Background
My arrival at The Centre for Rehabilitation of the Paralysed (CRP) was on the 12th of September 2001, for the duration of six months. My welcome and orientation was provided by foreign members of the physiotherapy teaching department. Information about how the Physiotherapy course was run and hand over of my work was given by previous national lottery funded volunteer John Wiseman.
The accommodation that I was allocated in the guest house was much better than I expected and lived there for my first month at CRP. Following this I moved into a flat that I shared with two other volunteers. This was much more appropriate as I found that there was in fact little room for lesson preparation and study in the guest house rooms. In both cases there was a Ayah that provided very good Bangla food.

My initial impressions of Bangladesh were that it was noisy and dirty (although nowhere near as bad as I had expected), but that the people were very friendly. It was definitely good to have a few days to settle in the oasis of CRP before venturing out into the real world, where all your senses are attacked in one go!!! Everyone that I met on my arrival were very friendly and welcoming, so it was easy to feel quickly at home.

Role
During my six months of work at CRP I have undertaken several different roles as a physiotherapy volunteer, mainly within the Bangladesh Health Professions Institute. Initially I was allocated a lecturing role. This included teaching a cardiopulmonary module to the second years and a management module to the third years. I had already been given some information about the content of the modules previous to my arrival in Bangladesh. This was very helpful as it allowed me to bring some teaching resources from the UK. My second role was to supervise 3 groups of students on cardiopulmonary clinical placement.

Lecturing
The first week of my stay was mainly observational as I had never had any previous teaching experience. I was quite amazed that only a small amount of information was able to be taught in one lesson. The first few lessons that I taught were quite difficult for me as I was very anxious about the large number of pupils in the class (32 second years and 39 third years), the language barrier and the fact that my age was very close to many of the students. In the end I realised that these things were not so much of a problem as I had sufficient knowledge/ experience to teach the students the basic principles of physiotherapy. In fact I think being relatively newly qualified was an advantage as lecture formats and content were fresh in my mind. The biggest battle was actually keeping the students disciplined during a lesson as they often displayed inattentiveness and immaturity towards learning.

Clinical placement
I started supervision of cardiopulmonary placement with the third year students in November 2001. I took two groups of 9 and 10 students, for five weeks each. The placement took place in Postgraduate Hospital, Dhaka, where I supervised the students on the ICU and wards. There was no established physiotherapy department in the hospital so it was a challenge to build up good communication and a professional relationship with the doctors and nurses. Most of the staff had no idea what chest physiotherapy was, or the criteria for referral. I therefore arranged for the students to do a formal presentation in front of the doctors. The hardest part of supervision was the ratio of students to teacher. It was very difficult to assess 9/10 students when they were working on nearly all wards in the hospital. It certainly helped me to develop my organizational/ time keeping skills!!!

The third placement I supervised was for 4 weeks, with 11 second year students, in Dhaka Medical College Hospital. This was actually harder than the first two placements for several reasons. The conditions in the hospital were much worse, including overcrowding, squalid conditions, and a much larger area to cover. The length of the teaching day on placement was a bit shorter due to longer travelling time, and more hospitals to drop off at on the way. This, added to an even larger number of students who had no experience at all in a clinical setting, meant that it was increasingly difficult to assess them. The students themselves found it difficult because they all wanted to show me their skills, but I was unable to give them enough individual time This was not only a safety issue, but it also caused some tension within the group as they became very competitive and were not working as a team.

Assessment of Students
This area was the most challenging for me. I found writing and marking exams /coursework very difficult in the knowledge that the marks were going towards the students final degree results and I was only two years qualified myself. Having had no experience in this area, I was mainly guided by my own memory of exams/ coursework. In the end I just set some practice papers / homework to give me some experience with marking. This helped to identify the students quality of written English and understanding of the work I had already taught them. The main difficulty was knowing to what level I was assessing them. Was I to assess them to the same level as you would expect from physiotherapy students in the UK ? I still don't have an official answer to this, but believe that it is impossible for them to be the same standard. This is partly because of learning the course in a second language, and partly because their previous education has not taught them to think laterally or to take responsibility for their own learning.

The other area of assessment was the clinical placement. I have already mentioned the difficulty of student numbers. The other main problem was that the placement assessment form was very difficult to use. It was very subjective, and therefore made it difficult to assess the students objectively. It also meant lack of consistency of marking between different supervisors. The students themselves seemed to expect very high marks for their placements. They did not really appreciate the comments and feedback given about their performance which was put in place to try and help them improve in the future.

Aerobics/ Circuit training Instructor
I was very involved in running fitness classes for the female students during my evenings. Along with another foreign volunteer, I ran an alternating programme of aerobics and circuit training. The classes were good fun and helped me to develop a good relationship with the students, as well keep me fit!! It was also a good way to teach some of the physio students about basic exercise and stretching, which is something foreign volunteers may just assume they know about.

Experience Gained
I have learnt many things from my time here in Bangladesh, and would recommend the experience in CRP to others who wish to work in a developing country.

The lecturing and clinical supervision has definitely helped me to develop my organizational and adaptation skills. I feel that I have worked in many new areas which have required me to take control and be assertive, even though I haven't had any previous experience.

Teaching the theory of cardiopulmonary has helped me to consolidate my knowledge of the subject, although I haven't really been able to progress any of my own clinical skills. The management module was a completely new area for me, but helped me to see how much I had actually did know about the basics after only two years of clinical practice.

My communication skills have certainly been challenged, not only because of the language difficulties, but also cultural differences between myself, students, staff and patients. I have learnt many things from the students about how warm and welcoming the people here in Bangladesh can be. I have also seen how difficult some aspects of the culture can be to work with. Sometimes the poor communication, time keeping and general self-discipline of other members of staff made my job more difficult than it should have been.

The experience of working in a government hospital here in Bangladesh is certainly something I will never forget. I dearly hope that things improve in the future.

Overall my time in CRP has been very fulfilling and enjoyable. This was helped by the general enthusiasm of other volunteers I was fortunate enough to share my time with. I will certainly think about returning in the future and hope that the physiotherapy profession in Bangladesh will continue to grow and develop.