By Carolyn Bell (@bellcarolyn13)
Physiotherapy Lead for Monklands, NHS Lanarkshire
Friday 26th February
A little shopping this morning and then off to Wellington Hospital to meet with some of the respiratory team. I was advised many individuals were unable to attend, however 20 individuals seemed a lot to me! A combination of respiratory physicians, physiotherapy staff and students , occupational therapists and nursing staff were there. Hopefully some of the contacts made will be maintained. I would also like all respiratory physicians to note that James Findleton , Consultant in Respiratory Medicine bakes a mean cake!
It became evident through discussion that the problems we have with service provision to patients with dysfunctional breathing are not unique to the UK. It is recognised that the treatment of those with dysfunctional breathing are often limited by a lack of service provision. There are a number of very highly trained physiotherapsits who deal with this patient group however services are often determined by an individual’s interest and drive rather than scoped, planned and funded service provision.
The need for planned input to asthma patients was also recognised. There are those severe asthmatics who require intervention to improve breathing pattern abnormalities however, there was also discussion about newly diagnosed athmatics who should be taught breathing control from the day of their initial diagnosis.
When benchmarking services it is good to know that whilst we recognise the need for service improvement it is also good to know that we are succeeding as much as the next man!
Saturday 27th February
Well the weekend has come around again. Time for some retail therapy and a bit of relaxation. A lovely craft market sees me boosting the New Zealand Economy!
Sunday 28th February
Meeting up with my friend’s sister today. She is a physiotherapist working in Wellington who I have heard a lot about but never met! People here are so generous with their time. A lovely day spent eating drinking and talking non-stop! Being a physio seems to bring a special bond, and there always seems to be at least one physio that both know!
There was much talk about stats, workload, and the fact that 25 years after starting work as physiotherapist’s we would both choose the profession again given the chance. A reflection that reflects positively for the physiotherapy.
It was so good at this time in my trip to meet up with someone who could relate to home. Being invited into her home grounds you for a short while before heading off on my travels once again.
Monday 29th February
I had planned to catch up with the New Zealand branch of the Winston Churchill Trust today however I have been unable to make contact. An unexpected free day!!! Weather has turned cold…its only 15 degrees….so headed for a day in Te Papa museum. There is an exhibition exploring the personal input of New Zealanders in Galipoli in the First world war. A very moving and personal tribute.
There is also lots of history of the New Zealand people; both those native to New Zealand and those who chose to settle here…………….and there is a giant squid!!! A fascinating museum with many different features!
This is my last evening in Wellington before heading off to meet physiotherapists working in Christchurch.
Tuesday 1st March
Just time for a cultural trip to the botanical gardens before heading off to Christchurch. Travelling time really is down time and seems like you’re wasting time however airports are a great place to reflect! During my trip I had hoped to come up with 3 key actions that could be initiated on my return home. At present I have 10 so a little work to be done on refining and prioritising!
Wednesday 2nd March
I had a meeting this morning with Tamsin Chittock. Tamsin works in the biggest multi-disciplinary clinic within New Zealand. Her work is predominantly with high performance sportsmen and women, particularly rowers, kayakers, runners and swimmers. During her work she began to recognise that some of her clients presented with breath holding and abnormal breathing patterns.
She had some awareness having previously worked with Anne Pitman, however she also trained in the Bradcliff method and has been incorporating breathing control with athletes as required. She links closely with the national teams and encourages that consideration be given to the importance of breathing control throughout training regimes.
Tamsin also recognised that she had developed a small caseload of individuals who had developed breathing pattern abnormalities following the earthquakes of 2011. Individuals would often present with a “sports injury” however she would recognise signs of breathing pattern abnormalities which appeared to be associated with post-traumatic stress. We discussed how some of these individuals respond positively to a physiotherapist who is recognised for their work with MSK conditions, whilst they would probably not have access to an individual with a respiratory background. All the more reason for me to liaise closely with my MSK colleagues…….could we introduce a brief 4 point screening for all MSK patients? One of my 10 action points to consider on my return!
