Norwegian physiotherapy teachers’ experience from working in a partnership project in Sudan - A case study approach

Figures & data

Figure 1. Model of the different phases of the Norway – Sudan partnership project on physiotherapy education.

Figure 2. Model of the length of stay for each NPTs involved, distributed on phases.

*3 months in Sudan and 3 months in Norway over 2 years

Table 1. Case study data collection and types of information.

Data collection	Types	Information
Documents	91 Monthly reports 13 Final reports Project reports and Minutes from partnership meetings	Personal reflections Personal evaluations Planning strategies, reflections and management
Interviews	5 Individual interviews	Personal information, reflections and perspectives Personal thoughts, feelings and attitudes

Table 2. Example of the abstraction process; meaning units, code, themes and subthemes.

Meaning units	Code	Themes	Subthemes
The challenge of teaching and communicating physiotherapy I found of great importance. (Final report #5)	Personal fulfillment, meaningful project, concern for others as well as active, legitimate participation.	NPTs’ motivation for working abroad	Personal factors Culture Project factors
The classes made me reflect – they made me angry, upset and happy. All in all, I learned a lot about myself and about how others think and reflect on challenges, as well as what others see as inspiration and what they value in life. Often we use the same vocabulary, but when you dig more deeply there are so many nuances regarding what we really mean, which is scary at first, but made me appreciate subsequently, the opportunities with which we are presented due to these differences. (Final report #3)	Although the NPTs prepared for both work and life in a different culture, they experienced differences between the theoretical knowledge and the situation-specific knowledge (knowledge in a particular situation).	Preparation for life in Sudan – learning for work	Meetings with leaders and former employees Preparatory course
I had prepared for what I expected to come. I had read about culture, history and things like that, however what surprised me was that it was impossible to prepare for what was to come. There were feelings in me that I never anticipated would be there. (Interview #1) As my work piled up, I worked more and more, and had little energy left to socialize. I had no social network other than the teachers at work. (Final report #4) I have learnt so much about the Sudanese culture, religion and also of course about myself in a new setting. (Final report #8)	They experienced a culture shock that decreased during their stay. They also found difficulty making friends with the locals. This gave an opportunity for personal growth.	Social life	Practical challenges Personal growth Socialization
Actually, I believe or in fact know, that they found us very demanding. They perceived us as critical and used to a completely different system. We felt we did not want to adapt to their system and found it difficult to do so. Therefore, I believe they were not always happy that we were there. (Interview #6)	Communication and meeting points were crucial. There had to be cultural and institutional negotiation between physiotherapy teachers coming from abroad and the faculties at the university and in the clinic. Difficult to know who had the relevant information and what this entailed. Feeling of not being wanted.	Academic community in the physiotherapy education department	University (written instructions, relevant information, informal structure) Education (meetings, manager) Other professions (in the clinic, assistants)
The weather is now starting to get warmer and some days, it is too warm to concentrate in the office and we are unable to work efficiently. We have a meeting room with air conditioning that we can use, but this is not always available. (Monthly report #1) At the beginning of my posting, I worked one day per week at a rehabilitation center for children. This experience gave me valuable insight into the way in which physiotherapy is carried out, mainly by physiotherapy assistants and technicians with very limited training. (Final report #7) During the different placement periods and contact with physiotherapist colleagues working at various institutions, I gained an insight into the conditions and challenges facing physiotherapy and physiotherapists, relevant for our future students. (Final report #6) The students have had to adjust to a new way of acquiring knowledge. They have had to be active and participate both in terms of theoretical thinking and through practical approaches. They have reflected on important topics and have been introduced to carrying out searches for relevant literature online. (Final report #13)	NPTs lacked pedagogical competence and did not receive any help, except from their colleagues and home institution. They extended their clinical competence. Challenges due to developing a new program, institutional challenges and different opinions on assessment. Challenges regarding students’ learning methods.	Navigating complexity and challenge	Competence (pedagogical, clinical) Technical-institutional (curriculum content, organization, examination, storing information, internet connection) Students’ requirements
Even though I had some minor disagreements with some of the staff along the way, this experience was exactly as I had anticipated. It was a huge job to organize patients for all of the 30 students and transportation for the patients and examiners to the location. For a long time, it felt frustrating, I was organizing this exam myself. But when the exam was only a week ahead, suddenly a huge team came together to work toward this! I was very relieved, everyone did a great job. This is rather typical of how work is carried out there from my experience; wait until the last minute. Surprisingly, big events like this are carried out with very little forward planning. (Final report #7) I think it is so easy to continually take on a little more and suddenly the whole physio-department is resting on your shoulders. (Final report #7)	Different perceptions of planning a task and taking on responsibility. Clarifying roles and responsibilities between the host university and the NPTs was important.	Sense of time – Culture matters	Task planning Responsibility
I think I really needed this time to think, reflect and make notes. This made it easier to end this job, to be able to carry on with life here in this very different society. (Interview #4) I learned to adjust and relax, realizing that not everything has to happen according to my way of thinking and I became more open to the possibility that there are many solutions and approaches to problems. My choice may not always be the best and definitely not always the one to be taken into consideration. (Interview #1)	Important to have sufficient time for post-work reflection together with relevant others. NPTs were open to new ways of doing things.	Finalizing the job – preparation for reentry into work in their home country	Sharing life-changing experiences Broader understanding of their future jobs as physiotherapists

Table 3. Recommendations for physiotherapy teachers in similar practices.

Important factors

Strive for autonomy, relatedness and perceived competence Prepare by acquiring knowledge relating to culture, language and work tasks Expect a culture shock in your social and work life Expect and endure cultural negotiations Be open to different ways of working Find meeting points for building an academic community and cooperation, as well as trying to understand and integrate the norms of the university Dare to question activities which derive from poor structures Acknowledge cultural differences that cannot be changed Agree upon responsibilities and clarify what this entails Discuss challenges with a local, experienced teacher Acknowledge your own feelings and resistance toward cultural differences Take time to reflect and process experiences from the stay abroad, to finalize your work there and when returning to work in your home country Expect that change can take several years