Author: Luke Stevens

Having always had a keen interest for humanitarian work, I wanted to involve myself with this area of physiotherapy having recently qualified. Whilst being a member of ADAPT, I was given the opportunity to spend some time working with ‘World Hope International’ in Sierra Leone, through the working relationships I had built. More specifically, I got involved in the ‘Engage the Children (ETC) Programme’ led by physiotherapist Anna Vines. In total, I was living in Freetown for three months, all the while gaining invaluable experience in the field of Global Health, especially as this was my first time working in this area.

I spent time working in a range of both clinic and community settings treating children with disabilities in Freetown and also occasionally up-country. The work I undertook involved treating children through exercises, distributing handmade equipment to aid positioning, and providing education to both families and communities to try and reduce the stigma surrounding disabilities. During my stay I was lucky enough to be involved in the ETC annual beach outing where we brought all of our families together to celebrate disability in an open and supportive environment.

Personally, this trip was about gaining first-hand experience in the Global Health world to hopefully pursue this area of work in the future. In addition to this, I wanted to be involved in Paediatric Physiotherapy, with it being a keen area of interest for me. Experience is what I desired and experience is what I got! From my first day, I was welcomed into the team and got myself stuck in with the work at hand, which allowed me to not only build my competencies in clinical skills but also my confidence in working in settings with limited health resources and infrastructure.

During my time I definitely encountered some challenges; one of the main ones was learning how to adapt according to the surroundings. For example, on many of our home visits equipment, toys, and resources were all limited, meaning that I had to be adapt in my treatment methods. Another challenge was the language barrier, the main language spoken in Sierra Leone is Krio. One of the biggest highlights for me from my entire stay, was actually becoming more confident in speaking Krio, partially in clinic. Speaking Krio to patients and their families made me feel like I was able to improve on my communication and quality of treatment.

I was able to build meaningful relationships with patients and colleagues which only furthered my passion for this area of work and made me feel genuinely fulfilled in the job I was doing.

My future plan following on from this experience is to gain a job completing Band 5 rotations in the UK for the NHS. I want to build my skills and competencies, to allow me to fully equip myself for more roles in Humanitarian and Global Health work in the future. Of course, I will continue to be a member of ADAPT to ensure I keep up to date with Global Health affairs and learn through frequent webinars and working relationships.

I think if I were to give any advice or take-home points, I would say that if you are interested in this type of work there are opportunities around if you are willing to look and find them. I would urge anyone who is interested to seek more information through ADAPT and to also reach out to other physios who have competed similar work.

Elspeth Robinson

Background

In 2002, after retirement as a physiotherapist, I read an article in Frontline about Kumi Hospital, an old leprosy centre in eastern Uganda and now a general hospital, asking for volunteers so I replied and soon arrived into an unknown world. Twenty years later, this has developed into a registered charity with UK Trustees and a local team involved with helping families with children with disabilities and living in extreme poverty in the remote rural areas.

Involvement

We are partnered with Kumi Hospital, Wheels for the World, Interplast UK and are linked with Dentaid. The local team consists of our team leader who is a social worker, a physiotherapist, a CBR worker, an administrator and a nutrition nurse all of whom are employees of the hospital but are volunteers for KCF. The hospital has an orthopaedic workshop which makes prostheses, simple wooden seating for brain damaged babies and children, standing frames etc.

I stay an average of ten weeks a year and I returned from my last visit in March 2022 when we were joined by our partner Wheels for the World, for a week’s distribution of 119 wheelchairs dispatched from UK and as many again mobility aids. The remaining weeks of our five-week visit were occupied with our rehab programme and fieldwork

The Soroti Care Centre was initiated by our CBR worker to provide support and assessment which we support. Families with children with disabilities or malnourishment can come for assessment and formulation of a treatment plan if appropriate. Home visits follow if necessary. Some of the activities we have include making walking aids such as parallel bars on site with local materials, income generation projects, simple housebuilding, providing wheelchairs, tricycles, mobility aids, rehab, funding for surgeries and hospital nutrition support with the payment of hospital bills with our mission being “Helping Others to Help Themselves”.

We have sponsored youngsters in education all of which have disabilities or a sibling with a disability. We fund school fees from baby class through to university level.

Challenges

• The latest challenge has been the COVID pandemic where the Trustees have been unable visit in person but our local team has continued as much as the restrictions allowed
• The people’s poverty levels and remoteness limit the access to healthcare and hospital services
• Lack of education in basic health issues and their ability to fund schooling
• Provision of transport
• Funding

Highlights of Last Visit

• The Wheels for the World Visit and Distribution
• Official Opening Day of the Soroti Care Centre
• The visiting Dutch Orthopaedic Surgeon’s camp

Future Plans

• Our next objective is to arrange the surgical mission of Interplast UK for plastic surgery in October 2022. Our local team is identifying the patients and compiling a list.
• To continue to consider the families holistically and provide resources within our ability
• To continue with funds raising efforts

Elspeth Robinson MCSP (retired)                                                                                   

Wheels for the World

Welcome to InterplastUK

Dentaid – The Dental Charity

http://kumihospital.org/

https://www.kumicommunityfoundation.co.uk/

Kentaro Mizuya (Ken) is a physiotherapist working in Japan. With a passion for humanitarian work, Ken has joined a few ADAPT events and shared his experience. We were interested to learn more about Ken’s experience, hence we had an informal interview in which Ken shared more about his humanitarian work.

