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28 August 2015

Last day at Groote Schuur! So many good memories and learned so much from the clinicians and students here. I won’t forget the amazing 6 weeks I had in Cape Town. Although I’m going to miss it, I’m excited to go home and start preparing for my next global health opportunity as a physio!

The next blog posts will highlight some of my traveling in the Eastern Cape up to Johannesburg followed by some reflections on my placement and some interviews I haven’t had time to transcribe yet! Look forward to it!

Reflections Before My Last Day at GSH

I’ve been feeling a little under the weather since I’ve caught a bug that’s been going around. Tomorrow will be my last day at Groote Schuur and I’m a little heartbroken. I am going to miss Cape Town dearly. But sitting here and reminiscing on my placement and all the friends I’ve met I can honestly say I will not regret making the decision to come here. Fun fact, I don’t think I ever intended to do an international placement in the first place. During the school year, I was on my way out of the classroom when I had just realized that Ann (our education coordinator) was about to do a quick talk about applications. I thought I’d stay just for the fun of it, but then realized that after hearing a bit about the opportunity, I decided that it definitely would be worth it. I may be slightly in debt (and I use that term loosely) but I will never regret it.

Before coming here, I had some conversation with Phil Sheppard as an informal mentor for this trip (thanks again!). There was already forewarning that this placement would require me to be a bit more independent. So Phil had offered to help me during my stay here in Cape Town by giving me some advice. Pre-departure we talked about preparations to work overseas as a physiotherapist. We shared about the importance of having a skill going to another country that can help empower the local physiotherapists. Throughout the week, I have been thinking as to what sort of skill I’d like to bring as a global therapist. I have a strong interest in orthopaedics and rehab so when I return to either Africa or another country, I would love to share this knowledge with anyone willing to listen and learn. This would require me to focus within the next year and increase my knowledge in these two areas. I plan to take as many courses as possible and make it priority to develop myself continually. Although I’m sad to leave, I’m also very excited to return and grow as a clinician to help people in the future.

One the reflective questions that Phil had me think about was “am I really needed here?” This question was constantly at the back of my mind throughout my placement. So after about 6 weeks later, I can honestly say, no, I am not needed here in Cape Town. Why? A couple of reasons... physiotherapy is well established and there is a system that currently addresses the issues of access to health care. Is it perfect? Nothing is really perfect, but I can say there are many well trained qualified therapists all doing community service that is improving the way people are moving within the community. The physiotherapists here are full of passion for their job and people. I’ve had the privilege of interviewing two local therapists for the Global Health Division and it’s very inspiring to hear form other physios who are passionate about their patients and job and are halfway across the globe. Some of these therapists speak the native tongue and can even better connect with their patients. As much as I love Xhosa class, I don’t think I’ll be an expert anytime soon. Perhaps one day, if there are other areas in Africa that need access to physiotherapy, I can brush up on my Xhosa/Afrikaans and visit again someday. But again, it brings me to my last point of being an expert in something, bringing something to the table.

The last thing I want to share is more of a personal thought. As a physiotherapist having exposure to people in a lower income bracket, there’s always a sense of guilt in being somewhat of a tourist. There’s always a conflict as a visiting therapist to easily get drawn into the tourist attractions. I don’t want to seem like a purist by being a selfless therapist treating marginalized populations. But there is a sense of guilt as I have more opportunity to enjoy these things and not have to worry about what I will eat the next day or having a roof over my head. The place I am staying in is very nice, spacious, furnished with everything you could ever need. Food and groceries are cheap especially because of the currency exchange. Things like skydiving, surfing and tandem paragliding come at little cost comparative to at home. On the other hand there is a very large population who do not have these luxuries. There is a very apparent gap in socioeconomic status all around in this area. The begging even becomes quite problematic, to a point where you shrug them off as an annoyance because it’s “just how it is”. But as a future therapist, how can I come from a humble place and not feed into the cycle of poverty and become “just a tourist”. I believe most of it must come from your mentality and accepting the fact that you are a visitor. There are obvious things you can do to avoid feeding into poverty by not encouraging begging. There are organizations that you can donate to that will ensure that the money will go towards essentials such as clothing, food etc. Also being aware that there is a disparity in socioeconomic status and being transparent about it; it is not good to be ignorant of these issues. A little guilt is okay, it means that you are actually aware but it shouldn’t eat you up. I think part of the whole deal of being a visitor is that there are sights, smells and sounds that are so foreign to you. I think if anything it would be a loss if you didn’t take advantage of these opportunities to experience something so novel. You must accept that you are a visitor and acknowledge those differences and most importantly, share those differences. In some way, doing so brings you closer to your patients and lets you become an advocate when you share these thoughts coming home.

