A changing idea

I have been in Madagascar for six weeks now, I can’t believe how quickly the time is flying! From my last post on the Parkinson’s Study day, my ideas and plans of what I want my time here to consist of have changed. On arrival, I had no set plan of what I would actually be doing whilst here, and therefore wanted to get to know the Physiotherapists and understand their ways of working before I began to identify potential areas I could help develop. At first, I sat down with the Physiotherapists at both HJRA and CAM, the two hospitals where I have based myself in Antananarivo to ask what teaching or training sessions they would like. I also spent the first 2 weeks of my time shadowing and observing the physiotherapists to try to understand how they work. I would then come home and write up a log of my findings and keep reflections of these.

My main observation was the lack of clinical reasoning skills being used amongst physiotherapists. This isn’t uniform amongst all staff, with some using basic treatment and clinical reasoning skills. I began to become interested in this area, why are clinical reasoning skills not being used? What is taught at University? What teaching and training opportunities have the staff here had previously? The key moment for me was when I was discussing training sessions with one Physiotherapist and they replied saying that they had had teaching on the McKenzie method before, but were unsure of when exactly it should be used in practise. This made me wonder, is it specific training sessions that are needed here, or do I need to dig deeper to understand physiotherapy in Madagascar, specifically in terms of clinical reasoning, in order to better understand how I can help with development in future?

Writing a report
I decided that the best way to gain an understanding of Physiotherapy in Madagascar was to collect as much information as possible. I will use my log of observations and reflections to form a basis of my understanding. I also decided to speak with the Physiotherapists and complete interviews to help develop my understanding further. I will then write up all my findings in a report which I will translate into French to make it available to the Physiotherapists in Madagascar. I hope that my report can also be of use to other Physiotherapists who decide to come and volunteer in Madagascar, to give them an insight into how the healthcare system works here. I will give recommendations on how I think the service can be developed in future.

Meeting with the Ministry of Health
I met with Dr Holy and Dr Leondaris from the Ministry of Health to explain my ideas and have a discussion with them to help develop my understanding of Physiotherapy in Madagascar further. This was a really useful meeting and laid the ground work for my report. All the interviews I completed were through my amazing interpreter Annie. Following the meeting, the Ministry asked if they could also receive a copy of my report to allow them to focus on key areas for the development of Physiotherapy in future. Very exciting!

Interviews with the Physiotherapists and Doctors
Following my meeting with the Ministry of Health, I then completed interviews of all the Physiotherapists and Doctors at the hospitals I had been working with, completing 30 interviews in total. (Again, Annie was incredible and so helpful throughout all of this!). The Physiotherapists here are so keen to learn and develop, and understand that by helping with my report it will provide a baseline of the current standard of service, which will identify key areas for development in future.

Meeting with Lanto- President of AKIMA
I then met with Lanto, the President of AKIMA (Association Kinesitherapie Madagascar). Lanto works closely with the University of Antananarivo, the only University teaching Physiotherapy in Madagascar. Lanto was a very inspiring woman to meet! She told me about her aims and ideas to develop the Physiotherapy University Curriclum, and how they work closely with the local hospitals to offer training sessions to Physiotherapists to aid their continuing development. Lanto explained that organisations such as Humanity & Inclusion, CBM, the Red Cross, and the University of Leeds have previously provided training to Malagasy Physiotherapists.

Lanto also explained that AKIMA have recently put in a bid to the WCPT (World Confederation for Physical Therapy) to become full members. This will be discussed at the WCPT conference in Geneva on 19^th May 2019. When accepted, it will offer a lot more opportunities and links for development in line with other countries, and AKIMA are very excited for this prospective change!

Moving hospitals and cities
In the upcoming weeks I will be moving hospitals and cities in order to try to understand Physiotherapy in as many places as I can with my limited time here! This also coincides with visits and teaching programmes from a number of Doctors from the UK, where I will be helping with the Physiotherapy aspect of their teaching programmes to Malagasy Physiotherapists and Doctors.

Going forwards…
My plans and ideas of what my time in Madagascar will consist of have definitely changed and developed! By taking the time to understand Physiotherapy in Madagascar, and build relationships with the staff here, I hope that I will be in a much stronger position to help with building a lasting, long term development and change in future. I am fully aware that I have likely bitten off more than I can chew, however I have to at least try, and for me, this felt like the best use of my time and skills here. I guess we’ll just have to wait and see!