Field report from Thomas Hermann and Sara Hofer, physiotherapists

Experience report

We were the first physiotherapists with Mudiro that worked in Namibia and were quite anxious about the experience that awaits us.

Our task was, on the one hand, in Rundu to exchange knowledge and experience with existing physiotherapists and on the other hand, to initiate and set in motion the creation of a similar physiotherapy standard in the hospitals in Andara and Nyangana.

In Rundu there is a department of physiotherapy. Unfortunately, there are currently no physiotherapists employed. An Occupational Therapist has been employed for a time in the hospital, but due to contractual employment difficulties, currently not working. Co-ordinated work, for this reason, is extremely difficult, because the remaining two employees in terms of practical physiotherapy work actually have little or no idea of the practice. The material in the practice is very diverse, but totally neglected and for the most part defective. Since our start in everyday working life, one of the delays suffered was that we actually stayed just two days in Rundu. All showed a great interest in our work and we had been eagerly awaited. We did however quickly realize that in such a short period of time, further education of this kind would be impossible. The topics for co-operation were very varied and broad. Both the most highly dedicated Orthopaedist’s, as well as the care staff and doctors of the paediatric department showed great interest to exchange knowledge with us, but without the presence of the former physiotherapist Linus, who would be able to ensure the continuity of the initiative it would stand no chance of success. We treated some patients, repaired available equipment as we could, and went on two days later, a little further to Andara hospital.

At Andara Hospital no physiotherapy facilities existed at the time of our arrival. On our first day, we unexpectedly met a Polish nun who does physiotherapist work two times a year in the region. She spends a week in Andara each time and then returns to her place of permanent employment at the hospital in Katima Mulilo. She is very active in the treatment of small children and has a lot of professional experience and training. Unfortunately, this is only ensures work related continuity. We accompanied them for a day in the «Bush» to visit patients who cannot manage to make it to the hospital. Thanks to the expert help of Domenic, a paraplegic local, who also speaks the native language, «thimbukushu», and is therefore indispensable as a translator, we found the remote huts of the patients. Although English is the official language, up here in the north in the Caprivi region it is rarely spoken and without our translators we could not get far. The most important part of the work that Sister Margret does is the identification of patients in the bush and the recommendations for further treatments at appropriate institutions. Our time at Andara was therefore extremely insightful and showed us the necessity of the treatment of the people in this remote region. For reasons of time on this day we could not tend all patients on the list and Sister Margret asked us if during our stay, we could make another visit since the next day she would be departing back to Katima Mulilo. For the outpatient treatments in the hospital we received keys to a room with two beds and a mobile partition wall. The administrative procedure for the recruitment of patients in the Andara region was done via an announcement on the radio. People heard the announcement and those who thought that physiotherapy could help their ailment, you would find on the next day in the hospital waiting patiently until they could be tended to. With the help of translators and at the same time to instruct, auxiliary staff, we tried to find out what is lacking. Our three auxiliary persons were Rosemary, Sixtus and Kosmas. Rosemary and Sixtus are nurses and Kosmas is actually a doorman, but apparently once did an introductory course in first aid. It was our aim, to educate the three in a little more than a week, to be able to bring the most necessary and most important exercises and to instruct their future patients. The three accompanied us during this week with more and sometimes less motivation, but from day to day it was clear that they were taking more personal responsibility and showed commitment and no fear of contact with the patients. Toward the end of the stay in Andara, we handed over to our three colleagues a register of the patients treated with a guideline consisting of images and exercises which we made together. We left the hospital with mixed feelings. We had made very cordial meetings and through our treatments a smile to a lot of faces. What the chances of success there are because of our training regarding continuity concerns, remains to be seen. This is mainly because the organizational conditions at the hospital is extremely complicated. Our work has been hampered by the fact that a co-ordinated guidance from the current matron was lacking. In addition, the hospital had suffered a loss of a brilliant doctor that had a passion for his work, Andara is now left with two doctors, a young Dutchwoman and the chief doctor which now has a large number of patients to manage. But we should also realize that the people seeking help for any advice from our auxiliary persons were extremely grateful.

The last two weeks of our stay we spent in Nyangana. We arrived in a very well kept and well organized clinic. The matron resident here is an excellent organiser and leads the staff incredibly well. By the way she herself regularly assists when it comes to patients at the emergency stations. Immediately after our arrival we had a packed schedule in terms of patients, the infrastructure as well as the translator were already there so that we could begin working without delay. For the whole week, we had our colleagues from Nyangana assist daily with simple exercises to complement existing patient examples. We were on site for one and a half weeks, available to the point that physiotherapy was soon on everyone’s lips. Hospital staff made extensive use of our offer, in addition to the outpatient work we accompanied them to stations where they normally work. There we provided assistance with mobile organizations and transfers of patients. Particularly in the case of working with the stationary patients have our colleagues shown a lot of commitment. It created an educational environment for us all in which we often joked and laughed together. In our eyes, the clinic in Nyangana, thanks to the thorough management of the matron, has the best opportunity to implement what they have learned from our stay. We are convinced that the agreements regarding continuity thanks to the commitment of all parties concerned are respected. At the end of our commitment in Nyangana we experienced a very touching farewell. We were warmly thanked by loud clapping and singing and we very much hope that we would be able to go again soon someday.

During our stay, we came to the conclusion that, in Rundu, they urgently need a physiotherapist with leadership qualities, for the people in the northern part of Namibia in the professional rehabilitation support sector. This would be the best approach for the two hospitals, Nyangana and Andara, to sustain satellite stations with basic knowledge in physiotherapy, for the more difficult cases a qualified delegate from Rundu would be necessary. Cost free transport from the two hospitals to and from Rundu already exists once a week.

As we now take stock of our commitment, we are more than satisfied with what we have accomplished in the short time we had to work with. The biggest stumbling blocks for physiotherapy we see the lack of staff in Rundu and the management of the clinic in Andara. With the right people in the right position however all three locations have lot of potential with simple but significant changes in gear. The continuity of our work is very dear to my heart and we hope that it succeeds. Mudiro, the establishment, helped to grow and further development of a physiotherapy in the north of Namibia and will continue to do so in further regions. We would like to further physiotherapists/inside for a deployment plan in Mudiro with our experiences.