In the third and final article in this CPD series on voluntary work, Janet Wright looks at questions raised by overseas projects
The rewards of volunteering extend far beyond the pleasure of having made a useful contribution. New skills provide a practical benefit, and the new experience provides endless chances for reflection (see ‘Studying the benefits of voluntary work’, Frontline 3 August 2011).
Each year physios set off for developing countries, eager to give a hand where it’s needed (see ‘Overseas aid’, Frontline 7 September 2011).
But how can you be sure that the help you want to give is what’s required or acceptable?
One of the attractions of volunteering abroad is the opportunity to see the world through a non-tourist’s eyes. Many volunteers find an unexpected extra benefit from seeing themselves and their practice – sometimes disconcertingly – through different eyes too.
The knottier problems of voluntary work abroad, however, provide some of the richest opportunities for reflective learning.
‘There needs to be a cultural awareness before you go,’ says Tina Everett of ADAPT, the CSP’s professional network for physiotherapists in international health and development.
Cultural sensitivity challenged
ADAPT’s support for members’ CPD includes encouraging them to use their overseas experience to contribute to cross-cultural issues in the UK.
Sensitivity to other cultures can be powerfully challenged when you’re working within them. The family loyalty that westerners admire, for example, may look different if a colleague takes three days off without notice when a relative visits unexpectedly.
One of ADAPT’s aims is to help develop effective physiotherapy services world-wide ‘in a way that promotes an understanding of healthcare in all cultures and belief systems and which is socially and economically appropriate.’
In developing countries beset by would-be helpers, different organisations may establish programmes that not only fail to complement each other but can even end up undermining each others’ work.
‘I was dismayed some years back, in Africa, visiting a programme where nationals had been trained for two years in basic but good and unsupervised limited rehabilitation tasks,’ says Jean Watson, who spent three decades working with leprosy programmes abroad.
When physios and occupational therapists came to work in the area, she says, they insisted on a new three-to-four-year programme based on western training.
‘Field staff lost their jobs or became demotivated “unskilled assistants” despite several years of field experience,’ she says. ‘Field work basically ceased in favour of hospital therapy.’
Who benefits from your work?
Another major issue is about who benefits most – the volunteer or the patients?
Physios are not like gap-year tourists working on building projects while local labourers are unemployed. Physios bring real and needed skills – and any improvement to their CVs is a welcome bonus. But the scheme they’re on should ensure that they can be used effectively.
One returned volunteer comments ‘One of the biggest lessons I learned was that a lot of voluntary work does not really make a significant contribution to sustainable change.’
She feared it might even hurt patients by raising expectations that could not be fulfilled, and create apathy among staff who saw one project fail after another.
A professional adviser who visited a remote area of India raised similar concerns with Birgit Mueller Winkler, the CSP’s professional adviser on international development.
‘She said there’s a lack of audit of these interventions,’ says Ms Mueller Winkler. ‘Sustainability and long-term effects cannot be taken for granted and depend considerably on the efforts of the organising agency.’
Some physios have been frustrated by the fleeting nature of their contribution
‘I was hoping to have a structured multidisciplinary approach to stroke care up and running in a sustainable format by the time my two-month stay was up,’ says Emily Rogers, who worked on a stroke programme in Ghana (see Viewpoint, Frontline 7 September 2011). ‘This totally unrealistic expectation was soon put into perspective.’
Hsien Chih Low, head of the Singapore Physiotherapy Association, agrees.
‘I personally feel that clinical placements overseas are best served if they are longer in duration,’ says Dr Low.
‘This will allow the physio enough time to settle into the new environment and get used to the culture of the new workplace. Placements of at least six months also allow the physio to follow up with their patients, to evaluate the effectiveness of their treatment plans, which can only improve their clinical reasoning skills.’
It’s a serious point, and one that should not be overlooked.
But what if a series of short-term volunteers provides the only physiotherapy available? In these far-from-ideal circumstances, experienced physios may be able to stitch together programmes that will last beyond their stay.
Additionally, visits of as little as a week can be valuable when they have been organised to carry out a specific training task.
Heather Hornung, clinical specialist in aquatic therapy at Aneurin Bevan Health Board, South Wales, regularly visits a rehab centre in Nagorno Karabakh, an independent country near Armenia. Though brief, her visits allow her to train staff in all aspects of aquatic therapy and pool management.
‘Keep in mind the idea of “training the trainer”,’ says Ms Mueller Winkler. ‘Be in touch with local physios or community rehab people who are committed to offer physiotherapy exercises to patients.
‘Work together in developing a realistic exercise programme they can continue with their patients after you leave, as we do when we give out home programmes to the patient.’
Put in the research
For the best chance of providing useful aid, do plenty of research before choosing a project. Ms Mueller Winkler advises physios to read literature from agencies working in the area they want to visit, and to contact ADAPT early on.
‘I greatly valued being part of a larger body of like-minded physios back home through ADAPT,’ says Clare Grimble, now working in community paediatrics in west London after helping set up a community support programme in Nepal for people with disabilities. ‘It brought much-needed moral support and excellent newsletters on overseas physio work.’
Ms Mueller Winkler also advises members to start an online discussion on iCSP.
‘Physios who have been on other projects can tell you if they have been well supported or not,’ she says. ‘Newcomers can really benefit.’ fl
How to use this article for your cpd
Use these prompts – adapted from those developed by educator John Smyth for teachers to use in their work – to help you think about the values and beliefs that underpin your physiotherapy practice (Smyth J. Journal of Teacher Education 1989; 40: 2-9).
Focus on a situation in your practice where you sensed a difference of opinion between yourself and the people you worked with, about the goals you were working towards.
- What do my practices say about my assumptions, values and beliefs about physiotherapy?
- Where did these ideas come from?
- What social practices are expressed in these ideas?
- What is it that causes me to maintain my theories?
- What views of power do they embody?
- Whose interests seem to be served by my practices?
- What is it that acts to constrain my views of what is possible in physiotherapy?
A digital copy of these prompts (for completing and storing on your computer or online in an ePortfolio) is available in the CPD webfolio; see ‘CSP resources’.
- The CSP’s publication ‘Working as a Volunteer Abroad’ lists organisations seeking volunteer physios. It highlights those that welcome new graduates.
- Find out more about ADAPT at http://adapt.csp.org.uk
- The CSP’s ePortfolio system is a valuable online resource to support members’ CPD – wherever they happen to be working.
- Learning resources that support the development of the behaviours, knowledge and skills for physiotherapy practice are now available through your CSP ePortfolio account.
- Further information is available at www.csp.org.uk/webfolio
- For more information, contact the CSP’s enquiries handling department on 020 7306 7050, firstname.lastname@example.org
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