Occupational Breakthroughs: Hydrotherapy & Cross-Training

For this run of posts, we’ll be taking turns to discuss examples of occupational work with a patient that has led to a personal breakthrough, or personal validation for our roles. It’s often assumed that doctors and healthcare professionals alike live contented lives because all of their work is funnelled towards a positive goal, ie. the betterment of others’ lives. However, in reality, working in the healthcare system can often be more frustrating than satisfying.

We all work with human beings on a daily basis, both inside the confidentiality of our patient relationships and in the public sphere with our staff. As all of us have come to realise, working with human beings requires great patience and, sometimes, in order to take three painstaking steps forward, it’s also necessary to take a couple backward too.

As the summer comes to end, we’ve taken the time to reflect over the last few months and discuss our ‘big wins’ and how they are propelling us through into the more difficult autumn months:

Initial consultations

The benefits of hydrotherapy for elderly people suffering with musculoskeletal problems is now well documented, however persuading an individual patient of the benefits can often be a laborious process. My recent success in persuading a group of elderly patients to take part in group hydrotherapy sessions is currently the win that is keeping me going. In any given day in my job, you may see a number of elderly people complaining of the same symptoms, it’s a sobering look into the future, as many of these conditions simply can’t be avoided as we grow older.

Working with elderly people can often be a real test of patience. These are people who are often resistant to change and stubborn to the point of rudeness. They have embedded habits, as we all do, that have been solidified over decades and huge defence mechanisms in place to protect these patterns of behaviour being broken. For these reasons, finding a way to suggest a new activity, in a foreign place to some elderly people can be a difficult challenge.

Introducing the environment

After discussions with my fellow consultants, we agreed on a plan, in conjunction with the local leisure centre, to make use of their hydrotherapy pools and create a new social community group with the intention of bringing elderly people with similar musculoskeletal issues together. Our theory was that if we could gently nudge our respective patients into the hyrdrotherapy pool together that they would be:

a) less self-conscious of themselves, as they would be grouped with people of a similar age who are also facing the same health issues.

b) encouraged to exercise in a safe, social fashion that has been proven to aid people with similar conditions.

The leisure centre was just a short walk away from our surgery, which gave us a great opportunity to point out the ease with which they could combine their regular appointments with their exercise, and an agreement was made with the leisure centre to install more accessible pool fittings to the hydrotherapy spas, so that our elderly residents would feel safe getting in and out of the water.

After 6 months of running this group we’ve seen an uptick in patient improvement, not to mention qualitative data suggesting that the social activity is providing an added bonus to our patient lives – something which is incredibly satisfying to hear.

Converting My Learning Into Experience

I’ve always had the feeling that my studies could have been a little more robust.

I might have passed all my exams with flying colours and received commendations from some of my tutors, but that didn’t mean that I’d suddenly transform from a nervous student into a capable professional overnight.

I found a job in the autumn of last year, just a few months after my graduation.

The wet, sprawling summer that I’d worked through in Cheltenham was slowly coming to an end. The days were steadily getting shorter and the green trees fringing the Cotswolds were starting to brown, a warning of the winter that was still yet to come. I’d spent 5 years training to be a doctor in Cheltenham and now that I’d found a job there too, I felt like I was becoming a real functioning cog of the community. It was a far cry from how I felt as a fresher of just 19 year old.

Fresh off the boat from Gautala, I’d felt like an outsider, an Indian boy separated from his family and his heritage. The way people acted shocked me on a routine basis, the climate felt alien and the water didn’t agree with my stomach. Like many other lost Indian kids, alone and intimidated by their new surroundings, I attempted to assimilate myself into the local Indian community. Around 4,000 or so Indians live in Cheltenham, however finding a way into the community proved difficult.

When the shopkeepers found out that I was a student all they wanted to do was sell me packs of dried noodles. The other students that I bumped into on campus were shy, ducking their heads whenever I tried to make eye contact. I spent my first few weeks in England, in the summer of 2011 like this, wandering between lectures and the library, lonely and isolated. It wasn’t until I began talking to my fellow class mates that I began to discover that I wasn’t the only one in this kind of situation.

Although a large percentage of my fellow student doctors were from English backgrounds, it didn’t take me long to realise that there were dozens of students on my course who were also separated from their homes and culture. These lost souls soon became my friends, my kindred spirits, my family. We lived, studied and worked together – they were good times. We found confidence in our companionship and this bled through to our professional development, helping us defeat our skittishness and improving our spoken English no end.

But these years of ease were not to last for long.

Before I knew it we were tossing our mortarboards up in the air, celebrating our successes but commiserating our imminent separation. Which leads us to my position today. My graduation papers are proudly displayed on the wall in my practice surgery, they are proof that I’ve done the work required of me. I’ve learnt the facts and proved to my peers that I can practice orthopaedics at a high level.

So, why can’t I have confidence in my skills?

I called home to get some advice from my Dad and he gave me some words of wisdom. He told me that he went through a similar stage of ‘impostor syndrome’ when he was my age. He’d just finished his own training as an engineer, he was ready to join the working world but felt unsure of his abilities.

