I arrived at The Centre for Rehabilitation of the Paralysed (CRP) on the 24th of September 2002, for a three-month period. My assignment was funded by the British Executive Services Overseas (BESO) and my remit was to work in the Bangladesh Health Professionals Institute (BHPI) teaching physiotherapy. I had previously been advised by email that I would be teaching a musculo-skeletal module to the first years and a professionalism module to the fourth years as well as teaching staff how to use new electrotherapy equipment.

The physiotherapy teachers of BHPI provided my welcome and orientation. The long-term physiotherapy advisor gave me information about how the physiotherapy course was run and handed over my workload. As well as teaching this included helping to set up and organise the physiotherapy department at Mirpur the new income generation building. Also counter-part training the local teachers to supervise the 4th year research projects, and working with the senior physiotherapy staff to improve their management skills. Then for November and December, when the long-term physiotherapy advisor returned to the UK, taking over the supervision of the interns in the Dhaka city centre clinic and running the physiotherapy service for the British High Commission (BHC) medical facility.

I moved straight into a flat with a Dutch Occupational therapist who was also a volunteer. This was great as we had plenty of room to work in the evenings on lesson preparation and marking. We were cooked for at lunchtime by an ‘Ayah’ who also cleaned our flat (a wonderful luxury as I hate cleaning and am not that fond of cooking).

My first few weeks of work at CRP involved a lot of teaching, mainly within BHPI but also in clinical areas. I had not really been given much information about the content of the modules previous to my arrival in Bangladesh so much of my time initially was spent planning lessons. Teaching all the qualified physiotherapy staff how to use the newly donated electrotherapy equipment firstly involved teaching myself how the particular machines that had been donated worked. Then devising operational guidelines for their use and finally running workshops to teach all the physiotherapy staff how and when to use them. I also worked with a local teacher in practical musculoskeletal spinal classes, not only to train the 2nd year students how to palpate and mobilise, but also to improve the teacher’s techniques.

Working on the 4th years research projects was very interesting, we set up the first BHPI ethics committee to grant approval for each student to undertake their research. The other area of research I ended up working in was on the scientific committee assessing the submitted research papers for the 2nd national physiotherapy conference to be held at CRP on the 31st of October. I was asked to co-chair one of the scientific sessions on the ‘big day’ so I was dressed in a sari by the Ayahs and having practised a whole knew walking technique made it onto the stage without falling over! The conference was very well attended and hugely successful.

Within the first 6 weeks of my assignment it was suggested that I return for a further 3 months in the New Year and I agreed to this. Specific objectives were set for this period, which included: -
Standing in for the long-term physiotherapy advisor to enable her to return to the UK to work on her PhD
Reviewing and rewriting the BSc (Hons) in Physiotherapy curriculum
Continuing to improve the managerial competency of the physiotherapy head of department and the physiotherapy course co-ordinator
Continuing to improve the income generating clinics
Improving overseas staff recruitment.

In November the 3rd year students had to take a clinical competency exam to enable them to either enter the 4th year of the BSc course or pass their Diploma. Previously no system had been set up for these examinations so I devised an examination procedure and the necessary paperwork to implement it. We examined 32 students using the new system which proved to be a reliable system but was quite complicated to work out the marking, so I have refined it to keep the reliability but make it more user friendly for subsequent years.

Also in November two members of Lieden University in the Netherlands came to BHPI for 2 weeks. Their remit was to gather information for a possible collaboration funded by the European Union. So for 2 weeks I, along with the rest of the physiotherapy staff, was involved in extensive workshops while teaching the students early in the morning or in the evening.

Much of the last 2 weeks before I returned home for Christmas was spent marking and setting exams, the students were off for their Eid holiday so it was time to catch up on all the non-teaching duties. I left Bangladesh on the 16th of December for 6 weeks but during my time in the UK was able to gather together documentation to help me fulfil my objectives when I returned.

I flew back to CRP on the 3rd of February and got straight down to work. The physiotherapy staff both local and volunteers expressed concern about the clinical placement assessment form. They felt it was very subjective, and therefore made it difficult to assess the students objectively and that it’s format caused a lack of marking consistency between different supervisors. This problem had also been mentioned on previous professional volunteer exit reports.

