Rebecca Fawcett

Four weeks physiotherapy placement spent in the most beautiful country in the world, full of wonderful people and once-in-a-lifetime opportunities; and what’s the best thing about all of this? It was all for free. In November 2014, as a first year student, I joined the Chartered Society of Physiotherapy (CSP). I was told that alongside being an official member of this professional body, I would also receive added benefits and opportunities. But I had no idea what lay in store for me! I learnt that the CSP also work in conjunction with Work the World, and there was a chance to win an elective placement abroad in a country of my choice - who could think of better experience than that?! Despite this, I had little hope that I would be chosen, at random, from the vast and ever expanding number of students entering the competition.

Yet, somehow, to my complete and utter surprise, I was one of the extremely lucky winners! Out of my shock and overwhelming excitement, I readily accepted the placement. I felt nervous before my trip, but the excellent organization and reassurance from the Work the World staff both in the UK office and in Sri Lanka on arrival, helped me to keep calm. As a first year student, I was still building up my skills and expertise in clinical practice, and despite my nerves, the one thing I had confidence in was that I knew it would be the best experience of my degree.

Without a doubt, this opportunity has both met and passed my expectations! Once I had let out all the jumps and cheers I could, I realized it was time to make a decision about where I wanted to go. It hit me almost straight away; reading through the list of countries, it was almost as if Sri Lanka was written in size 20, bold, italic across my screen. The reason why Sri Lanka stood out for me so much initially is because of its astounding beauty. After some research, I found the Hospital could offer a placement both rich in quality and variety. As a hospital in a British colony island, it was clear that the opportunities would be the best; language barriers would not be a main issue, and it provided an almost direct point for comparison to the UK. As well as this, there are also so many amazing chances to travel, at very affordable prices.

My placement was mainly based in the Outpatients Department, as well as observation of the Neurosurgical wards, Neurosurgical ICU, Pediatrics ICU, and an opportunity to watch an open heart surgery on the Cardiothoracic ward.

As expected for someone who has never travelled this far from home alone, I experienced some cultural shock on beginning my placement. One of the differences that stood out most for me in Sri Lanka is the huge number of patients that are seen in such a short space of time. In the outpatient department I found it almost hard to believe that up to 20 patients can be treated by one physiotherapist in a morning clinic lasting just 3 hours. Some patients would arrive at 6:00am in the morning to be lucky to be seen at 9:00am! Despite these numbers I was impressed at the level of knowledge, expertise combined with efficiency that the physiotherapists on this department had.

Alongside this, I noticed immediately at the lack of resources in the department; a couple of Therabands and sand bean bag weights are just an example of the more up-to-date equipment. Any additional equipment, such as taping or brace supports would have to be purchased by the patient prior to their appointment.

Furthermore, although patients were treated with dignity and respect, patient consent was often hard to come by. I found this hugely different, as in the UK there is large emphasis on gaining informed consent, and this is reinforced in teaching and essential to passing any practical exam! However, again due to the large number of patients and exhausting waiting times, patient consent is not perceived as important, or even necessary. Although it may have seemed at first that clinic was rushed and lacking compassion, I soon realized after treating my own under supervision, how extremely grateful each patient is for receiving treatment, and how much they appreciate the time and commitment of the physiotherapists. Even with double the treatment time and treatments only carried out in accordance with up-to-date evidence-based practice, I am yet to come across this level of gratitude from patients in the UK.

One of my most interesting cases on the Outpatient ward was a man who had crushed his hand in a road traffic accident. The injury was severe, and even 4 months after surgery he had very reduced range of movement and strength, making it very difficult to be independent and return to normal activities. Each week on my placement, under supervision, I practiced joint mobilizations on this patient, along with exercises to strengthen and advice on how to enhance his recovery at home. I was amazed at how much progress this man had made during my time on outpatients, and one of my most memorable moments is seeing the smile on his face after every treatment.

It especially made my experience memorable when this same man left me in my final week saying “You’re going to make a wonderful physiotherapist” - It felt amazing to make even the smallest difference to this patient’s life, and reminded me exactly why I wanted to be in this profession!  

Although there was an occasional language barrier, I found it helpful to know some key phrases in the local language, Sinhalese, and again patients were thrilled at the effort to speak the language they know. But of course, like all hard work there is some time for play; let’s not forget the weekends! Along with the amazing people I met whilst in Sri Lanka, there were a huge number of opportunities to travel with them. The staff in the Work the World house were very helpful in organizing trips away at weekends, and suggestions of where to go seemed to never end. What I enjoyed most about travelling in Sri Lanka was there was a bit of everything. And with Kandy being so central, it was not difficult to reach pretty much any place you liked the look of. You could take a trip down to some of the world’s most beautiful beaches, or if the heat is not for you, you can still enjoy the beauty on a train ride through Sri Lanka’s ‘Hill Country’ landscapes and tea plantations. Better yet, if you’re an animal lover Sri Lanka is the perfect place for you. There are chances to go snorkeling with colourful fish, whale and dolphin watching at sunrise, and opportunities to hold snakes, play with monkeys and give elephants a long and luxurious bath!

Overall, I have thoroughly enjoyed my time in Sri Lanka, both in and out of the hospital. On that note I think it’s time to end on some helpful advice. In terms of placement, I think it’s best to follow the motto: placement is only as good as you make it! I would definitely advise to be proactive, enthusiastic and don’t be afraid to try something new! It may be scary at first, but I’ve learnt that swimming in the deep end, often leads you to more exciting things. Remember that you are there to learn, so you won’t be expected to know everything but try your best, and your efforts will most certainly be recognized. The hospital staff are excellent and are keen for you to learn, so it’s best to always show what you do and don’t know! I am extremely grateful for all the people involved in making it possible for me to have this experience, and especially grateful to the physiotherapists who have given me a huge number of fantastic opportunities to learn during my time here in Sri Lanka.