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Time, Disability and Physiotherapy - An Elective in Zambia

Emma Cullingworth, third Year Physiotherapy Student. Keele University with a grant from MMA HealthServe
In the summer of 2001, I travelled to Zambia, to carry out an elective placement at Chikankata Hospital, which is run by the Salvation Army. The hospital is situated in the Southern Province, along a 30-km turn off from the Lusaka to Livingstone road. The nearest town is Mazabuka, which is approximately 60 km away.

While I was there, I worked alongside the physiotherapist, Mrs Musukwa. I had the opportunity to learn from her as we treated patients that I wouldn't normally see in the UK. The treatment techniques Mrs Musukwa and I used for our patients followed the basic principals that I have been taught as a physiotherapy student, but the application of these principals was quite different! Working in Zambia has increased my confidence and independence, as I had to think on my feet, without a pile of textbooks and a library around the corner!

Working with leprosy patients was a large part of my elective. Although the number of new cases of leprosy is decreasing, there are still many patients who struggle with the deformities they have, and who need help and education on how to protect their anaesthetic limbs. Chikankata organises many community home visits, and while I was there, a trip had been arranged to visit a number of ex-leprosy patients who, two years previously, had been re-integrated into their own societies. The purpose of the trip was to evaluate their circumstances and their disabilities, and alongside the social worker, to assess accommodation and food supply etc. From a physio point of view, we took measurements for sandals (which we later made from old car tyres), gloves and crutches (which we also made individually). This gave me the opportunity to be shown around traditional "African villages" and "mud huts". The people were so generous - they have so little yet they offer all they have. This was very humbling.

I also had the opportunity to attend a seminar by the Zambian Association for Physiotherapists working with Cerebral Palsy, on the theme of mental retardation. It was very beneficial, to see the different approaches to Cerebral Palsy, and how the structure of care differs to that in the UK. The classification of mental retardation is also significantly different. The tests used in western countries are inappropriate in countries such as Zambia because of the huge cultural differences. For example, in Zambia, timing is not seen as important, people rarely rush, or worry about the time. However in England or the USA, for example, people tend to be very time conscious. Many of the tests to assess mental retardation involve a time element, and it was said that these are not appropriate for Zambian children, as it is not normal for them to have a time limit set on any task. Consequently, many Zambian children were found to be mentally retarded according to the tests, when in fact they were not.

Generally speaking, the attitude to learning disabilities was very sad. As traditional culture is very strong in Zambia, many parents with disabled children believed that they had been bewitched or cursed - and as a consequence they were ashamed of their children, who were often left to fend for themselves. On a more positive note, the physiotherapists that I met at the conference were very enthusiastic about the work they were doing, and community based rehabilitation was high on the list of priorities, with education of both the parents and children.

I feel very privileged to have had the opportunity to experience life in Zambia, and I would like to thank all of those who have contributed, both with monetary gifts and by support in other ways. I have benefited both from a personal and a physio point of view. The people I met and worked alongside had such a strong faith in God. In the western world, we have so many things that we trust, that we have security in, but I learnt that God can and will provide for all our needs, wherever we live and whatever our needs may be. I have had my eyes opened to the poverty and disability that many people live with and (I'm sorry for the cliché) how much I take for granted and how much I have, that I can thank God for.
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