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Working Round the World Mobility is a must for physiotherapists in more senses than one, and for many of them this means travel overseas. It has taken many forms - tours of inspection; spells of work and teaching, sometimes to meet a particular crisis; war work (also outlined elsewhere in this issue); and full-scale emigration to work alongside and on the same terms as other residents.

This article records a selection of physiotherapists who have worked outside the United Kingdom, drawn from the Society’s records and from information submitted on request. It is by no means comprehensive and only snippets can be presented to represent years of work - but it is intended to give an idea of the vast amount of influence that British physiotherapy has had beyond these shores.

Military Service Members’ experiences on active service have been recorded in many issues of the Journal, starting in 1916 with an account of hospital work in Serbia, teaching local people how to cope with wounds. In a series of articles, the anonymous author tells how she watched an exchange of Austrian for Russian prisoners, and was distressed by their poor condition. Nevertheless, the hospital in a formal royal palace in Petrograd was well appointed; it was attached to a field hospital unit and a dressing station near the Front.

A more famous masseur during that war was the author John Galsworthy. ‘I learned massage some years ago’, he told an interviewer, ‘and brushed it up before I went out’. He and his wife worked a t an English hospital for French soldiers at Martouret.

Work on a hospital ship is recorded in 1917 by Beatrice Gubbins. Heat, storms and monsoons hampered work on a voyage via Gibraltar, Port Said, Ceylon and Australia to New Zealand. After eight weeks they were able to disembark in their home country the men who had been wounded a t Gallipoli, the Somme or in Flanders. Miss Gubbins then worked for six months at a convalescent military hospital in Wellington. She returned in a convoy around Africa with 800 fresh troops to reinforce the New Zealanders in France. The healthy men presented quite different problems for her and the five New Zealand masseuses - mainly sports injuries from efforts to keep fit en voyage.

The enthusiasm of Beatrice Wilson when she led the first contingent of the Overseas Service of Physiotherapy in the Second World War must have been infectious. Sixteen physiotherapists went to the Middle East, and on the outward voyage of the troopship she organised a thrice-weekly lecture programme for staff, and 400 treatments for the soldiers. She reported the experience in 1946, in the first of many accounts by members working in the Middle East.

‘At Cairo we found ourselves unexpected, but we became quite used to this, for nowhere a t any time were we expected.’ She was particularly thrilled to sleep under canvas. ‘I never lived in a house during the 20 months I was away, and I loved the nomad existence.’

Her team was misunderstood by colleagues rather than by natives - however ‘the surgeons and MOs soon lost their early terror of our supposed activities, which many apparently conceived to consist entirely of forced passive movements’.

The indomitable Miss Wilson turned an attack of jaundice to advantage by using her enforced absence from work to organise a Middle East Congress of the Chartered Society ‘with a good variety of lectures and demonstrations.’

Nowhere was safe from her approach: ‘I met our adviser in physical medicine bathing in the sea at Jaffa, and we immediately fell into one of our Corps discussions - I greatly at a disadvantage balancing on one toe; he, a tall man, comfortably in his depth!’

Home from Home As soon as conditions allowed after the First World War, British physiotherapists went to work in even further- flung locations.

In May 1925 Miss Gladys V L Nunn, a veteran of the Military Massage Service, recounted her experiences in North China - and showed an eagerness to learn as well as teach:

‘Massage. . . has been practised in this country in past centuries, and later on, when I have mastered the language to a certain extent, I hope to be able to learn something of the methods adopted. I am sure there will be much of interest to be gleaned from them, and in massage, as in most other things, one can learn a great deal from the Chinese.’

Miss Nunn must have enjoyed her work because in 1938 she was still there, in charge of the massage and electrical department a t Cheeloo University Hospital, Shantung, and treating many patients with gunshot wounds. ‘I have been able to prove the great advantage of early movements of near-by joints, where big scars were forming.’

At that time the Chartered Society had 535 overseas members.

Work in China did have its problems. Two years later the Society advertised a vacancy for a masseuse a t a hospital in Shanghai. The salary was below the Society’s recommended rate, but that was inevitable because the rate of exchange - with wartime Britain - fluctuated daily. There are no details of who, if anyone, applied for the post and how they travelled there.

