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Are Therapists Needed in the Developing World?

Gail Tyson has spent time as a physiotherapist in Rwanda, Uganda, Romania and Coventry. She currently works for UCCF as staffworker for Therapy Student's Christian Fellowship.
Introduction Healthcare is seen almost exclusively as being about saving lives, with little thought as to what then happens to those lives that are continued with the consequences of a serious illness or severe trauma. This article is written to dispel some of the myths attached to each of the therapy professions allied to medicine and to show its potential input into countries in the developing world.

Myth One: Therapists only needed to pick up the bits after a war. Physiotherapy and Occupational Therapy (PT & OT) have much to offer the victims of landmines and gunshot wounds, but it isn't limited to this.

1. Clinical Work. For physiotherapists this includes:
  • Rehabilitation after neurological trauma, be it from a bullet, stroke or by hitting the road from the back of a pick-up.
  • Work with the many people with burns or following plastic surgery.
  • orthopaedics - fractures, spinal injuries, post surgery for polio or the correction of talipes.
  • children with cerebral palsy, acquired pre-, peri- or post-natally, through measles or malaria or meningitis.
  • Diseases such as pneumonia and leprosy
For other therapists it includes:
  • OT input to psychiatry,
  • speech therapy for those with communication difficulties
  • dietetics and radiography!

2. Management of Rehabilitation.
  • Community Based Rehabilitation (CBR). The World Health Organisation's definition of CBR involves "the transfer of knowledge about disabilities and basic rehabilitation skills to the people with disabilities, their families and the community." (Chadda 1999) Most of the therapy professions are involved.
  • The setting up and management of a department in a hospital. Not many rural hospitals have their own physio/OT depts, but many are in need of one - and often all it takes is for a qualified therapist to spend time assessing the need and setting up an appropriate service.
  • Training someone else - a junior therapist, a nurse training as therapy-aide, or the relative of a patient/client in CBR. The relative simplicity of many of the actual therapy techniques, means the work can continue when the therapist has left.

Myth Two: Therapists are Too Expensive.
Many rural hospitals and community projects find it very difficult to afford the wages of a national qualified therapist. Mission agencies can help either with funding, or by sending qualified therapists - as volunteers or as longer-term personnel. This idea was used to the optimum in Rwanda pre-1994 with a physio and an OT at Gahini Hospital training nurses from hospitals throughout the country for 4 months in basic therapy techniques. Cameroon's first physiotherapy department was set up by two physios working as volunteers - one for 12 months and one for 6 months. (Stillman & Gurney 1999)

Myth Three: It is Difficult to Recruit Christian Therapists to Work Overseas.
Christian students are often desperate to go overseas and with the development of the therapy student elective in most courses today they have ample opportunity and encouragement to go. Their main problem seems to be finding a mission agency that will support and help them. We need to encourage our students to catch the mission 'bug' even at this early stage.

The system with most OTs and physios today encourages them to spend two years as a junior before applying for senior posts. After this is an ideal time to encourage a career break, when the therapist has enough confidence and professional experience to work on his or her own. At this point in time it is also relatively easy to find a job on return to the UK. Organisations such as MMA HealthServe have been set up to help the process but mission agencies must be willing to use them.

Finally, believe or not, there are some therapists who are willing to give up their life in the UK to work long-term overseas and these people need to be encouraged and helped to serve God in their chosen profession and place. Therapists can often feel that they are not as valued as other healthcare staff, and this can be very off putting to even the most enthusiastic person. But to see the benefits you only need to look at Elizabeth Hardinge's work as physio in Rwanda for over 30 years, Fiona Fraser's input as a speech therapist in Argentina for the past 6 years, and Sue Knight's pioneering of OT in both Rwanda and Uganda for 8 years.

Conclusion
Therapists often spend much time with individuals and families because the actual treatment requires it. In this way we often share much of our lives with these people and have a privileged insight into theirs. What an opportunity for the gospel to be communicated - in our lives and our conversation - so we not only rehabilitate bodies but also can begin the rehabilitation of the person's relationship to God.

Therapists are a vital part of the healthcare team in every part of the world and the sooner we recognise this, the sooner we can begin to work together for the benefit of the people we are called by God to serve.

References
  1. Chadda D (1999) Teager Stresses the Importance of CBR, Physiotherapy Frontline, Vol. 5, No. 13 p23.
  2. Stillman K, Gurney S (1999) Taking PT to the Heart of Africa, Physiotherapy Frontline, Vol. 5, No. 20, p29.
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