Things I Wish I Knew Before International Placement

There are several things I wish I knew before coming to South Africa for my placement:

- That people walk on the left side of the road. I was wondering why I kept bumping into people in the first week. Driving is quite challenging because everything is completely opposite!

- What words I would need to know in their native tongue in order to properly communicate with patients. It would have been a lot easier to ask locals and language teachers to translate the commands needed in clinic if I had this list handy. It builds rapport with patients and puts a smile on their face when you attempt to speak their language.

- Be aware of the subtle and even larger differences in culture. For example, the Cape Town mentality is very laid back, which was a big cultural difference. One concept that took a while to sink in was tea time, although not mandatory, was a half an hour break. Back in Canada and my previous placements in hospitals we would work straight to lunch. My mentality was that it was almost unproductive because it just put an awkward pause to your day. However I needed to learn that this was the norm and to be respectful

- Having a better understanding of the healthcare system, the history of the country and the health care issues here in more detail. Having a larger view of healthcare and the disparities in socioeconomic status would have helped me empathize with patients more easily. Sometimes it was very easy to see the patient as a complicated case rather than an individual with needs in difficult circumstances. Understanding townships and the struggles that patients endure are important when advocating for the patient and understanding motivational factors in health care.

Tuesday, August 18 2015

On Monday I ran into something unorthodox that I’ve never seen before in hospital. The picture is above and it’s called a PEEP bottle. I was somewhat confused and I asked the UCT students to repeat the word. I had to strain my ears because it almost sounded like a urinary container for patients. The PEEP bottle (positive end-expiratory pressure) is a very inexpensive way to help patients increase their tidal volume. Essentially you are blowing bubbles in a bottle filled with about 10cm of water through a straw. You are to instruct the patient to blow into the bottle until they blow out all the air in their lungs. Some of the advantages of using this device I’ve jotted down:

- increased tidal volume - helps stimulate coughing - helps encourage taking larger inspiratory breaths - fairly inexpensive and easy to construct - improve airway and alveoli opening - vibrations help with secretion clearance

Some things to keep in mind:

To progress: You can increase difficulty by finding a smaller diameter straw, longer straw, wrap tape around the opening, or adding more water. You can also increase repetitions; initially you would start with 3-5 for their first time and gauge how much the patient can tolerate. Infection control: Change water every 24 hours, clean the straw

This could be very useful alternative if patients cannot afford a device to that helps clear secretions like a Flutter. Especially in home care or in an environment without resources, this could be of benefit for patients with chest clearance issues. Maybe some other physiotherapists can comment; have you seen a PEEP bottle?

**Special thanks to Sarah, Helen and Marchelle for giving me a crash course on this innovative device

Manual for a flutter: http://pi.actavis.com/data_stream.asp?product_group=1933&p=pi&language=E

Clinical Tidbits from GSH

Tuesday, August 11 2015

UCT students have an opportunity during their blocks to receive supervision from their clinical instructors. Students will book a patient transported by a porter to the physiotherapy outpatient gym at a designated time to receive feedback on their treatment plans. These supervisory sessions are very helpful, especially for me since I get direct feedback on my treatment approach. It’s not mandatory for international students but I figure I’d squeeze as much knowledge into my brain before I leave South Africa! Some of the thoughts I’m jotting down are things that I learned from my last two sessions. There are things I’ve forgotten from first year, so it was a good refresher for me. Definitely looking forward to the next one!

