Jennifer Everhart, Pt, Mpt, With Patients At Hope House, The

Jennifer Everhart, PT, MPT, with patients at Hope House, the nongovernment organization in Niamey, Niger, for which she works. The children pictured are being treated there for clubfoot, post-op bone deformities, and plantarflexion contractures.

A 22

●

September 2009

Making a World of Difference

A

by Eric Ries

Physical therapists across the globe face many of the same problems and are responding with common strengths.

A

s a physical therapist (PT) in Ukraine, Sandra Kunanec, BScPT, navigates a health care system she bluntly describes as “in crisis.” The human need is great, infrastructure is lacking, salaries are poor, and services for people

In Brief There are many reasons to take interest in the contributions and activities of your PT colleagues around the globe, whether or not you choose to work alongside them. Among the most compelling are: v Learning from their research findings. v Learning from their clinical approaches to different care models and practice patterns. v Taking advantage of advanced training opportunities overseas. v Personal growth, whether in working with diverse populations or in gaining new perspectives on what you do and why you do it that way. v Gaining insights from other PTs’ successes in battling sometimesdaunting challenges. v Identifying ways in which you can help PTs and patients overseas, particularly in developing nations. v Deepening your understanding of the ways in which all PTs can advance physical therapy as a doctoring profession.

with disabilities barely exist—the legacy of a Soviet era in which, Kunanec disdainfully observes, “Everybody was healthy.” Officially, that is. In reality, “people with disabilities were tucked into a corner at home, or sent to an institution,” she says. “The strong survived, and that was it.” In 2009, “we’re still dealing with the old Soviet system,” Kunanec notes. “Legislation and care guidelines are archaic, insufficient, and don’t come close to meeting the needs of this population.” As one of only 120 members of the Ukrainian Association of Specialists of Physical Rehabilitation (as Ukrainian PTs are known) in a nation of 45 million, Kunanec concedes to often feeling overwhelmed. Had she not married a Ukrainian citizen, she might feel tempted to return to a comfortable life in her native Canada—except for one thing. “What keeps me going is why I ended up staying in the first place,” she says. Kunanec, born of Ukrainian-Canadian parents, was visiting family in Ukraine in 1993—2 years after independence from the old Soviet Union—when she toured one of country’s newly legalized non-government organizations. This one had been formed by parents of children with cerebral palsy who had declined to follow the Soviet-era practice of giving up their sons and daughters to the state-run system of internats, or orphanages—where such children essentially were and are warehoused. “I was very moved,” Kunanec says. “These parents wanted something bet-

ter for their kids and were determined to secure that for them.” Inspired to join that fight, she cofounded the Dzerelo Rehabilitation Centre in the city of Lviv. Kumanec “We now see quite remarkable results achieved with children whose situations we once thought hopeless,” she says. The Ukrainian Association of Specialists of Physical Rehabilitation is applying for membership in the World Confederation for Physical Therapy (WCPT), with a vote expected at the general meeting immediately preceding the organization’s next conference, to be held in Amsterdam in 2011. Membership in the WCPT—which represents more than 300,000 PTs (physical therapists and physiotherapists, as PTs are known in many nations) in 101 countries spanning all six inhabited continents— will “improve the profession’s prestige in Ukraine, help us forge a stronger identity, and increase our skills and knowledge through professional development and networking opportunities,” Kunanec feels. Those goals dovetail with the purpose of the 58-year-old WCPT, which describes itself on its Web site (www.wcpt.org) as “committed to furthering the physical therapy profession and improving global health” by “encouraging high standards of physical therapy research, education and practice; supporting the exchange of inforPT m a g a z i n e

●

23

mation between WCPT regions and member organizations; and collaborating with national and international organizations.” The WCPT offers an array of guidelines and services, including policy statements, educational support, practice resources, and electronic discussion forums on a vari-

ety of subjects. Its quadrennial congresses, which draw thousands of PTs, are scientific events that showcase advancements worldwide in physical therapy research, practice, and education. Ukraine’s experience with physical therapy as a developing country in some

WCPT President Marilyn Moffat, PT, DPT, PhD, CSCS, FAPTA, with colleagues and officials in Dubai.

