Australian Physiotherapist Perspective: Volunteering in Nepal

This Blog entry is a copy of the article I wrote for the official publication of the Australian Physiotherapy Association ‘InMotion’. Published in 2009, it is a summary of my experiences as a new graduate volunteer to Nepal in 2007/2008.


Volunteering to the max

In writing about her three-month stint in Nepal, physiotherapist Emily Smith (now Emily Eglitis) ponders the issue of Volunteers maximising their positive impact while minimising the negative consequences for host communities.

Committing your energy, emotions and sometimes even your health and safety to be a volunteer is a big task. It makes sense to find the most beneficial way to spend your time and resources, as it is not just for the duration of your time as a volunteer that you want a positive impact to be felt, but long after as well.

But in our quest to make things better, do we sometimes risk making the overall situation worse? If we help now, does it matter that the change may not last in the long run?

I am by no means expert on the subject of aid work, but while on my own quest to ‘change the world’ as a new-grad physiotherapist, I was confronted by a recurring question: How could I maximize my positive impact and minimise negative side effects from my work? Just as we try to practise physiotherapy holistically, maybe we can consider roles such as volunteering holistically as well.

Emily, client and family at Kanti Children’s hospital Kathmandu

After graduating from the University of South Australia in 2006, I worked for ten months in a private practice in Victor Harbor on the south coast, gaining valuable experience – and money to finance the whole venture. I decided to turn my combined desire to travel developing countries and my curiosity about volunteering into a round-the-world holiday that started in Nepal as a volunteer physiotherapist for three months in Kathmandu.

I worked at Tribhuvan Teaching Hospital (Neurology/Neurosurgery ward), Kanti Children’s Hospital (the only dedicated children’s hospital in the country) and a privately run rehabilitation centre – Sahara Care Home. My placement was organized through a local Australian non-government organisation (NGO).

As can be expected with any developing country, the healthcare system is under strain in Nepal. Delivering services to the estimated 86 per cent of the 29.5 million people who live rurally is a challenge made more difficult by the fact that in addition to Nepali, over 20 other dialects are spoken; even three months of study and practice in the Nepali language did not guarantee effective communication with those Nepalese, usually from smaller remote villages, who spoke another dialect. The sheer number of people is also demanding – population density equates to around 206 people per square kilometre, meaning that there are 5000 people per hospital bed. (By comparison, Australia’s population density is less than three people per square kilometre and an estimated 135 people per hospital bed.) Putting all this on top of a long and convoluted history of instability and corruption, you find a nation in need of assistance in many areas not limited to the healthcare system.

Petrol station nepal

In terms of physiotherapy, there are approximately 150 people working in the field and most are fully qualified. Unfortunately there are even fewer other allied health professionals, especially occupational and speech therapists. I was incredibly fortunate to meet and work under the guidance of the Associate Professor of Neurosurgery at Tribhuvan University Teaching Hospital, Dr. Mohan R. Sharma. Dr. Sharma became a good friend and mentor to me and involved me in the medical and grand-rounds of his neurosurgery interns and registrars. He appreciated that his patients were able to be assessed, treated and mobilised consistently during their stay.

The neurological patients I worked with very rarely received physiotherapy treatment unless they were gravely ill with chest complications. A large part of this was likely due to the under-referral of patients by medical team, which perhaps do not fully appreciate the benefits of physiotherapy in early mobilisation. There is also a lack of resources to treat all cases in need.

While my work was no doubt appreciated by patients and staff alike, Dr. Sharma and I realised that the benefits I was bringing to my patients were not going to last. as the saying goes: ‘Give a man a fish and you feed him for a day, teach a man how to fish and you feed him for a lifetime’.

In a ‘treatment’ role, it was pretty tough to contribute significantly early on. Because of the language barrier, I couldn’t treat patients safely and effectively without the help of someone to translate. I started to feel little useless and that I was absorbing more time and energy from the placement than I was giving back. This is an important consideration to take into account in the planning stage, as you want it to be worth the while of your hosts to orient you and help you settle in. this especially so when language is a barrier, which is why many institutions will strongly recommend a duration of at least three months.

On day I was feeling particularly unconstructive when one of my Nepali colleagues was working with a middle-aged woman with a degenerative brain condition causing severe ataxic gait. The physiotherapist had again tried the standard recipe of ROM exercises and that retraining that consisted mainly of steering the patient awkwardly across the room, accumulating two falls and more than a few near misses.

