26/04/2020
A bit of a long read....
But...
It's about me and physiotherapy and navigating the digital era of patient care.
physiotherapist’s musings in a time of lockdown living - Hélène Botha
I’ve been a physiotherapist for over 11 years and have worked in a variety of clinical settings. Settings varied from a heated indoor pool facility at Cape Town MediClinic to being the team physio for Waiheke United, a 2nd division league-winning soccer team on Waiheke Island, New Zealand. Work has taken me to treat IOD (Injury On Duty) patients in the Langkloof, Eastern Cape to volunteer as physiotherapist at a 350km extreme adventure race on Rodrigues Island, Mauritius at Expedition Africa in September 2019. I am a qualified yoga instructor, Learn-to-swim teacher as well as movement and breathwork enthusiast and coach.
For the past two years, I have worked as a locum physiotherapist in St. Francis Bay during the summer months. The practice I worked for is Fouché Swart Physiotherapy, a local business that has been a part of the village and especially the local squash and golf clubs for almost 10 years. Fouche studied at the University of Pretoria, where we qualified in the same class and have stayed friend since.
Fouche was in the desert in Morocco with friends when the country’s borders were suddenly closed due to the Covid-19 Pandemic. He has remained there and is eagerly awaiting the opportunity to repatriate back to South Africa. In the meantime, he has been spotted in caves and beautiful traditional tents in Morocco, making the most of his forced extended holiday.
In early March, another friend in Italy had been in full lockdown for some time and many people around her were sick or dying. It seemed like a country that was showing the way to us of what could be our future. I saw the fear in her eyes and understood how dangerous this new virus might become. A lockdown in South Africa seemed like it would follow shortly.
Due to previous myocarditis and years of suffering from Asthma as a child, the potential of a respiratory virus made me take strict precautions personally to avoid getting sick. In the physiotherapy practice, strict hand-washing protocols and other precautions were in place.
As physiotherapists, we are guided by the HPCSA (Health Professionals Council of South Africa ) and the SASP (South African Society of Physiotherapy) in general. In a time of an international health crisis, we are on the forefront of receiving information from the Department of Health who work closely with the WHO (World Health Organization). In this case, it is the first major pandemic in many years and many decisions needed to be made fast, research is updated daily, and we are informed as to which protocols to follow and what level of PPE (Personal Protective Equipment) to use.
It is the year 2020. We are in amidst an international health pandemic where many countries and nations are in various degrees of self-chosen and mandatory lockdown and isolation due to an unseen enemy. The way in which we as humans interact, has drastically changed globally. Physical distance and contact have become somewhat taboo and comes with a lot of fear and uncertainty. For physiotherapists, who usually work in awfully close proximity to other humans, this shifted our worlds completely.
The ways in which social or physical distancing for physiotherapist may be hard include the following scenarios:
1) Assisting a patient who has suffered a stroke, from sitting in their wheelchairs to lying down in their beds.
2) Putting acupuncture needles in someone’s neck who has acute pain and cannot look over their shoulder.
3) Getting a sputum sample from a patient in ICU with a lung infection who has a lot of pipes, drips and drains entering and exiting their bodies.
4) Being a soccer physiotherapist, running onto a playing field where a player has dislocated her shoulder.
Lockdown has been extended. We are on about Day 32. We will soon move from Level 5 to Level 4 lockdown as instructed by the South African Government. Level 5 Lockdown for physiotherapists has been strict, but because we are part of the frontline fighting this virus, our essential services continue. With a lot of red tape, masks, gloves and sanitizers.
For those not needing treatment in ICU’s or hospital beds, life in lockdown goes on. Unfortunately, human bodies still get injured and old pain does not magically disappear just because a coronavirus is doing the rounds.
In a digital age, the SASP has taken an unprecedented step to allow TELEHEALTH. Simply, the continuation of medical care, but remotely and digitally. Yes, we are allowed to treat patients online. As long as there is a video component involved and you are using the programs and software recommended by our insurers. Medical aids have even gotten on board an agreed to create new codes for TELEHEALTH treatments which covers these sessions, each fund making up their own price.
The first reaction of many people is confusion. How do you massage someone online?
Let me explain. Not how the massage works, but how a physiotherapy session can be structured to personally address your condition and help you make the best choices for your body. Here are a few scenarios:
1) An office worker in her late 20’s has neck and shoulder pain due to long hours of sitting in front of a desktop with an uncomfortable chair at work. Due to Lockdown 2020, she is working in her pyjamas on a laptop in a room with poor lighting at home. Her pain is increasing. A physiotherapist may assist her by virtually assessing her posture, her neck and shoulder muscle strength and her slumping position in bed while working. A postural correction exercise program can be prescribed where focus is placed on strengthening weak muscles and pain management techniques may be explored. She wants to get back to Crossfit and has a few questions. Being a millennial, she loves the idea of seeing the physiotherapist who used to treat her using dry needling, ultrasound and ultraviolet light on Skype.
2) A mother of a child who is differently-abled may not have to sit on public transport for 3 hours a day and needs advice on how to keep her child occupied while she works from home. She is dressed formally from her waist up and is wearing make-up and jewellery with a clean pair of tracksuit pants. Her child is a pretty busy child. He is almost 5. The playschool that her bundle of joy used to attend is closed and may be for the next while and she needs to know what the best way to feed him and seat him is. Luckily she has the option of TELEHEALTH where a NDT qualified physiotherapist can help her.