Proximal to Distal Stability

- patients require proximal stability before distal stability - priority goes to proximal muscles before working on distal

Posture and Hand Positioning:

- Do a quick scan of the patient’s posture, if the patient has hemiplegia keep that in mind and facilitate weight bearing in the non-weight bearing extremity. Note what is short and long ie. hemi-side is long and normal side is short due to lack of core control - Facilitate good posture with hand positioning, for example: if patient is sitting in posterior pelvic tilt and slumped over, push on sacrum and facilitate anterior pelvic tilt and scapular retraction, chin up - Promote upper extremity weight bearing in sitting, block the hemiplegic elbow and elongate the side of the trunk that is short and vice versa - You can ask the patient to cross leg to the side they are weight bearing to promote weight shifting - The weight-bearing ischial tuberosity is the side that is elongating - Weight bearing can help decrease spasticity in spinal cord patients

Promoting Weight Bearing with Glute Bridging and Engaging the Core

- Hemiplegic patients that require loading of lower extremities may require glute bridging as an initial progression before attempting sit to stand, glute bridge can help patients weight bear on the hemiplegic side and prepare for the extension portion of the stand - If patients do not engage core they may compensate with other muscle groups, in order to promote weight bearing and loading of the lower extremities, transverse abdominus (TA) must be active - Cues such as putting your hand under their lower back and asking them to flatten your hand, tactile cueing or even simply getting them to posteriorly tilt their pelvis - Ensure that you are adding pressure longitudinally through tibia to promote loading of joint and instructing them to engage core as they bridge and palpate the gluteus muscle to ensure contraction

Reading into Pain

- Impairments in gait may be due to pain and patients may not express it the same way we do in North America - may be more reluctant to express pain? - I would even say that these patients are either tough as nails or they can’t communicate with me due to language barriers

Challenges:

Some of the challenges I had while communicating with patients was definitely the language barrier. In one instance, I had a patient who did not express pain during ambulation in the parallel bars. But during our supervision session, the patient spoke Afrikaans and express that they had pain in the left knee and foot. Surprisingly I never picked up on this because either I missed it in the subjective/objective or it might have been a cultural issue of pride. Either way, there were major improvements made after addressing pain with modalities. The same issue of communication came up with teaching patients how to turn on TA. Not only language but cognitive barriers are an issue as well. Tactile cueing is very important in those with cognitive impairments. Often asking the patient to palpate medially to the ASIS and facilitating posterior pelvic tilt to allow them to feel a contraction will help. Also repetition is a key component in helping them understanding core activation.

Self-Reflection:

Not having much experience in neuro I am learning quite a bit from these sessions. It’s almost as if I’m relearning concepts from first year and finally seeing them in action. One of my issues is getting them to run before they can crawl. Having an outpatient neuro placement before this, I’ve been having a hard time working them up to the exercises I’ve been teaching more highly functioning patients in outpatient physio. I need to remember to test basic functional patterns and treat by making those functional movements part of the treatment and facilitate weight bearing and use of the hemiplegic side. On a side note, hamba (walk) is now the most common word I’ve been using with patients! Works quite well and they have a smile on their face when I attempt to speak their language. It makes it much easier to build rapport!

Bonteheuwel Community Visit

Sunday, August 9th

On Wednesday, I was able to shadow UCT students and their supervisor Latitia who gave me a small taste of what community physiotherapy looks like in the Western Cape. I have been looking forward to this community visit since Heather had offered a shadowing opportunity within the first week. The buses that take students to their placements in the townships leave the station at 7:30am sharp, so I had to wake up a bit earlier and catch them. Luckily, Carolyn (my classmate who’s doing paediatrics at St Josephs) takes the same bus so she was able to show me where to go. After a 15 minute bus ride, we arrived in Bonteheuwel where they dropped me off at the Community Health Centre (CHC). I met the other students who were doing their community block as we waited for Latitia. Students at UCT have their community block in 4th year as they have advanced clinical reasoning and able to better adapt to unique situations.

