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695 World Confederation for Physical Therapy The following items have been extracted from the May 1994 issue of the WCPTNewsletter which is published twice-yearly. Copies of the complete newsletter are available at f10 per Eastcastle Street, London W1N 7PA The Zimbabwe Physiotherapy Association The first physiotherapy association was formed in 1957 in the then Federation of Rhodesia and Nyasaland with 12 members. In 1965 when Rhodesia declared unilateral independence there were 25 members. The biggest growth of the profession took place in the 1970s with more than 100 physiotherapists working in the country when Zimbabwe reached nationhood in 1980. At present the ZPA database has the names of 135 physiotherapists. Until 1987 all physiotherapists were trained outside Zimbabwe, primarily in the United Kingdom and South Africa. An international accredited four-year BSc honours degree in physiotherapy had its inception in 1986 with the first student intake in 1987. The first eight students graduated in 1990. There are currently 72 students enrolled in the four years of the programme. A new intercalated degree in anatomy has been established for rehabilitation students (ie physiotherapy and occupational therapy) but due to staff shortages in the anatomy department this has not yet started. The University of Zimbabwe does not yet offer postgraduate degrees to physio- therapists but by means of staff develop- ment Fellowships two physiotherapists obtained master’s degrees in Scotland and Australia respectively and two more are currently in Australia on master’s programmes on Australian International Assistance Bureau scholarships. Ten workshops and short courses were held during 1993, run by either visiting lecturers or local experts. Two have already been offered this year. During 1993 there were also monthly anatomy revision sessions in the evening University of Zimbabwe Anatomy Department. Roughly one-third of physiotherapists working in Zimbabwe are engaged in private practice. In order to do so physio- therapists have to register with the National Association of Medical Aid Societies (NAMAS) who apply a screening test of their own. The Private Practitioners Association negotiates with NAMAS annually regarding tariff rates, and provided NAMAS tariffs are adhered to, fees are paid in full direct to the practitioner. In cases of misconduct NAMAS may refuse payment andlor scrap membership. The Ministry of Health has recently approved that government physiotherapists may engage in part-time private work. Government physiotherapists fall under the directorship of the rehabilitation unit in the Ministry of Health and Child Welfare. The unit is administered by a physiotherapist. Zimbabwe’s health care structure consists of about 700 primary health care centres where no rehabilitation workers are employed; 105 district and mission hospitals with 59 community based rehabilitation projects established at this level who employ rehabilitation technicians with provincial physiotherapists as overseers. The Family Health Project phase II which is funded by the World Bank will expand services by the construction of rehabilitation departments in another ten districts. The country has eight provincial hospitals, all with physiotherapy posts of which several are currently vacant and two are held by occupational therapists. There are seven rehabilitationcentres all of which employ physiotherapists and five central hospitals which currently employ ten year from WCPT, 16/19 physiotherapists in 35 posts, ie fewer than one-third of posts are filled. The shortage of manpower and low salaries have led to a depressing situation of frustration among government physio- therapists and resignation by new graduates as soon as they have completed their internship. The training of student physiotherapists is adversely affected by the shortage of clinical instructors and the absence of role models. Active recruitment drives by American and Canadian agencies have led to large numbers of recent graduates leaving the country. This brain drain is visibly affecting the quality of physiotherapy services in Zimbabwe and one can only hope they will return after two or three years of foreign experience better equipped than before. South Africa has a population of 30 million, 21 million of whom are black. At least 13% of the population, well over 4 million, are thought to be disabled. There are only seven large cities, and the contast between the urban ‘first-world’ and rural ‘third-world’ is often striking. More than 25% of the country’s population, and 64% of blacks, live in rural areas, although in recent years there has been an increasing flow to urban areas and a rapid growth of large peri-urban townships, often with widespread informal housing and inadequate services. Although the original training courses offered three-year diplomas based upon the syllabus of the CSP, the trend towards degree courses started in the late 1940s. All eight training centres now offer four-year university BSc Physiotherapyor B Physio- therapy degrees. The entry standards are high as places are limited; the largest universities can each accept a maximum of 40 candidates per year, selected from upwards of 700 applicants at some universities. All universities offering physiotherapy training are associated with academic, regional and community-based health facilities, and the minimal clinical practice over the four years of training is upwards of 1,000 hours. All universities require external examiners and the Professional Board carries out inspections of each training centre at approximately four-year intervals. All universities are now offering post- graduate education at honours and/or master’s level; some also offer post- graduate diplomas. Both the universities and the SASP are active in offering continuing physiotherapy education courses, the most popular being in orthopaedic manipulative therapy and neurodevelopmental therapy, with intensive The South African Society of Physiotherapy care, cardiopulmonaryrehabilitation, sports medicine, community rehabilitation and acupuncture also drawing interest. During the past two decades there has been a worrying drift into private practice, with upwards of 80% of registered physio- therapists working in the private sector by the late 1980s. In addition we have experienced an increasing drain of physio- therapists to the USA, as a result of very aggressive marketing policies coupled with political instability in South Africa. More recently there has been some evidence of a gradual return to hospital practice, which we hope will continue. The effective ratio of physiotherapist : population is probably in the region of 1:85,000. Even if achieved, a ratio of 1:18,000 would be insufficient in view of the distances involved in country districts, the poor transport services available in rural and many peri-urban areas and the high incidence of disability and disease in the lowest socio-economic groups. The present rate of qualification of graduate physio- therapists (under 600 in the last five years) can in no way keep pace with the projected population increase, particularly in view of the expected increase in the youngest and oldest age groups. Recognising the above, the SASP has addressed these and related issues in a series of position papers: 0 The role of the physiotherapy profession in future healthcare delivery systems. 0 The role of physiotherapy in primary health care. 0 The role of physiotherapy in rehabilitation. OThe role of mid-level and grassroots- level workers in the provision of physio- therapy services. ~ Physiotherapy, October 1994, vol80, no 10