Nearing the end of the treatment session while giving the patient a rest, the physiotherapist dejectedly declared to me, ‘I just don’t know what to do with her!’ I realised an avenue through which I could really help – the physiotherapist was smart and eager to learn and could obviously communicate in her native tongue to the patient. I was able to jump in and help, brainstorming ideas from my not-so-distant university days for further assessment, outcome measures and goal setting. I helped her to break the treatment session down from the complex task of walking into smaller task components of postural control and stages of the gait.

That day, we all left with a sense of achievement. I realised that encouraging and stimulating physiotherapists already there, and who will stay long after my departure, will benefit the local community the most. Continuity is the key – finding a method to help that will mean your contribution is felt by many more people long after you leave.

As Australian physiotherapists we are privileged to receive such a high standard of training and ongoing support and development from our professional body, the APA. Committing where possible to well-organised projects where there will be support and continuity in your contribution (such as in further training and education of physiotherapists in developing countries) means that we can use our unique skills to immeasurably benefit many other people. If there are no projects of this sort already in progress, you may be able to assist local people at a preparatory level toward this goal. Combining with established aid organisations and researching them well is one method of doing this.

Furthermore, there was a noticeable difference to the multidisciplinary approach to healthcare I have experienced working in Australia compared with Nepal, where doctors seem to be the first and last port of call for health. Advocacy for physiotherapy and its many benefits aimed directly at the medical community might improve service provision of physiotherapy and encourage outlets for professional development. Physiotherapy potentially could have a massive impact in primary and preventative healthcare.

When you arrive in a new community with a quest to make a difference, you want to make sure it is a positive difference you are making and not a negative one. Overall, the task of minimising any negative impact comes down to commitment – being honest with yourself and determining how much time you will need to become autonomous in the role you are playing and then to carry out your duties for a reasonable period thereafter.

Trek through Langtang Village, Rasuwa region Nepal

In a broader sense, being mindful of the unique set of social, environmental, cultural and political circumstances that surrounds the community in which you intend to work can also help when attempting to be holistic in your approach as a volunteer. Working with the local community to identify and tackle issues that are important to them is essential to an effective and enduring project. As Ian Edwards (University of South Australia lecturer and aid worker in Kabul, Afghanistan) points out. ‘The learning process works best when it is genuinely a two way process.’

This principle can also be carried into daily life. There are many disadvantaged groups in the community and how you interact with them is also important. Daily in Nepal I would walk past the homeless beggars, sometimes children who would hang onto my arms as I walked along the street, forcing harsh realities of life at me. To not give a few measly rupees to the beggars feels heartless.

However, children are often pulled out of school because begging is more lucrative. To pay them may mean you perpetuate the problem. What do you do? As part of living and working in a foreign country, you may be in a position to hire locals into employment, as cooks, cleaners, porters or trekking guides. Although you may be able to do the jobs yourself, providing proper working conditions and a fair rate of pay potentially could further your positive impact.

A huge environmental problem in Nepal is waste disposal, and clean drinking water is a luxury sold in plastic bottles that are non-recyclable and clogging rivers and piling up along trekking routes all over the country. It is avoided easily by filtering or boiling your own water. Being culturally sensitive to dress and responses to religious rituals, hand gestures, eating, bathing (and more) is important also. Occasionally, volunteers treat their time as if it is a holiday, neglecting that unpaid work still requires you to show up on time, work well and show respect for co-workers.

Considering how we can best spend our time and effort as physiotherapists will assist those who take the plunge and volunteer, and may even impact on the way we practise right here at home. The process of volunteering should benefit both the volunteer and the hosting community. Finding a way to do this takes considerable awareness of ‘the big picture’ and a consideration of what will happen after you have left. You may not be earning money, but an honest contribution is incredibly valuable and may have benefits beyond those originally expected.

Langtang Region Prayer Flags

Trembling Mountain

At 12.50pm on the 25th April 2015, a major earthquake measuring 7.8 in magnitude shook Nepal for fifty terrifying seconds causing widespread destruction and damage across the country. For context, ten is generally considered to be the upper limit of this scale, with each increasing number indicating double the energy release of the previous number (the highest earthquake ever recorded was 9.5 in Chile in 1950). Nepal is situated in one of the most seismically active regions on earth, with small tremors not uncommon, however major earthquakes such as this occur once every century. On this occasion, an estimated 9,000 people were killed and 22,000 injured across Nepal.

The village of Langtang, north of Kathmandu near the Tibetan Chinese border was completely buried under a landslide triggered by the force of the quake. The earthquake triggered a glacial collapse leading to an avalanche of rock, ice and mud, resulting in an air blast, equal to half the force of the Hiroshima atom bomb which sent shock-waves down the valley

Villages across the entire Rasuwa region were severely affected, with over 250 people killed in the event and many more injured, displaced and traumatized. For an economy based around trekking and tourism, the impact of the earthquake is still felt in these communities.