CCISIG: Developing Resources for the Developing World Celia Pechak, PT, PhD, MPH, calls the APTA Section on Healthy Policy & Administration’s Cross Cultural and International Special Interest Group (CCISIG) the association’s “best-kept secret.” But clearly word has been getting out the past few years, given that membership has jumped from around 50 as recently as 2005 to 220 as of this June. “It isn’t intuitive for PTs interested in global health issues to look for that under Health Policy & Administration,” notes Pechak, the CCISIG’s vice chair. She adds that about 4 years ago the 23-yearold group committed to embracing new communication tools and developing additional resources to better address the broad interests of its existing and potential members. One of those resources is an electronic mailing list that offers CCISIG members a convenient and practical way to network, collaborate, and share information. “We’re all in our little pockets of expertise and geography, trying to do the right thing,” Pechak notes, “but the more we can connect, 24

●

September 2009

ways parallels the profession’s history in other nations represented within the WCPT. But WCPT President Marilyn Moffat, PT, DPT, PhD, CSCS, FAPTA, emphasizes that wherever PTs are found— in developing countries where the profession is struggling to establish itself; as well as in developed nations where physical therapy has a longer track record, PT education levels may be higher, care provision may be less problematic, and production of evidence-based research may be more robust—the challenges PTs face are similar. And, Moffat adds, the strengths that PTs possess—epitomized by Kunanec’s resolve to overcome obstacles in Ukraine—are universal. “We all struggle with such issues as physician attempts to control practice, getting government and regulatory agencies to listen to our patient-centered concerns and understand that we provide the best services to the populations we serve, lack of resources—particularly in underserved areas, securing appropriate remuneration for our services, and striking a balance between our personal and professional

the greater our impact can be.” She’s got personal experience in making global connections, having initiated Health Volunteers Overseas’ physical therapy training program in Haiti and having conducted training for that nonprofit group in Vietnam, as well. But Pechak, an

Celia Pechak, PT, PhD, MPH, training rehabilitation technicians in Haiti. (Photo courtesy of Health Volunteers Overseas)

Making a World of Difference lives,” Moffat observes. But, she adds, “the burden is particularly acute for my colleagues practicing in the poorest areas of the world, who struggle to provide adequate services to so many, to perhaps get just one PT education program started, and to eke out a living with extremely low pay scales.” Scanning the global horizon, Moffat, a former president of APTA, sees reasons for great pride and great hope. “Physical therapists in many countries have pioneered aspects of practice,” she notes. Educational requirements are increasing around the globe, and “electronic communication is drastically changing the ability of PTs to learn and advance their skills instantaneously.”

Aptitude Plus Attitude As WCPT Executive Committee member for the Africa region, Sylvia Kambalametore, RPT, MSc, NDT, Cert OMT, chair of the 22-member Physiotherapy Association of Malawi, is doing her utmost to help bring the glob-

al store of physical therapy knowledge to her developing nation. She received her undergraduate degree in the former West Germany, and Kambalametore her master’s degree in the United Kingdom, because Malawi does not have a school of physical therapy. Thus, the nation of 14 million’s contingent of fewer than 30 PTs are graduates either of degree programs in Europe or 3-year diploma programs in neighboring countries such as Zambia and Tanzania. Rather than dwell on the innumerable challenges of being a private practitioner in the Malawian capital of Lilongwe, however, Kambalametore prefers to focus on the positives. “It’s been a slow process, but a school of physiotherapy is coming,” she says confidently. No, the government and health insurance do not pay much for PT services, but Kambalametore makes do by asking patients to supplement those

assistant professor of physical therapy at the University of Texas at El Paso who also has done volunteer work in Nepal, says she has turned her international focus to the CCISIG in recent years because “I feel at my core that it benefits the world if physical therapists take a greater role in global health, and I want to do everything I can to ensure that APTA members are part of that.” It’s fair to say that the CCISIG (click on “SIGs” at www.aptahpa. org) has succeeded in helping, literally, to put APTA members on the global map. And Pechak is thrilled with what she’s seeing. “It’s so exciting to me,” she says. “Many SIG members are actively involved in the profession’s evolution in developing countries— helping physical therapy get established or raise its standards. That builds sustainable change in those countries. And in countries where people with disabilities tend to be shut away,” Pechak adds, “CCISIG members are serving as advocates for their inclusion in society.” Illustrating the roles CCISIG members are playing in developing countries overseas are the following three PTs, whose collective body of experience spans four continents.

