There is a need for further development of physiotherapy in Afghanistan. Active and individually adapted treatment methods, clinical reasoning processes and evidence-based practice should be encouraged. There are several challenges in this, based on Afghan culture and traditions, gender issues, religious factors, an authoritative society, a medical approach in treatment, and isolation and limitations in access to information. By means of an Action Research project the physiotherapists could be included in further development and research to promote a sustainable and culturally relevant development.
In the changing landscape of global health, new challenges continuously emerge and new ways of addressing them are needed. There are huge discrepancies between health care services in high‐ and low‐income countries, and those countries' ability to deal with these health challenges. Physical inactivity is recognized as a growing and serious problem for global health. Physical therapy—an allied health profession primarily interested in function and movement of the human body—is well‐established and ‐recognized in most high‐income countries. In low‐ and middle‐income countries, however, physical therapists are either severely limited in numbers and inaccessible to most, or services are established largely outside of national health systems. Yet in these countries, physical therapists can have a major role to play from promotion and prevention to habilitation and rehabilitation. Using physical activity as its underpinning approach, there are clear gaps to fill within the spheres of non‐communicable disease, maternal and child health, aging populations, HIV/AIDS, musculoskeletal disorders and injuries, and mental health, to name a few. Thus in this discussion paper we propose that, as a component of collaborative interdisciplinary care and with contextually adapted and locally rooted services, physical therapy is an important health profession for health systems in low‐income countries.
There is little written about the cultural, social, and ethical challenges encountered by physiotherapists engaging in development work. This article takes a critical perspective on what it means to engage in development work as an expatriate physiotherapist, through a self-critical reflection on experiences from Afghanistan. The field notes from an ethnographic study of a development project conducted in Afghanistan were analysed to explore the transformative process of personal and professional development of the development worker. The critical reflective process entailed a change in meaning perspective, described as a shift from the position of an Idealistic Helper to an Enterprising Learner. Of importance in this process were "disorienting dilemmas" that challenged personal perceptions. Critical reflection over such dilemmas led to deeper understanding facilitating the process of change. The essential lesson learned is that the baseline for understanding others is an understanding of one's own meaning perspectives and manner of participation in relation to others and their context. The insights gained have implications for physiotherapists working in development contexts, for other development workers, and for physiotherapists working with patients in clinical practice in a nondevelopment context. Exploring how to collaborate in development contexts could be done using reflective groups with expatriate and local physiotherapists and/or patients. This could lead to greater understanding of oneself, each other, and the local context.
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