For their community block, students leave in pairs of twos with a supervisor and a local home care nurse. As a group, they travel by foot to each house to see their patients, because the nurse is a local, they know where each patient lives. Students are given an opportunity to have their own case load and treat a wide variety of conditions. Many people in these communities have a mixture of conditions layered with socioeconomic issues. As I was listening to the subjective portion of the assessment, I had a better picture of their current circumstances. There were issues such as caregiver burden, lack of transportation, inadequate access to home care and equipment.

The nurses would tend to the patient first for washing followed by an assessment or follow up with the physiotherapists. With washing, physiotherapy treatment and walking time each patient would take a little less than an hour. Latitia mentioned that time was a big issue since there are a lot of people in the community that require care. If a physiotherapist is experienced enough, an assessment should only take about 20 minutes. Some ways to streamline an assessment/treatment:

- when assessing a patient try functional clearing test first such as a squat or tricep push up. If the movement is impaired, break down the movement and find out what is weak and strengthen accordingly - try to test all possible muscles for each position, try not to change positions too often ie. supine, sit, stand - think more about functional movements rather than specific muscle groups for a treatment program

The most interesting thing about the nurses is that they were locals trained by hospital staff to tend to people within the community. The idea of empowerment is an important concept in truly improving access to health care in these townships. It is important to ensure that care provided to people is sustainable and does not finish when students/volunteers leave. This concept also applies to physiotherapists from other countries to do short-term volunteer work. As a Canadian physiotherapist planning on working overseas in the future, with whatever expertise I have, I’d like to empower the people/local physiotherapist in order to enhance their practice and being a humble visitor.

There is an evaluation form that the supervisor uses to grade students on their history taking, clinical assessment, communication skills, problem identification, intervention management, organization/efficiency and professionalism; each item score on a 6 item scale. Students are also asked to grade their satisfaction on a scale of 10 in terms of how they though the assessment went. I found that this assessment form would be an excellent way to give students feedback on how they were treating patients during placement. It would be something to consider bringing back with us to Canada as a way of improving the quality of our education.

Challenges in Community:

- time constraints: need to streamline assessments and be aware of your caseload and the amount of time spent for each patient - confined spaces: not a lot of space to maneuver wheelchairs and smaller areas for treatment/ambulation - safety: Bonteheuwel is an area of high gang activity. Physiotherapists are usually safe because the gang members recognize that we are helping the elderly in this area - infection control: need to be aware of infection control, bring gloves, sanitizer and always wear shoes - socioeconomic/social issues: being aware of their socioeconomic situation and understand the challenges they face with their family situations and take this into consideration when treating/making recommendations

August 8th 2015

I had an amazing opportunity to visit two townships this past week. Townships are communities that were formed during apartheid during racial segregation and the forced removal of black populations. Each experience has opened my eyes to the reality of lower socioeconomic populations and the challenges regarding access to rehab. On Tuesday, I was able to shadow my clinical instructor Samantha, to a Falls Prevention Class at a seniors centre (club) in Khayelitsha.

Khayelitsha means “New Home” in Xhosa, which is the most common language used in this township. It has a population of 391,749 and runs along the N2 highway. According to the census, Khayelitsha is one of the poorest areas of Cape Town with an average income of 20,000 rand per family, which is half of the city median of R40,000.

The focus for that day was to fit patients with gait aids, provide an education session and answer any questions they may have on falls prevention. Sam, three other students and I left the hospital around tea time travelled by mini-bus to the seniors club. Immediately on our drive there I saw the stark difference of infrastructure as many of the houses looked like makeshift huts. Once we arrived to the seniors club, there was a large group waiting in a large circle. One of the students was fluent in Xhosa, so it was a lot easier for Sam to communicate with the community. We talked about medications, blood pressure, diet, diabetes management, eye conditions and footwear.

Many of the recommendations were quite unique as they were adapted for their lack of resources. For example, Sam had pointed out that one of the locals had slippers which were a hazard for falls. She suggested that the patient use tape to give the heel support so that it would not fall off. Sam had to be aware of the socioeconomic burden of the community members when making recommendations that best suited their needs. Many of these recommendations wouldn’t be very applicable back and home and I was almost a little surprised at how unorthodox they were.