payments by “contributing as best they can.” The shortage of health care facilities means patients are likely to receive acute, sub-acute, and rehabilitative care at the same location and be seen by the same PT through the entire recovery process. This means the limited number of PTs, occupational therapists, and other health care professionals in Malawi must work together extremely closely. “You get very smart at prioritizing your time, and learn to broaden your skills,” Kambalametore observes philosophically. “Actually,” she says, “all of the challenges make my job ever so interesting. There are no dull moments. There is no room for burnout.” Kambalametore does concede, however, that her workload is “unbelievable. There’s so much to do in the areas of orthopedics, neurology, and infectious diseases. We see bone infection from sometimes wrongly or inadequately treated orthopedic problems. Osteomyelitis. Tuberculosis of the spine, on occasion. The list goes on.” Putting a good face on adversity and countering difficulty with determination

Sustainable Service During her 3 years in the Peace Corps in Cote d’Ivoire (Ivory Coast) in the 1990s, Jennifer Everhart, PT, MPT, saw how quickly and dramatically the lives of people with disabilities could improve given even minimal exercise, help from assistive devices, and rehabilitation. Inspired to service, she enrolled in PT school upon her return to the United States. Since 2007, she has been director of physical rehabilitation for a non-government organization in Niamey, Niger, that provides an array of services to people with disabilities, including school-enrollment assistance, socio-economic integration via micro-credits and other means, and general community development projects. The organization’s rehabilitation efforts run the gamut from community-based care, to coordinating surgeries for children, to distributing and fitting prosthetics and orthotics, to providing special seats or walkers to children with cerebral palsy, to a weekly casting clinic for children with clubfeet. Everhart is one of fewer than 50 PTs—most of them graduates of Niger’s 3-year diploma program—in a nation of 13 million. She PT m a g a z i n e

●

25

clearly are qualities shared by PTs worldwide, whether they’re battling Soviet-era attitudes in Ukraine, scarce resources in Africa, reimbursement headaches and encroachment threats in the United States, or, in the Philippines, the strictures of a 40-year-old law that groups PTs and occupational therapists, requires physician approval for PT services, and limits the role of PTs to rehabilitation. Attempts to separate out PTs and rewrite the 1969 law have proven fruitless within the Philippine legislature—which happens to feature a number of physicians, notes Maria Ruiz-Aguila, MPhysio, PTRP. Frustrating? Immensely, says Ruiz-Aguila, a former president of the Philippine Physical Therapy Association who is a professor at the University of the Philippines in Manila and a private practitioner working in pediatrics. Yet she’s quick to emphasize what works about the profession in her country. In order to receive a bachelor of science degree in physical therapy and sit for licensure, students in the Philippines must complete a 5-year program, the final year of which is devoted to intern-

ships, field work, or clinical training. It’s one of the more rigorous programs in the developing world, and a source of pride to Ruiz-Aguila. “High standards must be met in order to practice physical therapy in the Philippines,” she says. “Practice standards have been raised and education guidelines have been updated to ensure that Filipino PTs are in step with the changing

Maria Ruiz-Aguila, MPhysio, PTRP (inset) and participants in the Philippines’ National Physical Therapy Day in 2008.

says her biggest professional challenge, unsurprisingly, is “not being overcome by the magnitude of need” and instead focusing on where her time might best be spent. But it is not, she adds, as if her work lacks deeply satisfying rewards. “The absolute best part of my job,” Everhart says, “is giving hope to children who otherwise would have essentially no access to rehabilitation services, had no idea such services even existed, and are stigmatized by their society. In addition to cerebral palsy,” she says, “there are severe physical impairments related to polio sequelae, angular deformities of the lower extremities probably related to nutritional rickets, burn sequelae, improperly administered injections, and fracture complications.” Given the underdeveloped health care system, “PTs are often the last health care professionals these individuals encounter,” Everhart observes. Her advice to other US PTs interested in advancing the profession in underserved areas of the world? “Educate yourself by talking

