Winston Churchill Fellowship – My Final Week in New Zealand

By Carolyn Bell

Physiotherapy Lead, Monklands Hospital, NHS Lanarkshire.

Friday 4th March
I’m getting ready to move on and picking up my hire car today. Local bus trips are always exciting but it’s good to feel a little more independent with your own transport.

Another free day so time to reflect and address what I have learned since commencing this amazing trip. I have learned so much by working with and talking to the individuals I have met, however at no time have I felt overwhelmed by information.

The treatments I have been giving are clearly sound, and whilst I now have “more tools in my tool box” and my treatments will be enhanced, my overall plans will be largely unchanged………with more emphasis on the nose of course! I am hugely reassured by that!
I just need to persuade many of my colleagues to become dysfunctional breathing champions!

Another great show of spirit in Christchurch tonight. On walking through cathedral square I discovered it was filled with mobile kitchens, from caravans to pick up trucks. All cooking the most amazing food. Tables and chairs were set up, and were filled by families enjoying the food and listening to a guy singing. Ironic he should originate from Glasgow! A Nepalese curry was a great way to finish the day.

Saturday 5th March
Well another travelling day today but this time I’m driving myself. It’s nice to be able to choose the time you leave and where you want to stop. I have never been on a car journey that the instructions on the sat nav advise to turn right in 265 KM!!!

I arrived safely in Dunedin, after a lunch stop at the Moeraki Boulders. Massive round boulders on a beach. Very bizzare. I’m hoping some of my friends with knowledge of Geology may be able to explain them to me!

Dunedin appears to sit in a valley headed by the sea. It’s also got lots of very steep hills…..including the steepest street in the world, and buildings ….and street names very reminiscent of Edinburgh!
I will investigate more tomorrow!

Sunday 6th March
Once again “mundane job Sunday” has arrived! Once all jobs are done it’s time to explore Dunedin. It’s very strange to find yourself walking down Princes Street and George street! I spent a lovely 10 mins listening to a Maori choir singing and dancing in front of a statue of Robert Burns. I also had a chat to a vicar who was born and bred in Dunedin but had a broad Scottish accent! Lovely day to relax and catch up.

Meetings already set up for tomorrow so early start.

Monday 7th March
Meeting this morning with Bronagh Quinn. Bronagh treats patients with Neurological and vestibular problems, and also those with breathing dysfunction. She originates from Northern Ireland and still craves a “good cup of tea!” Bronagh is Bradcliff trained therefore the basis of her treatments involve the same core principles that have been evident through my trip however like all individuals she has developed her own techniques in presenting that information.

Bronagh incorporates breathing retraining with her neurological patients, as she finds many of her clients who have suffered a CVA over-use or fix with their upper chest. Another indication that I need to ensure all of my Physiotherapy colleagues have a raised awareness of breathing control!

A great analogy was used by Bronagh….when trying to encourage her patients to relax she asks her patients to ooze and melt!!!! I can definitely relate to that and it may be one analogy I adopt.

Once again Bronagh has been very generous in giving her time, sharing her experiences and material with me. Thank-you!

This afternoon sees me speaking to respiratory Physcians, ENT surgeon, Nursing staff and Physiotherapists at the Dunedin Hospital. I have to thank Dr Ben Brockway for arranging this.

It still feels a little odd presenting what I have learned to these individuals as I have come here to learn from them, however it is a great way to generate conversation!

Throughout my trip the basics of treatment have been consolidated but remain relatively constant, and this was no different in Dunedin. Very interesting discussions were generated including:

• How we ensure patients are reassured that their issues are not “all in their head” when they are referred to Physiotherapy
• How can we generate more research to validate our treatments?
• We need to ensure we develop links with ENT to ensure patients are not subjected to a host of unnecessary investigations
• There was recognition that staff working in call centres have high levels of stress, poor posture and due to reading from scripts can develop problems with speech patterning. Should we be addressing these groups of individuals when they commence employment in an attempt to prevent problems arising, rather than dealing with the problems once they are established? I have no doubt that in other areas of the world there will be a high incidence of people with dysfunctional breathing in specific professions. I have already come across individuals who treat a high number of lecturers. Can we be more proactive in these groups?

Whilst we did not come up with any specific answers to these questions it is clear that many of us are tackling the same issues on a day to day basis.

Another great day!

Tuesday 8th March
Well no meetings today as I now have 2 tomorrow so an unexpected free day. Decided to travel to Portobello, St Kildas beach and St Claire’s beach. Its great having my own transport and being able to travel where and when suits both me and the weather! Today is cooler but fine. It’s very windy but not raining. The scenery is amazing and I am hugely privileged to have been given the opportunity to travel to this amazing place.

