By Mike Sangster
Physiotherapist and Clinical Specialist in Pain Science at the IWK
A few years ago I fulfilled a dream held by every North American amateur soccer player, and in fulfilling this dream, my perception of my place in the world of medicine profoundly changed.
As a physiotherapist I work with children and youth who are experiencing complex pain. Early in my career I made the decision to find the place where my talents would intersect with a global health need. Physiotherapists by trade are ideal global health volunteers – needing neither sterile instrumentation nor operating room theatres to do our work, just our head and hands.
So that was how I found myself walking along a Peruvian beach, past concrete surfaces designed for four-on-four soccer. A group of young men motioned for me to join their game –an unlikely invitation for a 40-something Canadian taking a stroll. Being conscious of the risk I was taking in being alone on this beach, and not knowing the intentions of these young men, I kept walking. They were unrelenting, kicking the ball to me in a seeming gesture of good faith. When I deftly returned the ball their intensity heightened.
In that moment I could choose to keep walking. Or I could choose to step onto the pitch and accept the risk.
The World Health Organization has declared access to pain management a fundamental human right yet it is estimated that five billion people live in countries with insufficient or no access to treatment for moderate to severe pain. Further compounding the problem an estimated 90 per cent of health care workers in resource scarce countries have insufficient education on pain assessment and treatment. My plan in visiting Peru was to deliver effective training that would build long-term capacity in my South American colleagues.
When I first arrived at the Peruvian hospital patients were already gathering in the warm unventilated rehabilitation department and a long line had formed awaiting treatment. Patient after patient presented themselves and it was apparent that there was no way I would be able to treat my way out of this let alone find the time to teach what I had planned.
South Americans traditionally play an open style of soccer, free-flowing, creative and uncertain. They creatively explore ways of moving the ball forward. In comparison, my North American game is one of discipline, less freedom of expression, and more rigid. In the heat of a South American midday sun I struggled to find my touch on the concrete. When I settled into my position no one passed me the ball as I continued to break a South American rule in finding my space. I even scored a goal, only to have it called back because of a third rule infraction. It became clear very quickly that our team of four wasn’t functioning. I had brought my North American game to a South American pitch. I had been playing how and where I wanted to be, not how and where my team needed me to be. I needed to embrace the uncertainty of this game.
Resources in the Peruvian hospital were very limited and planning in the way I had become accustomed was simply not possible. My colleagues and I needed to explore a way to move forward. I needed to leverage their expertise as they were closest to the challenges and as such would have the best ideas for solutions. So I positioned myself to solve patient problems in real time and use my skills to build capacity as we saw patients together. We creatively explored a way to move the ball forward according to their rules. I had to surrender the need for control and be coachable.
Once I realized my place on the pitch ‘their’ game became ‘our’ beautiful game. The match went on indefinitely that hot afternoon and it was clear that they would determine when it was over, not me. At the end of the day our team of four had won and we celebrated our victory, together.
That initial journey to South America has led to many other amazing journeys around the world, and allowed me the privilege of being a part of many beautiful games. If I had kept walking that first day on the beach I never would have fulfilled a dream.
The lessons I learned on the pitch have forever changed the way I practice and view health care. Choose to accept the risk. Step onto the pitch, whatever and wherever that pitch is. Embrace the certain uncertainty that will come with that. Listen with vulnerability, learn, and creatively explore – with your team – the way to move the ball forward. Be coachable. Go where your team needs you to go. And often you will find that where you are needed is precisely at the place where your comfort zone ends. And when you achieve them, celebrate your victories, together.