26

●

September 2009

roles of PTs in health care globally.” Ruiz-Aguila notes, for example, that PT education in the Philippines includes a dedicated course and considerable fieldwork in community-based rehabilitation. “As a developing country

to others with experience. Find short-term volunteer assignments through groups such as Health Volunteers Overseas (www.hvousa. org) to become more familiar with the realities. Be prepared to step back and recognize your limitations. Be ready for clinical conditions and practices that will not measure up the standards you’ve come to expect. Be patient in identifying how you best can contribute to improving the conditions you encounter, and mindful of contributing in a culturally appropriate manner. Find a mentor.” “Finally,” Everhart adds, “it is important we recognize that our role in international physical therapy increasingly should be transfer of knowledge. We must identify ways to help local PTs and health care professionals develop the skills they need to treat disabling conditions. It is, of course, extremely rewarding to help a child walk for the first time. But it is critical that we work side by side with local PTs to pass along knowledge that will ensure sustainable results long after we have left their country.”

Making a World of Difference in which not everyone can afford to go to hospitals or even clinics, our presence at the community level is very much needed,” she notes.

Positive Trends The quality of physical therapy worldwide inexorably is linked to how much education PT students receive. On that score, Moffat concedes, “There’s incredible variation” globally. But the trend is encouraging. The WCPT’s declaration of principle for education “recognizes that there is considerable diversity in the social, economic, and political environments in which physical therapy education is conducted throughout the world” but recommends that “education for entry-level physical therapists should be based on university or university-level studies of a minimum for four years.”1 “Every WCPT-member country in which PT education is below the baccalaureate level knows that must change,” Moffat says, “and they’re all moving

toward that. In the more-developed countries,” she adds, “physical therapy associations are realizing how important the DPT program is.” Drawing from a PowerPoint presentation she’s been sharing with audiences around the world since assuming the WCPT presidency in June 2007, Moffat offers a quick summary that highlights the breadth of PT education programs within each of the WCPT’s five regions: v Africa. “Diploma programs are found in Ethiopia, Kenya, Malawi, Uganda, and Zambia. There are four-year programs in Ghana, Rwanda, South Africa, Zambia, Zimbabwe, and Egypt—with Egypt now considering master’s or doctoral-level education. Nigeria’s situation is interesting, in that it has four-year degree programs, with a fifth year for internship, available at seven universities. The DPT is being discussed in Nigeria.” v Asia Western Pacific. “Diploma programs are found in Afghanistan, Cambodia, Fiji, Indonesia, Malaysia, and Singapore. Fiji and Nepal are mov-

Stateside Support Like Everhart, Jeff Hartman, PT, DPT, MPH, credits an eyeopening overseas experience with setting his career course. Four months spent in Nepal as assistant coordinator of mobile health clinics for a volunteer organization “exposed me to extreme poverty and needs and inspired me to do something about it,” he says. A subsequent experience at a rehab clinic in Sierra Leone, where he was one of four PTs in a nation of 5 million people that had been devastated by a civil war characterized by torture and amputations, inspired Hartman to supplement his physical therapy credentials with a public health degree that would facilitate working in the international arena. He now is stateside director of operations for Hillside Health Care International, which operates a facility in an impoverished area of southern Belize that includes a freestanding clinic, mobile clinics operated in coordination with the Belizean Ministry of Health, and community education programs for local health care workers

ing toward three-year degree programs. Sri Lanka is moving toward a four-year degree program. Four-year degree programs exist in Australia, Bahrain, Bangladesh, India, Iran, Japan, Kuwait, New Zealand, South Korea, Taiwan, Thailand, and the United Arab

Everhart with a young patient in Niger.

continued on page 30

and the population at large. “I get down to Belize several times a year,” says Hartman, who is based in Wisconsin. “My job is to be the liaison between the clinic staff and the board of directors. I have my hands in the daily operations of the clinic and in stateside activities that primarily involve fundraising, recruitment, medication and supply procurement, and program development.” While emphasizing that he enjoys being a clinician and greatly appreciates his part-time employer in Madison’s “understanding of my passion for international work,” he admits that he “probably would do the Hillside work full-time” were it financially feasible— and, ironically given his role in serving the underserved in Belize, if it offered health insurance. Hartman relishes the role Hillside is playing in Belize and that physical therapy increasingly is playing in underserved countries. “Doctors and nurses may be able to keep people alive in small villages around the world, but what kinds of lives do their patients with disabilities face?” he asks. “PTs around the world are improv-

