting.’
Due to her interest in children’s work as part of a Christian faith community, it then also led her to take a gap year place carrying out youth work in the UK in 2004. ‘During the gap year, people kept asking me: “So, after this, what’s next?” “I am yet to decide, or I am praying about it,” I would say.’
She was attracted to the MSc in exercise and nutrition science at the University of Chester, despite the steep costs as an international student. ‘I had a dream of owning a gym, with its very own physiotherapy unit, so I felt that having knowledge about nutrition would be very useful. Before doing this, I had to return home and apply for a different visa. I had to prove that I had finances for tuition and accommodation, which came to about £16,000.
I asked God for a miracle and one day while I was busy starting to fret about how it would all work, someone I had been talking to asked me for updates and then asked me to give them the documents from the university.
Before I knew it, they had called the university given them their card details and paid all my tuition upfront and the accommodation bond. They also wrote a letter stating that they would support with accommodation which made the visa application process straightforward.’
The long route to registration
But not everything about her career journey was as smooth. ‘When I tried to register with the Health and Care Professions Council (HCPC) as a physiotherapist in the UK, it was a very complex process. I can’t say I had support in order to decipher the information and figure out what was needed.’
The HCPC required evidence to show her Ugandan qualification met the required UK standards. ‘Since I was already on my master’s program, I had to ask someone to meet with key people back home in Uganda to get me references, and further documents.’
After two years of ‘back and forth’ with her application returned twice as incomplete, she received good news.
‘I remember the day when I received the letter with the words “you have been approved for entry onto the register as a physiotherapist” – I jumped around, screamed, jumped on the chair, screamed some more, did my happy dance. It still is a very beautiful memory!”
The journey towards securing an actual job was equally drawn out. ‘Everywhere I applied wanted UK experience.
I thought to myself, “But I need a UK job in order to get UK experience!” I went to the local NHS trust – they wouldn’t let me volunteer or do a work placement. I went to private providers – they needed five years’ experience because of insurance requirements. It became complicated and I had to think outside the box. The only other place I could think of finding physiotherapists in order to shadow or work with them was the gym, but then no gym would hire me because I was not a qualified gym instructor.
‘I said to myself, “You want a gym instructor qualification, I’ll get you one.” I enrolled onto the level 2 gym instructor course at West Cheshire College. Later I was able to shadow a physiotherapist who had a private clinic at one of the local gyms. We had got talking during one of our practical sessions on one of the exercise science modules. It was sheer surprise hearing that we were both physios, both qualified gym instructors, and we were both pursuing the same master’s degree!
‘I shadowed, then volunteered for a couple of months on his falls and cardiac rehab classes, until one day, I stepped in when he needed someone to cover him for a few days. Thanks to that, I was able to put that experience on my CV, and got offered a locum post within a short period.
She reflects on this route to getting her foot in the door, ‘I really had to break that door in to truly enter the physiotherapy world.’
A world of difference
Despite all the red tape, UK healthcare has distinct advantages compared with its Ugandan counterpart, she admits.
‘It was great to see so much “standard” equipment in the UK compared with Uganda, and to be able to give it out to anyone based on need, not on whether they could afford to pay for it. Still struggling with the waste within the NHS though! Equipment gets issued and when patients do not need it any more, there is no one to collect it,’ she exclaims.
‘Working in the UK, I’ve found that there is more structure whereas in Uganda, it is not uncommon for a newly qualified physiotherapist to find themselves heading a whole department or a private clinic, which is what happened to me. You are thrown in at the deep end!
I managed the finances, the support staff, I dealt with patient queries, and worried about how to bring in more clients, I thought about what equipment was needed among other things. Both systems have their unique ways of facilitating career growth and progression.’
There are always pros and cons when choosing to work in a completely different environment overseas. One can imagine that being surrounded by people who looked like her was a major benefit of training in Uganda.