A majority of these patients had long standing issues. Without divulging too much information and breaching confidentiality, a lot of them had chronic comorbidities and long standing neurological issues. Many of them had not been treated because a lack of transportation or education on their conditions.

The great thing about physiotherapy in the Western Cape is the mandatory requirement to do 1 year of community service right after graduation. There is a definite need for community physiotherapy in the townships with a lack of transportation, resources and little knowledge that physiotherapy can help. Many UCT physio students post grad find themselves gaining valuable experience and strong insight on the current health issues in South Africa and how to address them. This if definitely something we can learn from as Canadian physiotherapists. I would love to see more community development work as physiotherapists and hopefully provide access to those who require physiotherapists; one of the populations being the First Nations Communities.

I’ll write more about my visit to Bonteheuwel, but there are a lot distractions in Cape Town! The food here is amazing and there are so many places to visit! We just finished driving around the Cape of Good Hope and saw some amazing sights. Pretty exhausted, but very happy.

I also went to Xhosa class again this week! There were less people this week so I was able to ask her to teach me some words I could use at the hospital. Enjoy!

New Xhosa Words:

Walk – Hamba Stand – Yima Sit down – Hlalaphants Push – Tshova Bend – Goba Young Woman – Sisi Young Man – Bhuti Older Man – Tata Older Woman – Mama

Happy Birthday _______. - Mini emnandi kuwe _______.

Community Visit Today

August 4th 2015 Very excited for my first community visit in Khayelitsha, which is a local township here in the Western Cape. Tomorrow I’ll be heading to Bonteheuwel to shadow UCT students doing their community block. Pumped!

July 29th 2015

It’s 12 degrees Celsius with a bit of rain and winds about 9 m/s right about now. May to July are South Africa’s winter months which are characterized by a few cloudy/rainy days predominantly in the Western Cape. Luckily the weekends have been pretty clear, giving us the opportunity to climb Table Mountain, visit Camps Bay and Hout Bay.

Today I had the privilege of joining a weekly language class at a local bar for international students (called FOREX short for Foreign Exchange). Two of our housemates from France invited us to learn Xhosa, which is one of the 11 official languages of South Africa. Noma is a local from the Eastern Cape who’s been teaching Xhosa for about 5 years. She’s been offering free lessons at FOREX every Wednesday to anyone willing to learn. What was really nice about this class was the extra tidbits she would share about the culture and language. I was furiously taking notes tonight over a warm fire with a room filled with foreign exchange students.

Xhosa is a phonetic language which means the way you read it, is the way you say it. It requires special attention to the tone that you use as one word could mean two different things. For example, “hamba” means go whereas “hambaa” with a harsh tone and drawn out “a” at the end means go away. It’s also an agglutinative language, meaning it uses stem words with suffixes and prefixes to make different terms. The most predominate characteristic of this language is the use of clicks with the tongue.

This was the most interesting part of the class since there were people from all around the globe in one room trying to make clicking noises. When a word has the letter “c” you use a dental click, where you put your tongue behind your teeth. An “x” indicates what they call a lateral click, where it comes from your cheeks. A “q” is probably the loudest click which comes from the roof of the mouth; they call this a post-alveolar click.

We finished off the night with some authentic South African food. Many of the dishes used different forms of maize. One special dish that comes to mind was called “pap” which was finely ground maize brought to a simmer for a corn-bread type texture meal. We also had “samp” which are stamped/ chopped dried corn kernels eaten with gravy. There was also an assortment of red meat and fish which tasted amazing (my favourite was the tripe!).

I’m hoping to learn a bit of Afrikaans and Xhosa in order to improve communication with my patients. One of the local physiotherapists had mentioned that hearing someone speak your mother tongue when receiving treatment puts you at ease. I hope to do my best by at least attempting to introduce myself in either of these languages. Below are some words we learned today in Xhosa. Try it out! It’s a lot of fun trying to figure out how to say some of these words. One of the medical students from Cape Town University also taught me how to count to ten in Afrikaans. I’ve added a link with a website that has audio files of all the pronunciations.