Just after the war Miss Elizabeth Errington King of Sidmouth was appointed to the Colonial Service as a physiotherapist in Hong Kong.

Other MCSPs followed. In 1957 Marjorie Fogg, superintendent physiotherapist in the Hong Kong Medical Department, wrote of the problems of coping with the influx of refugees caused by unsettled conditions in China.

Jane M Climas keeps up the tradition today by working

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Working on gross motor skills at the Matilda Child Development Centre, Hong Kong

in the Matilda Child Development Centre in Hong Kong, a charitable foundation which specialises in early intervention with a multicultural integrated programme.

The call of the colonies was strong in the 1950s, when post-war blues again persisted in Britain, and a letter from Kathleen Macpherson MCSP of the Canadian Physiotherapy Association in 1951 explained that there were about 50 vacancies for physiotherapists across Canada. With 400 CPA members, almost all in employment, there was an obvious need to recruit from abroad.

Miss Macpherson offered one word of warning: ‘British physiotherapists are made very welcome provided they do not indulge in criticism of Canadian methods and in holding up British methods and conditions as always being superior. Sometimes they are - but it is not for the recently arrived newcomer to reform the situation.’

A later letter commented that it was advice which Canadians might also take when they came to work in Britain!

The need for immigrant physiotherapists in Canada persisted, and in 1959 Hazel Southard, president of the British Columbia Branch of the Canadian Physiotherapy Association, was appealing on behalf of her part of the country.

Several British physiotherapists have held positions of honour in Canada - only last year Lesley Ann Bainbridge was elected president of the CPA.

Very different conditions were experienced by Lois Dyer (now OBE FCSP) when she went to work in South Africa in 1949. In 1954 she accepted a post in Northern Rhodesia, now Zambia, and visited villages where no white woman had been seen before, where the wheel had

not been invented, where there was no written language and whose inhabitants filed their teeth for cannabalistic reasons.

In a South African hospital for non-white patients, she was amazed to see that local African orderlies were carrying out many less skilled tasks associated with physiotherapy, without any threat to the status of the scarce physiotherapists.

‘Thus I realised the value of using common sense in the delegation of tasks to make the best use of my time’, says Miss Dyer. ‘I believe that this realisation has underpinned my lifelong support for the role of helpers and carers and the importance of sharing skills appropriately with others.’

Miss Dyer did have some problems with the patients, however. Even the most educated appeared to prefer witchdoctors to orthodox medicine and when they did come to hospital, failed to appreciate the value of physiotherapy. A bottle of medicine seemed much more comforting, even for a broken leg.

Similar difficulties were encountered by D A Kellock in Bombay when treating the after-effects of poliomyelitis in 1958. Common practices were the application of tiger’s fat or pigeon’s blood to the affected parts, and standing patients in a pit of warm sand. Fortunately the Ayurvedic tradition was more helpful, with physical treatment based on massage and exercises.

The Ghana Cripples Aid Society was founded at the instigation of Hellen J Price who first went to Accra in 1954 as part of an orthopaedic team. Lorry accidents and endemic disease such as poliomyelitis brought 700 to 1,000 patients a day to the unit, staffed by three doctors.

A seven-month old victim of ‘injection paralysis’ held by Hellen J Price. Infants with this condition attempted to grasp the ground with their toes when trying to take weight on the affected leg

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Bribery and corruption bought places in the queues which Miss Price compared to Cup Tie fever. A particular problem was caused indirectly by malaria for which a quinine injection was the routine treatment. ‘Hence the mass plunging of hypodermic needles into infant buttocks and the association of paralysis with injection.’

Political events hampered the progress of orthopaedic care in Ghana, but on a ‘post-coup’ visit in 1969 Miss Price observed that although Ghanaian orthopaedic surgeons were rare, the work was being continued by Indians of international repute, and the Ghana Cripples Aid Society was well supported and thriving.

Political problems also hindered Maria Hollingsworth who went to Malta when her husband retired. While waiting interminably for a work permit it did not occur to her that the officials were also waiting - to be bribed!

