Physiotherapy Across Borders: Advancing Orthopedic Manual Therapy in East Africa

[00:00:00] Physiotherapy Practice in Kenya looks like is we have the public spaces, public hospitals, public institutions. In the public institutions, that is where a lot of Kenyan patient population go to. In those institutions there is very few physiotherapists to begin with, even very few orthopedic manual therapists. So you can find in the public space one is responsible for up to 60 or 70 patients.

[00:00:30] So today on the Hands On Hands Off podcast for AAOMPT, we have two really special guests. So we have Otieno Martin Ongwen from Kenya and we also have Mwajumwa Nakaziba from Uganda. So both of these guests are coming to us from East Africa. Mr. Otieno Martin Ongwen is a passionate physiotherapist from Nairobi, Kenya, currently the clinical director

[00:00:58] at Afia Africa Orthopedic Services. Mr. Ongwen has received specialty training in orthopedic manual therapy, cardiac rehab, pediatrics, neural rehab, sports physical therapy, cancer rehab, as well as modern evidence-based pain science. Mr. Ongwen stands out as a dedicated educator and a clinical mentor to a number of physiotherapists in Kenya and East Africa region. He occasionally teaches at the Kenya Medical Training College for the higher diploma in orthopedic manual therapy.

[00:01:28] Dr. Ongwen is a professional therapy program and was the first Kenyan to provide mentoring sessions for physiotherapists and other clinicians around the country. He stands out as a key contributor to continuous medical education to clinicians in Kenya and has been involved in bringing top educators from around the world to teach within Nairobi and different regions within Kenya.

[00:01:49] In addition to Kenya, Martin has been involved in different humanitarian programs within Kenya from training Kenyan runners on injury prevention and providing education, treatment of triaging patients in rural areas who cannot afford healthcare services. And it's for that reason that the Afiabora Mashanani Good Health in Villages initiative was conceptualized. And I have a quote from Otieno, otherwise known as Martin, that I would like to share with you.

[00:02:17] My passion for OMPT Kenya and the rest of East Africa, that we get to have more than a thousand clinicians who get to harness their clinical reasoning skills to improve the quality of life of patients in East Africa, especially in rural environments where resources are scarce, and that patients get to save the little resources they have on improving other aspects of their lives.

[00:02:38] To have physiotherapists trained in OMPT help bridge the gap in glaring, help bridge glaring gaps in healthcare in the East African region from clinical practice, research, leadership, technology, and innovation, and the prevention of the steep rise of non-communicable diseases. So I had the pleasure of interacting with Martin at a conference. And so I'm so happy that he's here today. And I'd also like to welcome his colleague, Mwajuma Nakaziba from Uganda.

[00:03:08] So Ms. Mwajuma Nakaziba is a strong advocate for physiotherapy and women leadership in Africa from Uganda. She's a clinical physiotherapist and holds a bachelor's degree from Mwajuma Nakaziba, University of Science and Technology. As a clinician, she practiced general physiotherapy, but with passion and postpartum rehabilitation. Currently, she is pursuing dual programs.

[00:03:32] So an advanced diploma in pelvic and reproductive health at Amriff International University, Nairobi, Kenya, offered by the Jackson Clinics Foundation. Concurrently with a master's in business administration with specialization in project management at University of Europe for Applied Sciences at the Berlin campus.

[00:03:54] She has previously been a presenter at the World Physiotherapy Congress Online 2021 and panelist at the IFAM to Basel in Switzerland in 2024. Additionally, she holds various leadership roles in the profession, currently serving as the secretary general of the Uganda Association of Physiotherapy, as well as the public relations officer of the East Africa Community Physiotherapy Organization.

[00:04:21] She's driven many activities that have led to the growth of physiotherapy in the East Africa region. Through the regional collaborations, she has spearheaded the implementation of higher national diploma specialization courses in Uganda, such as orthopedic manual physical therapy. And a quote that I asked her to give us about her passion for OMPT practice is the following.

[00:04:44] I find fulfillment in helping people reach physical abilities to maximal potential, but also the fact that I can collaboratively help them address their individualized needs with designed, personalized treatment plans, while creating a source of empowerment for them to have control over their health. OMPT practice in my country is the most popular in our practice, but non-existent in terms of the clinical specialization.

[00:05:10] Despite this, there is a lot of potential for growth since most of the physiotherapists are drawn to treatment techniques within this field, which they try to adapt, but still limited because of high patient workloads, limited resources, and clinical expertise. So at this time, I'd like to bring to the podcast our two very special guests.

