University of Melbourne 2019

Physiotherapy, Peru Arequipa

Goldring, VeronicaI went to Arequipa to complete my global placement in the physiotherapy and rehabilitation department of a local hospital.

I spent my first week attending Work the World’s Intensive Spanish Course. I highly recommend it as it helped me develop the basics, and allowed me to practice conversational Spanish.

I spent the following three weeks in the hospital. The physiotherapy and rehabilitation department was a totally different setting compared to Melbourne.

Firstly, the department was not divided into specialised areas of physiotherapy — any physiotherapist would see any patient.

In Australia, stroke and other neurological cases are typically referred to the neuro-rehabilitation department. Similarly, orthopaedic patients attend the outpatient musculoskeletal clinic — patients see a physiotherapist with an appropriate specialisation.

Apart from two senior staff members, physiotherapists in my department were either graduates or students.

Secondly, local physiotherapists did not regularly assess patients.

They did complete a form following the initial assessment, but subsequent sessions would be dictated by the recommendations provided by the rehabilitation medical consultant. It was not apparent that physiotherapists were required to offer diagnoses.

Thirdly, treatment was heavily based on electrotherapy, manual therapy and exercise prescription. There was little focus on providing education to patients so they could self-manage their conditions.

Goldring, VeronicaI found this surprising. In Australia, we are encouraged to focus on teaching patients to self manage. This improves patient self-efficacy and helps us as practitioners become more efficient with our time.

Lastly, the hospital didn’t keep patient histories. Instead, each patient had a small card stating the diagnosis and treatment recommended by the medical consultant.

This was surprising, as comorbidities may influence rehabilitation treatments and approaches.

I appreciated how the lead physiotherapist asked my opinion on cases, like how I would manage a patient with patellofemoral pain syndrome. He also asked for my thoughts on a patient who had ruptured her ACL, but wasn’t going to undergo surgical intervention.

He was content with my responses, so allowed me to lead on these patients. This gave me great confidence in my knowledge and made me feel a part of the team.

He also asked me to give a short presentation on neurodynamic testing in my final week at the hospital.

Giving the presentation was quite a challenge — I was asked to deliver it in Spanish! It was, however, informal and focused on a learning exchange rather than being judged or marked.

One case that I found particularly interesting was an elderly male who’d had a stroke around a year prior. It was apparent that he did not receive the best acute care, so he had developed a contracture in his right arm, severely affecting his gait.

Due to the lack of medical records, it was difficult to determine exactly what had happened. I expected it to be the case that he had not received an immediate referral to the the rehabilitation department.

Goldring, VeronicaThis may have been in relation to poor administration, funding, or government regulation at the time. Though, I could only speculate.

It’s also possible that he didn’t receive the most appropriate care because he was diagnosed with simply ‘stroke’. There was rarely any information specifying which type of stroke and in which area of the brain.

I will note that everything was conducted in Spanish. It’s possible that I misinterpreted certain things due to my lack of fluency in the language.

Exploring Peru

Living in a house with like-minded students from different countries was so much fun. We became one big happy family. Every weekend, my housemates and I went on trips out into Peru.

On our first weekend, we spent Saturday exploring Arequipa, taking in the views and visiting ‘El Monasterio de Santa Catalina’.

On Sunday, a few of us went to the town of Yura and hiked to a waterfall. The scenery was mountainous and beautiful.

The second weekend was probably the busiest. I caught an overnight bus to Cusco with two other students. We arrived in the early hours of the Friday morning.

Goldring, VeronicaWe had a nice breakfast and then went on a free walking tour to explore this city, learning about its history, pisco sour and alpaca wool.

On Saturday, we travelled to Machu Picchu by bus and train. We took a guided tour, then had time to ourselves to explore and taking photos of the site returning to the town of Aguas Calientes. We had a nice touristy dinner when we got there.

We went to bed early that night, knowing we had to be up early. We were headed to La Montaña de 7 Colores (Rainbow Mountain) at 2:30am.

Rainbow mountain was so much fun and one of my favourite sites in South America. The hike was short and easy for the most part. It was only during the final 30 minutes that the path became extremely steep. The lack of oxygen at that altitude made it significantly harder!

The walk was stunning, and we were surrounded by beautiful colour for the the entire hike.

We went to Colca Canyon on our last weekend. It was a challenge but enjoyable. Colca Canyon is the 3rd largest canyon in the world.

Goldring, VeronicaThe hike was two days long, and we spent the majority of day one plodding downhill, with only a bit of uphill walking towards the end.

The second day’s hike was only three hours long, but it was all uphill and quite challenging.

We spent the rest of the day going to different sites like local volcanoes and geothermal pools.

I loved my experience in Peru. Work the World’s program was extremely well run and the team in the Work the World house were extremely accommodating.

To be honest, I don’t think I could have asked for a better experience!

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