Malawi last trained physiotherapists in the 1980s before the government commissioned the College of Medicine to start training professionals in the field in 2010. Our reporter, FATSANI GUNYA, spoke to Spain-based physiotherapist and trainer, TOM VAN BIESEN, who recently conducted a training course in the country in conjunction with the Physiotherapy Association of Malawi.
Briefly introduce yourself.
I was born in Belgium. I graduated as a physiotherapist in 1999, as a sports manual therapist in 2003 and as an osteopath (DO) in 2011. I worked in my own private clinic until 2013 when I moved to Spain where I freelance in different clinics across the country.
What brings you to Malawi?
A couple of years ago, I got in contact with Dr. Margaret Wazakili. She is an International Joseph P. Kennedy Fellow on Public Policy in the Department of Disability and Elderly Affairs. Since she is a qualified physiotherapy herself, and also the president of the Physiotherapy Association of Malawi, we organised a continuing professional development (CPD) course. In essence, I came to Malawi to share some expertise and best practice in the profession with members of this noble association through this short course primarily on shoulder problems.
What is your assessment of Malawi’s general health landscape, especially its physiotherapy sector?
Healthcare in Malawi has still a long way to go but I think everybody is making a lot of effort to improve healthcare services for the people. As for physiotherapy, starting the training of physiotherapists at the College of Medicine was a huge and important step forward. In time it will make physiotherapy more accessible. After all, the use of physiotherapy, not only as a curative but also as a preventive therapy, can reduce significantly other medical expenses, as has been shown worldwide.
How significant is physiotherapy to the healing process in people?
The use of physiotherapy can speed up the recovery process and limit the stay in the hospital, which is beneficial for both patients and guardians. I realise that for many Malawians, access to private clinics is almost impossible, therefore I think it’s important that the government keeps investing in the training and employing physiotherapists to ensure access to this extremely helpful therapy for all the people.
What would you recommend as the ideal therapist-patient ratio for best results in physiotherapy?
The ideal therapist-patient ratio is difficult to determine. Even in Europe, there are great differences between the countries, going from five physiotherapists per 100 000 inhabitants in Romania to 246 physiotherapists per 100 000 in Finland. In Belgium, it’s 172 and in Spain it’s 86 per 100 000 inhabitants. All in all, a lot needs to be done to help reduce the gap. But we may not need this lot if people and states can invest in physiotherapy; more as a preventive measure than a curative one. But this does not mean to wash down the significance of the profession.
What can be some of the necessities for one to become an accomplished physiotherapist?
To become a physical therapist you need to master the basic medical sciences like anatomy, physiology, biomechanics, relevant pathology etc. Besides that specific physiotherapeutic skills and patient relation skills are required. A physiotherapist needs to be able to work effectively and in a safe way, so intensive training in differential diagnosis, clinical reasoning, palpation etc. is highly recommended.
Spain, where you are settled now, has of late gained a reputation for its prowess in football. How much of a role do you think physiotherapy has played in promoting the game?
The role of physiotherapy in football and sports in general is huge. Not only for the recovery after an injury, but also for the prevention of injuries. Top clubs are spending a lot of money on a decent medical staff, including various physiotherapists and osteopaths, because they can’t afford their players to be out of the game for a long time. I think that the popularity of physiotherapy in sports plays an important role in making physiotherapy better known by the greater public. I worked as a physiotherapist for a handball club for two years and for a football club for four years.
What lessons can Malawi learn from Spain in this regard?
What Malawi can learn from most of the European countries is the value and importance of physiotherapy in the recovery of patients. Physiotherapists can work with a wide range of medical conditions, such as musculoskeletal problems, cardiology, pulmonary problems, urogenital problems, paediatrics, neurology, geriatrics etc. Because of this wide variety of physiotherapeutic fields, I want to point out again the importance of the basic and specialist training of physiotherapists in Malawi.
The first step was already taken in 2010 with the start of the bachelors programme in physiotherapy and now the first specialisation or CPD course taking place, so things are going in the right direction with lots of efforts from the government, the Physiotherapy Association of Malawi and the physiotherapists themselves.