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Multidisciplinary Study Tour of China and Tibet
The standards themselves may be sumrnarised as follows: 1. The organisation and development of clinical education placements should involve liaison between the clinical education providers and the schools.
2. The school provides the clinical education placement w i t h relevant information on the course, the placement and the students.
3. The physiotherapy manager provides the appropriate structure for the effective conduct of the clinical placement. 4. The clinical educator has sufficient experience and expertise t o fulfil the objectives of the placement. 5. The student receives sufficient inform-
ation to allow himiher t o comply w i t h the objectives of the placement. 6. The clinical educator undertakes preparation to fufil the objectives of the placement. 7. There is evidence of the student being fully integrated into the physiotherapy department.
8 . Within the first week, a learning contract is negotiated between the student, clinical educator and clinical tutor, which takes account of the particular needs of the individual student and the given parameters of the clinical education placement. 9. There IS evidence that the clinical educator fulfils the objectives of the learning con?ract
10. The clinical tutor fulfils the role as liaison person between the placement and the school. 11. An evaluation of the placement will be carried out by the student, the school, the clinical educator and the physiotherapy manager. 12. There is evidence of a programme designed t o review annually the appropriateness, applicability and suitability of the clinical education placements. A copy of the 'Standards for Clinical Education Placements' document, detailing the criteria which apply t o the above standards, is available from the Professional Affairs Department, Chartered Society of Physiotherapy, 14 Bedford Row, London WC1R 4ED
Multidisciplinary Study Tour of China and Tibet GRACE DOREY
MCSP
Physiotherdpy Mandger, BUPA Hofpitdl. Bu\hey WE believe this was the first British multidisciplinary study tour of hospitals and clinics in Tibet with our party representing six medical professions. The group included Dr Henry Doig (medical practitioner), Mary Doig (radiographer), Janet Pope and Aelethea Hill (health visitors), Susan Austin (social worker), Pat Hales (neighbourhood nurse manager) and Judy Woodford, Gave Jackson and Susan Walker who were Chartered physiotherapists. I was the tour leader. We arrived in Shanghai considerably jet lagged after a long haul flight via Moscow, and felt we might have arrived in China a little earlier by taking a slow boat.
Children's Hospital of Shanghai Medical University Our first visit was arranged to see the Children's Hospital of Shanghai Medical University where we saw a mixture of traditional and western medicine. In one room we saw a young child w i t h post-injection paralysis treated with interrupted galvanism (see picture right) while in an adjacent room we saw a girl being given deep Chinese massage to her neck, back and legs for stomach-ache (see photograph overleaf). We were pleased t o see some of the children wore glasses as during the first physiotherapy study tour of China last year w e were informed that children with poor eyesight were taught to massage the eye acupuncture points in order t o improve their sight. A t Shanghai University there is a threeyear training for physiotherapy students who are not doctors. Previously we had heard that doctors graduate and then train for a further year in physiotherapy. This research-oriented hospital offered an admirable preventive medicine and development control programme for children equivalent t o British regimes.
Physiotherapy, November 1991, vol 77, no 1 1
Quyang New Residential Area Our visit to the new residential area in the Hongkow area of Shanghai was extremely impressive. Modern, compact, 11-storey high-rise flats were linked by gardens and play areas. We were proudly shown the flat of a Residents' Association helper enjoying extensive views of the other blocks. Social welfare was undertaken by these helpers and we were fortunate t o be able to visit one of their kindergartens where we sat in on a delightful singing and dancing lesson by the reception class. On our way to Shanghai Airport, we were upset to see a burns victim paraded outside a temple, encircled by a crowd of curious Chinese.
Altitude Sickness In Tibet, the group displayed various symptoms of altitude sickness, having flown from Chengdu to Gonga, the highest city in
Chinese boy being treated with interrupted galvanism
the world at 12,000 feet. We suffered from dizziness, nausea, headache, dyspnoea, tachycardia, tinnitus, tingling extremities and epttaxis. Forgetfulness and word dyslexia became additional amusing complaints. Fortunately Dr Doig's advice, comfort and care proved invaluable. Treatment for altitude sickness included oxygen, diuretics, antiemetics, increased fluid intake, and most important of all, rest. Apparently, it takes six weeks t o acclimatise fully t o these heights. Dr Doig became increasingly concerned with the lack of warning from tour operators, and felt that more research was needed into altitude sickness, particularly for travellers arriving by air. Altitude sickness affected our people regardless of age or physical condition, although i t was naturally worse in those w i t h impaired respiratory function and because so many of our group displayed symptoms w e reorganised our programme of visits.