When speaking of what sparked his passion for humanitarian work, Ken talked about an experience during high school: He had an interview with a man from developing country, which inspired him to explore other parts of the world and improve the quality of life of those in need. After becoming a physiotherapist, this experience continued to encourage him to make use of his physiotherapy skills and dedicate himself to humanitarian work.

Ken has had various experiences of humanitarian work as a physiotherapist:

1. He volunteered in Dominican Republic in 2011-2013. He was mainly involved in the rehabilitation of patients and education of clinicians on mobilisation techniques.
2. Ken’s first humanitarian experience was as part of the response to the Earthquake in Kumamoto in 2016, when he mainly worked on providing shelters and support to victims.
3. His most recent humanitarian work was in Mozambique in 2019. Here he was mainly rehabilitating patients and supporting the medical team.

Fig1. Picture of Ken teaching manipulation skills at Dominican Republic

Fig2. Picture of Ken repairing a wheelchair in Kumamoto

In 2017, Ken registered with the Japanese Governmental Emergency Medical Team as one of the first few physiotherapists. The Japanese Governmental Emergency Medical Team is part of the Japan Disaster Relief (JDR) team and is classified by WHO as Type 2 Emergency Medical Team. JDR is run by Japan International Cooperation Agency (JICA). JDR has existed since 1979, but their response to the Nepal earthquake in 2015 was the first mission that included a physio as a part of JDR medical team.  Ken participated in the second one, which was the Mozambique cyclone response in 2019.

Ken shared the details of the response to Mozambique. In March 15^th 2019 Cyclone IDAI hit Mozambique, leading to more than 1,000 deaths. The JICA organised JDR for the response: The first medical team was dispatched on March 28^th, and second team on April 5^th. Ken was part of the second dispatched medical team.

Fig3. Picture of destructed buildings in Mozambique

There were a few roles as a physiotherapist in the team. Apart from attending to patients with rehabilitation needs, another major part of the volunteer work is assisting the normal function of the medical team. This includes interviewing patients in the reception area, maintaining equipment such as tents, toilets and generators, burning waste, preparing meals, and other non-clinical work.

Fig4. Picture of field clinic and accommodation area in Mozambique

Including follow-ups, 794 patients attended the clinic. The most common diseases were acute respiratory infections, acute watery diarrhoea, malaria and cholera. Among these patients, around 5 had rehabilitation needs.

When speaking of the differences between work in Mozambique and that in Japan, Ken said that due to the nature of the response, they had to be creative and flexible with the resources around them. This included making walking aids with wooden sticks from local trees. At the same time, they also had to be aware of the effective use of resources. For instance, due to a shortage of plastic chairs, they made use of card board boxes and issued them to patients instead. This was because it would be unfair if only some patients have received them.

Fig5. Picture of Ken issuing crafted stick to patient

Apart from lack of resources, there were a few more challenges faced by the medical team. The weather at Mozambique is extremely hot, with temperatures of up to 52 degrees. This can easily cause dehydration and general discomfort of the patients and staffs. In addition, the area of major traumas was far away from city centre, leading to bad access and delayed arrival of equipment. In terms of medical perspective, data collection was difficult as there was inconsistency on the type of instruments being used. Also, there were no exercise handouts that could be issued to patients after therapy sessions. Despite these challenges, the medical team was welcomed by the locals and blended in well with them.

Fig6. Picture of the medical team and the locals

The field clinical was open for 12 days, and Ken and his medical team left on April 17^th. When asked about other thoughts on this volunteer work, Ken said that humanitarian work connects people, and that even under the worst circumstances, there are no people who don’t smile. Ken plans to continue with the humanitarian work and get involved in JDR. He hopes to work abroad when he has fewer social commitments.

Reflection on the interview

In this interview, what motivated me the most is the passion and dedication Ken had on humanitarian work. As there was no overseas physiotherapy overseas network in Japan, Ken joined other virtual events organised by other international physiotherapy networks in order to learn more about physiotherapy humanitarian work. That was quite similar to that in Hong Kong where I’m from: The role of physiotherapists in humanitarian work is not as significantly recognised as that of Doctors. Also, as a student with no real-life experience with humanitarian work, I was quite surprised that the major part of the volunteer work is non-clinical.