XHOSA Introduction phrases: Molo – Hello Unjani? – How are you? ndiphilile enkosi wena? – I’m fine and you? Ngubani igama lakho? – What’s your name? Igama lam ngu _____. - My name is ______.

Clicking Words! amacici – earring uxolo – sorry/excuse me qoqosha – tidy up

AFRIKAANS Counting to 10 one – een two – twee three – drie four – vier five – vyf six – ses seven – sewe eight – agt nine – nege ten – tien audio clips: http://www.easyafrikaans.com/easyafrikaans/learnmain.html

#languages xhosa afrikaans westernMPT

July 28th 2015 I’ve completed my first week at Groote Schuur! After a bit of floundering and getting used to a new country and the hospital, I’ve finally gained my bearings. Here are some interesting similarities and differences I found between South African and Canadian healthcare.

Differences:

- Prevalence of HIV - Small differences in abbreviations. One example is that they put a # before each diagnosis in the charts, whereas we use # as a short form for fractures, HPT is hypertension whereas I’ve seen HTN back home - Different terms for equipment. A walker is called a walking frame - A “sister” is a nurse with more experience and training. They have titles for nurses with different levels of training: student nurse --> staff nurse --> sister --> head nurse (head nurse is the equivalent to a nurse practitioner).

- There are no physiotherapy assistants (PTA) in their hospital system - Hospitals in South Africa have less technological resources, stats are paper based and there are no mechanical lifts - They have mandatory tea-time at 10am which is a 30 minute break in the morning - English, Afrikaans and Xhosa are the most predominantly spoken languages in the Cape Town area

Similarities:

- Most of the abbreviations are still the same - Interprofessional collaboration between all disciplines (speech-language pathologists, occupational therapy, doctors, nurses) - Scope of practice for physiotherapists are the same

Challenges:

Accents: It’s sometimes really hard to understand staff and patients (I asked a lot of people to repeat)

Names: Sometimes I can’t pronounce them!

Speaking Afrikaans: …and the other 11 official languages in South Africa. Some patients respond better to Afrikaans/Xhosa versus English

PTA: Not having a physiotherapy assistant

In order to maximize my global health experience, I hope to start building on key competencies to prepare for work overseas in resource poor countries. For those who aren’t physiotherapists competencies are knowledge skills and attitudes we strive to build as physiotherapists to help support the evolution of the profession with the changing health landscape and research.1 For those in Canadian physiotherapy, we’re familiar with the seven Essential Competency Profile (ECP) roles; expert, communicator, collaborator, manager, advocate, scholarly practitioner and professional.1 According to Cassady and colleagues (2012), these are all relevant to working in resource-poor countries with three additional novel roles: global health learner, critical thinker and respectful guest.2 The picture above is a quick summary of the additional competencies plus some added information under some of the original key roles. In noting the differences in our health care system and being aware of the cultural differences, I plan to develop these competencies and be more cognizant of how I treat patients in the remaining five weeks.

Plan of Action:

Communicator: Learn how to count to ten and 5 basic words in Afrikaans by the end of this week

Critical Thinker: I will commit to 2 blog entries a week to personal critical reflection (motivation for coming to SA, impact of presence or actions, etc)

Global Health Learner: Within two weeks from today, understand the South African Health Care system and learn of 3 differences in policy compared to Canada

Manager: Find 1 novel way to help transfer patients safely and effectively from bed to chair within 2 weeks from today.

Respectful Guest: Be more aware with the way I phrase sentences when discussing differences between Canadian/South Africa health care resources.

*Special thanks to Ingrid Yu and Phil Sheppard for introducing me to this article!