Tibetan Medical Hospital of the Autonomous Region A t the Tibetan Medical Hospital w e learned about Tibetan acupuncture where only one acupuncture point is used. A gold shallow needle is applied t o the top of the head accompanied by moxibustion and is used for a number of conditions such as hypertension. Cupping is performed for arthritic conditions, using a hollow yak horn by sucking rubber tubing attached t o the pointed end t o produce a vacuum. Faradism accompanied by Chinese acupuncture is applied t o facial acupuncture points to treat sinusitis and toothache. Nonluminous infra-red lamps are combined w i t h acupuncture as a treatment for low back pain and arthritic joints. The ancient art of cauterisation using a heated branding iron with a pencil applicator is still used for various joint conditions. These physiotherapy treatments are performed by nurses.
743
Left: Chinese massage for stomach ache
Right: Tibetan woman being treated with electric acupuncture for toothache
A t the Medical Institute in Lhasa, 3 0 doctors qualify each year after a three-year training.
Tibetan Medicine Tibetan medicine is based on the work of Yutok Yonten Gonpo ( 7 0 8 - 8 3 3 ) w h o compiled the medical manual The Four Medical Codices containing theories on p hy s i01o g y, path 01o g y, d i ag n0s is a n d treatment. Gonpo travelled extensively in China, t o India and t o Nepal. According to Tibetan medicine, physiology is divided into three areas - 'long' meaning vital energy; 'Chiba' meaning internal heat and 'Paigen' meaning phlegm. A n imbalance in any of these three functions causes disease. Observation, investigation and palpation, combined w i t h pulse reading, urine
investigation and questioning are an important part of diagnosis. In the 1 8 t h century Timon Tanzin Phyntsoka compiled a book listing 2,000 medicinal herb, animal and mineral treatments. Medical ethics are an important part of the training of medical students w h o are taught to love and respect their patients without discrimination, regardless of their financial position, sex or physique. Diagnoses are made without assumption or guesswork and there is considerable emphasis on continued training and improvement. Private practice with its attendant selfishness, greed and deceit is prohibited. The medical philosophy is beautifully painted and embroidered on t o brightly coloured silk 'thang-kas' or wall charts, and
covers the areas of embryology, astrology, anatomy, physiology, pathology, diagnosis, treatment, dentistry and herbal medicine. When we left China for the bright lights and opulence of Hong Kong, w e felt sad to leave this vast and magnificent country with its charming people and hoped one day t o return.
ACKNOWLEDGMENTS
To Louisa our delightful interpreter and guide, whose command of the English language was exceptional and who showed genuine care and concern for our problems. To the very special group who, despite illness, showed great courage, support and humour when conditions were less than perfect.
Abstract of Higher Degree Dissertation ~~
An Investigation into the Effectiveness of Energy Reclamation Equipment and some Design Implications for Hydrotherapy Facilities ALLEN HINDE MA BA PGDip(Des) MCSP DipTP CertEd MISM
Course: Master of Arts in Design Research for Disability, Disability Design Research Unit, Sir John Cass Faculty of Art, Design and Manufacture, City of London Polytechnic Housed at: Disability Design Research Unit
THIS project aims t o establish the place for energy conservation equipment in hydrotherapy pool management. A literature review established the ventilation requirements within hydrotherapy facilities and a computer model was designed to allow
the ventilation heat losses t o be calculated. On-site monitoring of a hydrotherapy facility generated data during the heating season (December t o April) which was used in the computer model t o calculate the heat losses and their costs, and which allowed extrapolation t o include the whole year. The model was then used to predict the heat losses and costs arising following the installation of a flat plate heat exchanger, and comparison was made between the t w o outcomes. Savings of approximately 60% were shown t o be expected when using heat exchangers, varying w i t h the size of the hydrotherapy room and its location within the United Kingdom. A questionnaire t o all District superintendent physiotherapists in the UK mainland brought a 6 3 % response and allowed baselines t o be identified against which the computer model could be compared, enabling the modification of predictions as necessary. Aspects of design t o maximise the advantages of installing heat exchangers have been illustrated, especially t o reduce heating costs, t o protect the fabric of the building from condensation damage and t o avoid physiological risks t o the users' health. Concept designs were drawn, and a scale model constructed t o illustrate the features.