[00:05:39] So welcome to another episode of Hands On, Hands Off. And just to remind you, the Hands On, Hands Off podcast is through the American Academy of Orthopedic Manual Physical Therapists. I am very excited today. I have two guests that are from abroad. And so I'm really excited to just have us bring in some guests from some other countries to hear a little bit more about what physiotherapy looks like in different areas.

[00:06:05] To give you some context, I met Anguen at the IFOMT conference, which is the International Federation of Orthopedic Manual and Musculoskeletal Physical Therapists. We were in Basel, Switzerland, and I was trying to hang my poster and I was doing it very poorly and it was falling and I was frustrated and I was late.

[00:06:31] And Otieno came up to me and started helping me to hang my poster. And from there on, we struck up some conversations and I was able to actually go to his session at IFOMT, which I'm going to let him and Mojuma tell you a little bit more about. But I was fascinated by what they were talking about. And so we were able to reconnect and bring them onto the podcast. So I'm going to turn it over to the two of you. So Otieno, why don't you get us started and just tell us a little bit about yourself and who you are, and then we'll move on to Mojuma.

[00:07:02] Awesome. Thanks, Amy, for the invite. I'm really excited to be here. Yeah, it was a nice meeting at IFOMT. And yeah, my name is Tieno Machinongwen. I am a physiotherapist out of Nairobi, Kenya, currently in Oslo, as we speak. And I wear two hats as a clinician and as an educator.

[00:07:29] So I teach as well as see patients. So trying to balance between the two. I work for Afriacar Orthopedic Services. And what we do, we basically do continuous medical education for physiotherapists, but also go to rural villages in Kenya to educate, try and treat patients with non-threatening musculoskeletal diseases.

[00:07:59] So that's a little bit about me. Wow. Well, thank you. And so what is the context of the education that you're involved with? Yeah, I teach mostly at the Kenya Medical Training College, different hospitals in Nairobi, both private and public hospitals, as well as local universities that we have in Kenya, like AMREF, JQuat.

[00:08:25] So anywhere that I'm invited to speak about orthopedic myotherapy, I'll definitely go. Great. Mojuma, let's hear a little bit about you. Thank you. Thank you, Ami. Thank you, Martin, for a great acquaintance. And I'm glad to be here with all of you. I'm Mojuma Nakazira, Secretary General of the Uganda Association of Physiotherapy, which is our national body.

[00:08:50] I'm a clinical physiotherapist, but currently pursuing my master's degree in project management in Berlin, concurrently with my adverse diploma in sexual and reproductive health at AMREF International University in Nairobi, Kenya.

[00:09:10] I've been a clinical physiotherapist for the past four years, but also very active in my organizational work back home, basically for affronting advocacy for physiotherapy in Uganda. Okay. Okay. Wow. Thank you. I mean, I think you said, Otieno, that you wear two hats. It looks like you wear four. And I think Mojuma might have you beat. It sounds like she wears five hats. You both are very involved in it.

[00:09:41] So I'm going to start with a question. Can you share a little bit about your journey, your background and your journey into physiotherapy? And what drew you both into this field in your respective countries? Should I go first? Should I ladies first? How about ladies first? We'll do one of those. Okay. Um, basically my physiotherapy journey was more like a blessing in disguise.

[00:10:08] Actually, I didn't think I would ever become a physiotherapist. I didn't know about physiotherapy as a high school science student back in Uganda. We were only aware of becoming a doctor, a nurse or a pharmacist. So when I was unable to get the right grades to enroll me into a public university that I really wanted,

[00:10:33] I was a little frustrated and my parents were advising me to wait for the following year to enroll. Maybe the points that the public university required, I would meet the points, but that wasn't the case. I didn't want to wait for a four year. So luckily enough, through my father's networks, I didn't know how he came across someone from a public university and they told him about physiotherapy.

[00:11:00] But he still didn't explain to me what exactly it was. So I just ended up getting an admission for physiotherapy into Mbara University. It's in the southwest of Uganda, one of the best medical universities, which I was happy about.

[00:11:18] But I was still not content because for the first one month at the university, I kept running between physiotherapy and laboratory technology until when the program administrator advised me and told me, no, you need to make up your mind. I stayed in the physiotherapy class for about two or three weeks. I'm like, maybe let me just keep on.

[00:11:42] And when I had my first anatomy practical, it was quite interesting for me. So I say maybe physiotherapy could be the thing, but my passion drew later when I started the clinicals and I was having more interactions with people. And that gave me an eye opener that they still need for people to know about physiotherapy in Uganda.

[00:12:09] And this drew me to actually enroll and engage in the organizational activities at a national level to advocate for the profession. Yeah, that's that's fantastic. And I was reading the white paper that you both had sent along, which talked about some of the limitations in your respective countries. And it was, you know, I commend you for what you were doing because it's so it seems still so early in Uganda.