Image retrieved from: http://www.physicaltherapy.utoronto.ca/wp-content/uploads/2012/07/Thinking-Beyond-Our-Borders-Image-e1343137952845.jpg

References

1. Essential Compentency Profile for Physiotherapists in Canada. 2009. Retrieved from http://www.physiotherapyeducation.ca/Resources/Essential%20Comp%20PT%20Profile%202009.pdf

2. Cassady C, Meru R, Chan NM, Engelhardt J, Fraser M, et al. Physiotherapy beyond Our Borders: Investigating Ideal Competencies for Canadian Physiotherapists Working in Resource-Poor Countries. Physiother Can. 2014 Winter;66(1):15-23.

#globalhealth #essentialcompetencies westernMPT physicaltherapy

July 20th 2015

After getting a good night’s sleep we set out to explore the area for a quick breakfast and coffee at a local restaurant. Food is fairly inexpensive as our meals cost 25-35 rands which is approximately $2.60-$3.65 dollars Canadian. We set out for Groote Schuur and immediately noticed beautiful Table Mountain behind the hospital. It must a real treat for those working in the area to see it every day. We quickly met up with the University of Cape Town (UCT) Clinical Educator for the Department of Physiotherapy and she gave us a tour of the facilities. After finishing registration, we had to make a trip to the main UCT campus to pick up our student cards. We met two German medical students from Munich also doing their international placements at Groote Schuur and we decided to go together.

To get to campus you need to take something called a Jammie, which is a blue bus dedicated to transporting students to campus for free. After asking almost everyone if we were on the right bus, we finally arrived and took in the sights. The campus was incredibly beautiful and Table Mountain looked even more magnificent as it was a lot closer. After getting our IDs (and Carolyn getting her head cut off in the picture) we walked around campus one more time before heading back home.

Tips:

+ For those considering a placement here, you can get a pay-as-you-go sim card. It offers basic calls, text and data (SIM card is 3.50 rands and you charge your account with any amount, .50 rands/SMS and .79 rands/minute for calls). You would have to find an unlocked cell phone to use this service

+ As a elective student you are allowed to take the Jammies to their designated locations for free, it will save you quite a bit of money for transportation

+ Make sure you have accommodations where you can store your passport and money in a safe

+ DO NOT take public transportation by yourself, at night or when the bus is empty. It will be much safer to take a cab

+ Quick SPAR and Pick & Pay are the equivalent of any grocery store back home

+ People here are very nice, don’t be afraid to ask them questions :)

July 19th 2015 Touchdown in Cape Town! Our driver thought he was picking up 3 Canadian girls, a bit of a surprise for him! We've finally settled in our lodging and just getting ready for tomorrow's orientation at Groote Schuur hospital. Luckily it’s an 8 minute walk, pretty much just down the road. According to the taxi driver Groote Schuur means farmhouse! Not sure if its true, but we'll find out tomorrow.

An Intro

Hi everyone! Before jumping into my journey to South Africa, I wanted to tell you a little bit about myself and why I decided to commit to an experience overseas. My name is Corey Kim and I am a second year physiotherapy student at Western nearing the end of my final year of graduate school. Born in South Korea, I came to Canada at a very young age. Being immersed in Western society but maintaining my Korean heritage has always been a challenge growing up in London, Ontario. My exposure to these cultural differences has been formative in helping me respect others and appreciating cultural diversity. This sparked an interest in other cultures during undergrad and led to opportunities for short-term volunteer work in Mexico and Dominican Republic. My exposure to marginalized population sparked an interest in returning with a transferrable skill to aid those in need. After carefully considering my own personality traits and strengths, I decided physiotherapy best suited me in my pursuit of providing an accessible service.

As I was navigating our program, I was very focused on making the most of my two years of education and seizing every opportunity. However, amidst all the new information, assignments and exams I had lost sight of what I planned on doing before entering the program. This thought had not dawned on me until Dave Walton prompted a reflection exercise during our consolidation course; he had us reflect on why we decided to become physiotherapists. Upon hearing this question I was almost taken aback. I had almost forgotten my initial goal realized I had let marks and school structure govern my growth as a physiotherapist. Dave reminded us that we all share one common trait; we are human beings, with the capacity to be compassionate individuals and the ability to help others. We are simply normal people with special skills. These reflective exercises primed me for Congress 2015 and the waves of inspiration that followed.