2. The school provides the clinical education placement w i t h relevant information on the course, the placement and the students.
3. The physiotherapy manager provides the appropriate structure for the effective conduct of the clinical placement. 4. The clinical educator has sufficient experience and expertise t o fulfil the objectives of the placement. 5. The student receives sufficient inform-
ation to allow himiher t o comply w i t h the objectives of the placement. 6. The clinical educator undertakes preparation to fufil the objectives of the placement. 7. There is evidence of the student being fully integrated into the physiotherapy department.
8 . Within the first week, a learning contract is negotiated between the student, clinical educator and clinical tutor, which takes account of the particular needs of the individual student and the given parameters of the clinical education placement. 9. There IS evidence that the clinical educator fulfils the objectives of the learning con?ract
10. The clinical tutor fulfils the role as liaison person between the placement and the school. 11. An evaluation of the placement will be carried out by the student, the school, the clinical educator and the physiotherapy manager. 12. There is evidence of a programme designed t o review annually the appropriateness, applicability and suitability of the clinical education placements. A copy of the 'Standards for Clinical Education Placements' document, detailing the criteria which apply t o the above standards, is available from the Professional Affairs Department, Chartered Society of Physiotherapy, 14 Bedford Row, London WC1R 4ED
Multidisciplinary Study Tour of China and Tibet GRACE DOREY
MCSP
Physiotherdpy Mandger, BUPA Hofpitdl. Bu\hey WE believe this was the first British multidisciplinary study tour of hospitals and clinics in Tibet with our party representing six medical professions. The group included Dr Henry Doig (medical practitioner), Mary Doig (radiographer), Janet Pope and Aelethea Hill (health visitors), Susan Austin (social worker), Pat Hales (neighbourhood nurse manager) and Judy Woodford, Gave Jackson and Susan Walker who were Chartered physiotherapists. I was the tour leader. We arrived in Shanghai considerably jet lagged after a long haul flight via Moscow, and felt we might have arrived in China a little earlier by taking a slow boat.
Children's Hospital of Shanghai Medical University Our first visit was arranged to see the Children's Hospital of Shanghai Medical University where we saw a mixture of traditional and western medicine. In one room we saw a young child w i t h post-injection paralysis treated with interrupted galvanism (see picture right) while in an adjacent room we saw a girl being given deep Chinese massage to her neck, back and legs for stomach-ache (see photograph overleaf). We were pleased t o see some of the children wore glasses as during the first physiotherapy study tour of China last year w e were informed that children with poor eyesight were taught to massage the eye acupuncture points in order t o improve their sight. A t Shanghai University there is a threeyear training for physiotherapy students who are not doctors. Previously we had heard that doctors graduate and then train for a further year in physiotherapy. This research-oriented hospital offered an admirable preventive medicine and development control programme for children equivalent t o British regimes.
Physiotherapy, November 1991, vol 77, no 1 1
Quyang New Residential Area Our visit to the new residential area in the Hongkow area of Shanghai was extremely impressive. Modern, compact, 11-storey high-rise flats were linked by gardens and play areas. We were proudly shown the flat of a Residents' Association helper enjoying extensive views of the other blocks. Social welfare was undertaken by these helpers and we were fortunate t o be able to visit one of their kindergartens where we sat in on a delightful singing and dancing lesson by the reception class. On our way to Shanghai Airport, we were upset to see a burns victim paraded outside a temple, encircled by a crowd of curious Chinese.
Altitude Sickness In Tibet, the group displayed various symptoms of altitude sickness, having flown from Chengdu to Gonga, the highest city in
Chinese boy being treated with interrupted galvanism
the world at 12,000 feet. We suffered from dizziness, nausea, headache, dyspnoea, tachycardia, tinnitus, tingling extremities and epttaxis. Forgetfulness and word dyslexia became additional amusing complaints. Fortunately Dr Doig's advice, comfort and care proved invaluable. Treatment for altitude sickness included oxygen, diuretics, antiemetics, increased fluid intake, and most important of all, rest. Apparently, it takes six weeks t o acclimatise fully t o these heights. Dr Doig became increasingly concerned with the lack of warning from tour operators, and felt that more research was needed into altitude sickness, particularly for travellers arriving by air. Altitude sickness affected our people regardless of age or physical condition, although i t was naturally worse in those w i t h impaired respiratory function and because so many of our group displayed symptoms w e reorganised our programme of visits.
