ZA best PT experience

Kevin Williams, SPT

Manguzi, South Africa

• Small town in NE corner

• 1 tar road

• ~6,000 residents

• Many more in homesteads scattered through the area

• Subtropical climate• 90s and VERY humid

^ ^ ^ ^ ^ ^ ^ ^ ☺

Site accommodation in rural South Africa

• Rondavel (ron/DAH/vel)

• Circular hut with thatch roof

• Room for 4 students

• Electricity, refrigerator, washing machine, shower, bathroom, small electric stove/oven, and fans (thank goodness!)

< outside of the rondavelcomplete with braai (BBQ firepit)

Lines for drying clothes and the always important mozzy nets >

Manguzi Hospital

• Made up of Inpatient wards, Outpatient department, Therapies, Pharmacy, Dentistry, Optometry, etc.

• Wards are large rooms with anywhere from 8 to >20 patient beds

• Physicians and Therapists assigned to specific wards and work together treating patients in their ward.

Objectives

• Provide quality therapy services in an underserved area of rural South Africa.

Barriers

• Cultural differences and effects on body mechanics• Long periods in lumbar flexion• Carrying heavy objects on top of head

• Transportation to medical services• Poor neonatal health secondary to variety of economic

and cultural issues• High incidence of CP and congenital HIV

Solutions being implemented

• Work within cultural norms• Therapists must offer pacing suggestions and culturally acceptable lifting

techniques• Individuals must continue to plow and plant gardens, carry water, and maintain the

homestead

• Bring healthcare to the patient• Manguzi hospital has 10 satellite clinics to bring healthcare services closer to

patients – includes seating clinics for wheelchair users

• Community caregivers work with the hospital to go out into the community and keep track of known patients/screen for serious pathology

• Where staffing allows home visits may be done by Therapy staff

Conclusions• Significant challenges exist, but the therapy team in Manguzi is

battling every day to provide quality care

Solutions Continued…• The therapy team has created a High Risk Baby Program which tracks

any child born with a risk factor• Risk factors include HIV exposure, low birth weight, low APGAR,

twins, seizures, physical abnormality, and young mothers• The program includes regular check-ups for every child in the

program allowing early detection and treatment of any pathology• HRBP has won national awards in SA therapy community

Most profound clinical experience

• Working with patients using a take-home paper system in place of an Electronic Health Record. • Extremely difficult, as you can imagine

• Cards are meant to be taken to every healthcare encounter to keep all providers informed of unrelated visits

• Instead the cards often become damaged, contain poor documentation, or are completely illegible

• Remarkably they are rarely lost or forgotten

• I will never take our electronic documentation for granted again!

Most profound cultural experience

• Tie between:

• hiking with a group of South Africans to a cave with a waterfall over the entrance and camping with hundreds of bats

• Walking a deserted beach at night with a group of people from 5 different cultures on a turtle tour. We saw hatchling sea turtles escape their nest and journey to the ocean

References

• Manguzi Rehabilitation Department program description

• http://manguzirehab.blogspot.com/p/rehabilitation-programs.html

• Madden, V. J. (2013). ‘OUR TRAINING LEFT US UNPREPARED’ – TWO PHYSIOTHERAPISTS’ REFLECTIONS AFTER WORKING WITH WOMEN WITH LOW BACK PAIN IN A RURAL ZULU COMMUNITY IN SOUTH AFRICA. Journal of Community and Health Sciences, 8(2). Retrieved February 15, 2019, from https://www.bodyinmind.org/wp-content/uploads/Madden-et-al-2013-JCHS.pdf.

• My own experiences in Manguzi