The number of amputations horrified her at first. They were caused by the poor roads (still a feature of Maltese life) leading to many traffic accidents, and from the tendency to diabetes propagated by close intermarriage, compounded by an aversion to dieting and predilection for fizzy drinks. The poor eyesight due to diabetes added to the toll of traffic accidents and their over- eating could render the Maltese liable to strokes.

In spite of the abundance of work Mrs Hollingsworth’s professional career in Malta was brought to an abrupt end when Don Mintoff was elected and the British were immediately removed from their posts. Now living in Spain, Mrs Hollingsworth has the last laugh. Malta is now independent and its &1 has a higher value than sterling, so her Maltese pension is worth more than her salary at the time.

Tales of a beautiful land of plenty with a perfect climate and a happy population drew Ida Eirene Thomas of Dyfed to Southern Rhodesia (now Zimbabwe) after the war. Unlike other emigrants, she found a shortage of jobs for physiotherapists and was glad to do part-time work for cash, and supplement her diet with free meals offered by the Tobacco Auctions.

After obtaining a post in a Government hospital she found no difference in medical treatment for African and European patients - but was distressed by a vast gulf in other respects. When the European hospital was celebrating Christmas and there were no signs of cheer for the African children, she appealed to her church for donations and ensured that every child received a toy.

Miss Thomas may have influenced the course of history because among her patients she treated two Prime Ministers - ‘endearing’ Roy Welensky and ‘shy and retiring’ Ian Smith.

Missions Missionary work was a major reason for physiotherapists to go overseas. Patricia Thomas (later an education officer at the CSP and now living in Kent) considered it a privilege and an adventure to be the first chartered physiotherapist to be sent out by the Church Missionary Society in the 1950s. After a three-week voyage to Mombasa she admitted to a distinct diminution of pioneering zeal and feeling only thankfulness to be on dry land. Limited finance restricted her selection of

equipment and she chose to take one Bristow coil, one galvanic battery, a sling suspension unit and a short- wave diathermy machine.

It was several months before she could unpack this modest repertoire - ‘life in Africa is unpredictable and unhurried’ - and she spent part of the time learning the language of the Baganda with a class of ten-year-olds.

Most of her work was with the effects of polio and her conclusion in 1956 would still be applauded today: ‘We believe that a positive approach to health means seeing each patient as a whole person.’

A series of Journal articles in 1956 recorded the work of others in the mission field. D J Ward was sent by the Religious Society of Friends (Quakers) to Korea, where her work was hampered by not knowing what the future of the country might be - still a cause of uncertainty. (There was a British Commonwealth General Hospital in Kure, where Margary Farrell MCSP had worked in 1951 with the Army.)

N A Wendover emigrated to South Africa in 1969, and after some other posts became sole physiotherapist at the Charles Johnston Memorial Hospital which was run by the Society for the Propagation of the Gospel at Nqutu, Zululand. She planned and developed the physiotherapy service there. Later she took a similar post at the Zomba General Hospital, Malawi, leaving there for Nigeria in 1978. She is now a member of the Committee of the Ugandan Society for Disabled Children.

The Salvation Army sponsored Susan B Andrew to work at the Leprosy Hospital, Bapatla, India in 1976. She prepared patients for reconstructive surgery of the hands, treated them for ulceration, and educated them in prevention of damage to their limbs. Before leaving she taught some of the patients to take over the treatments.

Helen Smith tells a sad story of physiotherapy at a mission hospital in Zambia, which had been without a physiotherapist for two years before she arrived in 1988, six months after qualification. She returned to Britain a year later and the hospital was unable to replace her. However, Mrs Smith is now gaining experience in Devon in a senior post, hoping to return to Zambia one day.

Christian faith is also a motive for Valerie Taylor OBE who actually first went abroad in 1969 under the auspices of Voluntary Service Overseas, to what was then East Pakistan, near the Burmese border. She soon realised the need for permanent facilities and set up the Dhaka Centre for the Rehabilitation of the Paralysed. It rem3ins the only such establishment in a country of 120 million people where thousands are paralysed but there are only six qualified physiotherapists. Her work has been jeopardised by floods and cyclones, and she had to be air-lifted out of the country during the Independence War in 1971. As a single woman, who has also adopted two of her former patients, Miss Taylor is not immune to the difficulties of working in a Moslem country.

