After being on prac in borneo for a while now, i have noticed just how large the cultural differences in regard to treatment are. Treatment here is very different to in Australia because it is expected that the family takes care of the patient as soon as they are medically stable. This means that pts are discharged from hospital straight away even though they have not had any physio and their neuro conditions are still extremely acute. After they are discharged the family will look after them and hopefully bring them back for outpt raheb however if the family decides not to come back for physio then the pt receives no treatment at all.
Before discharge the physios try to teach the family the best way to transfer the pt and do as much physio as they can fit in, in the few wks the pts are in hospital. However teaching family that have no idea about correct manual handling or any physio techniques often takes up a lot of time and results in the patient having less actual treatment time. Having the pts at home also means that often the physios spend most of the treatment time undoing all the bad habits the pt has developed whilst at home. This normally includes poor posture and inparticular a very poor gait pattern and compensatory techniques, as family members often try to walk the pt before the are even close to being ready.This has shown me how different the culture is here and how lucky we are that in Australia it is expected that we stay in hospital until we are able to be discharged from the multi- disciplinary team. It has also meant that now when a patient from a different culture comes to an australian hospital for treatment, i will have a better understanding of the family involvement and try to include them more in regard to the treatment plan for the patient.
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Its great that you have had the opportunity to see the way a health system in a foreign country works - sure makes you appreciate what we have access to here! Its also important to remember how valuable our hands on input can be - imagine what the patients abilities would be like if they didn't have access to therapy to 'tune them up' after the bad habits of home. Often we get caught up in fixing things like gait patterns to perfection, but just imagine how much better that patients life may be at home with their family, rather than in a hospital bed. Sure, perfect gait is fantastic, but only if its what the patient wants. Although it may be frustrating for the therapist to see all of their hard work be undone, we need to often step back and see the bigger picture.
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