Nepalese documentary film-maker Kesang Tsetan followed the Langtang people in the weeks and months after the earthquake to document and record the journey of the Langtang people. He created a film that explored what the Earthquake could reveal about the people of this region who have a strong Tibetan Buddhist culture. His film Trembling Mountain shows the personal suffering wrought by the calamity, by ‘story tent’ testimonies interspersed with and serving as thematic and counterpoising elements to the activities of resettlement. This work is also contributing to the Langtang Memory project which aims to create a space for healing through the active process of remembering and documenting in collaboration with the Langtang Community.

It is now four years later and much of the rebuilding has been completed across the country and for Langtang, the infrastructure is restored and trails open for trekking. Emily Eglitis, a local physiotherapist and yoga teacher who has lived in Nepal, now leads yoga-trekking tours to Langtang in an effort to help support the local Langtang economy. “The natural beauty of the region, it’s cultural and spiritual diversity and the kindness and warmth of the people make Nepal the perfect destination to explore the challenges of trekking with the benefits of yoga”. Emily learned about the film whilst leading a group through the Langtang region in March this year and before returning home to Australia, met with the film-maker and to secure a copy of Trembling Mountain. There will be a single screening of Trembling Mountain as a fundraising venture for the Langtang Memory Project and community support on the 27th June 2019 at Wallis Cinema Mount Barker.

Tickets are available through Eventbrite and more details are here on our Events section on the PhysiYoga facebook page. For queries email hello@emilyeglitis.com.au. I hope to see you there!

When Nature Calls, It Won’t Get Lost in Translation

Questions About Trekking in Nepal That You Are Too Afraid to Ask

For some reason, the topics of poo, wee and bottoms seems to be either the subject of childish jokes or only discussed at the Dr’s office. But just for a moment, let’s get serious and talk about something that effects us all – the call of nature. If you like to plan ahead or have travelled to developing countries before, chances are, you’ve already experienced or thought about what the toilets will be like.

If you are thinking of joining us in Nepal, you’re probably especially curious about Out Houses there.
Most of the time, we don’t give much thought to our daily visits to the Lavatory. But habits and expectations surrounding relieving onself can change considerably across countries. Often it’s hard to ask these questions for fear of seeming ignorant, and instead we silently stress about them. BTW, Some poor folk face this fear on a daily basis: parcopresis is a fear of defacating in public places while paruresis is a fear of urinating in public places.

Your Travelling Toileting Profile

Type 1: The Fully Prepared

Those who really care (or worry) about the type, state and shall we say “accessories” of their Water Closet. If this is you, I have included links to each section where you can jump into your detailed research and know all the ins and outs to fully prepare yourself.

Type 2: Go with the Flow

You’re happy to do your business whenever and where-ever is necessary. The smells and sights of the lavatory don’t phase you too much, afterall, we’re all human. If this is you, I hope you pick up some pointers here to make your travels a little more straight forward. For you, I have condensed this blog in to my 4 Top Tips so you can pick the topic of interest to hone in on it.

Type 3: Quietly Interested

Those of us who live somewhere the between the two extremes; we’re not particularly afraid of the foreign rest rooms, but we’ll take any new tips that will help make our travels that much easier.

My 4 Top Tips for Toilets while Trekking

Toilet Types in Nepal

You will come across all types of toilets while in Nepal from the regular western type, to the Asian style squat toilet. Most however are usually the squat variety (especially when travelling overland). Mid to high-end hotels and cafes will likely have Western style toilets.

Regardless of type, one thing that is for sure: DO NOT FLUSH TOILET PAPER! Nepal is an ancient country and the plumbing cannot handle it. It will clog the system. You will need to put the paper in a rubbish bin (if in a hotel or cafe) or a plastic bag and take it with you if there isn’t a bin available.

For an in-depth description of what toilets are like in Nepal, I highly recommend you checkout this article by gogoguano.com – a website dedicated to teaching you how to use toilets while travelling.

Toilet Guide: Nepal

Which brings me to my next tip.

Toilet Paper Vs Water

Many countries in the world prefer to use water over toilet paper as a more hygienic and sustainable approach to toileting than toilet paper. If you don’t think you go paperless, or you find yourself without toilet paper, simply bring a roll of toilet paper with you. I also recommend a few small plastic bags (nappy sacks from the baby aisle work well and they’re usually scented too) and a small tube of hand sanitizer to keep you going.
If you use water, you are expected to let your bottom air-dry. I have to admit, I got a little tired of having a wet bum. So in the colder months my personal preference was to use a combination of water washing and then a little pat-dry from toilet paper.

