JUNE 1980 P H Y S I O T H E R A P Y CORRESPONDENCE 51 D ear M adam , I read “A n O pen L etter to an E ndangered Species” by Professor B. T. le R oux in your issue o f M arch, 1980 with interest. T h e angered reaction to this on the p a rt o f several physiotherapists surprised me. Clearly physiotherapy is in a sad state at th e institu­ tions w here Professor le R oux w orks and he greatly lam ents this lack o f an essential service and th e sub­ sequent ignorance o f w h at physiotherapy can achieve. H e hints at facto rs th at m ay be causative: adm inistra­ tors, w ork-load, salary structure. T he central them e of his letter is one of strong and absolute positivity: let us do everything possible to re ­ verse the trend. I f you look closely, he even suggests jways and m eans of doing so. I th an k P rofessor le R oux fo r m aking m e realise yet again how superbly fo rtu n a te w e are in this T raum a U n it to have m otivated physiotherapy available to chest- injured people by day, by night and over weekends. Perhaps we are just fo rtu n ate. Perhaps m editerranean C ape Town has som ething to do w ith it. I ,w o u ld not believe th at o u r attitude o f respect tow ards them on w ard rounds, pointing ou t their successes while gently raising hell w hen th e service should have been better, has anything to do w ith it. O r w ould I? J. W. V A N D E R SPU Y , F.C.S. (S.A.) Principal Surgeon and H ead, T rau m a U nit, G roote Schuur H ospital M adam , I t is a sobering thought th at a T horacic Surgeon has to rem ind us th a t w e have hands and should use them, especially as y o u r correspondence colum n has in fact .in th e last two years had no few er than fo u r rem inders. ) I refer to th e S.A. Journal of P hysiotherapy of M arch, 1978 in w hich I w rote concerning the im portance of hands in th e practice of P hysiotherapy, particularly in the treatm ent o f respiratory disorders. F u rth e r corres­ pondence appeared in th e June issue of th e sam e year from Miss R unnalls and Miss Lem m er. M ore recently, in D ecem ber 1979, as a treatm ent note, Miss C hatterton m ade a p lea fo r massage. M achines are insensitive b u t have their place as a use­ ful addition to the trained, sensitive hands o f an in­ form ed physical therapist. I f to use one’s hands has be­ come unfashionable, w here lies the fau lt? Is it in the pre-registration o r post-registration training program m es? Or, once qualification has been achieved, is it th a t we forget o u r training an d becom e lazy? Or is it th at we have becom e so bogged dow n in a pseudo-scientific m orass, th a t the m anual skills on which our profession depends are neglected? I am convinced th at ours is a w orthw hile profession. L et us take action to prove to o u r colleagues in the M edical P rofession th a t th e P hysiotherapist to-day can be as proficient as the physiotherapist o f yesterday. MISS S. H. M. B LA C K W O O D , M .C.S.P., Dip. T.P. D ear M adam , P rof. B. T. le R oux’s letter m ust reflect the views of m any doctors concerning our profession, and perhaps w e should th an k him fo r this “w arning” . H owever, I w ould like to present a few facts on behalf of the p h y ­ siotherapists w ho are disappearing from th e services of th e Provincial H ospitals th ro u g h o u t South A frica. A t m ost training centres in South A frica it will take fo u r years o f hard studying to obtain a B.Sc. in Physio­ therapy. Sacrifices begin at th a t stage w ith shorter v aca­ tions and a very full curriculum . U niversity fees are very high and no rem uneration is received whilst in training. A fair am ount of m oney is invested by parents, by th e State, producing each graduate. F ew bursaries are available, but w here th ere is a will there is a way, and loans are m ade available to students. M ost of us feel th a t this effort is w orthw hile because we will have an h o n o u rab le profession on com pletion o f o u r studies. O ne then starts w orking w ith much enthusiasm and pride, and quite justifiably looks forw ards to earning one’s first pay cheque. F o r a few m onths this cheerful optim ism m ay persist, and; if one is fo rtu n a te enough to continue living at hom e w ith p aren tal support, m arry a w ealthy husband, o r inherit a sm all fo rtu n e, the phy­ siotherapist m ay continue her w ork happily ever after. F o r m any, however, graduation also heralds th e begin­ ning o f life as a single independent person. A t the end of the m onth th e rent, telephone and electricity bills m ust be paid. One also needs a certain am ount of stam ina to p u t in a full day’s w ork, so there is also a fo o d bill to pay. Only in rare cases does tran sp o rt to and fro m w ork involve no cost at all, and m ost centres will provide an out o f hours service if th e physiothera­ pist feels th e p atien t will definitely benefit fro m this. R unning a car today is no m ean expense, and even m o to r bikes involve a substantial outlay! T h a t covers the b a re essential expenses needed to exist. As professional peo p le we are expected to have the correct appearance. T he ra re visit to a hairdresser is necessary an d fro m a practical p o in t o f view it is m ore sensible to w ear slacks and tops which w e m ust pay fo r ourselves. W ith th e miles o f w alking a day’s w ork involves, a good p air o f shoes, which will easily cost 10% o f a m o n th ’s salary, lasts a b o u t nine months. Should a therapist have a loan to repay she will defi­ nitely have