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International Fellowship Award
Program
Summary Reports
I was in the training course of a University Diploma of respiratory
physiotherapy, directed by Philippe Joud, a French respiratory physiotherapist,
when he asked me if I would like to apply for the AARC International
Fellows Program. He asked if I wanted to go to the USA, to meet some
respiratory therapists, and learn about their job ,their role, their
training, how they are organized. I did agreed, of course, and he explained
me how to go in the AARC site and fill the form to apply for the fellowship.
I asked Philippe Joud, my unit manager, the SKR President, present and
past, and another ICU manager to write letters of recommendation for
me. They accepted, and were very enthusiastic about my project.
At the moment I learned that the AARC choose me, I bought my plane
tickets, and the same day, I began some English lessons, once a week,
with an English teacher. I have been working every day to be able to
communicate more easily from the first day of my arrival. I prepared
one presentation that included information about my job, my hospital,
and my town for my hosts, and the International Council.
I am a physical therapist, but I have been working in an ICU for 8
years, and take care of the respiratory problems on top of orthopaedic
problems. I know, even if I am not specialized, that a respiratory therapy
specialist is needed in every unit, and that they need to be well trained
if they want to do their respiratory job correctly. I work as a respiratory
therapist, but I am not recognized either by the hospital, or by the
government, even if I am recognized as a specialist by my colleagues
and by the physicians. I am not allowed by the law to do all these tasks.
Moreover, I am not in the unit during the night and the week ends. I
wanted to learn the training, the role, and the organization of the
respiratory therapists. I wanted this trip to help me to propose in
my country recognition of this speciality, and a special training program.
This was very important to me, because I worked a lot on the application
modes of a law wrote by the government in 2002 about the role of the
physical therapists in the ICU.
I began my fellowship in Atlanta, with Vijay Deshpande. I visited
the respiratory therapy school. I could evaluate all the material needed
for the teaching of respiratory therapy, and the level of the training
course of mechanical ventilation, because I attended the same courses
as the respiratory students. Then, I visited a hospital in Atlanta,
going to different units, where I could see materials, organization
of the respiratory team, and where I met the respiratory therapists.
The day after, I was in a hospital in Macon, with Tom Madrin. I visited
different units, and followed some respiratory therapists while they
were working. In both hospitals, I was surprised by the organization,
all the things the respiratory therapist do as part of their practice,
from the intubation to the extubation, and after. Moreover, they are
responsible for all of the respiratory materials on top of the respiratory
therapy. I learned that the RT carried out intubation, and in some place
were responsible for transport, even for neonates. Some are specialized,
for example in nutrition, EFR, or voice and swallowing rehabilitation.
I visited too an ambulance from the children’s hospital. After
Thanksgiving with Vijay Deshpande’s family, I went to visit the
Vanderbilt hospital in Nashville. This is a new hospital. I had chance
to speak with one of the men who prepared its conception. There, I could
especially see the respiratory therapy for kids. Again, there, I visited
the hospital and saw material, rooms, organization, met respiratory
therapists, learned their tasks and their organization. After, I went
to Cookeville, Tennessee, where my host was Brian Pugh. He manages a
home care business. I could see respiratory therapy after hospital,
all the equipment he rents, how the technicians, and the respiratory
therapists, manage patients at home. I went with him and his technicians,
to the patient’s home. There were some patients I wouldn’t
see in France. I visited Brian Pugh’ sleep lab with his manager.
In Cookeville, I went in the hospital with Colleen Schabacker, and visited
all the units, with different respiratory therapists, saw weaning and
extubation, and was there for a patient coming back from cardiac surgery.
I was surprised because everyone knows exactly what to do, and all is
done in few minutes, and when the physician arrives, all is already
ok. Because of all the different places I saw, I had a good conception
of the scope of respiratory care, from ICU to home.
On top of all the technical things RTs do, and specialization, the
RTs read articles and research papers, do their own research, and write
protocols. Everything concerning the patient visit is written in the
patient records, and they survey their patient at least every two hours.
We have to learn more about that. Really, the physical therapists working
in ICU, or in pulmonary units have tasks close to the RT’s tasks,
but there are various numbers of them in the unit, with various training
(not mandatory), no one during the night, nothing official, depending
on training and motivation of the persons, and few protocols and research,
except for some PTs with dynamic medical teams.
Then, I arrived in New Orleans, for the AARC congress. The first thing
I enjoyed was to meet other International Fellows, and the AARC International
Committee. It was great to meet the people responsible for choosing
the Fellows, and to know what we will do, and where to be, the following
day. Like in the other places I visited, all was so well organized,
planned, and at the same time we had free time in that beautiful city.
It was good to meet people interested in respiratory care from other
countries, and see that even if we have differences, our professions
are very close. I have now friends in the USA, Spain, Argentina, South
Africa, and Thailand. I was really impressed by the awards ceremony,
and so glad to receive one myself. I am now proud of this, and can show
it to my colleague, and my managers, Professor Samii and Professor Genestal,
who helped me with the travel. I could hear there high level lectures,
and had so many choices, that it was difficult to choose. Many times
a day I could meet people from the committee, they were very friendly,
and in the same time very professional. I never felt alone, lost or
confused. Always busy, but not too much, and I could see a lot of things,
even if I had not enough time to see all I wanted to.
The morning with international council was very exciting. I learned
a lot from the other countries, and took notes because it gave me a
lot of ideas. The exhibition hall was huge, and so rich, will all the
exhibits, and materials to discover. It was very hard to leave New Orleans,
and USA, I had new friends, and had the feeling that the time was too
short; in the same tim, I was very tired, because I did and saw so many
things.
When I came back in France, I was more sure then ever, that a specialist
in respiratory therapy was needed in the units, and most of all, in
my unit, the ICU. I had more assurance to do my job. I felt like my
brothers and sisters from across the sea, helping me in what I daily
do. I was more comfortable, and sure that I had to learn more about
the ventilators, the modes, and the cardio-respiratory, physio-pathology
of my patients. I began to write protocols on every thing I do I would
like to begin some research protocols on respiratory therapy. I want
to work more for recognition of my job in my country; and I know that
the AARC will help me, for example, with the proposition of recognition
of the training course the SKR (society of French physical therapists
working in respiratory units) proposes.
I would enjoy to travel again, to meet other professionals in other
countries I would enjoy having some Fellows here, in my hospital, in
my unit.
In conclusion, all was close to perfect. I was hoping for several things
when I arrived in USA, but never would I have believed I was going to
have so huge a professional and personal experience. What I enjoyed
was that everything was planned, that I was never alone, days and evening.
Every host had planned before what he/she was going to show me. I met
hundreds of people, all so different. But never someone not interested
in his job, and always patient with the French fellow, and happy to
give me a part of their experience. I can today keep in touch with most
of the persons I met in USA, and my daily job is richer because of this
experience..
Thanks for all to the AARC and to my hosts. Hope I will be able one
day to give it back.
Laurence Vignaux
2004 French Fellow
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