PT m a g a z i n e

●

27

Opposite page, clockwise: A boy with clubfeet in Niger, Everhart with a smiling patient, a case of neglected clubfoot on a 5-year old girl for whom Hope House provided surgery. Above: Gait training for a 25-year old amputee. His prosthesis was made in Hope House’s workshop.

continued from page 27

Emirates. Australia and New Zealand are discussing the possibility of instituting DPT programs.” v Europe. “There’s quite a bit of variation, ranging from diploma programs in Bulgaria, the Czech Republic, Estonia, and Serbia to master’s degree programs in Belgium and Poland. In between, there are three-year baccalaureate programs in Austria, Croatia, the Czech Republic, Demark, Estonia, France, Germany, Italy, Poland, Slovenia, Sweden, and the United Kingdom. Four-year baccalaureate programs exist in Bulgaria, France, Germany, Greece, Iceland, Ireland, Latvia, Lebanon [grouped in Europe within the WCPT], Malta, the Netherlands, Norway, Portugal, Romania, Spain, Switzerland, and the United Kingdom.” v North America Caribbean. “It is anticipated that all physical therapy education programs in the United States will be at the DPT entry level by 2015. Canada is at the master’s entry level. Five WCPT-member

nations in the region have baccalaureate programs—Jamaica, Panama, and Suriname among them. There is a diploma program in Guatemala.” v South America. “All countries within the region that have PT education programs are at the baccalaureate level.” One of those South American countries is Brazil, where Gil Almeida, PT, MS, PhD, Pos-doc, is president of the Council of Physical Therapists and Occupational Therapists of the State of Sao Paulo. In that post, he oversees licensure and professional standards of about 50,000 PTs and 70,000 occupational therapists. Direct access to the services of PTs is the law in Brazil. That’s the good news. The not-so-good news is that about a third of the nation’s 120,000 PTs are unemployed under a system in which government reimbursement for PT services is minimal. Still, Almeida is optimistic that government funding will increase as Brazilian politicians increasingly recognize that physical therapy helps decrease health care costs and improves qual-

ing quality of life in ways that empower individuals and enhance communities.” Hartman encourages PTs in the United States to devote whatever time and/or money they can to those efforts. “Put yourself in

ity of life. “The politicians feature beautiful hospitals and clinics in their campaigns, seeking to sway voters,” he observes. “Quality Almeida health care makes voters happy, and politicians ultimately will make that connection to physical therapy.” (Of two large countries that are not WCPT members, Brenda Myers, the organization’s secretary general, says “physical therapy as we know it has not existed in China or Russia. WCPT has had contact with a number of education programs in China,” Myers reports, “and we’re doing what we can to encourage the adoption of WCPT education guidelines there and facilitate establishment of the profession and an association.” In Russia, she says, “while seeds have been planted toward developing education programs, there has been little activity toward developing an association.”)

patients’ shoes,” he urges. “If you had a child, mother, or brother who was disabled, who was unable to go to work or school, and who perhaps even was being abused for being different, wouldn’t you want a better life for that family member?”

Overcoming Obstacles

Sommermeyer (standing) teaches neck evaluations in Iraq. 30

●

September 2009

Zach Sommermeyer, PT, DPT, has experienced a wide crosssection of global PT practice, having done a student clinical in Australia, taught physical therapy for a non-government agency in Iraq in 2004, and now consulting on Iraqi issues while living in Ankara, Turkey. Sommermeyer, who grew up in Texas, is networking with aid organizations, universities, and clinicians in Turkey in pursuit of his long-term goals of providing pro bono services to underserved populations and developing research and student partnerships between US entities and Turkish counterparts. “In Australia,” he observes, “the quality of service delivery generally is the same as in the United States.” In the areas of Iraq

