We have now been observing and working with the Physiotherapists at HJRA (the local hopsital in Antananarivo) for two weeks. We decided to start developing training sessions on topics that the physiotherapists requested help with. I had emailed the doctors and physiotherapists before arriving in Madagascar, and they had explained that they are now seeing a lot more patients with Parkinson’s Disease, but have had very little training in how to assess and treat these patients. This was the first of our training sessions to Malagasy physiotherapists, physio students, doctors, and medical students.
We delivered the training with the assistance of our incredible translators who had already translated our Power point presentation into French (all teaching material in Madagascar is in French). The translators then translated our spoken descriptions and discussions during the presentation into Malagasy, therefore the translators were working with three languages during the presentation!
Continuing Professional Development (CPD)
CPD is a mandatory practice in the UK in order to maintain professional registration, however this is not the case in Madagascar. Supervision and training sessions are not normally practiced in Madagascar, with any training sessions given being delivered by foreign therapists who arrive in the country. We are hoping to give teaching sessions on requested topics, and emphasise the importance of CPD during each session. Following our sessions, we will then ask the physiotherapists to deliver training sessions to each other, in the hope of helping to embed CPD into the practice of Malagasy physiotherapists.
Every patient is different!
Physiotherapy in Madagascar is not an autonomous profession. Physiotherapists actually study nursing initially and then choose physiotherapy as a separate branch of nursing to study. The training to become a physiotherapist is taught by doctors, who teach a ‘recipe’ style approach to treating patients. For example, “if you are treating a patient who has suffered from a stroke, you must treat them by following steps A, B, C.” The fact that each patient is an individual and will present with different symptoms is not taught as part of the Physiotherapy curriculum in Madagascar.
During our training session, we emphasised the fact that no two patients are the same. We began the training session by asking the physios to name some typical signs and symptoms of Parkinson’s disease. We then broke down these signs and symptoms further into different categories, including what to look out for and ways to treat these symptoms. Following each symptom, we would emphasise the fact that some, not all Parkinson’s Disease patients may present with a variety of these symptoms, and it is important to recognise these in order to offer individual, specific treatment plans.
We attempted to make the training session as interactive as possible through audience participation and demonstrations of each activity. The best response was to our balance workshop where we taught weight transference through the use of balloon tennis!
Following the presentation, we then had a patient demonstration from one of the physiotherapist’s patients who had been diagnosed with Parkinson’s disease. By teaching in this way the Physiotherapists were able to put their theoretical knowledge into practice.
We received great feedback from the training session, with all who attended explaining that they felt much more confident in their understanding and treatment of Parkinson’s Disease patients in future. We are planning to continue to develop teaching sessions, in the hope that we can support the development, training, and skills of the physiotherapists. I have attached a short video of the training session. (*All photos and videos have been shared with permission*).