Success has crowned her efforts with the start of building of the centre’s first permanent home. The foundation stone was laid in 1990 by the first lady of Bangladesh, Begum Ershad.

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An outstanding modern example of the missionary tradition is Jean Watson OBE FCSP who began work with the Leprosy Mission three years after she qualified, in 1960, and is now its physiotherapist consultant. She has worked and lectured in the Far and Middle East and Africa, and even when on a two-year sabbatical from TLM she worked with leprosy and other patients among the aborigines of Australia.

Miss Watson has developed a system by which change in impairment due to or following peripheral nerve damage can be measured. Her current work, in collaboration with the Chinese Ministry of Health, focuses on the management and support of disability control (prevention and limitation) activities among present and former leprosy patients; and on encouraging programme managers to measure the effect of activities on physical impairments.

Helen Taylor working for VSO in a leprosy colony in north-east Thailand

A member signing herself as ‘Vair’ wrote from India in 1931 to give a case study of ante-natal care for the Maharani of a State which is irritatingly named only as ‘X’. Though married at 14, there had been great agitation because the Maharani still had no children at the advanced age of 17, and her retinue already included a lady doctor, two nurses and four maids. ‘Vair’ was asked to provide daily massage for her back and limbs to counteract lack of exercise.

Treatment was often delayed because the Maharani had to bathe, pray, make offerings to the gods, then eat breakfast and drink her husband’s and uncle’s toe- rinsing water before massage could begin. ‘Indians have no idea of time’, wailed ‘Vair’ - but she was paid for the hours of waiting, and the result was a healthy son and heir.

Paula Stiebel went to Qatar in the Persian Gulf to treat the arthritic knees of the Ruling Sheikh in 1954. A car fetched her by night when the Ruler suffered a bad attack of sciatica. She found him reclining on rugs and surrounded by four attendants - Negroes recently released from slavery. Attempts at deep massage proved frustrating: ‘It is not easy to massage a man of 20 stone on the ground, especially as the attendants would not allow more than four inches of flesh to be exposed at once.’ Miss Stiebel’s first priority was to find a plinth and save her back!

E Kate Kerr turned to private practice in Botswana in 1992 because of Government-imposed restrictions on expatriate employment. Even the physiotherapy departments run by local people are having to close for lack of staff. Heavy loads carried on heads and hard manual labour cause cervical and lumbar spine disorders, and the high consumption of alcohol leads to many road traffic accidents.

With a Zimbabwean midwife she also runs ante-natal classes, and hopes to set up a part-time clinic in the north-west of the country, which currently has no physiotherapy service at all.

Private Practice Members who wished to settle permanently overseas often found themselves covering the same ground as the Society’s Founders had in this country. Doctors and the general public were often ignorant or suspicious of massage, and practitioners in the 1920s and 1930s found they had to demonstrate the efficacy and respectability of their techniques to indigenous professionals. The co- operation of workmen in setting up electrical and gymnastic apparatus could also be a problem, and the laws of the host countries required study.

Those financing themselves could run into trouble. A correspondent in 1930 urged would-be emigrants to ensure they could draw on at least enough money to live on for a year and to pay the return fare to England in case of emergency.

‘We thank our correspondent for drawing attention to matters of such importance to new-comers in the further parts of the Empire’, said the editor.

Spells of work in specific posts as private practitioners have brought members a variety of experience.

Epidemics Sudden crises in less developed parts of the world have often called forth medical teams from Britain.

Argentina Monica Martin Jones MBE FCSP was one of six physio- therapists who worked for half a year in Argentina when there was a serious outbreak of poliomyelitis there in 1956 affecting 2,000 people. The British community, through the British Embassy, paid three of their salaries and the Argentine Government funded the others.

The epidemic was most severe in Buenos Aires; children washed the pavements, tree trunks were whitewashed, streets were sprayed with disinfectant and families who could do so left the city.

Contractures and scoliosis were major problems and treatment had limited success because surgery was not available. However, a major part of their work was lecturing and training local people in rehabilitation techniques, and this teaching function has characterised most such expeditions ever since.

