The reception is very nice at PIMS. We got name and phone number of the driver that picked us up from Mumbai. Dr. Deepali met us at arrival to PIMS and she is also coordinator for the SCI-unit and the one making our schedules and taking care of us during our visit. 

We were accommodated at the International Hostel and have one small apartment each. It includes a room with small kitchen corner with a fridge and water kettle. We have bathroom and shower with good warm water (all roofs are covered with solar panels) and a balcony. Good living circumstances. We get 50 hours of internet from the hospital, if we need more, we pay for it. Internet connection is usually pretty good, but with occasional interruptions. I pay 5000 Rp/month for the room since I am employed, and we buy our food at the hospital Food court or in the village. Food and travels are relatively inexpensive in India.

We had a very interesting and extensive tour around the hospital and visited several wards and clinics. During the first week we also had meetings with the Head of several clinics. 

All teaching is done in English which works well with the teachers, students and most of the staff, some nurses at SCI-ward only speak limited English. I am used to work and teach in English, but occasionally the Indian pronunciation is difficult. However, conversations with patients were harder. Out of the 8 patients we had admitted now, only one speak some English. However, we should always have somebody with us to enforce continuation of training which limits the language problem, but patient counselling is difficult when we do not exactly know what the staff are saying when they interpret.

Indian culture is very different and exciting and people here are so proud of their culture. I have been in India several times before and have worked in other middle-income countries, so the culture crashes are not as evident longer, but they were there initially for sure. The Indian tradition celebrates a lot. During the time we were here, the “culture week” went on. The inauguration was grand with speeches and performance by the students and sport competitions. The next day was traditional dress day where many had the most beautiful Saris and other traditional clothes. The day after were costume day where student, with huge creativity, showed up looking as Bollywood stars and famous cartoons.

Differences in culture have to be taken into account when goals are set, patient counselling is done, during some assessments and in training. With time we sometimes realize that we mean slightly different things when for example talking about independence. It is slightly harder to address sexual issues compared with Sweden. Families, mainly mothers and wives, are present in all care and rehab, and including them in training in not helping to much is an important part. 

During this period is was a lot of cultural events going on under the Culture week. Performances by teachers and students, different clothes days etc and we were invited to most of it.

We were invited to go with medical interns on a camp in a nearby village where all schoolchildren were screened both medically and dental. A very interesting experience.

We rented a car and driver and went to Ellora caves situated about 2 hours away from Loni. A fantastic place with old Hindu and Buddhist caves with wonderful inscriptions. We also took a rickshaw to Shirdi, the holy city, and visited the temple, had lunch and did some shopping.

We were invited for some dinners at colleagues houses which is very nice. Great hospitality. One dinner we were also invited by CEO of PIMS and we could wear our Saris, which seem very appreciated here. We did need help to put them on correctly though.

At the university campus there is a gym that I went to sometimes. Otherwise, we mostly went for walks in the area, the market and for lunch or dinners outside the campus. Good food is easy to find but often is it very spicy. 

This is a great experience, both to teach and work in this different kind of set-up. Also, to live in a different culture and find your favourite places, coming into an everyday rhythm and get perspectives on our lives in Sweden. I recommend everyone who is interested in trying something new, learning to know new cultures and getting other perspectives on work and life to apply and go. 

Many activities related to the SCI-ward took place and a long-time cooperation regarding SCI rehabilitation is planned for. Some examples of activities were:

-          Attempts to ensure availability of inexpensive technical aids have been one of things I have prioritized. We met with the only occupational therapist at the hospital who is heading the orthotics unit. Written instructions and examples of wheelchair gloves, universal cuffs, slide boards were handed over to him and he made copies. He also ensured that they will be able to make individualized orthotics for the patients to purchase.  Additionally, we established contact outside the hospitals and made a wheelchair cushion.

-          We initiated weekly staff meetings with the SCI staff, worked on structure on team meetings and family/patient meetings.

-          Outdoor activities with SCI patients were initiated and will continue with the team. Outdoor community training, transfer from wheelchair to rickshaw and car and gym training. This has been appreciated activities both from patients, relatives, staff and students. On earlier visits I have introduced basketball and tennis training which staff has implemented in the weekly schedule. 