Attending Halifax Congress 2015 was one of the best things that could ever happen to me. I finally started to understand how physiotherapists could make an impact globally and what Global Health Care really means. I had the opportunity to meet with many physiotherapists at the CPA Global Health Division (GHD) social who shared the same aspirations. I was starting to see glimpses of what the future could look like and it was exciting. I was even given an opportunity to be on the communications subcommittee for the GHD. I am very thankful I was able to attend Congress this year. Without the student bursary offered through CPA, I would not have had the opportunity to develop a clear career path.

I am now on my way for my very last placement in Cape Town South Africa Groote Schuur Hospital which will be a kick-start to my ambitions for the future. I will be in the Acute Care Neurology ward for 6 weeks treating patients with ailments specific to their culture. The aim of this blog is to share my experiences, development and growth as an aspiring global health care professional. It is also meant to be a reflective diary in preparation to work in the global health field. I’ll also do my best to provide helpful tips or things I wish I knew to help anyone navigating their own journey. But most importantly, I want to stir up passion for my profession and invite others to become engaged in global health.

These thoughts are personal and are not affiliated with any of the organizations I am currently involved in. Feel free to comment or contact me if you have any questions! [email protected]

#southafrica capetown westernMPT

July 19th 2015 After a late night getting to know some of the students at the social, Kevin and I woke up for our volunteer shift the next morning. Bursary award winners must volunteer for two shifts during the conference. What this might require you to do is pass out survey forms and greet people at the door of the seminar rooms and perform a head count for the Congress coordinators. We were able to catch some of the amazing speakers, one being the plenary speaker Scott Jones who shares how physiotherapy helped him during devastating circumstances. After our volunteer shifts we finished off the afternoon with a couple of more very interesting seminars. In the evening there were many socials and AGMs scheduled so our Western group split off to do their own exploring. I decided to attend the Global Health Division Social and had an excellent time meeting people who shared the same passion! The night ended with amazing conversations and a lot of inspiration. It was tonight that I finally had realized where I saw myself in a couple years, I wanted to be involved in the Global Health Division.

July 18th, 2015

Day 1: We had some time to explore the harbourfront and boardwalk. After some early morning shenanigans with the Western contingent Kevin and I arrived to the conference centre introducing ourselves to the volunteer coordinators Nancy Walker and Carolyn King (super nice people!). Following a brief introduction and instructions regarding volunteering, we grabbed our registration packages. It included a free draw string bag full of goodies and pamphlets. Once we attended the first sessions for the day we transitioned into the main hall for the opening ceremonies and the Enid Graham Memorial Lecturer Mindy Levin. Following the lecture we were all invited to the reception to socialize and visit the exhibition. Like bees to flowers, we moved from booth to booth and had some very interesting conversations with all the exhibitors. Even had the chance to speak to Western faculty members and even ran into the head of the department of physiotherapy at my last placement! After meeting everyone (and collecting all the free swag) all the students met for the NSA AGM meeting.

The NSA meeting was an excellent opportunity to connect with other students. The meeting was very productive as we discussed how we could tackle some of the obstacles that our student assembly was facing. The only thing I wish we had more time for were breakout sessions where we could connect with our peers and further brainstorm more solutions to dream bigger for the NSA in the future.

We ended the night at Maxwell’s Plum, one of the many great pubs along the downtown area of Halifax. We had a great time getting to know each other and talking about the experiences we had during our placements. Definitely one of the highlights of the trip!

Tips for students:

- Take advantage of the Congress app to schedule your sessions and set reminders for start times - Visit the exhibition! Lots of free stuff! - Try to attend and be engaged at the student AGM, its the best way to meet other students

#PhysioCongress #mustangsRIDEeast #thestudentexperience

Touchdown in Halifax!

June 18 2015 Arrived last night using porter taking advantage of the complimentary beverages on the plane to get the night started! Once we arrived at the Barrington Delta we explored the town to find the infamous donair on pizza corner! Full with donairs and happiness we came back to the hotel to rest up for our first day of Congress

#physiocongress #thestudentexperience #mustangsRIDEeast

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