[00:12:36] You know, physiotherapy still has a way to go in terms of getting people enrolled and, you know, making sure that it's it's sustainable in terms of getting people into kind of that orthopedic realm, which we'll talk about in a few minutes. But I love that story. It sounds like you weren't quite sure, but then the path maybe found you. So, Otieno, what's cool from you about kind of your journey into physiotherapy in Kenya?

[00:13:03] Well, a lot of my journey has been inspired by my mom. She is my first physiotherapy mentor, educator, as well as guide. And ideally, the goal was to be a neurosurgeon. But then as well, getting into medical school in Kenya is very competitive and very difficult and didn't have the best grades in high school.

[00:13:28] So I decided, let me join something that is related and close to the medical field as much as possible. And once I joined the physiotherapy school, I figured I think this is way much better than, you know, opening up people's skulls and, you know, looking into their brains and getting them back into their, you know, good quality life and getting them back to what they enjoy doing the most.

[00:13:56] So I was like, yeah, I think this is the best profession that I get to still be within the medical realm and still provide the best quality services for the patients that I get to see on a day to day basis. Yeah. So that's technically my journey as a physio. And here I am today. And here you are today.

[00:14:20] And so since you're already, you already have the stage, can you tell us a little bit about what it, what orthopedic manual physiotherapy practice looks like in Kenya? And I feel lucky that I got to hear you speak at the international conference. So I got a little bit of a flavor of this and it was just really eye opening to me to recognize how different, you know, practice can look and what some of the limitations are in different countries. But tell us a little bit about what the practice looks like in your country.

[00:14:50] Yeah, well, orthopedic manual therapy ideally started around, let's say the first, the first cohort graduated in 2020, 2012. Myself, I was in the second cohort graduated in 2015. So it's still very new and a very new area of specialization within the physiotherapy profession.

[00:15:15] So it was started out, you know, by the Jackson's foundation. Richard Jackson was one of the lecturers at the Kenya Medical Training College about the inception of the college, which was in the 1980s. And I went back to the US, came back to Kenya after some time. And looking at the profession, there was a need for an introduction of specialization into the training.

[00:15:45] And after a lot of debate and a lot of looking into what is the best entry point for specialization, they decided that orthopedic manual therapy was going to be the one that they're going to start with. So that is how it did start around that time. And ideally, it's what they did.

[00:16:10] They took the orthopedic residency program that is similar to the one in the US where physiotherapists already who have been practicing or who had just recently graduated. They went back to school again and did both deductive and inductive training where you had a bit of online training of the program and practical classes.

[00:16:38] So every module, so the classes were divided into different modules where we had foot and ankle, hip and knee, and every module had like two weeks or two week period of time where people came into school after studying online for like around three months. And we came in with our patients and we came in with our patients as well. And it was heavily practical skills that we were learning.

[00:17:07] And they did bring different lecturers from the US into Kenya for the two week period that we were in classes. So that is, it's pretty similar to the orthopedic residency in the US.

[00:17:23] But since the bureaucracies of training in Kenya, they couldn't introduce it at a university level, they had to introduce it as a higher diploma in the college in the Kenya Medical Training College. So if you, there's very different politics surrounding healthcare.

[00:17:44] And one of the major challenges was trying to introduce advanced training into university, yet we did not have a bachelor's degree at the time that is already training physiotherapists. So that is technically how the journey of orthopedic manual therapy started. And was it hard to find physios that were interested in pursuing the advanced training?

[00:18:11] You know, is that something you were a part of, which is trying to grow interest and educate people on what it means and how it could change practice? What was that like? Yeah. In the beginning, it did take a lot of convincing. Well, technically for me, I think it was pretty easy for me to just join the class. Because I was already two years into practice as a physio.

[00:18:41] And back as a student, I always kept wondering why are we treating patients for 15 years with back pain? You know, why are we doing the same procedures of treatment that are not working? What is it so special about physiotherapy? So I was at the point where I felt like, you know, physios are not technicians. We are not people to just put tents, hot parks, cold parks.

[00:19:10] You know, if you look at the referral pathway of what physios looks like in Kenya, you know, you have a doctor refer patients to you with a list of instructions. And with those, we still kept treating patients for as long as 10 years, you know, so you had patients as huge as this. Wow.

[00:19:30] So I was like, okay, I need to figure out what is it in physio that we can do to improve the quality of our treatments and the lives of our patients. So it was easy for me to go back to school. Yeah. But we had to do a lot of convincing for other physiotherapists to join.

