In this blog series, Lara shares her experience as an oversea-trained physiotherapist working in the UK. From guidance on the HCPC registration process to discussion around UK and international physio news, she hopes to provide help to foreign physios looking to work in the UK - and to connect with those of you who already are!
When I went travelling around South America, Paraguay wasn't on my list. I barely knew it was somewhere above Argentina, and that-was-it.
Call it coincidence, power of the universe or a change of plans but somehow I ended up in Paraguay for two weeks. In that time I learnt that yes, it is above Argentina but it is also surrounded by Brazil and Bolivia. I learnt that their first language is Guaraní (original language that came from Amazonian tribes) and the second Spanish. I found out that there are still more than a dozen tribes that are actively living in isolation and some of them don’t even communicate with modern society. I was also able to meet local people and specially in the capital, Asunción, I realised that my lack of knowledge about Paraguay was the cause of my prejudices (as often is). In fact, throughout history, Paraguay has often been exoticized by Western travellers which has led to frequent misconceptions about the country and its people. I did not expect people my age to be so prepared academically for instance, and I was fascinated by some great entrepreneurs I met on my way.
Delighted with my visit in Paraguay I caught myself paying attention every time I read something about the country or every time someone talked about it. I couldn’t help feeling part of a re-discovery and even convinced a family of travellers to go and explore the country.
And then I came across Pandora, a British Paraguayan-born physiotherapist. She commented on a forum I follow on the CSP website. I contacted her and she agreed to tell me a bit more about her story (thank you!).
Pandora was born in Paraguay but when she was 3 months old she was adopted by a British couple. She was raised in the UK and went to University here. However, she always grew with this feeling that she wanted to go back, not only to meet her biological family but also to work with the people of her country, in this case, as a physiotherapist.
Whilst studying she found a placement with a medical organisation that provided care in isolated communities and tribes. And off she went to see, learn and help.
She was fascinated when the group went off to meet the ‘Mbayá’ tribe. After driving off roads and then walking a few miles with no clear path, the members of the Mbayá tribe appeared. They stood up in the long grass, they climbed off trees…
Communication was tricky as they speak a different language. So someone would translate what they said in their language to Guaraní and then to Spanish for everyone to understand. Usually in this case they will simply ask the tribe if there was someone ill or that needed help and then go and see that person in particular.
In other communities where they spoke both Guaraní and a bit of Spanish Pandora noticed how communication was much easier in Guaraní. For example, if someone was asked about their knee pain in Spanish they would answer with a simple ‘yes, it hurts’, whilst if asked in Guaraní they would go on to tell more details, about the onset of symptoms, their duration, etc.
One of the main concerns was health education. Sometime tribes expected that with ‘an injection’ or ‘tablets’ the issue would go away and therefore would request and expect these. Imagine how hard it must be for a physiotherapist to break that concept and engage someone in therapy, when sometimes we fail to do so in what are considered "modern populations" back home!
How can we introduce rehabilitation concepts to those populations? What communication strategies could we use? How can we provide care but at the same time preserve and protect their indigenous status?
As this was a few years back I wanted to check with someone that is currently practicing in Paraguay to see how the situation is today. All of the physiotherapists I contacted told me exactly the same as Pandora: isolated communities or indigenous tribes ‘don’t believe’ in physiotherapy. For a long time they have been treated with injections and medicines that provided quick but short-lived relief, therefore physiotherapy and concepts such as long-term rehabilitation, exercise therapy, etc are still very abstract to these populations…
This matter has brought to me many internal debates: how can we introduce rehabilitation concepts to those populations? What communication strategies could we use? How can we provide care but at the same time preserve and protect their indigenous status?
(Spoiler alert: I still don’t know what to think! So many political, cultural and ethical challenges!)
Going back to Pandora, she also had the opportunity to work in a neuro rehab centre in Asunción. She was very honest when she told she had some of my prejudgment thoughts before she started, only to realise that her colleagues in the centre were really up-to-date with current treatment and evidence - they were using the same outcome measures she uses in London and they kept good links with different associations across the continent.
We both agreed that in general there is work to do around physiotherapy and specifically in health education, especially in isolated communities - but we both felt quite motivated by the fact that Paraguayans physiotherapists are already out there pushing for change and development.
About the author
Lara is a Spanish physiotherapist who has been working in the UK for the past 3 years. Having worked as a rotational physiotherapist over here, she's had experience in a wide range of specialities and now works as a Band 6 Physiotherapist. However, it hasn't always been easy finding her way and adjusting to the UK system. She's since been sharing her experience and helping other foreign-trained physios to come and settle here; firstly through her own blog, and now as part of the QP team!