‘Benefits of training back home included being with my country people, familiar surroundings and not being that far from family and friends. Similar culture and language means a lot because you are easily understood.’ This experience can be incredibly encouraging when starting a career, especially when different environments later on may not always be as diverse and inclusive as they should be.
Justine did locum work for a couple of years across a number of NHS trusts in England. Most of the time, she found herself to be the only Black person on the team, but she says she learned to accept that.
But when an opportunity to take part in filming for the We Are the NHS recruitment campaign arose, she took it up. ‘I very much wanted the advert to be representative, because I believe that we need more representation in the physiotherapy profession,’ she said. ‘My friends and colleagues found it exciting to see someone they knew in the NHS advert. I also got interviewed for many media outlets including newspapers, magazines, radio, TV stations. It was exciting being interviewed by all of them including the BBC.
‘I can say that my desire for greater Black, Asian and minority ethnic representation and inclusion was aroused while learning about health inequalities and social determinants of health while enrolled on to the master’s in public health course at the University of Warwick.
I have since felt the desire to do something about reducing the gap in inequalities, hence my involvement in the CSP BAME network, and my trust BAME network where I am the vice chair. I was also part of the consultation group that worked on the CSP’s forthcoming Equity, Diversity and Belonging Strategy.’
She now works with care homes on the enhanced health in care homes programme with her trust. Key activities include multidisciplinary meetings with GPs, care home staff and other health and social care professionals. Their aim is to provide proactive support and reduce avoidable hospital admissions. There’s a lot of variation, including infection control training for care home staff.
Going forward, Justine is thinking of how to incorporate her public health expertise into physiotherapy, so as to do more work aimed at primary prevention.
‘I believe physiotherapy has a key role to play in primary prevention on a whole population level,’ she adds.
The accidental physio
Sporadic journeys can often lead to life-changing destinations. Even the journey towards a physiotherapy career can be almost accidental. Let’s take Doreen Caesar, who calls her winding path into physiotherapy ‘a coincidence that was meant to be.’
Benefits of training back home included being with my country people, familiar surroundings and not being that far from family and friends. Similar culture and language means a lot because you are easily understood.
‘I initially wanted to study medicine but back then in Ghana there were only two medical schools, and it was not easy to get admission there. After two years of studying general science at the University of Ghana, I didn’t get admitted.
‘Having said that, I gained admission into physiotherapy in my first year, but my dad really wanted me to study medicine, which I continued for the second year. In the end, physiotherapy still found its way to me! As I said, it was meant to be.’
Doreen loves working with older adults, and much of her work now focuses on these patients.
Ghana may be a popular country to visit for many within the diaspora in the UK, but it has marked differences when it comes to working there in comparison with the UK.
‘The first difference I see between us Ghanaians and those in the UK is that our training is longer,’ Doreen says. ‘In Ghana, it’s about four or more years training, as opposed to the three years in the UK.’
And while using cadavers in anatomy teaching is not always a given in UK universities without a medical school, the Ghanaian approach is on a different scale. ‘Another difference – which might come across as a shock to some reading this – is when studying anatomy, all the physios used dead bodies to study the muscles and bones.
‘We were given a set of skeletons that we could take home with us for further study. You had to be very good with memorising key parts of the body, so this is the way it was done in Ghana.’
It’s so important to remember and acknowledge the cultural differences in other parts of the world. As Doreen shares this information, she appears completely relaxed, and calm. But she didn’t find all the transitions so seamless.
Doreen says, ‘The HCPC registration process was very straightforward for me. I was blessed to have people from my school who had gone through the process before, so they guided me on how to fill out the application form, and I was then registered after the first application I made.
‘However, other parts of transitioning into a new environment did come with some challenges.
Abbreviations are so commonly used when conversing with colleagues here in the UK about physical work, and that’s not something I ever used whilst in Ghana. Obviously I got the hang of them in the end, but that was definitely challenging in the beginning.’