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Morocco When some 10,000 Moroccans became paralysed in 1960 as a result of using cooking oil adulterated with trio- ortho-cresyl-phosphate, ten MCSPs - in two relays - joined a team of 46 physiotherapists recruited by the International Red Cross. The country had become independent only four years previously and had no physiotherapists of its own. The teams from 14 countries found themselves working long hours in primitive conditions and sometimes under armed guard. The administrative problems of calling and recalling vast numbers for treatment, many with identical names, and an undisciplined idea of time, were an added complication.

The patients suffered neurological damage, primarily differing degrees of paralysis in the hands and lower legs, although some had central nervous system damage with resultant spasticity. Because of transport and allied difficulties, a proportion of patients never received any treatment, although each physiotherapist dealt with up to 70 people a day, and kept records of muscle tests. After several months of superhuman effort, almost everyone affected by the oil was given a repeat muscle test.

This provided a lesson for Lois Dyer, who led the first British contingent: ‘1 was fascinated to see how many people showed great improvement or total recovery despite having received no treatment!’ She recognised the value of monitoring the natural outcome of disease and disability. ‘This taught me to have a healthy scepticism and to be objective in the assessment of the impact of physiotherapy.’

There was in fact an incentive not to show improvement because the Moroccan Government instituted a pension

Lois Dyer with a Moroccan mother and child during the ‘cooking oil’ paralysis outbreak

scheme for certain patients affected by the paralysis, so there was a reluctance to be discharged as fit, which would end any entitlement to the pension.

Spreading the System In 1948 the newly-formed World Health Organisation saw the need for setting up effective health care systems in many parts of the world. British physiotherapists were not slow to offer help. Many major health establishments were set up by MCSPs, who trained local people to take over from them when they returned home.

In the early 1950s Miss M Margereson, later superinten- dent physiotherapist at the NdXeld Orthopaedic Centre, helped to found the Rehabilitation Centre in Rio de Janiero, when she was invited to advise on the development of physiotherapy services in Brazil.

Jenny Wigram foreshadowed later developments when she worked for the Malawi Government from 1979 to 1982. At times she was the only physiotherapist in the country, but soon after she returned to the UK her assistant, David Msosa, completed his training as a physiotherapist in Kenya and went back to work in Malawi.

In yet another part of Africa, The Gambia, Helen Lee worked from 1979 to 1982 as a volunteer, with people with leprosy and cerebral palsy. In 1982, following an unsuccessful coup, she worked for WHO helping to rehabilitate people injured during the fighting. Later she worked with disabled children and adults in the community in south Lebanon. This naturally led to running courses for local people helping Palestinian refugees in Jordan, in the late 1980s.

Rather different was the contribution of Sheila M Harrison who was employed by the Health Department of Western Australia from 1984 to 1991 to plan and introduce a co-ordinated system of physiotherapy in obstetrics and gynaecology. She organised in-service workshops, wrote a training manual and made visits throughout the State to monitor and help with the programme.

One important step was the increase in undergraduate education for physiotherapists in Perth. A graduate diploma in physiotherapy is continuing, and distance education units are offered to staff widely scattered in the large State.

Chartered physiotherapists continue to act as pioneers and several in recent years have been promoting physiotherapy in China and Russia where the profession is unknown as practised in most of the rest of the world.

The Old School Ties The first physiotherapy school in South East Asia was co-founded by R Jacques, who was pleased to leave a poorly-paid post as sole charge physiotherapist in a Cornish rehabilitation unit. In 1948 he finished training at the Field and Morris School and offered his services to the World Health Organisation. In 1950 he was given two weeks’ notice to report to Geneva. He immediately sold his belongings (his house was rented) and went with his wife and four-year-old son for five days’ briefing. They

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then flew to Bombay where after only two more days of briefing he started work on an All-India School of Physiotherapy with an associated treatment centre.

His colleague was Mrs Page Coleman Mehta, an American who had married into a prominent Bombay family.