For a great education on how to toilet yourself using the water method instead of toilet paper, read this article.
A guide to cleaning yourself without toilet paper

And that leads me to the next important subject…

Left hand Vs Right hand

Left hand is for wiping & washing your nether-regions, and the right is for eating and greeting. Before my first visit to Nepal I would stress about using the wrong hand and the wrong time and committing multiple social taboos and horribly offending the locals. I can tell you this – once my left hand was involved in wiping and washing a Number 2, I couldn’t forget it. In fact, I don’t think I looked at my left hand the same way again for months…

Secret Women’s Business

I think it’s safe to say that at the very least, many women find having a period a little inconvenient, especially on trek. But I’m lucky – for many, it can be painful and even debilitating. If this is you, I highly recommend consulting your doctor for solutions as soon as possible to rule out endometriosis or other medical conditions.

Although menstruation is a taboo subject in Nepal and not easily discussed in public (more on that later), I easily found and purchased sanitary products from roadside pharmacy stores, albeit a limited choice. For short visits like ours, it would likely be much more convenient to take your favourite products with you.

Consider that sanitation in Nepal is far from perfect and it would be a good time to consider more sustainable alternatives such as a menstrual cup like the Diva Cup. http://divacup.com/ (this specific product was recently introduced to me by a friend when discussing this very topic, and I have to say it is my new favourite thing in the world – consider it, trekking or not!) So give the Menstrual Cup a thought – they can be purchased online or from an increasing number of Chemists. Not only is it far more sustainable, but it will require less frequent changing and they are becoming more common place in Nepal.

To Illustrate what I mean about typical sanitation;

One night in Kathmadu, I was at a friend’s house when her sister called out “I’m just going to toss the garbage” as she walked out the front door with a bag of household rubbish. I imagined a scenario much like home where we wheel the bins out every Wednesday night (ok, so more realistically, in a mad rush Thursday morning). Except she literally was going to “toss the garbage” into the street. You see, there was a specific spot near an intersection that people tossed their household garbage. Stray dogs would pick through it for morsels of a meal. Rats sporadically scurrying in the background. Occasionally someone would attempt to reduce the pile by setting it on fire. In fact, on a similar garbage pile in another part of town, a dead cow had ended up on one. Eventually it would get big and obtrusive enough, so a truck (I’m assuming government ordered one?) would come and shovel it up and take it away. And the cycle would start again.

Spare a thought for many Nepali women. Even though it was officially outlawed, the traditional practice of Chhaupadi is still common place. This is where menstruating girls and women are banished to small huts outside the family home, sometimes resulting in disastrous consequences for the women.  http://www.abc.net.au/news/2018-03-10/chhaupadi-nepal-menstrual-cup-revolution/9531814

Sometimes their diet is severely restricted during this time and they are also not allowed to touch men or cattle or enter the kitchen. This is more entrenched in religious families and village communities, who think of menstruating women as dirty and unlucky and will blame misfortune on them. I am happy to say I didn’t experience any of this personally when I lived there and attitudes are slowly changing.

Why Retreat to Bali?

October is our first ever PhysiYoga Retreat and we’re going to beautiful Bali.

Why Bali? And why go on a retreat?

I created this retreat is because making change isn’t easy. Serious change that is. Sometimes it requires a kick-start to get momentum in the right direction. After all, a good idea and a good intention need a good dose of motivation to get them off the ground. So maybe you want to go a bit deeper into your yoga practice – to move more and feel stronger.

But perhaps you’re also limited by what your body allows you to do. So this retreat is aiming to combine a therapy stream for those needing some extra support for their aches and pains, as well as a yoga stream for those wanting a deeper challenge.

This short-stay in Bali (family friendly and during the school holidays) will be a time to pause, reset and create some necessary changes in your body to start achieving more. Have a girls week away. Or reconnect with your partner.

Bali is the place to do this as it is now a Yoga haven, recognized as one of the health and wellness destinations of the world. Diverse healthy food, exotic weather and warm welcoming people with a beautiful Hindu influence gently appearing through the art and temples around you. Sure, you might sweat, but chances are you won’t really care. (When I’m there I don’t wear makeup, or just maybe a little for a date night). Don’t take my word for it: Here’s five reasons why Yogi’s love Bali.

