Taking on a Beautiful Challenge: My experience as a VSO volunteer physiotherapist in Ethiopia

“When someone shares something of value with you and you benefit from it, you have a moral obligation to share it with others” so goes a Chinese proverb. It is for this reason that I have decided to volunteer two years of my time in what was once a strange land thousands of miles away from home. Of course, I have other reasons as well. I volunteer to gain international experience and professional advancement, for the adventure of living in a new and exotic location and immerse myself in a totally different culture, to gain a fresh perspective of my own career, for the sheer satisfaction of being able to say “I did it!”, but most of all, to share my skills and endeavor to change the lives of the people I serve. I volunteer simply because I am a global citizen and it is my responsibility to care for my fellow human beings as they also care for me.

The Challenges

Despite the warm hospitality that was accorded to me by my Ethiopian colleagues and some of the locals, there were some challenges that I needed to deal or cope with if I wanted to make my placement successful.

First, there was the constant bombardment of the eternal question: “How can you volunteer in another developing country when you come from a developing country yourself?” And my answer has always been the same. Why shouldn’t I when I have the ability and the capability to share my skills and change lives? I have lived in a developing country all my life and I know first-hand how it is to survive with limited means. I breathe, I feel, I touch poverty every single day, so how can I not know the developing world better?

Then there was the language and cultural barrier. It was a bit difficult at first to effect even the minutest of changes because of some resistance brought about by ingrained cultural practices. In addition, the language was hard to learn in the beginning. Although my colleagues speak very good English, the main struggle was communicating with the patients who mostly come from rural areas. Slowly, I learned to speak basic Amharic. I have also learned to respect the culture and the fact that culture is dynamic and positive changes can be effected without destroying the cultural identity of the people.

The next challenge was the low status of the profession in the hospital. In the beginning, I was struck by the low status accorded to physiotherapists by senior health professionals, especially medical doctors. Our young physiotherapists often found it difficult to communicate with the medical team; hence they were left out of the treatment and discharge planning of their own patients. Quite often, they went to the wards and found out that their patients were already discharged without their knowledge and permission. Because physiotherapy is still in its infancy in Ethiopia, awareness of the profession is still very poor. Its importance in the prevention of disability is still not generally acknowledged even by policy-making bodies. This issue, I believe, fuels the low morale of local staff who feel underappreciated despite their efforts to be acknowledged as a profession at the same level with nurses, doctors, and other health professionals.

The Achievements

Tackling these challenges, however, was not as painful as I anticipated because of the genuine support shown to me by my local colleagues. Even though most of them were just recently qualified, my young and dynamic colleagues were always willing to learn from me and at the same time share their local expertise. I was able to share my knowledge and skills to them easily because they were always open to new learning. It was very important to me to work alongside local counterparts as it was the most effective way I knew to ensure sustainability of my work as a VSO volunteer, and I knew that building the capacity of the physiotherapy department would take far longer than my two-year placement.

My time at Gondar University was quite an interesting and productive journey. After working closely together with my local colleagues and another VSO volunteer, Joanna Griffin, positive changes in the department began to unfold slowly before our eyes. We have managed to develop service development objectives, which served as an action plan for the year. Under the service development program, standardized assessment and treatment forms were developed, which made it easier for the physiotherapists to keep patient records. The in-service trainings and journal clubs likewise honed the physiotherapists’ clinical knowledge and skills and most importantly their clinical decision-making, which resulted in more thorough assessments and proper treatment planning. This, in turn, lead to more patients being discharged when they should be, hence patient outcomes and satisfaction were improved. This also decreased daily patient traffic in the department, which then made the local physiotherapists less stressful and hence were able to spare some time getting involved in continuous professional development opportunities such as browsing journal articles in the research library and attending in-service trainings and journal club discussion. In addition, we as a department were able incorporate evidence in our practice, improve our patient management skills, enhance our teaching and coaching skills, implement HIV and AIDS mainstreaming activities, conduct the first-ever Physiotherapy Awareness Week, publish and disseminate a monthly e-newsletter, Ethio Physio. The list goes on. The positive changes in the department also boosted the confidence of the local physiotherapists as it showed that by working together as a team towards common goals, they have the capacity to effect positive changes even with limited resources.

These achievements would not have been possible without a supportive environment and willingness of my colleagues to allow my work to develop. And I have been very fortunate to have a placement that gave me the opportunity to maximize the use of my knowledge and skills. There was so much to be done, so many gaps to fill, and so many opportunities for positive input. Despite initial resistance to change, which was expected, my colleagues gave me the support that I needed to do my work effectively and showed enthusiasm and appreciation for all my achievements. This has made me more determined to work harder alongside my local colleagues and effect positive change as much as I can.

Volunteering in Ethiopia has given me a fresh perspective not only about my career, but also about being a responsible global citizen. The ups-and-downs were just brushes that polished my personality. I would like to believe that I have become a different, if not better, person. My dealings with the Ethiopian people has somehow humbled and inspired me, for despite the difficult circumstances that they have to face on a daily basis, they are striving not only to survive but more so, to improve their lives. My young colleagues’ enthusiasm and genuine willingness to learn from me has given me the motivation to go on and share whatever I have to share with them. Unknowingly, in the process, I was also learning from them, and learning a lot about myself. I have learned that life still goes on even if we experience resistance in our work. I have learned that it’s not yet the end of the world when a project fails because there is always another alternative lurking around the corner if we just give ourselves time to reflect about our priorities against the priorities of others, accept that we can’t always do things our way and that common sense is sometimes more effective than knowledge gained from books, and lastly be humble enough to accept our weaknesses and rely on the strengths of our local colleagues.

Working in Ethiopia has been very enriching, both professionally and personally. Overall, I feel that this is an experience that can’t be traded for anything else.

The Donkey's Death Call

For the first time, I heard a donkey cry. This evening, I heard a donkey cry amidst the constant chuckle of car engines in the streets of Addis Ababa. Suddenly, I felt the urge to write about it, not because it was one of my firsts but because it was one of the most honest, emotional, spine-tingling sound I've ever listened to in my whole life. It was like the combined sound of a woman mourning over her husband's sudden death, and a child longing for a mother who just passed away, and a young man whose lover has been snatched away by death, never to return.

Death. That was the message the donkey was trying to convey in a series of guttural moans that seemed to come out after having been kept bottled inside for a long time. I looked around and all I could see was death.

To the beggars and street dwellers, it could be death of their hopes for a warm meal and a dry bed. To the old father standing by the corner store waiting for his young daughter to come home after enjoying the company of a lover, it could be the death of his aspirations for a better life. To the young woman sitting in a taxi who just learned she'd contracted the deadly virus, it could be the death of her ambitions. To the taxi driver who just hit the donkey in the middle of the road, it could be the death of his earnings for the day.

The donkey's cry seemed to tell us that every one of us suffers death every day, in one way or another. I refuse to think about mine, and try to replace these morbid thoughts of goats bleating, cows mooing, dogs barking, and birds chirping in the morning.