Tibetan Medical Hospital of the Autonomous Region A t the Tibetan Medical Hospital w e learned about Tibetan acupuncture where only one acupuncture point is used. A gold shallow needle is applied t o the top of the head accompanied by moxibustion and is used for a number of conditions such as hypertension. Cupping is performed for arthritic conditions, using a hollow yak horn by sucking rubber tubing attached t o the pointed end t o produce a vacuum. Faradism accompanied by Chinese acupuncture is applied t o facial acupuncture points to treat sinusitis and toothache. Nonluminous infra-red lamps are combined w i t h acupuncture as a treatment for low back pain and arthritic joints. The ancient art of cauterisation using a heated branding iron with a pencil applicator is still used for various joint conditions. These physiotherapy treatments are performed by nurses.
743
Left: Chinese massage for stomach ache
Right: Tibetan woman being treated with electric acupuncture for toothache
A t the Medical Institute in Lhasa, 3 0 doctors qualify each year after a three-year training.
Tibetan Medicine Tibetan medicine is based on the work of Yutok Yonten Gonpo ( 7 0 8 - 8 3 3 ) w h o compiled the medical manual The Four Medical Codices containing theories on p hy s i01o g y, path 01o g y, d i ag n0s is a n d treatment. Gonpo travelled extensively in China, t o India and t o Nepal. According to Tibetan medicine, physiology is divided into three areas - 'long' meaning vital energy; 'Chiba' meaning internal heat and 'Paigen' meaning phlegm. A n imbalance in any of these three functions causes disease. Observation, investigation and palpation, combined w i t h pulse reading, urine
investigation and questioning are an important part of diagnosis. In the 1 8 t h century Timon Tanzin Phyntsoka compiled a book listing 2,000 medicinal herb, animal and mineral treatments. Medical ethics are an important part of the training of medical students w h o are taught to love and respect their patients without discrimination, regardless of their financial position, sex or physique. Diagnoses are made without assumption or guesswork and there is considerable emphasis on continued training and improvement. Private practice with its attendant selfishness, greed and deceit is prohibited. The medical philosophy is beautifully painted and embroidered on t o brightly coloured silk 'thang-kas' or wall charts, and
covers the areas of embryology, astrology, anatomy, physiology, pathology, diagnosis, treatment, dentistry and herbal medicine. When we left China for the bright lights and opulence of Hong Kong, w e felt sad to leave this vast and magnificent country with its charming people and hoped one day t o return.
ACKNOWLEDGMENTS
To Louisa our delightful interpreter and guide, whose command of the English language was exceptional and who showed genuine care and concern for our problems. To the very special group who, despite illness, showed great courage, support and humour when conditions were less than perfect.
Abstract of Higher Degree Dissertation ~~
An Investigation into the Effectiveness of Energy Reclamation Equipment and some Design Implications for Hydrotherapy Facilities ALLEN HINDE MA BA PGDip(Des) MCSP DipTP CertEd MISM
Course: Master of Arts in Design Research for Disability, Disability Design Research Unit, Sir John Cass Faculty of Art, Design and Manufacture, City of London Polytechnic Housed at: Disability Design Research Unit
THIS project aims t o establish the place for energy conservation equipment in hydrotherapy pool management. A literature review established the ventilation requirements within hydrotherapy facilities and a computer model was designed to allow
the ventilation heat losses t o be calculated. On-site monitoring of a hydrotherapy facility generated data during the heating season (December t o April) which was used in the computer model t o calculate the heat losses and their costs, and which allowed extrapolation t o include the whole year. The model was then used to predict the heat losses and costs arising following the installation of a flat plate heat exchanger, and comparison was made between the t w o outcomes. Savings of approximately 60% were shown t o be expected when using heat exchangers, varying w i t h the size of the hydrotherapy room and its location within the United Kingdom. A questionnaire t o all District superintendent physiotherapists in the UK mainland brought a 6 3 % response and allowed baselines t o be identified against which the computer model could be compared, enabling the modification of predictions as necessary. Aspects of design t o maximise the advantages of installing heat exchangers have been illustrated, especially t o reduce heating costs, t o protect the fabric of the building from condensation damage and t o avoid physiological risks t o the users' health. Concept designs were drawn, and a scale model constructed t o illustrate the features.