Making a World of Difference Just as the level of PT education is trending upward worldwide, so, too, is autonomy—which “exists in some countries in all WCPT regions, and is growing,” Moffat says. That list includes, in addition to the United States (where PTs in most states enjoy some degree of direct access), Canada, Australia, New Zealand, the United Kingdom, Ireland, South Africa, most of the Nordic countries, and Colombia. Salaries earned by PTs are, of course, all over the global map—ranging from “what the average PT earns in the US [a median income of $80,000 in 20082] to countries in which PTs make the equivalent of $3,000 to $5,000 per year,” Moffat notes. “It’s all related to standard of living and many other factors.” To cite one example at the low end of that range, Sylvia Kambalametore says a governmentemployed PT in Malawi “probably would start at about $500 a month.” Even by local wage standards, she says, “that’s considered not so good.” Exciting to Moffat, however, is the global character of research being conducted to provide evidence for PT

practice. The value of such research is emphasized in WCPT declarations of principle on evidence-based practice,3 research,4 and education.1 The WCPT “believes that physical therapists have a duty and responsibility to use evidence to inform practice and to ensure that the management of patients/clients, their careers and communities is based on the best available evidence.”3 It further emphasizes that research in physical therapy should encompass “all domains that impact on the practice of physical therapy,” from basic science through health care policy, and that PTs have a responsibility to “share freely the results of such research through a range of dissemination routes.”4 In fact, “physical therapists in many countries are doing great research,” Moffat says. Indeed, nearly 60% of original submissions to Physical Therapy (PTJ), the peer-reviewed journal of the American Physical Therapy Association, come from outside the United States—with submissions from Australia, Brazil, and Canada leading the way.

to which he’s had access, however, “quality of care, availability of equipment, and expertise in using equipment vary greatly,” he says. “Many times, if exercise equipment is available it collects dust, because most physicians order only modalities.” Iraqi PTs have no national organization, he adds, and attempts to create one are hampered by ethnic divisions and resistance from a government-sponsored health workers syndicate that doesn’t want to lose its PT members. “In Turkey,” Sommermeyer says, “PTs’ education level is at least a bachelor’s degree, with some master’s and PhD graduates. But in many developing countries PTs still are treated as technicians by physicians in most settings and are not allowed to practice autonomously. There are many rehab clinics and hospitals in urban areas, but service delivery tends to decline in poorer areas and among refugees.” Sommermeyer has witnessed some of the major challenges to effective health care delivery in the developing world—including

“Research is being generated around the world that is relevant to the practicing physical or physiotherapist,” says PTJ editor in chief Rebecca Craik, PT, PhD, FAPTA. PTs worldwide benefit greatly, she notes, by the aggregation of global research at such Web sites as Hooked on Evidence (www.hookedonevidence.com), the Centre for Evidence Based Physiotherapy (www. cebp.nl), the Physiotherapy Evidence Database (www.pedro.fhs.usyd.edu.au/ redirect.html), and the Canadian Stroke Network (www.canadianstrokenetwork. ca/eng/index_flash.php). Carolynn Patten, PT, PhD, is enjoying a preview of the next generation of international researchers, teaching PTs from abroad in the PhD program in rehabilitation sciences at the University of Florida. Citing the work of students from Italy, Switzerland, and India, she says confidently, “these individuals are going to have a big scientific impact. They’re going to rock the world.” The world needs all the PTs it can get, observes Moffat—particularly given the steady spread of what she calls the “dis-

government and private corruption, lack of cooperation among international aid organizations, and “trying to get people from different religious, ethnic, professional, and socioeconomic backgrounds to come together to solve a problem.” But when physical therapy “works” despite the obstacles in its path, beautiful things happen. “It’s rewarding when you see local people using the training you have given them in the clinic to help their fellow citizens,” Sommermeyer says. “It’s rewarding when you see a person you helped get a wheelchair go out into the community and vote for the first time. It’s rewarding when you clean and bandage a wound for a person who walked 5 miles to get to the clinic. It was rewarding attending a meeting where, for the first time, Iraqi citizens with disabilities could come together to give voice to the challenges they face and issue quality-of-life recommendations to the new government.”

PT m a g a z i n e

●

31

eases of civilization” that are exacerbated by sedentary lifestyles and poor diets. “Physical therapists are exercise experts, ideally qualified to help prevent or mitigate the effects of obesity, diabetes, cardiovascular disease, smoking-related problems, pulmonary diseases, and some cancers,” Moffat says. “The enormity of the problem requires the efforts of everyone involved in health services delivery. The unsustainable alternative is spending more and more money on sicker and sicker people.”

