Physiotherapists in Afghanistan. Exploring, encouraging and experiencing professional development in the Afghan development context

Abstract: Aim: The aim of the thesis is to analyze the matter of supporting professional development of physiotherapists in Afghanistan, and the issues involved in expatriate physiotherapists working with professional development cross-culturally and in development contexts. The thesis is based on two field studies, aspects of which are reported on in four papers. The first field study aimed at analyzing and describing the physiotherapy component of a disability programme. The aim of the second field study was to explore the process of a development project, in order to gain understanding of how such work can be done in a better way. Participant observation was used for the data production of both studies. The adult learning theories of transformative learning and situated learning were used as a theoretical framework in the thesis. Paper I describes the situation, needs and challenges for developing physiotherapy in Afghanistan. The therapists worked in isolation with little opportunity for further education or professional development. Their approach was mainly medical, where the work was dictated by the patients’ expectations and doctors’ recommendations. They used primarily passive methods of treatment, and their work was affected by cultural, religious and situational factors and they demonstrated a basic capacity of clinical reasoning. Paper II explores factors that impacted learning and professional development of the Afghan physiotherapists in the development project. Examples of these factors were: a pattern approach to treatment, linear thinking, and socially oriented decision-making that affected how new things learned were put into practice; concrete representations and an instrumental view of knowledge characterized learning approaches; language barriers, different interpretations of meaning and cultural codes challenged communication; and a prescriptive, encouraging approach of the expatriate physiotherapy development worker affected teaching and learning. Paper III explores professional ethics for Afghan physiotherapists and identifies two ethical tensions for the professional practice of Afghan physiotherapists: between individualistic and communitarian ethical perspectives, and between normative ethics and local morals. Paper IV is a critical reflection over the expatriate development worker’s development process through, and impact on, the development project. The perspective of the development worker is transformed from an idealistic helper to an enterprising learner as a consequence of active participation in and a self-critical reflection of the process. Conclusion: Working with and researching professional development cross-culturally and in development contexts is complex and requires consideration of many different factors. Cultural competency is essential, where to understand others one needs to first understand oneself, and oneself in relation to others. This requires support when in the field. Physiotherapy theory and practice must be adapted to the local context. Actions taken towards promoting learning and professional development must be firmly rooted in the Afghan context, and investigated, planned and implemented together with Afghan physiotherapists. The professional development of Afghan supervisors and teachers should be a priority. To encourage reflection of both Afghan and expatriate physiotherapists a communicative learning approach could be taken, where ethical challenges and disorienting dilemmas can form the basis of a reflective discourse and lead to increased understanding.