[00:19:53] And, you know, there was that notion that why are we being trained, you know, by foreigners, you know, and what is so special about this foreign type of training that we don't have here, you know? Sure. So that was, it wasn't, it wasn't easy to build up the numbers, but we did a lot of work in trying to do free continuous medical education in different parts of the country.

[00:20:20] And people were like, oh, wow, you've only seen this patient once and there's massive improvement. You know, what, what is it that you did? And then I was like, yeah, I went back to school. And if you really want to know more a lot about what we did is you, you have to join the bandwagon.

[00:20:38] So after a series, after, after the first three cohorts graduated, people started, you know, patients, you know, when patients start to say, I want to be treated by so-and-so, the other physios were like, okay, what, what does so-and-so do that is different from what I do? So yeah, they joined the orthopedic manual therapy class. So you guys should also join the training. And that is how we started spreading the word.

[00:21:08] And today we at least have around 200 graduated orthopedic manual therapists, which is a good, it's a good number for us that. Wow. I love that. So Otieno, can you tell us a little bit about what some of the biggest challenges are that you face in developing further OMPT practice in a, in a lower resource country like Kenya. Can you tell us a little bit about that? Yeah.

[00:21:36] One of the biggest challenges is technically a lack of resources, I would say, in both clinical educators, clinical mentors, research and an avenue for continuous medical education. So, since orthopedic manual therapy is growing.

[00:22:00] I mean, the, the, the, the, the Jackson's foundation is still involved in the Kenyan context where we still have the higher diploma in orthopedic manual therapy at the Kenyan medical training college still ongoing. And we have intakes still ongoing as well. And the, the program has since transitioned from the Kenyan medical training college to a university, which is AMREF.

[00:22:25] So, since it's a university, it makes it a lot more lucrative, you know, cause then there's a question of, um, where would I join a higher diploma yet my salary scale still remains, still remains the same. Right. So, one of the motivations for people to go back to, uh, to go back to, uh, to school is because for one reason or another, they, they, they want an increase in their pay rise, right?

[00:22:54] Right. They want their quality of life improved by the education that they get. So, um, for a long time that has still remained the same. So, uh, technically that's, that's a different story, but it's still one of the challenges is despite getting into continuous medical education, spending time and resources to advance education in the field, we still remain at the same salary scale for physiotherapists, especially those working in government institutions.

[00:23:22] So that becomes a demotivating factor, but the fact that it has moved through a university, it makes it a little bit easier for the bureaucracies and policy makers to decide that, Hey, that is an advanced education. And with advanced education comes, um, a higher pay, but still there's a lot of people working in the background to try, you know, and improve, you know, talk, talk around with policymakers, but yeah, a lack of resources.

[00:23:52] Yeah. We need more clinicians coming in and this is, um, ideally, uh, it's not the same as in the U S where there's a lot more continuous medical education platforms, both online and in-person platforms where physiotherapists can always go to number one, upgrade the skills that they already have. Number two, remind themselves about what some of the things they forgot, you know, you know, with, with, with, with practice comes redundancy, right?

[00:24:20] So we tend to be, we tend to remain to some of the old, uh, methods that we, we tend to use. But if, if you have, um, platforms where we are continuously reminded to improve, uh, we are continuously reminded that there is new research out there that, uh, has come out to improve, uh, managing food and ankle pain, for example. Yeah.

[00:24:47] So those are some of the areas, you know, research, a lot of resources, a lot of, um, uh, a lot more clinical educators in the field. And also, uh, one of, one of the biggest challenges as well is we had people come in to upgrade, to do the orthopedic manual therapy training program.

[00:25:06] But then after, after all these, um, months, uh, hours of clinical training and practice and learning, when they went back to the institutions, they were taken to the Barnes unit. They were taken to the, uh, pediatric unit. So it's, it's, it's, it's the transition of the transition of knowledge from all the, all the knowledge that you've amass.

[00:25:31] And then you go back to your institution and then you're taken to a department that does not foster, you know, your skills, uh, and training. Then it becomes, um, it, it, it becomes almost like, oh, I just have another, another certificate to my name, but it does not translate to clinical practice.

[00:25:52] So those are some of the challenges and also, um, a lot of times, uh, if you look at the motivation of why people go back to school or continuous education is the manufacture, right? Once they get a promotion, all they needed was to study a little bit more, get promoted. And then after that, they go back to either managerial skills. So there's a lot, there's no transition of knowledge and skills into practice.

[00:26:22] So those are some of, those are some of the challenges that we face, um, in the orthopedic manual therapy space. And you're right. That's a big, that's a, a big challenge. If, if you're finding the people that want the advanced training and the education, but they're not going back into a practice setting that allows them to utilize the new skills and grow the new skill set. And that's, um, it, it, it almost stops there.