no m ore than a few cents to spare at the end o f each m onth. As she c a n ’t afford insurances she relies on good luck preventing som eone fro m rem oving her sparse possessions from h er bedsitter o r room in a com m unal set up, o r som e dru n k w riting off h e r car. As th e years continue the physiotherapist may scratch together an a irfare to go on a w orking holiday abroad. This I m ust adm it is one o f the big perks about being a physiotherapist — w ork is available w orld wide. W h a t’s m ore, out there in the big wide w orld salaries allow one to save in o rd er to do post-graduate studies, fu rth e r one’s skills, as well as to continue travelling and living. In m ost countries South A frican physiotherapists are welcome because o f their high standard and willing­ ness to w ork. On returning hom e to Provincial Service th e old w eary ro u tin e o f scratching fo r an existence begins once m ore. M any physiotherapists have done post-graduate courses which are not accredited by the Province. T h e tim e spent w orking ab ro ad is also ignored unless one spends tw o years in th e sam e hospital, fo r which one is given one y ear’s credit by Provincial standards. I t is R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 52 F I S I O T E R A P I E JUNIE 1980 discrepancies such as these w hich m ust be rectified if teaching hospitals wish to have fully staffed physio­ therapy departm ents. This w ould also relieve the frus­ tratio n of having too few physiotherapists treating too m any patients w hich inevitably results in inadequate treatm ent, so th at indeed the rem aining few m ay ulti­ m ately be labelled superfluous. In spite o f a heap o f dedication and a real love fo r m y w ork the prospects o f continuously scratching to re­ m ain above the breadline fo r an o th er thirty-five w orking years, forces m e to lo o k to an alternative way o f earning m y living as a physiotherapist. T h e choices open are to go in to private p ractice w hich allows one m o re freedom in spite o f having to w ork extrem ely hard. A lternatively one can choose to w ork a b ro a d as m any good South A frican physiotherapists have done and are doing. So in reply to y o u r challenge, dear colleague, m ay I rem ind you th at th e w hite rhino was only able to m ake a com e back, because “certain people” sat back and analysed th e facts. T hey then decreed th at white rhinos sho u ld become a protected species an d a great deal o f effort was p u t in to helping them to rem ain alive and healthy, so th a t they could proliferate. M ay I suggest th a t a sim ilar supportive effort b e invested in the return of physiotherapists to Provincial services. V. A . D A L L E V E D O V E (Miss) B.Sc. in P hysiotherapy D ear M adam , I w ish to take this oppo rtu n ity to reply to Professor B. T. le R oux’s open letter to an endangered species, as it allows m e to rectify a few o f his m isconceptions. T h e concern he shows regarding the deficiencies in the Provincial physiotherapy service is shared by all of us w ithin the service. W e are fully cognisant o f th e shortage o f physiothera­ pists and are aw are of the reasons. T h e situation in N a ta l is n o t unique, o th er Provinces also have their difficulties in filling vacan t posts. T here a re m any good physiotherapists in the N atal Provincial Service who, against great odds, have given excellent service fo r m any years an d they continue to do so, despite the fact th at they could increase their earnings by n o t w orking fo r th e A dm inistration. P rofessor le R o u x ’s reference to a “central p o o l” o f physiotherapists is erroneous. N o such pool exists. E ach hospital has its allotted num ber of posts an d applicants m ay apply fo r p o sts; in th e hospital of th eir choice. It is a well know n fa c t th a t physiotherapists, w ho have a n open field w hen it comes to em ploym ent o p p o rtu n i­ ties, p refer to w ork in areas of their own choice and, in som e cases, w ould ra th e r resign than be transferred to an o th er hospital, as could w ell happen if there w ere a central pool. T o m y know ledge P ro fesso r le R oux and his staff have never tau g h t large classes of student physiotherapists in N atal. T h e largest class I can rem em ber was twelve. D ue to th e m any difficulties, w hich Professor le R oux is o b ­ viously unaw are' of, large classes have never been a d ­ m itted to the clinical years o f study. Physical facilities an d teaching resources have lim ited us to an intake o f a m axim um o f twelve. S tudent training on an ethnic basis has severely curtailed the num bers o f students whilst en­ quiries have rem ained high. F o rtu n ately there has been som e relaxation in the ethnic clause and that, together w ith a change in the physiotherapy curriculum has led to tw enty-eight new student registrations in 1980. T h e physiotherapy school is now fully integrated and has students o f all race groups in training. R egarding post-graduate training, betw een 1971 and 1978, nine courses in Inhalation T h erap y w ere given by th e Provincial M edical R ehabilitation Services on an in-service training basis. Sixty five physiotherapists were aw arded th e C ertificate in C om petency in Inhalation T herapy. I t is proposed to raise th e status an d standard of th e above course to th a t o f D iplom a in R espiratory T h erap y so th a t it m ay becom e eligible fo r recognition by the South A frican M edical and D en tal C ouncil as an additional