Eswati physiotherapist seeks to make a difference where it really counts
Physiotherapist Michelle White from Eswatini spent two months at the end of 2020 working in the Tintswalo District Hospital’s rehabilitation department as a Tshemba Foundation volunteer. Michelle is no stranger to working as a community-based physiotherapist and has previously offered her services as a sports physio to community projects; has worked in Uganda; and has volunteered at Mercy Ships on the specialised surgery ship the Africa Mercy, both in Madagascar (as a physiotherapist) and in Senegal (as a clubfoot physiotherapist).
In addition to working in a clinical environment Michelle has also worked as a Sustainable Health Financing Analyst. She has a Masters in International Public Health from the University of Sydney and says she chose this course to gain a better understanding of the public health sector: how its systems should deliver healthcare, what results in inefficiencies, and ultimately how these can be addressed. “After working in a public hospital in South Africa I realised that while we have amazing nurses, doctors and physios working in the public health sector, the system in which they work is very flawed,” says Michelle. “It is not so much the lack of skill or knowledge, than the system that results in inefficiencies.”
When asked why she feels medical professionals volunteer to work in places outside of their comfort zones, Michelle says she believes being exposed to cases and situations – which you wouldn’t normally experience in your normal context of work – offers an opportunity for growth. “It’s also a great opportunity to connect with other people who have a similar drive: to expand their knowledge and share their skills,” she says.
Michelle recognises the value of sharing her skills with people who may not be able to afford or access it under normal circumstances. “As a physio, in my comfort zone a patient would pay a fair bit of money to access my skills, whereas in a volunteering situation I am gifting it to patients for free.”
Q: Michelle, why do you volunteer?
“I do it because I get great fulfilment using my physio skills to help people in government hospitals, specifically here in South Africa. The people who are accessing government healthcare services often need rehabilitation services a lot more than people who can access private healthcare. And I say that because many people who access the public sector – about 84% of South Africans – are blue collar workers who perform manual labour. The work they perform also means that they are more likely to be injured. I feel I can make a much bigger impact and difference rehabilitating patients here, as opposed to patients who access private healthcare, who are often able to earn an income through passive means, or to whom a physical injury would not be as devastating as it would be to a manual labourer.”
Q: How did you hear about the Tshemba Foundation?
“I had finished volunteering with Mercy Ships and while looking for what next to do, a friend sent me the link…and I thought ‘Why Not!’”
Q: What did you expect when you came? What was the picture in your head?
“I expected the living conditions to be wonderful in terms of the bush and a beautiful lodge and was looking forward to living in the stillness of the bush.
“With regard to the work in the hospital, I had done a year of community service in a hospital in Mpumalanga previously, so felt I knew what to expect.
“With regard to the team, the resources and the types of patients I would see, I expected to see a lot of illness, and a lot of hopelessness in the patients with regard to their illness. I also expected a lot of frustration with the process and with team members. But, I also anticipated big wins and victories with regard to being able to assist patients, and also being able to connect with other members of the permanent staff, as well as bring new energy, AND have some fun.”
Q: What has been a highlight thus far?
“Being involved in Tintswalo’s clubfoot clinic was definitely a highlight – the team is very enthusiastic, and though they had undergone some basic training, they hadn’t yet had any long term mentorship. I was really able to use the experienced gained in my last field service with Mercy Ships here. I really enjoyed being able to spend time with them, and help them fine tune the skills they already had, as well as show them a few other techniques.
“I felt my contribution to the clubfoot clinic was well-received and we achieved a happy balance of being able to complement what they had already established. My input and advice was welcomed, which is very important when you’re volunteering. It also speaks to the willingness to learn and the humility of the physios I worked with.”
Q: Any low points?
“Outside of the clubfoot clinic I must be honest it took a while to get to the point where my opinion and clinical reasonings were heard and valued, and I didn’t feel like I was there just to substitute the existing team.
“It took me a while to integrate into the team, even though I was only there to help, but the team needs to figure you out first. So you do encounter barriers and resistance.
“Language is definitely a barrier too and I’d often have to rely on other physiotherapists for translation. Initially there was some resistance to this as well, which can be quite disheartening. After I’d been there for some time though, we shifted to seeing and diagnosing the patients together.
“I must admit that I did feel disappointment in some of the apathy and hopelessness I felt coming from some of the permanent staff, who didn’t really fight and advocate for the patients. Although having said that, there were doctors who fought for their patients to the nth degree, especially the doctors doing their community service.”
Q: What are the challenges you face or have faced, working in rural Mpumalanga?
“With regard to seeing patients in rural Mpumalanga one cannot forget that getting to the hospital for them is difficult and expensive.
“As a physio, if you want to rehabilitate a patient thoroughly, you would want to see them three times a week for a good session, but for many patients that is just not possible. So if you’re trying to rehabilitation a shoulder, or a fracture, or a spinal cord injury, your rehabilitation work is undone during the time before they come back.
“It’s a sad tension between the knowledge the patient needs to get back to work, and that I really need to see them more frequently. One has to encourage and educate them and their families (while faced with a language barrier), to self-manage at home, and that it is up to them to take care of their injury in the time that you do not see them.
“Other challenges I’ve encountered are traditional beliefs and the fear of the demonic.”
Q: Any stories you’ll definitely be sharing with friends and families for many years to come?
“The children are precious, but I’d probably share some of the breakthroughs with some of the therapists, as many initially put up boundaries and were suspicious about what motivated my being there. I too can be quick to jump to conclusions but my grace for the therapists grew as I learned about what the year has been like for them, their challenges with their children, and other burdens they carry from back home – it definitely struck a compassionate chord.
“I think the very fact that we’re able to come and volunteer means that we are from a privileged background. I don’t know what family responsibilities and financial requests my colleagues at the hospital may face, but I do know that volunteering is not an option for them.”
Q: Would you come back?
“If my time and circumstance allowed, I would.”
Q: Any advice for would-be volunteers?
“I would recommend that people come for at least three weeks to a month. The first bit is taken up by orientation, and in order to add value, come for longer.
“If you are thinking of volunteering, approach your role with humility. Have a conversation with your sectional head about what your role is going to be and find out where you can add value.
“Try not to implement changes, without understanding what it is you want to change. Systems in a hospital develop organically, and there is often a reason why they have developed: take your time to understand why and how they have developed.
“In this context take a slow and gentle pressure kind of approach, as people will take time to warm up to you.”
Thank you, Michelle, for your holistic and compassionate approach to healthcare, and thank you for volunteering through the Tshemba Foundation.3