‘Neither of us was a qualified teacher and we both had reservations about our abilities’, Mr Jacques blithely admitted, but they evolved a curriculum based on the CSP 1948 syllabus, with an American emphasis on remedial exercises. He did not say how many students were accepted but they were all university science graduates. After 18 months Mrs Mehta left but Mr Jacques continued and when the school was running well turned his attention to the treatment centre, concentrating on types of patient previously ill-served -those with spastic conditions and paraplegia. He had to combat opposition from the patients themselves, who saw no point in struggling against their Karma - punishment for misdeeds in earlier lives. The UN and the World Veterans’ Foundation then sponsored a rehabilitation team and when Mr Jacques’ extended contract ended after 3% years he was able to hand over to Mr MacAdam and Mr J Venton-Gough.

It is unlikely that any physiotherapist today would be given such professional opportunities just two years after qualification.

In many places it was not possible to establish a school on the spot, and one solution was to train selected local people to a certain standard, and then send them to physiotherapy schools in Britain. This was the plan adopted by Marjorie McDowell in Colombo, Ceylon, although she complained in 1956 that the students tended to say that lifting and carrying was really a labourer’s job and not theirs. Funded by WHO, three chartered physiotherapists worked in her thoracic unit and prepared two students a year to go to the UK.

Clinical placements can be particularly difficult for physiotherapy students overseas and Pam Marlow was able to help while working for the Association for the Physically Disabled in Kenya in Nairobi. From 1971 to 1975 she was physiotherapist in charge there, with a staff of 15 physiotherapists (volunteers from six countries), holding rural clinics in 100 different locations each month, and working with the East African Flying D&r Service. The placements must have been exciting for the students, some of whom returned to work there after qualification.

Also working in Kenya and Uganda as a teacher for 28 years was Wyn Cannell, who now lives in Powys.

South Africa was another country whose education system drew heavily on the expertise of British physio- therapists, although they did not usually set up the schools.

The first physiotherapy school in South Africa was started in Johannesburg in 1938. By 1960 it was a department of Witwatersrand University and gave a four-year degree course. The Transvaal Province started a school in 1948 at Pretoria Hospital with close links to Pretoria University,

Dr Alphonso R A Onuoha at work in Kuwait University

Yet another decade later the University of Cape Town started a school with a three-year diploma course. This is now a degree course and a British trained physiotherapist, Professor Pat Bowerbank, is in charge of the education and clinical programmes.

All these schools were inadequate to provide the numbers of physiotherapists required, and overseas staff were recruited for both clinical and teaching posts, while South African girls went abroad to train.

Miss A M Bodoano became principal of the Pretoria School in 1958, and Miss M H S Roper was head of the teaching staff in Cape Town - she was succeeded by Margaret White in 1967. New Zealand schools also have strong links with Britain, and Fran Elkin founded the Dunedin School of Physiotherapy. The tradition continues to this day: Linda Maxwell (nke Atkinson) who is the author of another article in this issue and trained at the RAF School of Physiotherapy in Wendover was the first physiotherapist in New Zealand to be awarded a PhD.

Another recent undertaking is the school of physio- therapy in Bethlehem, Israel. It was set up in response to a British Council report in 1987 about the status of physiotherapy services in the West Bank and the Gaza Strip. Physiotherapy was provided by overseas-trained staff and was inappropriate to the Palestinian agrarian society. The physiotherapy department a t Bethlehem University started work on a curriculum and Lesley Dawson joined them in 1988 as chairperson. With the help of Palestinian assistants - and the considerable hindrance of the political situation which closed the university for long periods, imposed curfews, and prolonged armed hostilities - 19 students graduated in May 1993. A second group of students started in January 1992.

‘Bethlehem University is based on the American liberal arts college model, so it was quite a change for me to learn to deal with credit hours, grade points averages and semesters’, confesses Miss Dawson.

‘Clinical field work is done in a variety of placements

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in the West Bank, Gaza Strip and recently in Israel. All students must complete a minimum of 1,000 hours of supervised clinical practice. We have very few well-qualified motivated clinical supervisors in the physiotherapy field as yet and thus during the eight- week CFW blocks all staff from our department are out supervising students. Last year Bethlehem University began a part-time diploma for clinical supervisors in physiotherapy, nursing and midwifery so we hope for better supervision in the future.’

The situation in the Gaza Strip and West Bank is changing yet again and it will be interesting to see - if all promises are kept - how this affects the development of physiotherapy training there.