Of course, there have been many high points and positives. In Ghana for example, she would meet patients who would come to the physio practice as early as dawn, just because of how much they valued the difference treatments could make. ‘I adjusted very well to my surroundings as Ghana is my home.’
However, she admits that entering the UK job market was tough. ‘Getting my first physiotherapy job was very difficult. Wherever I went to apply, I would be told that I didn’t have the UK qualification. I even went for jobs in the care area and was told I was overqualified. I didn’t stop and continued to keep going for any care, support or some other job to keep my feet going. I eventually became a support worker for learning disabilities within the NHS.
‘Then through that, I saw other appealing job roles being advertised. A nurse colleague showed me the advert for the occupational therapist assistant job, which I then applied for. However, the recruiting manager called and informed me of a physio role coming up. She told me I could withdraw the application for the OT assistant role and instead apply for the physio role when she advertised it. So I did – and got it.’
She adds, ‘The amount of guidance and encouragement I received towards getting this role almost felt like a miracle. There was just so much support. It was my first chance to get a physio job.’
Patients are like family
Doreen started by working in the community, in a rehabilitation centre. Now she is an advanced specialist physiotherapist in an intermediate care team. She said: ‘We try to facilitate discharges from hospitals, and prevent admission to hospitals. We work with all adults, but most of our patients are quite elderly.’
Some would call her success luck, but it sounds more like effective networking and a huge amount of drive.
Support and valuable advice shared by generous colleagues were pivotal, but speaking with the right people was the first step in gaining further opportunities for promotion. Excellence and hard work is key to someone who is very passionate about their job, especially when it involves supporting others.
Doreen says her cultural background and how much her patients mean to her adds to the reason why carrying out her work is like being with a family.
‘When I see some elderly patients, it’s like I see my grandparents in them. My role involves thorough assessments from medical conditions to diet, and so much more. It’s pretty holistic but I try to go beyond that and make sure that the patient is going to be safe and well looked after. If I feel like something needs to be improved for them to feel more safe, I then try to escalate that. No matter what the powers-that-be say, I will try to raise that.
‘As you can imagine, a lot of these patients suffer from loneliness, too. I love to give them my time, and ensure that they feel valued at all times. I almost treat them like family.’
A job where you build relationships with not just your colleagues but patients too must be incredibly rewarding, despite challenges to start with.
When it comes to the ground-breaking work of Black physiotherapists, we hear so many stories behind what inspired them, and Sandra Agyapong-Badu’s story is an emotive yet inspiring one.
Sandra was also born and raised in Ghana, and started studying biological sciences at the University of Ghana, Accra as a route towards physiotherapy. Just before getting on to the course, she lost her father.
She says, ‘Sadly my dad died from a stroke. That stage in my life really got me thinking. I thought a lot about the care he received before he passed away.
‘I was among the first batch of undergraduates to study physiotherapy in Ghana. It seemed like a brilliant opportunity. We had numerous academics and health professionals from the University of Ghana and the Korle-Bu Teaching Hospital teaching us about different conditions and infections that may require physiotherapy as part of the care and rehabilitation process. We were receiving so much knowledge from different areas, and were essentially creating the curriculum for training future physiotherapists in the country.’
In her final year, she did her dissertation which came with deep and thorough research. ‘I looked a lot into the cause of a stroke,’ she says. ‘I looked into reasons behind why one side of the body weakens more than the other, and at the multiple contributing factors behind it. I did measurements with 18 outpatients, and as a final-year physiotherapy student, I looked into standing balance recovery in stroke rehabilitation.
‘In my assessment I got to speak and interact with the patients, carers and physiotherapy assistants who shared their experiences. It was truly a good learning curve for me. Gaining all of this invaluable experience on the ground in Ghana really paved the way for the work I was going to then continue overseas.’
She headed to the UK three years later to study an MSc at the University of Birmingham after being accepted through a scholarship. The MSc advancing physiotherapy practice cohort was a niche group of physios looking at developing advanced clinical reasoning skills. She was able to choose modules in manipulative and neurological physiotherapy, based on her experience and interest.