Once again I need to thank all of those individuals who have given up their time to share their experiences with me.
After my meeting with Tamsin I took time to walk around the city of Christchurch. My overall initial impression was that the city resembles a war zone. There are multiple car parks where buildings once stood. The cathedral is a shell behind protective fencing. There are many buildings still waiting to be demolished. The city is constantly humming with the sound of jack hammers, drills, and circular saws.
There are also some very poignant areas. 185 white empty chairs on the corner of a city block. One for each individual who died in the earthquake. The Cardboard cathedral which was erected is an amazing piece of architecture, and thankfully this will continue in use as a church once the cathedral has been repaired.
I then came across small pockets of land that had been planted in an attempt to re-introduce green space into the city, or turned into children’s play parks. Shops, coffee shops and street food vendors have taken up residence in shipping containers ensuring that some of the city life remains.
Street art can be found on every corner. Within these areas there is a real buzz!
Once you aclimatise to the bleakness of the landscape you can see past the cosmetic and appreciate a city which is trying to re-engage with the heart of Christchurch…..the people. I am sure there is a lesson in there for us all!
Thursday 3rd March
I have a meeting later this afternoon so time to catch up on emails and a little more shopping! Lunch in an outdoor food court amongst the shipping containers, listening to a street singer! What more could you ask for?
A half an hours walk out to Sydenham to meet Itje Van Stolk. She’s based in a gym….she is one of many professionals who had to re-locate after the earthquake. Itje was born in Holland but has travelled extensively and has a marvellous accent! She provides a unique service in NZ in that she provides classes for patients post stroke, patients with diabetes, patients at high risk of falls, patients with intermittent claudication, and “senior moment” classes for those elderly individuals who wish to maintain their fitness. It appears that these classes are very few and far between in NZ. In Holland they are a normal part of the health service.
This is an area that I have always been interested in being trained…..many years ago….as a Remedial Gymnast. Classes were our specialist area and I have continued to recognise the many benefits of educating and exercising groups of individuals. Not only is it cost efficient but the social impact for patients can be huge.
Itjes specialism is treating patients with dysfunctional breathing. Again she is Bradcliff trained but draws upon many years of experience to augment her treatments. We are both in agreement that the more tools you have in your tool box the more individually based our treatments can be! Dinah Bradleys books are widely used to enlighten her clients.
Itje also recognises the huge impact the earthquake has had on individuals in Christchurch. In her opinion as many as 50 – 60% of the population will have elements of dysfunctional breathing caused by “post-earthquake stress”. There are many small earthquakes here that individuals used to laugh about and take in their stride but after 2011 that has all changed. Nearly everyone in Christchurch was affected personally by the earthquake and those memories return every time a tremor is felt. Itje deals with a large number of patients who suffer from anxiety and I think these individuals will be echoed in the caseloads of those individuals specialising in dysfunctional breathing.
Whilst her treatments mirror my own there was learning on both sides with regard to phrases used and specific instructions. I am amazed by how much can be learned simply by observing the practice of others. Itje gave freely of her paperwork and advised of specific websites etc that she uses. Thank you!
I was then treated to an evening of hospitality in Itjes home. A pizza and wine commenced the evening in her home town of Lyttelton before going to Itjes house for dinner!! Her house was badly damaged by the earthquake and still has plastic windows and gaps around all of the doors. There are also major cracks in the walls. The house has moved 11cm on its foundations and has been left a little crooked! Instructions were required ….and were in fact written on the back of the bathroom door…… to open it from the bottom! Luckily no-one was injured in the house although Itjes daughter had to take refuge under the kitchen bench.
All of our discussions about the earthquake were neatly backed up by a 3.4 quake out at sea which shook Itjes house as we were eating dinner! I was more than a little shocked, but by Itjes standard this was minor and we carried on eating! It was very nice to be included in the life of a NZ family even if for another brief moment.
Please return next week to read the fourth and final blog from Carolyn Bell about her time in New Zealand on a William Churchill Fellowship.