World Confederation for Physical Therapy

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Page 1: World Confederation for Physical Therapy

695

World Confederation for Physical Therapy The following items have been extracted from the May 1994 issue of the WCPTNewsletter which is published twice-yearly. Copies of the complete newsletter are available at f10 per Eastcastle Street, London W1N 7PA

The Zimbabwe Physiotherapy Association The first physiotherapy association was

formed in 1957 in the then Federation of Rhodesia and Nyasaland with 12 members. In 1965 when Rhodesia declared unilateral independence there were 25 members. The biggest growth of the profession took place in the 1970s with more than 100 physiotherapists working in the country when Zimbabwe reached nationhood in 1980. At present the ZPA database has the names of 135 physiotherapists.

Until 1987 all physiotherapists were trained outside Zimbabwe, primarily in the United Kingdom and South Africa. An international accredited four-year BSc honours degree in physiotherapy had its inception in 1986 with the first student intake in 1987. The first eight students graduated in 1990. There are currently 72 students enrolled in the four years of the programme. A new intercalated degree in anatomy has been established for rehabilitation students (ie physiotherapy and occupational therapy) but due to staff shortages in the anatomy department this has not yet started.

The University of Zimbabwe does not yet offer postgraduate degrees to physio- therapists but by means of staff develop- ment Fellowships two physiotherapists obtained master’s degrees in Scotland and Australia respectively and two more are currently in Australia on master’s programmes on Australian International Assistance Bureau scholarships.

Ten workshops and short courses were held during 1993, run by either visiting lecturers or local experts. Two have already been offered this year. During 1993 there were also monthly anatomy revision sessions in the evening University of Zimbabwe Anatomy Department.

Roughly one-third of physiotherapists working in Zimbabwe are engaged in private practice. In order to do so physio- therapists have to register with the National Association of Medical Aid Societies (NAMAS) who apply a screening test of their own. The Private Practitioners Association negotiates with NAMAS annually regarding tariff rates, and provided NAMAS tariffs are adhered to, fees are paid in full direct to the practitioner. In cases of misconduct NAMAS may refuse payment andlor scrap membership. The Ministry of Health has recently approved that government physiotherapists may engage in part-time private work.

Government physiotherapists fall under the directorship of the rehabilitation unit in the Ministry of Health and Child Welfare. The unit is administered by a physiotherapist. Zimbabwe’s health care structure consists of about 700 primary health care centres where no rehabilitation

workers are employed; 105 district and mission hospitals with 59 community based rehabilitation projects established at this level who employ rehabilitation technicians with provincial physiotherapists as overseers. The Family Health Project phase II which is funded by the World Bank will expand services by the construction of rehabilitation departments in another ten districts.