[00:26:45] So, um, I mean, that, that sounds like a, a, a, you know, a difficult thing, but it's, um, you know, important to hear about what some of those challenges are. Mojuma, what are some of the biggest challenges that you face in developing on PT practice, uh, in Uganda? Um, of course, the biggest challenge is the resource constraint. Um, we do not have, uh, resources to advance our trainings.

[00:27:10] And currently even the few therapists that are interested in knowing PT have to go to Kenya to study. And like, there are lots of costs that they have to incur just to get this kind of specialized training because we don't have it available in all the institutions in our country.

[00:27:30] Uh, but, um, looking at the other side is even the basic facilities sometimes do not have the necessary equipment, like privacy in their spaces. So people cannot even practice the hands on or MPT because one is having a small physiotherapy clinic and maybe just one bed, no curtain. So you're limited to even do the basics that you can know, or know how to do.

[00:27:59] But the huge and most biggest challenge is the high, high patient therapy ratio. Uh, Uganda has a population of over 48 million people, and we are just 500 therapists in the country. So sometimes you would want to deliver quality individualized care, but you're limited.

[00:28:20] You cannot do your manipulations for, to get the effective or the efficacy of the treatment because you need to see maybe eight or 10 patients in just maybe four or five hours. And even if you look at the private facilities where people have to still pay for the service, uh, either way, like you're going to find maybe one or two therapists because the facility cannot afford to pay more than five therapists.

[00:28:49] So that's one of the biggest challenges. And, and Otiano, can you, one of the things I found interesting, uh, at your presentation, um, and I found was just talking about the volume of people that you could potentially see that you don't necessarily have time for. So what are some of those, um, you know, examples of what practice looks like in a, in a day? Like what, what does that look like for you if you're, if you're treating people? Yeah.

[00:29:16] Um, um, I, I was, I was a little lucky cause I was in private practice. Um, and, uh, so, uh, if you look at, if you look at how, um, uh, uh, uh, physiotherapy practice in Kenya looks like is we have the public, uh, public spaces where public hospitals, public institutions, um, in the public institutions. Uh, that is where a lot of the Kenyan patient population go to.

[00:29:43] And, um, in those institutions, as Mwajuma has mentioned, there is very, very few physiotherapists to begin with. Uh, even very few orthopedic manual therapists, uh, to add on top of the few number of physios in general. So, uh, you, you can find, uh, in the public space, one patient, um, is responsible for up to 60 or 70 patients.

[00:30:09] Now, the, the, the, the thing about orthopedic manual therapy in the outpatient departments was since the clinicians were trained on, um, good clinical judgment skills, there was very minimal time in, in terms of kind of like deciding, you know, clinical pattern recognitions.

[00:30:26] What, what could this be so that we had actually a very good improvement of pro still treating a huge volume of patients, but still becoming very precise at what they needed to do for this patient for efficiency purposes. So it was, it was, it was, it was great in that sense that we had, uh, clinicians who were trained in orthopedic manual therapy, very good at kind of like,

[00:30:50] picking up clinical patterns, um, addressing, picking up one of the most, the main challenges for patients and addressing that within the timeframe that they had. So we had an increased number of, uh, you know, patients being seen. Ideally it's, it's not ideal to see 60 patients in a day or seven patients in a day. No.

[00:31:12] But I think it's, it's, it's ideal that if I'm seeing 60 patients in a day, I have within that short period of time, the best, you know, clinical reasoning skills that I can utilize to help that patient within that short period of time. So it was, it was a win-win, uh, for, for, for one of the major, I think one of the major hospitals, uh, in Kenya, the Kenyatta National Hospital. Brought in around 10 physios to be trained in orthopedic manual therapy.

[00:31:42] And the 10 physios were put in the outpatient, outpatient department, which led to, um, you know, patients saying, uh, you know, we, we are getting way much better. You know, the, the physios are efficient just because of the training. But of course, as, as, as, as we mentioned, you know, sometimes some of the limitations is we don't have enough, um, support from the institutions that we work with to enhance.

[00:32:12] The training and the skills that we've received as orthopedic manual therapists, but in outpatient, in outpatient private clinics, you, you have enough time with your clients, you know, and, uh, uh, people you, you can, you can manage your. You can, you can, you know, schedule as, as you wish so. But in the private, in the, in the, in the public institutions, it becomes a little bit difficult with, uh, planning. But it sounds like if there's, it sounds like there's more recognition, like it's starting.