Instead of diving head first into his work, he nervously tiptoes, expecting to make a mistake with ever step he took. He doubted his skills, he even doubted the tools at his disposal. DC-DC converters and wiring systems that had seemed to reliable months before, suddenly looked flimsy and weak. He had nightmares about his work failing and causing someone injury.

The only advice he could give me was to ‘get stuck in’. Mistakes were bound to be made and there was no way of avoiding them.

Dear Mother, London is beautiful but bunions are not…

Dear Mother,

I’m sorry it has been so long since my last letter.

Since starting my fourth rotation here in London I’ve been faced with many new experiences that I did not think that I’d be confronting.

My very first English Christmas was an alien experience but an enjoyable one. I have now firmly accepted my new found identity as a ‘hipster’, having discovered my favourite place to sit and drink tea in Camden. Lastly, I saw my first ever bunion today and it looked worryingly familiar.

I missed you and the rest of the family more than anything else this Christmas. In India; the lights, the religious fervour, the intangible feeling of festivity itself is borne on the air. At nights, when I still struggle to sleep in the relative quiet of my flat in Clapham, I entertained myself imagining the rest of the family walking through the markets in Mumbai. I pictured you sending off Ranjeet and Papa to claim the spices and fruits whilst you and I sneaked off to sip on cool Mango Lassis. I wondered if this year you’ll be sharing that lassi with anyone else, or if you’ll be sitting alone in the market.

To sate my home sickness, I visited the closest thing that London has to offer in comparison. When I asked my flat mates about the local Christmas Markets, I think they misunderstood me. The only place I needed to go to lift my Christmas spirit, they told me, was Hyde Park. Although it was a far cry from the Mumbai Markets, Hyde Park’s Winter Wonderland certainly delivered a festive shot of entertainment that put a smile on my face that did not disappear until well past the New Year.

With the joys of Christmas and the New Year behind me, the start of this year has been dedicated to living at a slower pace of life and taking time for myself. Last year, the course stepped up a notch in difficulty and I found myself under increasing pressure to meet deadlines. My personal tutor recommended that I attempt to take more time to myself. He told me that there was a significant correlation between the amount of miles between International Students’ homes and the amount of hours that they pile into their work at home. So this year I’m going to be dedicating a couple hours each week to simply putting my feet up in a cosy Tea Parlour in Camden and reading a good book.

With all this going, you’ll be surprised to hear that I’ve also been getting a lot of work done in the mean time. I saw my first bunion last week – and it struck me as oddly familiar. The patient’s foot was uncomfortably squashed into stiff black shoes and it’s clear that they were in a great deal of discomfort because of this. Do you also suffer from this particular problem? I’m not sure what the treatment options are back in Mumbai, but over here there’s a dedicated private bunion surgery that patients can apply for – maybe this is something you could consider looking into?

Thank you for the presents, a taste from home is always appreciated.

Your Daughter,





Missamari to Manchester: A Student’s Journey

Bhavin’s journey from Mountain born school boy to fully fledged Medical student in metropolitan Manchester is a unique one, not to be taken lightly.

Over 2,000,000 Indian students leave the country to study every year and that number continues to rise.

However, the majority of these students tend to hail from suburban dwellings.

The cities in India are amongst the most populous across the world, so when city dwelling Indian kids leave their bustling towns to advance their studies, they often find international Educational centres to be rather quiet in comparison.

For Bhavin, though, it was a completely different story. Transplanting himself from the isolated mountain community of Missamari, he recounts his first impressions of Manchester and how he adjusted to living in his new home:

“I’d never been a big football fan as a child, although I wish I had been.

As soon as I got my papers to study in Manchester, the only cultural touch point that my fellow village people could offer me were references to Manchester United and Alex Ferguson. I laughed along and nodded, but truthfully, besides the fact that I knew Manchester University was one of the best learning institutions in the UK, I knew very little else about the city that I was going to be spending the next five years of life in.

Before I left Missamari, my Father talked to me whilst I packed my bags. The clothes I was packing were mostly traditional items, as I carefully folded my veshti away my Father warned me that I may need to adopt a more Western style of dress once I arrive in Manchester. My Father was nervous about my leaving. He wasn’t scared about the crime though. He wasn’t afraid of the football hooliganism. The thing my Father was afraid of was my Indian heritage.

I was breaking from tradition. For generations my family had farmed the land, making the most of the ever expanding crop of land we had inherited from our ancestors. Rice had been our main export for decades, but rice was to be my future.

After excelling in School, my Father knew that I had to leave the country in order to pursue the career of my dream. He’d never had the opportunity to leave India. Although he’d spent his youth travelling through the country, hitching on the hundreds of miles of railway lines, my Father had never left the country of his birth. I was the first in my family to do so and the thought that my rural cultural upbringing would hold me back was a fear that my Father held right until I left for the airport.

“Son, you must learn. Not just about the bones and the fixings of the body, but also of the culture of the people that live there. Go to one of the football matches, cheer on the Manchester Uniteds and become one of the people there.”

My Father’s fears turned out to be unfounded. Manchester is a truly Cosmopolitan city, one that is filled with people of all different cultures and nationality. England is a country that has embraced me with open arms – in a month’s time my Father will be visiting me and leaving his native India for the first time ever.

I told him to take a piece of Missamari with him for me.”