This past spring, the third-year DPT class participated in a six-week clinical practice selectives course to prepare us for our 24-week internship. About half of the class stayed in Elon and studied in more depth specialties like orthopedics, neurological disorders, or pediatrics. The other half of the class spent time learning about physical therapy all across the world in places like Alaska, Australia, Belize, Peru, Belgium, which is where I went with six other classmates.
Every fall, students from Vrije Universiteit Brussels (VUB) come to Elon to sit in on classes and go to area hospitals and clinics to work with physical therapists. This spring was our turn. Although a bed sounded great after the long flight over, in order to fight jet lag we ventured around the city to find waffles and fries. All seven of us stayed in the most perfect AirBnb in the French neighborhood of Auderghem. It was just a 20-minute metro ride to the center of Brussels.
This would be a very long blog post if I told you everything we learned in six weeks, so I will hit the highlights:
- The country of Belgium itself is diverse yet divided in terms of government and language. The northern half has more Dutch roots and the people speak Flemish while the southern half speaks French. The city of Brussels is in the center and is a melting pot of Dutch and French. In order to treat all patients, the physical therapists we met knew both languages and spoke English, too. Most of the research they read is in English, so it is necessary for them to learn a third language. Very impressive.
- The first day we jumped right in to classes at the VUB and helped with human cadaver dissection in the anatomy lab. We worked with medical students who moved VERY slowly through dissection. They allowed us to help but I could tell in their faces they didn’t like my technique. As a physical therapy student at Elon we spent seven months dissecting, focusing mainly on muscles and their origin, insertion, innervation, and action. The Belgian students were graded on their precise dissection so I stopped and decided it was more enjoyable to chat with them about their lives while they dissected.
- Back at Elon, I am dependent on my car to take me everywhere. It was nice to take a break from the, “car life,” and walk and take the metro. I would average around 20,000 steps per day. We may have gotten turned around (lost) a time or two, but it was all part of the experience.
- The physical therapy education is different in Belgium. At the VUB, students get their Bachelor of Science and Master of Science in rehabilitation and physiotherapy. This takes four years. After that they do not have to take a final board exam and are free to work. If they would like to specialize in manual therapy, they can continue for another year to achieve their advanced master in manual therapy. I am planning on taking the board exam in just five short months. After over two and a half years of DPT school, I am ready for this day to come. But I also think how nice it would be to not have to take a national board exam. I’ll keep dreaming.
- American health insurance is confusing; Belgian health insurance is even more confusing. Every Belgian citizen has health care and pays a flat fee of 30 euro to the therapist ($35) for a strict 30-minute appointment. The patient gets reimbursed a certain amount of that by the government. Making $70 dollars per hour sounds great as a therapist but sadly taxes are so high that nearly half of what a “physio” makes goes back to the government.
- Outpatient therapists in Belgium work crazy hours to be accommodating to the working persons’ schedule so most work 12-hour shifts Monday through Saturday. Two of the therapists we followed had private clinics and worked out of their homes. I guess that helps with the commute. The physios we met in Belgium live, eat and sleep PT.
- Speaking of eating, waffles, fries, chocolate and beer. What more can I say? I miss the sweet smell of 1-euro waffles around every corner. I am not use to living in a big city, so I really enjoyed venturing to the city square, the Grand Place, to soak in the culture and to enjoy walking around with my classmates before we departed for our 24-week internships.
- In America we must document everything we do with patients to be able to get reimbursed by insurance so we can get paid. I would say probably 25 percent of my working day on my clinical rotation right now is spent documenting patient care. In Belgium, there is no need to document to get paid so therapists only document if they need to remember something to do with a patient. As a result, they can see more patients throughout the day.
- One day we went to circus school (one of I believe five in the world) and observed a physical therapist that worked with acrobats. It was a unique experience to see these amazing, fearless athletes flipping around bars and contorting their bodies in ways they are probably not meant to be contorted.
- We met a Belgian Olympian who went to Rio last summer. He was being tested for Overtraining Syndrome by performing multiple VO2 max tests on a bike. He performed one test in the morning and another test in the afternoon and the amount of lactate in his blood would determine if his body was able to recover or not.
- Every therapist treats differently, but most of the manual therapists we observed treated primarily with joint mobilizations and manipulations and left exercise up to the patients to do on their own time. This is something I would have a difficult time doing.
- We observed physiotherapists at three large rehabilitation centers around Belgium. In the U.S., insurance dictates how long people are eligible to stay for inpatient rehab post stroke, TBI or SCI. Patients are able to stay in rehab for much longer in Belgium. Some may stay for a year. Revarte, a rehab center in Antwerp, had state-of-the-art equipment with an amazing treadmill for gait training that one of our classmates got to try out.
- Last, but certainly not least, Brussels is so central to everywhere else in Europe that we had the opportunity to explore many other countries. It’s amazing how you can take just a two-hour train ride or flight and be swept into such a different culture. One of my favorite weekends away was to Salzburg, Austria, where we rode bikes on a Sound of Music tour and were surrounded by the Swiss Alps. It was so breathtaking.
This was a long post and I could go on for hours and hours about all the memories the seven of us made while in Belgium and in cities all around Europe on weekends. If I could, I would go back in heartbeat. I am so thankful for the plethora of experiences that Elon has to offer. I was able to learn so much more about myself as a physical therapist by gaining an appreciation for another culture.