I adapted a copy of a placement evaluation form used extensively in British physiotherapy courses, simplifying the language and making it more specific to Bangladesh. The new form was then implemented on the 2nd and 4th year placements. The staff found the new form easy to use if more time consuming than the previous form but as they found it very reliable in grading students’ capabilities they felt it was worth the extra time. The students themselves expect very high marks for their placements but the new evaluation form did not automatically give these. At first they did not really appreciate the form but hopefully began to realise that it was put in place so that the comments and feedback given about their performance could help them improve in the future.

I took over the duties of the long-term physiotherapy advisor which included teaching the Wealth, Health and Inequality module to the 1st years, the research module to the 3rd years, intern supervision, treating patients at the BHC and supervising the 4th year research projects. The latter being particularly time consuming as each project at first submission took about 3 hours to read and correct and I ended up doing this for 15 of them.

One of my objectives was to review and rewrite the BSc (Hons) in Physiotherapy curriculum. This was obviously done with input from all the other teaching staff. The new curriculum should help to improve the quality of physiotherapy education at BHPI.

The curriculum will be displayed on the CRP website so that future physiotherapy volunteers can access the course contents and objectives of the modules they will be teaching and therefore be able to plan in advance. This is one way of trying to address previous volunteers (and indeed my) lack of specific information on the teaching requirements of their time in BHPI. Another improvement that has been made in this area is the introduction of an induction programme for new staff organised and arranged by the physiotherapy course co-ordinator.

I worked with the course co-ordinator to assist him to draw up a year plan allocating specific teachers to teach the specific modules that they have sufficient knowledge in to teach competently. Thereby highlighting modules that need input from a foreign volunteer to counterpart train the local staff in the areas where they lack sufficient knowledge or skill. This has enabled specific staffing requests to be sent to funding organisations. It is hoped that these improvements will encourage foreign volunteers to work at CRP/BHPI and help to make their stay a pleasant and positive experience.

This plan also enabled us to give figures to the senior management of CRP on the number of local staff that need recruiting to run both the BSc and Diploma Physiotherapy courses.

In the clinical area of CRP I worked with the head of the physiotherapy department to improve the quality of care given to patients, improve the standard of documentation of the patient records and to help him increase his management skills. We implemented a clinical audit system and undertook clinical audit in the physiotherapy musculo-skeletal outpatients department. This highlighted some areas of practice that could be improved and the head of department discussed these with his staff. Hopefully he will continue to use the audit system as an ongoing tool to keep standards as high as possible.

A staff appraisal system was also devised but as yet has not been implemented but hopefully will be in the near future.

I worked with the interns teaching them how and when to use the various electrotherapy equipment and to improve their spinal assessment skills. Some of the interns then worked with me to improve the spinal assessment form for the physiotherapy department.

In respect to the income generation clinics I spent some time each week with the interns improving their clinical and documentation skills. This facilitated a local physiotherapist taking over the work at the BHC medical centre, which had previously only been staffed, by an ex-pat physiotherapist. I did not get to help with the new department at Mirpur as although it was supposed to open in September 2002 the building was still not finished when I left in April 2003 although the week I left Bangladesh some physiotherapy services were started there.

I left Bangladesh 2 weeks earlier than originally planned as I felt I would only be able to finish the curriculum if I had more reliable computer access. The computer at BHPI is needed by many staff and often cuts out due to power failures. Therefore I have finished rewriting the curriculum in the UK and sent it back to BHPI for approval.

I enjoyed my time working at BHPI in Bangladesh, and would recommend the experience to others who wish to work in a developing country. I have worked in various areas some of which were new to me, such as reviewing the curriculum which I have really enjoyed doing. My communication skills and my patience have certainly improved, not only because of the language difficulties, but also because of the cultural differences between myself, and the students and staff.

I would like to thank all the staff of CRP and BHPI who welcomed me and worked with me and the students who have taught me a lot about how life is in Bangladesh for different sections of the population in their essays. Hopefully I will be able to return one day.