qualification. I f th e overall m otive behind P rofessor le R o u x ’s letter is sincere and m ean t to be constructive, it is to be w el­ com ed an d h e m ay be forgiven his lapse in n o t going to th e right source to obtain the tru e facts. I ho p e he will give su p p o rt to th e South A frican Society of Physio­ therapy an d all o f us who, through the years, have striven to im prove th e lo t o f th e Provincial physiothera­ pist. C. A. L IG G IN S Senior L ecturer, H ead: S ub-D epartm ent of Physiotherapy N a ta l Provincial A dm inistration/U niversity of D urban- W estville D e a r M adam , In y o u r M arch 1980 issue, P rofessor le R oux m akes a num ber of u n supported statem ents to which space does not p erm it an ad eq u ate reply. W e w ould, how ever, like to m ake th e follow ing comm ents. W e th a n k him sincerely fo r his concern an d obvious aw areness o f som e o f th e dangers we are exposed to in w hat he seems to regard as our struggle fo r survival, yet feel sad th a t his outlook is ra th e r parochial, if n o t ill- inform ed. W e sym pathise with the drought h e and his colleagues are experiencing in D u rb an and h o p e th a t th e rains com e soon. T h e “p u d d le” we at G ro o te S chuur H ospital h a d in 1979 has now becom e a lake w hich has been interm ittently topped up w ith tributaries from overseas. T h e nationw ide staff shortage leads to areas o f dt y p leted departm ents, an unsatisfactory situation which isv̂ self perpetuating. I t produces physically an d em otionally exhausted staff, dissatisfied w ith their treatm ents w hich they have to p a re in o rd er to cope w ith th e sheer n u m ­ bers — n o t exactly a gratifying feeling fo r them . W e do assure P rofessor le R oux th a t w e dislike having to do this as m uch as h e an d his colleagues dislike seeing us do it. W e are aw are th at this can in tu rn lead to a drop in th e stan d ard of treatm ent. T his we regret and do our u tm o st to avoid. T h e situation is n o t im proved by the abuse o f physiotherapy departm ents, using them as dum ping grounds. Some doctors, when at a loss w hat to do next will refer a p a tie n t “f o r a b it o f physio” . H ow ­ ever, we do acknow ledge th a t o u r use as placebos has its place. In som e elective cases this is acceptable. A n essential p a rt o f any m edical professional’s m ake-up is th at o f su p p o rter or active listener. T h ro u g h o u t th e severe staff shortage o u r departm ent experienced last year, we m aintained o u r norm al 24 h o u r service to the best o f o u r ability. W e feel rightly p ro u d of th e ladies w ho w orked hours over and above an average day in order to com plete th e w ork. T hus we have no need to h a rk back to the seemingly glorious era of the 1950’s. H ere an d now such “good” physios are alive, well and plenty living in C ape T ow n! R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) Strange as it m ay seem to P rofessor le R oux, the 1980’s also has physios who are aro u n d a t extubation time, w ho do w ork their patients up fo r operations, who do com e in early fo r w ard rounds, w ho do join in tutorial groups w here w ork allows, an d w ho feel their job is worthw hile. H aving w orked in a variety of physiotherapy d ep art­ m ents w e w ould lik e to inform Professor le R oux th at the w o rd “w orthw hile” is o u r passw ord to job satisfac­ tion, and also assure him th a t th ere a re plenty o f us aro u n d w ho d o care a b o u t this. W e care ab o u t our stan d ard of w ork, a b o u t im proving p atien t care, ab o u t furthering our know ledge. Ours is in very essence a car­ ing profession. T h u s it saddens us th a t he seems n o t to have appreciated th e m ajo rity o f us w ho still regard it as such. Professor le R oux m ournfully feels th e days of co n ­ viviality have fa d e d with the passage of tim e an d that a generation o f doctors know n o t o f our abilities and ^ sc o p e . W e at G ro o te Schuur H ospital have enjoyed the PE ncouragem ent an d good com m unication from no t only th e interns an d registrars but fro m m an y of w hat he regards as the “A n tiq u e generation” (although all should be aw are th e C ap e A ntiques are ra th e r special an d nationally acclaim ed!). M ost of us w ould agree w ith his anatom ical observa­ tion. O ur hands a re indeed one o f our greatest assets; som etim es sadly underused, som etim es abused, som e­ times replaced by a variety o f m achinery. In so doing, we lose th e valuable an d essential com m unication we an d the patients gain by touch. H is th eo ry th a t p o st operative sputum retention is of a higher incidence th an in those sputum less days o f the 50’s is debatable. D oes h e hav e any figures to substan­ tiate his claim ? T hey w ould, w e feel sure, m ake fascin­ ating reading. N ow to salaries, which does becom e ra th e r boring, b u t the issue should be clarified. Since the m ajority of us know roughly w h at salaries w e are likely to receive before we com m ence training, no one in th eir rig h t m ind w ould start if they w anted to get rich quick! M oney is certainly not a reason fo r going into th e job. M ost choose th e profession because it is a fascinating, stim u­ lating. rew arding, although a t times a m adly frustrating job. I f w e do have com plaints to m ake ab o u t our sala­ ries o r conditions o f w ork, w e refer them to the N atio n al ^E xecutive C om m ittee, w hich is o u r elected spokesbody. P