Volunteer Physiotherapy Work, Physiotherapy Cambodia, Physio Hub

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Julie's adventure teaching cardiorespiratory physiotherapy in Cambodia - one suction catheter for the day and charades style teaching!

in All Physio Blogs, International Physio Volunteers
22 Jun 2014  |  0 Comments
 

Hi everyone and thanks Sarah for asking me to contribute my thoughts on volunteering abroad.

My story seems grossly inadequate next to others I have read, for I have neither opened my own orphanage in India and nor have I built a school in Africa with my bare hands. In fact, I live in suburban Australia and in what I would describe as relevant luxury and I have the great fortune of working in a large public hospital where my biggest decision of the day is which café I should buy my perfectly brewed coffee from. 
So how do I come to be on Sarah’s great website you might ask? Well, like most physios, I was born with that genetic makeup that drives us to pursue our passions…..to see the world, explore far flung places, experience new things, to bask in the aromas of different foods and cultures, and if offered the chance, combine all of this with work.                         

To say I love physio is an understatement. I love the fact that I can have a part to play in helping someone go from their absolute worst through to their absolute best. I love the medicine. I love teaching the medicine and yes, I even love learning quirky facts about conditions that seem relevant only at a pinch. So when the opportunity came up to work with Steve West-Newman on his project to teach physiotherapists in Cambodia for a couple of months, I didn’t give it 2 seconds thought. I was there.

 In hindsight, it was probably only 1 second thought that I put into this project, for before long I had organized my holiday leave, I had been in contact with the people organizing my accommodation and I’d bought my Lonely Planet Guide to Cambodia. With weekend getaways already planned, I was on the plane and it was only at this moment I rather naively first pondered exactly what it was I would be doing when I got there.

I had travelled through several third world countries in the past, so had a small sense of what to expect, however I rapidly came to appreciate there is a very big difference between traveling through and working in a particular place. The family I stayed with were nothing short of amazing and as the weeks progressed I delighted in the long discussions we had about medical care and life in general in Cambodia. I also relished the opportunities to talk to Steve and Lisa about their years in Phnom Penh and all that they had achieved in their time there. Stories of Khmer Rouge and the devastating effect on the country and its people stunned me and I rapidly appreciated the little bubble in which I usually live.

My work involved teaching the cardiorespiratory component to physiotherapists undergoing their clinical placements as part of a process to upgrade their diploma to a degree standard. This was to be undertaken in 2 hospitals- one a large general hospital in the centre of Phnom Penh (this was mainly the neurosurgical ICU) and the other a TB facility on a different side of town. It seemed like an easy enough task, for cardiorespiratory physio was my thing, ICU was my even bigger thing and I’d worked as a clinical educator for a few years at my old university in Brisbane. “How hard can it be?” I thought.

Within about 1 hour of starting “easy” rapidly became “not so easy” and by the end of the day I’d moved quickly into “this is a disaster.” What hadn’t immediately occurred to me were the potential challenges, least of which was the fact that I spoke neither Khmer nor French and the students spoke minimal English. This one I could easily overcome as I was a self-confessed charades legend from way back and there was no ventilator setting or pathophysiological condition that couldn’t be described using hand gestures or a white board. Give me props and I was on fire.

It was more the other challenges I found tricky, those fundamental things we take for granted when money is less of an object. Things like infection control. There were so many questions that struck me that first day. Things like:

1.) Exactly where do I wash my hands between patients?
 
2.) Why is there a packet of OMO washing powder in the back corner of the nurses station? Surely, there is soap? And water? Maybe a sink?
3.) Just the 1 suction catheter for the day then?
4.) How can I make a good clinical decision with so little information?
5.) If I tie this flimsy little mask so tightly I can’t breathe, will it be enough to protect me in this TB hospital? Did I ever have that BCG injection?

 

But these are all questions from a physio trained in a healthy health system. In the third world, tracheostomies are rare as they run too high a risk of infection, lab tests are few and far between because they are too expensive, every patient in the unit is on the same vent settings because no one knows any different, and nurses provide something far from “intensive care.” Patients with no family are left in the same position for days with no change in bed linen and no turning for pressure relief. Pressure ulcers are many, infection is common, food is only given to those who can afford it and patients die needlessly. This was a rude shock and when I went home that first night my thoughts revolved around something like “what can I possibly do here? This is so far into the too hard basket, I can’t find my way out. Is it worth even trying?”

The next day however, I stoically decided that that was perhaps a slightly defeatist approach and I’d give it another day. And so…. I set about turning my head around. I stopped looking at things from the perspective of fortunate Australian “on holidays” and started looking at it from a local context. No, in all fairness I probably wasn’t going to solve all of Cambodia’s problems in 8 weeks but no one had actually asked me to. What I could do, was to make a very small contribution by giving local therapists some knowledge and skills from which they could then build on to teach others.  

Before long I immersed myself in the local culture and I came to enjoy it. I learnt how to cross a road without getting run over, I enjoyed having every joint dislocated on a weekly basis by the local blind massage therapists, I’d sussed out the best smoothies in town and when I awoke 1 night to the sound of a rat eating my beloved Lonely Planet Guide just 1 metre from my bed, I rolled over and went back to sleep. I had made it. 

Work was the same. Even though little kids still cried when they saw me because I was the only foreigner in the hospital, I came to know the staff and teaching sessions became major events. This gave me endless amusement because I’d start explaining a couple of concepts to 2 or 3 students around a white board and within minutes, a crowd of 15 people would have gathered. The eagerness of people to learn was infectious and like nothing I’d ever seen. Finally I’d found a place where I could talk endlessly about ABG analysis and CXR interpretation and people wouldn’t run away. I felt like David Beckham at a kids soccer ground. The kindness extended to me was enormous and despite the turmoil they have experienced over the years, the Khmer people all seemed to have smiles that lit up a room. What a privilege to be accepted into their world so readily. 

Volunteering changes you forever. Whether you commit to this life or whether you return home to the life you previously led, something changes. For some, it’s impossible to return to “normal life.” For others, you develop something more akin to daily tolerance. You appreciate what you have but you also develop an ability to look at situations for what they are.

To smile and inwardly giggle when bureaucrats ask you for umpteen signatures to enable you to do the same job you’ve always done. To laugh openly when you’re asked to sign out a new pen because of cost cutting measures, only to realize you don’t have a pen to sign it out with.

We live in a privileged society. Volunteering shows us just how much.

 

 
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