As I step off the plane which had just arrived to the capital city of Tripoli, Libya, the western world I grew up in was gone as I opened my eyes and saw women dressed in traditional Muslim clothing.   Groups of kids were lingering around speaking the native language of Arabic, sitting and chatting as if they were waiting for something exciting to happen. This was the culture that would teach me things that go far beyond the Physical Therapy ward of the two hospitals I was to volunteer. With only two weeks to live the life of an average Libyan Physical Therapist, I had to get started.  

With the help of relatives, my experience started with meeting the department chair for physical therapy in El Touby, the government hospital in Tripoli. The clash of cultures became a reality when I went to shake the director's hand and he gave a shy laugh and did not extend his hand in return. My dad would later tell me that his actions were out of respect, and in the highly religious population, it was common to not shake hands with the opposite sex. I was then graciously given a tour of El Touby Hospital where I would have my initiation. My first observation was that the only patients roaming around the physical therapy ward waiting for treatment were women. The therapists informed me that today was "Women's Day," and that the opposite sex alternated days for treatment. I understood and noted that privacy and respect are highly cherished values in this Muslim country. Although this is a new concept to westerners, the alternating days would allow for the most comfortable setting for the patients to receive their treatment.

This cultural shock interested me and I questioned my new therapist friends about the treatment for the two sexes. They informed me that although the days are alternated between the two sexes, the sex of the therapist was irrelevant to the patient, and any of the therapists were allowed to work with any of the patients. Water therapy was the only type of therapy that was administered differently and with more sensitivity. Female therapists were allowed to work with women in the pool, and male therapists with the men.

My first struggle in this hospital became clear very quickly, as many people attempted conversation with me, and although I know elementary Arabic language, my English was not going to get me anywhere.  Just as I was beginning to worry about the language barriers, a young and modest girl turned to me and said "So, why did you choose physical therapy?"  I was relieved to hear words that I could actually comprehend. I began explaining all my experiences in various physical therapy institutions in the United States, and the critical role that physical therapy plays in the American world of health.  In the middle of our conversation, I had forgotten that this girl did not speak English as her native language. She proceeded to tell me she was privileged enough to be selected to study English at the British Council in Libya. She took interest in my American background and made it a point to make me her personal shadow.

The first day with her gave me insight into the standards that Libyan hospitals have for patient treatment and the way physical therapy is taught. With the influx of patients throughout the day, I took notice of a certain red colored note card each of the patients came in carrying. Instead of the therapists sitting down with the patients and performing a proper evaluation of the patient to determine the appropriate treatment program, the patients are required to visit with the doctor first.  The doctor then writes on the red note cards what type of treatment the therapists should conduct with the patient. The therapists have little to no input on the treatment program for the patient. With the hospital being free of charge for the patients (Libya has nationalized medicine), one can imagine the effectiveness of treatment the patients receive. I was also surprised to find out that the therapists were on a three month rotation for the various physical therapy specializations. There is not one field of physical therapy that they specialize.  The girl that I was observing was in her third month rotation of occupational therapy, while others were in the pediatric ward, or working in the hydrotherapy section. 

Physical therapy in Libya has the bare minimum of standards compared to the United States. With the state of the art equipment and highly trained physical therapists that are produced in America, Libya has only a mere fraction of what America provides. Although the equipment was less than advanced, and the treatment time for each patient was minimal, there was a sense of a community bond that I had not experienced in any of my observations in America. Everyone in Libya knows the conditions they live in and can relate to one another in a more personal way than anyone in the US could imagine. They are all aware that that they need to rely on family and close friends to keep life light hearted. Life is not as easy in this oil rich country.  Professional success is much more difficult to achieve with the social and political norms.  I did observe this communal union was expressed between the patients themselves, but more importantly in the patient to therapist relationship as well. I could sense this relationship in the way the therapist would nudge and play around with the patient, and there was just an automatic sense of comfort with one another, as if they had known each other all their lives. Everyone is treated as a valuable family member.