Another physiotherapy teacher drastically affected by hostilities is Alphonso Onuoha, who qualified as a physiotherapist in Britain and gained a doctorate in Canada. As associate professor and chairman of the physical therapy department at Kuwait University he saw his premises ravaged and the students and staff dispersed. At the end of the Gulf War in 1991, however, international aid and individual contributions from British physiotherapists helped to restore the building and equipment and it is now once more a thriving institution.

Advanced Teaching British physiotherapists have also travelled the world teaching and demonstrating at postgraduate level. Their visits range from well-established programmes of education, such as the courses organised by the Bobath Centre; to ad hoc arrangements inspired by sudden emergencies, such as the training in rehabilitation techniques by British physiotherapists in Croatia, instigated by Vivien Grisogono to deal with the continuing effects of civil war.

An indefatigable traveller and lecturer on subjects related to arthritis and hydrotherapy is Jane Barefoot, who has held courses and workshops in Australia, America and Scandinavia. These are not confined to physiotherapists; in New Zealand, Singapore and Hong Kong she has advised both physiotherapists and patients on setting up self-support groups.

In paediatrics, Sophie Levitt (who also has a South African degree) has run courses on children with physical, mental and severe visual disabilities, under the auspices of many international organisations. As well as seemingly most of the countries of Europe, she has carried the word to Israel, Canada, India, Japan, New Zealand and America. ‘Wherever I go as an international consultant and educator I feel privileged to be known as a British physiotherapist’, says Miss Levitt, who is currently tutor and consultant on the community based rehabilitation course for trainers and supervisors from developing countries at the Institute of Child Health, London University.

Sport was a major key to rehabilitation of paraplegic patients as promulgated by Ida Bromley MBE FCSP. She has discussed treatment and run workshops on the management of patients with spinal cordhjury in many countries, including Australia, China, Japan, Taiwan, Turkey, South Africa and the USA. The enormous growth in knowledge is largely attributable to her

inculcation of the principles originally developed by Sir Ludwig Guttmann, who recognised the importance of physiotherapy.

‘However medically fit doctors can make paralysed people it is the physiotherapist who brings them to independence’, says Miss Bromley.

This knowledge was spread though participation in international sport. The first international games for paralysed people were held at Stoke Mandeville Hospital between teams from Holland and Great Britain in 1948. As the games became well known, and increasing numbers of countries joined in, they showed patients what could be achieved, brought the potential of paralysed people to the attention of the general public, and provided an opportunity for international exchange of learning between the accompanying personnel.

Respiratory physiotherapy was the field of Diana Gaskell MBE FCSP while superintendent physiotherapist of the Brompton Hospital, who travelled extensively to lecture and run courses between 1968 and 1988. She found that in the majority of countries she visited the care of surgical patients was of a high standard.

‘I felt that I was able to help most with the care of patients with chronic pulmonary disease, especially in the underdeveloped countries where very little physiotherapy was available and many patients were poorly educated and unable to afford good medical care.’

During her visits overseas she found that many physiotherapists had been influenced by the work of her predecessors, the late Winifred Linton FCSP, and Jocelyn Reed FCSP, particularly the film they made in 1942 at the request of some American surgeons who had seen their work.

Marching Forward Evidence to the Review Body last year showed that increasing numbers of UK physiotherapists are going to work abroad. The freedom of movement within Europe facilitated by the European Community will ensure that the urge to travel within this continent is not impeded.

Further afield, WCPT-Europe is ‘twinned’ with Africa. Teaching and learning tours have already taken place in both directions.

The undergraduate physiotherapy curriculum now includes optional electives, many of which take the students abroad. Although they can stay only a short time, these spells of overseas experience must foster understanding between professionals in different countries. In a less formal way, the International Physiotherapy Students Association organises social and tutorial meetings which help to encourage communication between countries at the outset of the participants’ careers.

UK physiotherapists are still needed urgently in many countries, although in others there are political and professional restrictions. If this article has stimulated members to think of finding out more, Thelma Harvey in the International Affairs Unit at the Chartered Society will be pleased to provide all available information on their country of choice. Physiotherapists are indeed fortunate that their profession offers such exciting possibilities.

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