[00:32:41] Is that true where it's starting to be recognized that if you train physios in this area, maybe that they're working through patients more efficiently because they're exercising clinical reasoning. And like you said, recognizing clinical patterns. Is that something that you think is, is starting to happen in Kenya? Oh yeah.

[00:33:01] Um, there is, I mean, there's, uh, one of the things that, uh, the Richard, uh, Richard Jackson Foundation did was do research based on the students, uh, that had graduated through the orthopedic manual therapy program. And, uh, that, that was the, the skills before and the skills after and the improvements and adjustments that they had had after the training. So we have massive, massive improvements.

[00:33:29] And it's not the main, the main area is patients coming back and saying, I don't know what, I don't know what you did, but over the last 20 years, I think what you did was what I needed, what I needed for me to get better. So the patients themselves started saying, uh, we are getting better.

[00:33:52] We want to be treated by so and so, and the hospital was like, okay, if this is the lot that is making the patients get better, then this are, this is a lot that needs to be in the outpatient department where most of the musculoskeletal conditions are. So we have had, um, a big improvement in terms of number one, patients selecting actively selecting. I want to be seen by so and so. And number two is the institution starting to recognize that. Oh, okay.

[00:34:21] We actually have physiotherapists who are really skilled at, uh, you know, managing some of the caseloads and even the doctors now are starting to refer. It just goes, it just goes to the physio, just go see the physio.

[00:34:35] So it is, it is starting to, it is starting to like, I mean, over the years it has tremendously improved, but we had to do a lot of work of going to, uh, different rural areas in Kenya to, you know, talk about continuous medical education, talk about clinical pattern recognition in foot and ankle pain, for example, low back pain, neck pain, and also decided to go to Uganda. So that's where, you know, physios are like, okay.

[00:35:03] I mean, this testing is boring. Let's do a lot more clinical reasoning stuff. So it's, it has grown tremendously. I would say. And we, we say sometimes even in the States that the patients are our best marketing, right? Um, cause they talk to each other and they say, you know, this is what my experience was. I want to pursue seeing someone that has that training. What Juma, what's it like, um, in Uganda?

[00:35:27] So like, like a little bit of a day in the life of, of working in OMPT, uh, practice or using OMPT in practice. What's that like in Uganda? Uh, well, I was also lucky I was working in a private setting, but I got, I used to visit some of the public, uh, settings. Usually in Uganda, um, for example, the national referral has like 10 therapists who are general physiotherapists, not OMPT therapists.

[00:35:55] So each of these 10 therapists is going to have a case load of over 20 to 30 people to see. And this is because the service is free. And sometimes these people are coming from very far away and they cannot go back home. So you're probably having maybe eight hours of work and you need to see 20 people. So what happens? Maybe today a patient is going to get on an infrared.

[00:36:21] You're not going to get time to do a manipulation that would be really effective. So you could do an, some electrotherapy, teach them one or two exercises and tell them to go home, give them the next review. But, um, it's quite challenging because of a high, the number of patients is high, but the physios are very few. And when you come to the private settings, patients would love to access the services, but they are really expensive.

[00:36:50] So everyone has to opt for, uh, for the free services. And then when we look back down to the communities, our policies and guidelines, our national policies have not yet allocated for physiotherapists in some of the hospitals at the lower community level. So, uh, physiotherapy services are still limited to the national referrals, regional referrals.

[00:37:18] But our scheme of service is being reviewed and maybe hopefully we'll have physiotherapy at the local health centers. So it could cut down the number of patients that are coming to the national or regional referrals and maybe improve the quality of care being delivered. But hopefully it's just in the pipeline. And for that orthopedic manual therapy, no specialists yet.

[00:37:45] So we all just, um, get a few trainings. For example, if, um, uh, we have conferences, workshops, you learn one or two skills here and there that you can just implement. Plus the knowledge that you gain during your studies. But. So it sounds like people are learning skills, but it's not, the training isn't maybe more as formal. And so you're learning skills and trying to implement those in your clinic flow with your patients. Is that kind of where the, the state of things are now?

[00:38:16] Yes. Yes. For those that are very passionate about the different fields of specialization, you know, you use the online, um, materials from, for example, physiopedia. Uh, most of our guidance are enrolled into physiopedia, uh, any, uh, workshops, trainings, exchange programs, but we do not have it certified in our system yet. Because even the therapists that are enrolled in AMREF, like my program that I'm studying.

[00:38:45] I'm not sure if it's going to be accredited in my national system, but we are optimistic because we have, um, East Africa community kind of thing as the countries in the region. So maybe our policy makers would benchmark later on and then can accredit us into the system, but nothing concrete as yet. Because of the profession we are growing.