The country has eight provincial hospitals, all with physiotherapy posts of which several are currently vacant and two are held by occupational therapists. There are seven rehabilitation centres all of which employ physiotherapists and five central hospitals which currently employ ten

year from WCPT, 16/19

physiotherapists in 35 posts, ie fewer than one-third of posts are filled. The shortage of manpower and low salaries have led to a depressing situation of frustration among government physio- therapists and resignation by new graduates as soon as they have completed their internship. The training of student physiotherapists is adversely affected by the shortage of clinical instructors and the absence of role models.

Active recruitment drives by American and Canadian agencies have led to large numbers of recent graduates leaving the country. This brain drain is visibly affecting the quality of physiotherapy services in Zimbabwe and one can only hope they will return after two or three years of foreign experience better equipped than before.

South Africa has a population of 30 million, 21 million of whom are black. At least 13% of the population, well over 4 million, are thought to be disabled.

There are only seven large cities, and the contast between the urban ‘first-world’ and rural ‘third-world’ is often striking. More than 25% of the country’s population, and 64% of blacks, live in rural areas, although in recent years there has been an increasing flow to urban areas and a rapid growth of large peri-urban townships, often with widespread informal housing and inadequate services.

Although the original training courses offered three-year diplomas based upon the syllabus of the CSP, the trend towards degree courses started in the late 1940s. All eight training centres now offer four-year university BSc Physiotherapy or B Physio- therapy degrees. The entry standards are high as places are limited; the largest universities can each accept a maximum of 40 candidates per year, selected from upwards of 700 applicants at some universities.

All universities offering physiotherapy training are associated with academic, regional and community-based health facilities, and the minimal clinical practice over the four years of training is upwards of 1,000 hours. All universities require external examiners and the Professional Board carries out inspections of each training centre at approximately four-year intervals.

All universities are now offering post- graduate education at honours and/or master’s level; some also offer post- graduate diplomas. Both the universities and the SASP are active in offering continuing physiotherapy education courses, the most popular being in orthopaedic manipulative therapy and neurodevelopmental therapy, with intensive

The South African Society of Physiotherapy care, cardiopulmonary rehabilitation, sports medicine, community rehabilitation and acupuncture also drawing interest.

During the past two decades there has been a worrying drift into private practice, with upwards of 80% of registered physio- therapists working in the private sector by the late 1980s. In addition we have experienced an increasing drain of physio- therapists to the USA, as a result of very aggressive marketing policies coupled with political instability in South Africa. More recently there has been some evidence of a gradual return to hospital practice, which we hope will continue.

The effective ratio of physiotherapist : population is probably in the region of 1:85,000. Even if achieved, a ratio of 1:18,000 would be insufficient in view of the distances involved in country districts, the poor transport services available in rural and many peri-urban areas and the high incidence of disability and disease in the lowest socio-economic groups. The present rate of qualification of graduate physio- therapists (under 600 in the last five years) can in no way keep pace with the projected population increase, particularly in view of the expected increase in the youngest and oldest age groups.

Recognising the above, the SASP has addressed these and related issues in a series of position papers:

0 The role of the physiotherapy profession in future healthcare delivery systems. 0 The role of physiotherapy in primary health care. 0 The role of physiotherapy in rehabilitation. OThe role of mid-level and grassroots- level workers in the provision of physio- therapy services.

~

Physiotherapy, October 1994, vol80, no 10

Page 2: World Confederation for Physical Therapy

696

The Norwegian Physiotherapists Association (NFF) Around 6,200 members, new challenges

and opportunities keep our head office executive committee and 21 local branches highly active and fully occupied. Our head office has 17 employees.

The NFF's Centre for Physiotherapy Research and Development is expanding with additional staff members, project co- ordinators for various research projects, and continuing research counselling.

There are still a large number of jobs available for physiotherapists throughout Norway. No unemployment is registered and we believe that there are more than 200 jobs vacant at the moment. Physio- therapy education in Noway is still a three- year study, followed by one year obligatory supervised clinical training before a licence is obtained. The NFF is promoting plans for a four-year programme with final examin- ation after the fourth year.