Changing Lives Celia Pechak, PT, PhD, MPH, an assistant professor of physical therapy at the University of Texas at El Paso who is vice chair of the APTA Section on Health Policy and Administration’s Cross Cultural and International Special Interest Group (CCISIG; see sidebar beginning on page 24), knows that even those APTA members who’ve taken the time to read this article may question what, exactly, international physical therapy has to do with them. It’s the age-old question posed by everyone from school kids to white-collar professionals sitting through mandatory seminars: Why do I have to know this? Pechak ventures three reasons: v Need. “There are approximately 650 million people with disabilities worldwide [according to the United Nations Convention on the Rights of Persons with Disabilities]. Many if not most of them live in countries where there is limited or no access to physical therapy services. Our assistance, in whatever form it takes, is critical.” She advises American PTs to visit the Web sites and resources of the WCPT, CCISIG (section membership is required), and Health Volunteers Overseas, for starters, to see how to get involved. v The profession. “As we look toward Vision 20205 and being a doctoring 32

●

September 2009

profession, we must expand our role in the global health arena. If we in the United States care about gaining our rightful role in health care in our own country, establishing the profession’s role internationally goes hand in hand with that.” v Personal and professional growth. “Getting involved in physical therapy internationally really benefits those who care to get involved,” Pechak says. “Experiencing different care models in developed and developing countries offers PTs new knowledge and skills, and exposes them to different practice patterns that prove applicable back home. Also, great advanced training is available via education programs in many developed countries.” Bill Romani, PT, PhD, ATC, SCS, a senior research scientist at MedStar Research Institute and an associate professor of physical therapy at the University of Maryland, wrote an essay for the WCPT Web site titled “How a WCPT Congress Changed My Professional Life.” In the piece, he wrote that he felt compelled to become involved internationally after attending a symposium on physical therapy for torture victims that had been presented at the 2003 congress in Barcelona by clinicians from South Africa and Zimbabwe. Romani now works closely with both the WCPT and CCISIG to help “get the word out about the role PTs can have in global health, and the opportunities available to do so.” He sees his niche as helping developing countries establish or improve PT education. Betty Kay, PT, PhD, says working as a PT overseas changed her life, too. A research scientist at the Rehabilitation Institute of Chicago and assistant research professor at Northwestern University, she received Health Volunteers Overseas’ (HVO) President’s Call to Service Award in 2006, which honored her 4,000-plus hours of service in Vietnam and Uganda.

She also was instrumental in establishing HVO’s physical therapy division. Kay relishes everything about her overseas experiences, she says, from the professional insights she gained—“seeing your practices from a new perspective makes Kay you rethink what you do, and why you do it that way”—to the personal thrills of experiencing foreign cultures with colleagues who are natives. “I haven’t met anyone yet who had a negative experience, or who wouldn’t do it again,” she says. Moffat’s journey to the WCPT presidency began in the 1980s, with volunteer, consulting, and teaching opportunities in Taiwan and Thailand. Now, in her “spare time” between teaching at New York University and maintaining a private practice, she jets around the world in her WCPT role. If it’s Tuesday, this must be Malaysia. “I’m hoping to help advance our profession in ways that will make people’s lives easier all around the globe,” Moffat says. “I wouldn’t trade this experience for anything.” PT Eric Ries is associate editor, manuscripts. He can be contacted at [email protected].

References

1. World Confederation for Physical Therapy. Declaration of Principle: Education. Available at www.wcpt.org/ node/29029. Accessed June 18, 2009. 2. American Physical Therapy Association. 2009 Median PT Salary Information. Available at http://www.apta.org/AM/ Template.cfm?Section=Surveys_and_Stats1&Template=/ MembersOnly.cfm&ContentID=59484. Accessed June 18, 2009. 3. World Confederation for Physical Therapy. Declaration of Principle: Evidence Based Practice. Available at www. wcpt.org/node/29552. Accessed June 18, 2009. 4. World Confederation for Physical Therapy. Declaration of Principle: Research. Available at www.wcpt.org/ node/29461. Accessed June 18, 2009. 5. American Physical Therapy Association. APTA Vision Statement for Physical Therapy 2020. (HOD P0600-24-35). Available at www.apta.org/AM/Template. cfm?Section=Core_Documents1&Template=/CM/ HTMLDisplay.cfm&ContentID=25855. Accessed June 18, 2009.