3) A teenage male gymnast, 17 years of age, is finding the joys and confronts of home-schooling confusing. He enjoys the benefit of doing his homework on the lounger at his family’s swimming pool in their garden. During breaktime, he takes a dip. Over the last two months, his mother has noticed that he seems to have an odd posture. While eating sandwiches topless with dirty feet on the sofa, his father notices that it looks like his spine is in the shape of a questionmark. Who are they going to call? Possibly the TELEHEALTH physiotherapist recommended by their medical aid who has experience in the treatment of scoliosis.
4) A retired politician in his late 70’s has not been smoking for just about the same length of time that a national lockdown has been enforced. He has noticed a lot of coughing in the morning and feels that he doesn’t quite know what the best way is to get rid of the phlegm. He has been walking more frequently up his stairs and notices that it is becoming easier for him to breathe and he can climb many more times before getting tired. He needs advice. Living in a forward-thinking and fast-acting country, his cousin told him about TELEHEALTH. He looked for someone who understood lung conditions and was passionate about teaching him about the most efficient ways to clear his airways. He also got advice about the safest way to increase his exercise, how often to rest and stretch and a breathing exercise to help it even easier for him to breathe.
5) A patient in her 50’s has stepped out of her corporate career after a major heart attack and severe exhaustion. She has rested and healed at a Step Down Facility and used to get daily physiotherapy sessions while preparing to get back to her own home. She is back at home during Lockdown 2020 and working part-time for a travel agency. She now plays with her dog daily and developed a keen interest in baking. On an internet search about fast Chocolate Chip Cookie recipes, she found out about the dangers of sugar and read about the correlation between her coffee and sugar habits and the fatigue she experiences. Her medical aid is allowing TELEHEALTH physiotherapy sessions to help her in her recovery process. Luckily some physiotherapists are highly skilled in the assistance and management of lifestyle diseases and helping patients after having heart or lung surgeries. She finds the comfort of her own home fantastic for her sessions.
6) A slightly unhealthy guy in his 40’s who owns a company who assist small start-up companies ends up with knee surgery after hurting his knee while coaching his son’s football team. His recovery has been going well. He has stopped using the 2 crutches 10 days ago and is experiencing a lot of swelling and discomfort around his knee. His knee is swollen and is moving less than it did 3 days ago. The area around his scar is red today. He is scared that he is doing damage to the knee after surgery. The SASP has allowed physiotherapists to work remotely, and luckily he remembers a physiotherapist who helped him years ago with his migraines.
7) A Professional athlete in her 30’s has contracted Covid-19 and is at home feeling miserable. She attends her work conferences without the video setting while rubbing essential oils on her wrists and sinuses. She is coughing. A lot. Before it is her turn to speak, she has to drink kombucha to wet her throat and use her steam facial sauna to make sure she doesn’t cough while speaking. Her body is sore from the incessant coughing day and night. She remembers a physiotherapist mentioning a better way to breathe once in a pilates class for pregnant ladies. She looks the physiotherapist up online and contacts them immediately.
8) An architect in his 60’s has seen around 15 physiotherapists in his life for conditions ranging from Bell’s Palsy, cellulitis, Pudendal nerve entrapment and a broken pinky once. He has lived in a few countries and enjoys the wealth of knowledge he has gained over the years from physiotherapists in different healthcare settings. In some countries, physiotherapists are not “First Line Practitioners” which means they are not allowed to treat patients who have not been referred by a doctor. Fortunately, in South Africa, he can just use TELEHEALTH to call his physiotherapist. He also enjoys going to osteopaths and Yoga Nidra from time to time. His longboard and mountainbike are collecting dust during lockdown. He has however put his punching bag back up and has used his indoor rowing machine for the first time in a year. When he got up 2 weeks ago, he had some pain and stiffness in his foot. He uses ice and a tapping technique to make it feel better and continues with his daily fitness activities. The lower part of his calf is aching more and more towards the end of the day and he wants to go hiking whenever Lockdown 2020 permits. He gets in touch with his physiotherapist who happens to also enjoy hiking, climbing and surfing.
In short. Physiotherapists and massage therapist are a little different. Physiotherapists are allowed to treat patients during an international health pandemic and South Africa is on the forefront of healthcare and allowing treatment to continue.
I find myself in the comfort of my home in the forest past Rheenendal, about half an hour from Knysna. I find myself treating and assisting patients from the comfort of the yoga and meditation studio on the farm that I live on. I find myself sending exercise programs to those who are committed to take their health and the functioning into their own hands. Their own hands are their best option at this stage. Time is less of an excuse in the times we are living in. Physiotherapists massage, manipulate joints, stretch muscles, encourage neural mobility, help lymph to move, gets connective tissue more mobile. Physiotherapists massage, but we also educate, advise, solve problems, listen to problems and make your time with us a personal experience. Physiotherapists massage, but we also assist in lifestyle management, postural awareness, disabilities and optimizing function.
I find myself being a physiotherapist in a digital age with a laptop that has a camera pointed at me and at you. I find myself taking massage out of my toolkit for the moment and using my voice to guide you. I find myself enjoying the new trials this digital age of being a healthcare professional in a first and third-world country at the same time.
I find myself, a fit and healthy individual in her mid-thirties, with a health history that may categorize me in a higher risk category than I want to be in to contract a virus. We find ourselves in a time where the world is being united due to an unseen enemy, where we are learning to adapt to a new norm, where we are slowing down, finding new ways of consuming and spending our precious time. We find ourselves in the same physical bodies as before lockdown, just a bit further apart from others than we are used to. Our bodies move and change and adapt.
I find myself in a time where I am grateful to be a physiotherapist in a rainbow nation where healthcare is still valued and adapts smoothly to the times we live in. I find myself inspired to assist patients in a new way and co-create treatments where you get the expertise and knowledge you need to look after your body well and to live in a strong, healthy body, functioning optimally.