One of Winston Churchills beliefs is that if you live and work among people, you develop a greater understanding of who they are and why they function the way they do. This generates tolerance and a greater respect and unity. Reflecting today I can honestly say that the New Zealand people have been exceptionally friendly and accommodating. They have gone out of their way to ensure that my trip is as rich as it can be, both professionally and personally. I have been given access to their experience and wisdom in the treatment of patients and everyone has had great recommendations for restaurants, places to visit ……..and wines to drink!!!! I have been included in people’s family lives and been taken out for coffee, lunch and dinner! In all respects New Zealand is an amazing country.

Wednesday 9th March
Well up bright and breezy this morning as I am speaking to a newly formed cardio respiratory group at Otago school of Physiotherapy. There are others joining via a weblink form Wellington.

These individuals had all agreed to meet at 8.00 before they started their day jobs at 9.00!

The individuals present had a mix of backgrounds from ITU Physiotherapy to MSK. Dr Margot Skinner was also present. Dr Skinner co-ordinates the cardiovascular/pulmonary sections of the physiotherapy curriculum at the School of Physiotherapy, University of Otago. She has had a long standing interest in the physiotherapy management for people with chronic diseases including the diseases of lifestyle and the management of sleep disordered breathing.

It is clear that in New Zealand they are trying to encourage Physiotherapists from very early in their training to consider the patient as a whole. This includes recognition that if a patient presents with a musculoskeletal problem the role of their diaphragm and breathing must be considered ……….if they can’t breathe they can’t move!!! This is definitely an area that I feel we need to make a bigger priority.

Other areas that were discussed were:

• The prevalence of dysfunctional breathing following pulmonary embolus and pneumonia. Some of my patients do present following both of these scenarios so is this something we should be more aware of and educate in the acute phase?
• Recognition that there are many children from the Christchurch area that are developing dysfunctional breathing. This is one area of “trauma” but this could be extrapolated to other scenarios.
• The necessity to consider sleep health.

A very beneficial morning!

At lunchtime I met Justine Turner who is a Physiotherapist who works in a practice which is owned by an osteopath. She recognised that whilst he could improve his patients they often returned with similar issues. Many of his patients required education and training and in many cases this included instruction into correct breathing patterns. Justine comes from an MSK background but recognised the role that breathing control has to play in MSK conditions. She again is Bradcliff trained and utilises the philosophy they have developed, whilst like all practitioners she has developed her own methods of delivery.

Once again it is amazing the small things you can pick up by chatting about the types of patients we treat and the methods that we use. I must thank Justine for lunch and her partner for an exceedingly good cup of coffee!

Well that’s the last meeting of my Fellowship. The time has passed immensely quickly!
I have deliberately left tomorrow free to allow me to reflect on my experiences so far, and think about my next steps.

Thursday 10th March

Well everything feels a little different today! No meetings planned, no venues to find or presentations to give!

I have struggled to find the words to sum up this amazing experience. I have been able to travel to a fantastic country and met some very inspiring individuals and world leaders in the treatment of dysfunctional breathing. I have been met with nothing but kindness and everyone has gone out of their way to help in any way that they could.

Thankyou to the Winston Churchill Trust for giving me this opportunity.

I also need to remember to thank all of my colleagues back in the UK who have supported me throughout the planning of this trip, and those who have covered my work whilst I have been away! I should probably also apologise to them in advance as I am sure I will be very enthusiastic on my return and probably a little unbearable!!!

This is now beginning to sound like an Oscars speech so time to move on!

I think to summarise, the consensus of all the key points of treatment of patients with dysfunctional breathing are:

• Recognition of dysfunctional Breathing and triggers
• Education
• Nasal hygiene / Nose breathing
• Relaxation and breathing control – in all positions
• Posture management
• Self management including speech control, exercise, rescue remedies any specific issues to patient
• Sleep Health

Easy!!!!!!!

A few key learning points from my trip………..there are many more!!!

• The nose is under utilised and under considered!
• Need to consider breathing pattern dysfunction when treating all patients!
• Very strong links to Vocal Cord Dysfunction, Pelvic floor dysfunction and Gastric issues
• There are many different ways to treat breathing dysfunction but all rely on same underlying principles
• Need to address Breathing Dysfunction prevention – Asthmatics – Workforce
• Need to engage Physiotherapy staff and medical staff at an early stage
• Using “tech” may persuade some non believers – very useful with athletes
• Research is required!

I am under no doubt that the real journey will begin once I return to work and start analysing all of the information I have gained however, this is a very exciting time both for me, my colleagues and my patients!!!!

Thanks for reading my blog!

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