[00:39:16] So, so it sounds like it's still in its infancy and it, uh, it sounds like you're getting some leadership and some training resources from, from Kenya. Um, due to the, you know, how close the two countries are. Is that right? Martin or, or, or Tiano, are you able to kind of share resources with, with other countries that are still trying to kind of catch up and implement more OMPT practice into their workflow? Martin Ortega Yeah.

[00:39:42] So part of what we started doing, um, as Africa was just, you know, go to different countries. We started with Uganda actually. So we, uh, um, we did massive, uh, trainings in continuous medical education in, uh, very different hospitals and rural setups in Kenya. And that got physios excited about the training and about the orthopedic myelther program. And then we were like, okay, I think we need to start moving out of Kenya.

[00:40:12] So we started with Uganda, went to Rwanda, Tanzania. So, um, every time I'm back, uh, back home, um, ideally we would like to travel a lot more to different countries within East Africa to do the continuous medical training.

[00:40:26] But, um, for physios, you know, just to provide, uh, little, little snippets, we wouldn't, we wouldn't provide certification courses because it's, it's, it's technically what we have, like the weekend courses in the US where you come in, uh, on Saturday, uh, do a couple of, uh, learning, uh, clinical skills, uh, training within the weekend. And then we leave.

[00:40:52] So, um, but then that, uh, you know, it's, it's better to start that way than, you know, just have online, online classes where a lot of the physios, um, in East Africa utilizing. So we, we are trying to do a lot more training in different countries in East Africa, but we don't have enough resources to do it. If we had enough resources, we would have done a lot more countries as well. Yeah.

[00:41:19] And so what, as we kind of wrap up, I do have a quite, one of my questions is what do you, what are the next steps for really advancing OMPT in, um, countries like Kenya and Uganda? And I'm sure Mojuma's answer is going to be a little bit different, but what do you, what do you need to advance it? And what are some of the supports that you need from the global community in order to do that?

[00:41:45] And I realized some of it is, is, you know, inherently based on the health systems that you have in your countries, which are unique, but tell me a little bit more about that. Yeah. Uh, well, ideally first, um, is the, the easiest option is to start online, uh, trainings and mentorship for the different physios. Um, and I still do this.

[00:42:07] I try to, uh, and at Africa, we still, we, we try to link different physios across the globe with East African physios. So we try to look for physios who are interested in particular topics. And they say, I know someone who is doing women's health. Uh, would you like to match with them? So we are trying to do some sort of online matching with, uh, different physios who can mentor clinicians who are interested in certain topics within East Africa. Yeah. That is the online platform.

[00:42:37] Um, but one thing I usually do is I like to invite people home. So if I meet a clinician at iPhone or at the, the world physiotherapy Congress or, uh, social media platforms, I say, would you like to come to Kenya for a week or two or three days, teach a couple of physios in different parts of the country. Um, and through that, um, ideally we, we just need clinicians who, um, have specialties in certain areas. Sure.

[00:43:07] Um, and then, uh, what we do is we look for, we look for physios, the physios in Kenya who are interested in certain areas, the physios in Kenya who are interested in sports, the physios in Kenya who are interested in orthopedic immunotherapy, which already has a platform. So they just can join easily. And there was a lot of work that went into doing that.

[00:43:26] Um, but, um, what needs to happen is we need to have a lot more number one online platforms where physiotherapists can join to learn, um, that are not too expensive. But my goal is to have as many international physios come to Kenya for some time, teach, treat, interact with the local physiotherapists because to me that provides some sort of mentorship.

[00:43:55] I want to, I want to be like Amy, for example. I want to be like, uh, um, Brad, for example, you know, I want to be like so-and-so because, uh, that provides some sort of motivation for the physios. Yeah. Yeah. Yeah.

[00:44:12] And I think something that I think is important to having gone to other countries and taught myself is teaching the teachers, you know, not just teaching the physios, but teaching the educators, um, and giving them the tools so they can, you know, continue to, to teach physio students that the highest level possible for what's available in that country. Um, but I love that. I love that you already have this mentoring infrastructure in place.

[00:44:40] There's a lot of research about mentoring and how important that is in professional growth and, you know, um, people sticking with their profession. So I think that's fantastic. And I, I love that you just kind of go shopping at these conferences and find people to come to Kenya. Um, you're, you're a bit of a salesman. I'm learning, Oteno, but I think you have to be in your position because you're passionate about it. Yeah. Yeah. Am I right, Mojuma?