        My cooperation with PIMS will continue during several year with continuing developing SCI- rehabilitation and teaching of staff and students. Research within the SCI area has been discussed and will very likely start in some time, however first the ward should be running more smoothly, and more new patients need to be admitted. 

I have visited PIMS 3 times before this time to start a spinal cord injury (SCI) rehabilitation centre at the hospital. The centre was initiated for approx. 1 year ago. During my previous visits I have trained staff, worked clinically with patients and lectured for students at different levels. Since about 6 months back, I am employed as visiting faculty at PIMS and my lecturing schedule has increased some since then. This time I went with a neurologist I worked with in Africa, Katarzyna Trok, and a colleague, Malin Andersson, to further improve the work at the SCI-unit. KT also went as LP-teacher, MA came for SCI-rehabilitation.

Going under the LP exchange programme was the first time for me, and the extra preparation were mainly to understand the LP program, structure and register as teacher. I got my schedule about a week before departure however I decide most of what to include in my lectures/workshops/training and what order to have them in. 

Visa and vaccinations are mandatory while other preparations were similar to my previous visits.  

It is always inspiring to work in different culture and PIMS is not an exception. It is good to see things from other perspective which also is useful with the increasing internationalisation of patient load in Sweden.

We always have a summery meeting in the end with the Principle, Neuro physiotherapists teachers and those from other disciplines that have been involved with the SCI-project, such as orthopaedic, respiratory, cardio and community physiotherapists. There we can discuss progress, challenges and future plans.

I often address my abroad experiences in my lecturing in Sweden, at KI physiotherapy education and at CBR course.  And of course, many of my colleagues and patients in Sweden are curious and I have presentation regarding my work in low- and middle-income countries for both staff and patients at my work place. The structure of World Café might be something I could include in teaching; however I am at this point only seeing the students at one time at KI.  

The structure of this teaching hospital, which I believe is common in India, is very different from what I am used to. The students have clinical training parallel with lectures, as I understand basically all the time, and are supervised according to a ladder-system from teachers to more advance students that supervise the more junior ones. Lecturing and treatment of patients is ongoing every day.

The teaching I conducted mainly regards SCI. I lectured and had workshops with the third year PT students, master PT- students and Interns. I also had one lecture for medical students. For the staff I previously have been lecturing on SCI, this time we had a certificate course on wheelchair assessment, adjustment, procurement and some outside propulsion skill training. During lectures I was usually by myself, however for workshops or clinical training with students often some of the teachers participate.

From the experience I had there before, my lectures this time focused a lot on expected outcome for SCI patient with different level of injuries, goal setting, expected neurological recovery and how to progress training. Students also asked for teaching and workshops on assessing the patients, which we then went through, both lecturing and as clinical workshop. Additionally transfer training from wheelchair to bed and floor, bed mobility, gait training and wheelchair assessment and skill training have been included.

The students are very respectful, they greet you respectfully and stand up when teachers come into the room, they participate well and seem interested and some ask a lot of questions which is good.   

During the morning sessions, the SCI-patients are at physio for training. I participate with supervising and expertise and work clinically together with neuro-teachers and neuro-students. This, I believe, is one of the most important teaching structures when they can understand the importance of different techniques and how to progress training to make the patient succeed in different tasks. I have been focusing on active rehabilitation where continuity and consequent training is paramount, for example during ADL and transfer training. I also participate in ADL training with nurses in the mornings. A focus on how to progress and adjust training for each individual patient was always present.   

I participated in the World Café with ACI related topics. This was an interesting experience and seems like a good structure for discussions.  

I did spend 23 days at PIMS this time and the teaching/supervising is an ongoing process during almost the full days. We work usually between 9-17 on weekdays and 9-13 on Saturdays. Some mornings I was there at 7.00 to work with the nurses to train them in ADL training.

This time I had approximately one lecturing every other day (10%) and one workshop every other day (10%). And every day a few hours of clinical teaching (40%). Between these hours, I spend most of the time having discussions with staff to improve the function of the SCI-unit and some with student that approach me with different questions or topics. On Saturdays I ran a certificate course/workshop with the staff on wheelchair (6 hours in total).