Physiotherapy education was previously carried out in independent colleges. A recent common university and college reform has changed this. We now have 26 centres for higher education, ie professional 'education for teachers. physiotherapists, orthopaedic engineering, occupational therapists, radiologists, etc, all integrated into these centres. Thus, we are in the middle of big changes whose results are not as yet foreseeable.

Twenty students from the very first two-year college-based postgraduate programme in manual therapy graduated in December 1993. A similar two-year college-based postgraduate programme in psychiatridpsychosomatic physiotherapy started 'January 1994.

A proposal for a new law for health personnel may give physiotherapists new opportunities that we welcome. We hope to obtain official authorisation for our

specialisation programmes, and we also want to see changes in the referral system. We are very optimistic that these changes will take place.

There are considerable discussions about the financial system of the total health service system in Norway and a new law proposal is expected in August.

There is a growing interest in twinning programmes with Hungary and Tanzania.

Tori1 Bergerud Buene

The Nigeria Society of Physiotherapy Nigeria has a population of 118 million The needs of the association are to:

military, federation and state government hospitals, and private practice.

rehabilitation services. 3. lntearate aovernment Dolicies.

committee of four members, a national workers. governing COUnCil of 18 ' mmbers, 6. Computerise the secretariat/database. state committees and hospital branches. ,. Identify with Similar professions to There are five university based degree present a voice. programmes (BSc), and university based graduate programme; training of physio- 8. Be active within WCPT Africa. therapy assistants has stopped.

A Singular View - The Art of Seeing with One Eye by Frank E Erady, edited by Ron Heamden. Edgemore Enterprises lnc, UK Distributors, Lavis Marketing. 73 Lime Walk. Headington, Oxford OX3 7AD. 1992 (ISBN 0 9695534 0 4). Illus. 125 pages. f7.95.

Around 10,000 people lose a n eye each year. This book, which is reckoned to be the only publication dealing with the subject, sets out to explain monocular vision and how those affected can adapt. The areas covered include care of the prosthesis, the need for spectacles and advice on how to return to normal activities like driving or taking part in sport.

The author is a professional engineer whose background in aviation and electronics helped him when he lost an eye in an accident during a test flight. The book looks at his own experience, gives practical advice on how to adjust and has a n important chapter on how to look after the remaining eye.

A Guide to ADL edited by C F Vreede. Eburon Publisher, PO Box 2867, 2601 CW Delft, The Netherlands, 1993 (ISBN905166316 1). Illus. 149pages. Price25 Dutch florins (approx f9.35).

In this book the authors, members of a study group on transcultural rehabili- tation medicine, set out the structure and

functioning ofthe activities of daily living which, they say, are widely considered to be the 'pivot of rehabilitation'.

The guide has three parts - the first considers what ADL are, the second looks at how ADL should be used and the third examines when and where ADL can be applied. However, the authors suggest that in order to benefit from the book, intensive .study with repeated reading and practical application may be required. 'Mere understanding will not suffice.'

Smooth Ride Guides: Freewheeling Made Easy - Australia and New Zealand F l Publishing, 44 Talbot Road, Highgate, London N6 40P. 1994 (ISBN 0 9521982 0 q. 176 pages. f9.95.

This is the first in a new series of guides for travellers with disabilities. The guide includes a foreword from the Spinal Injuries Association which commends the book, but points out that individuals should elways check whether their own specific requirements will be available before booking.

The guide, which has been written with support from the Holiday Care Service charity, gives details of hotels and their facilities for disabled people, descriptions of key tourist areas and accessible

attractions, travel information and lists associations involved with disabled people in Australia and New Zealand. It also gives some information on climate, medication and medical treatment.

The next guide will look at the USA and will be published next Spring.

Groupwork in Occupational Therapy by Linda Fin/ay, occupational therapy consultant. Chapman & Hall, London, 1993 (ISBN 0 412 35220 6). 232 pages. f 13.95.

Practical approaches to group manage- ment are explored in this book which stresses the need for group therapists to have an understanding of the individuals that make up a group as well as the dynamics of their combined behaviour.

The first part of the book looks at under- standing groups, while the second section concentrates on group management. It suggests that therapists should analyse and evaluate group work and be aware of what the author dexribes as the 'powerful emotions and motivations that a group can evoke'.

Physiotherapy, October 1994, vol80, no 10