[00:45:10] Um, she's laughing. I just want to something. So Mojuma, I want to, I want to punt that question to you now. So what are the next steps for advancing on PT in your country? And what do you believe you need from the, from the global physiotherapy community? Um, first of all, I would just want to thank the whole, to be grateful for the regional collaboration of physiotherapists like from Kenya, Rwanda.

[00:45:39] It's been a very great stepping stone for us to add getting exposure about all these specializations. And, uh, currently we are just having two physios that are enrolled into the Jackson specialized program, but this was because of the resource constraint and other physios are reluctant because we do not have the program back home.

[00:46:06] Um, it would have been much cheaper if we can have that training, uh, in our country, the resources that we need for such trainings in our countries. I believe we would have more numbers of physiotherapists, uh, in order to become on PT therapists. But I think the other issue too is research is still, uh, the area of on PT is still under the same, uh, in the same time. Um, we have more research, uh, in the same time.

[00:46:36] We conduct research studies, but, but we don't get to publicize our research. So even our policy makers are not able to recognize the importance of the programs. They're not able to acknowledge why do we have to have on PT specialists in hospitals.

[00:46:59] So I think if we have more research and collaboration with the international community, especially in, uh, publicity and doing some projects, it would help you be the other thing that should be being a very big cornerstone in physiotherapy growth in my country. So if we can still have a channel mentorship for that, OMPT therapy, elevate our standards.

[00:47:31] Yeah. Yeah. Well, I mean, um, maybe, um, continuous, uh, continuous advocacy is what, and I would just like to appreciate this platform because I think if we continue advocating and, you know, going out to conferences, becoming salespeople like Martine, maybe we'll have OMPT girl. Yeah.

[00:47:57] And I think, I, I think it was so important that you brought your, um, your story to, you know, the international platform. And I know you've done that before, but I think it's so great because I, as a, as a clinician and an educator, my myself and a researcher, I think it's really important for us to see, you know, what the differences are and what practice looks like in other countries.

[00:48:22] And I also think it's important for us to, to move everybody together, you know, and not just, um, advance what we're doing in the United States, but share the knowledge and share the, the research and, um, and, and try our best to bring it to other countries because it's the right thing to do. You know, we're all in it to provide better care for our patients. And so I want to thank both of you. You're both leaders in, in physiotherapy and your respective countries.

[00:48:50] You're both trying to move the needle and improve, you know, access to the education and, um, you know, to, to really move OMPT practice in your, in your countries. And I want to thank you for all the work that you're doing. And I'm so glad that I was privy to hearing your presentation in Switzerland, because it really, um, impacted me and made me think a little bit differently about, you know, what we need to do as a, as a family,

[00:49:16] as kind of a global community to make sure that everyone is moving in the right direction. Um, so I want to thank both of you for coming on the hands-on, hands-off, um, podcast through AOMT. Um, it was really nice to have a conversation with you and I know it won't be the last. Yeah. Thank you for having us. Yeah. We, I mean, we, we, we could, we could share a lot more, you know, very, uh, specific experiences

[00:49:42] and now, you know, orthopedic manual therapy has been for, uh, most importantly for our patients. You know, that is to me, that is, um, the, the most ideal reason for going back to school is to ensure that you have, um, a lot more up your alley in improving patients' life, uh, that, that, that, that provides quality, you know?

[00:50:04] So, um, any, any, any, any, any form of education that goes into, um, improving the quality of lives of our patients through our clinicians, then that, that is something that, uh, we need to look into the future for, and it's not, it's not just orthopedic manual therapy. Um, it's, it's, uh, oncology rehab. Um, it's, it's looking, looking at physical activity exercise as prevention, you know,

[00:50:32] rather than cure because, uh, our health systems, our health systems are not even good at curing the sick. So we need to make our health systems, uh, very good at preventative medicine. And I, I believe physiotherapists have that opportunity to be the people at the forefront of preventative medicine. So. I totally agree with you. Uh, and I tell my students sometimes, even if you change one life, one patient that was

[00:51:01] impacted by your care and they can do something better or they have a better quality of living, it's totally worth it. Um, you know, we would love to reach more, but even if it's just a handful, I think it really matters. Um, so thank you. And the, yeah, the Richard Jackson foundation, uh, mantra is you teach one, you treat many. Um, and that is also one of the mantras that, you know, we use if you, if, if, if you guys

[00:51:28] come in and teach, let's say 10 or 15 physios, um, that is going to be, uh, you know, around, you know, 10 times 20 patients lives affected, you know, for the better. Yeah. So true. It matters. So thank you both so much. And, um, I know that we will, we will, uh, come together again soon and you're right. Oh, Tiano. There's a lot more that we need to talk about. So hopefully this is just the beginning.

[00:51:56] So thank you so much, uh, for coming.