The format for this retreat allows us to find a balance for the “me time” with the “we time”: time for ourselves, so take care and look after us. But then valuable time to reconnect with someone important in our lives. If we don’t do this regularly we risk burnout and our relationships and family life suffer. One of the problems with burnout is that we often don’t even  recognize it as burnout – we just feel “funky” or like we’ve lost our Mojo.

And if you’re self employed, it is ESSENTIAL to protect your Business Mojo! Your livelihood and sanity (at the very least) depends on it. Just this year I (finally recognized) I was suffering the beginning of burnout. But not before my health had started to deteriorate and family chaos was enveloping. My husband urged me to look after myself and used this metaphor: “You better not jump off the bus, because if I’m driving, then we’re all going over the cliff!”.

So I did. I looked after myself and I’ve distilled what I did into this retreat to share it with others.

Somethings can’t be put off. Take this advice from the Dalai Lama when he remarked that Man (as in, mankind) is in fact the most surprising thing in this life:

“Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

It’s important to start NOW. Look after yourself. Protect your mojo.

If you want to get moving more. Reconnect with a dear friend (or the family), now is the time to make a change that you’ll thank yourself for later.

I’ll see you in Bali.




What is a Therapeutic Immersion?

As the name suggests, an Immersion means going deep down into something and surrounding yourself in the subject. Think of how you might immerse a Tim Tam in a cup of tea and use it as a straw, sucking the hot drink through it. The tea permeates the whole biscuit, softening the crumb and melting the chocolate.

A Therapeutic Immersion in this case, means completely immersing yourself in your health and wellness journey. It involves completely surrounding yourself in a nourishing environment in every sense so that all the nourishing practices permeate through you to the deepest depth. It is the combination of  healthy food, therapeutic yoga, time to unwind and the use of bodywork to help address physical obstacles and restrictions within your body that are in your path.

Why does a Therapeutic Immersion work?

Aristotle apparently once said “the whole is worth more than the sum of its parts”. He recognised that it is much more powerful when all components exist and work together side by side, rather than as separate entities. Just as a working car is more useful (to most of us) than a pile of car-parts. An intelligently and individually designed Yoga practice can have amazing health benefits. So if you  combine it with healthy food, beautiful and tranquil surroundings, sleep and down-time from our face-paced life and you have just supercharged the benefits.

How the Immersion works

A Therapeutic Immersion is an effective way to kick start change because it gives you an opportunity to change things up from the “normal”. You are suddenly in an environment where you have a distinct lack of excuses as to why you can’t do what YOU need to.

You are participating in “Deliberate Practice” – ConnectTherapy allows us to break down your movement goals into bite-sized chunks and train you to move differently. This may wake up new muscles and work them in a way they haven’t been worked before.

And it helps you break habits you didn’t even know where there: instead of just running through the motions of your regular work-out or Yoga practice or daily routine, you are suddenly in a novel environment and you are getting the opportunity to experience new ways of doing things. New routines. Or a break from the old ones.

Who benefits from a Therapeutic Immersion?

Anyone who wants to move better, feel healthier or take some down-time are perfectly suited to this program. There are no pre-requisites.

If you’re feeling like your mojo has taken a holiday without you (I’m looking at you self-employed business-owners) this could be the recharge you need (and for Yoga Teachers, this could mean CPD points too!).

Basically, if you’re unsatisfied with how your feel or how you move, then this program is for you.

What happens on a Therapeutic Immersion?

This is what you can expect from one of my Therapeutic Immersion programs.

Day 1

  • Arrive at our venue, settle into your room and acclimitise.
  • If you are taking the Therapy Stream (Chikitsa), you will have your 60 minute ConnectTherapy Assessment
  • Welcome Yoga Class
  • Welcome Dinner

Days 2 & 3

  • Morning: Group Yoga Session
  • Breakfast
  • If you are taking the Therapy Stream (Chikitsa), we will spend 60 minutes in a ConnectTherapy treatment session which will include hands-on bodywork and releases
  • Free time during the day: swim in the pool, or perhaps rest, relax & read. You may choose to visit local markets or participate in cooking classes or other cultural activities. If you are bringing friends or family, take the time connecting.
  • Lunch
  • Late afternoon Yoga Session
  • Dinner
  • Optional evening program, exploring further yogic techniques such as meditation, breathwork (pranayama) and philosophy

Day 4

  • Morning: Group Yoga Session
  • Breakfast
  • Farewell



Your next step…

Go to www.emilyeglitis.com.au/bali for all the details of our current Therapeutic Immersion. Email emily@physiyogastrath.com.au to book your place today. Due to the personalized nature of this program, numbers are strictly limited.