‘My clinical experience in stroke, Parkinson’s, cerebral palsy and MSK conditions came in handy but it was a sharp learning curve,’ she adds. ‘For my MSc dissertation I got the opportunity to work with some doctoral students, further heightening my interest in research work from my time doing my BSc in Ghana. Right after my master’s, I looked into gaining experience within the research field so I could then do a PhD.’
Sandra displays so much experience, so much knowledge, and so much passion in wanting to keep pushing herself. Clearly, this passionate Black physiotherapist was inspired by the exposure to different ways of learning – and the discovery of her own strengths and skills – to go further.
‘My PhD was jointly funded by a studentship from the University of Southampton and the Ghana Education Trust Fund. I looked into changes in physical function with ageing and how we can find simple, reliable and valid measures to assess these on the field and in practice.
This is all part of the incredible journey toward how else I can use more of my skills and experience to create a supportive, inclusive and collaborative research and teaching ethos.
‘Muscle plays a major role in physical function and maintaining muscle mass and strength is key to physical function and independence in older adults. I looked into identifying non-invasive bio-markers of MSK health such as walking speed, muscle size, strength, tone, elasticity and stiffness, and how these affect function in healthy ageing.’
Sandra added: ‘I was always surrounded by hard-working and innovative physiotherapists, and our work has taken us to national and international conferences. We’ve received funding for further testing and it’s exciting to note that my study findings are being extended via a number of interesting new projects both nationally and internationally, including work with clinicians at the Korle-Bu Teaching Hospital, Accra and the European Space Agency.’
After her PhD, she started a post-doctoral role at the University of Birmingham, which has been academically rewarding with excellent publications on physical activity and health, and a feature in the Sunday Times on their work on acute effects of sedentary behaviour on physiological function in older adults.
‘Recently I’m beginning to see the importance of having more of a global outlook on things,’ she said. ‘My further research and of course experience is enabling me to look beyond the UK. Are there ways we can apply our research and practices and make these applicable to older people outside of the UK? The ageing experience in sub-Saharan Africa is completely different, for example.’
She has adopted an impressively supportive, inclusive and collaborative research and teaching ethos.
‘Health inequalities from a BAME perspective is also of great interest to me, as there’s emerging evidence to support the link between economic inequalities and physical inactivity. I’m developing my skill set and experience through collaborations with colleagues to provide evidence to improve policy, interventions and practice, particularly when supporting patients from different cultural backgrounds.’
Now, it’ll be close to impossible to not feel uplifted or inspired after reading the stories of these three powerhouses. It is proof that you can establish yourself in any and every environment. There should not be a glass ceiling based on ethnic backgrounds.
So what vital bit of advice would Justine, Doreen and Sandra give to a fellow black person who is a student, or looking to further their career in physiotherapy?
Justine says, ‘Do not limit yourself. If you see a block somewhere, don’t ever believe it’s something you’ll never get past. Think if you can climb the block, push it out of the way, or get help from someone who can support you in getting through it. Don’t just sit there.’
Doreen adds, ‘The first thing that really helped me was being a member of the CSP and its BAME network. Find yourself a network to belong to. You will find so much support. The BAME network really helped me and made me feel so welcomed.
Also, if the job expects 100 per cent from you, give 200 per cent! Do your best, be resilient, and don’t give up. There are hurdles and challenges, but we see so many of our people doing so well.
We’ve all had challenges but we are still doing it. Get involved in the network, don’t just stay in isolation.’
Sandra finishes, ‘Be open and be ready to take on some really big challenges. We should open up to more areas. We play such a massive role in supporting people to be active. Train yourself and be ready for transitions too, and research!
If the research doesn’t work the first time, try again in a different way. Also, please document as much as you can. Your future employer would like to hear about it one day.’
Number of subscribers: 1