Experiences of frontline physiotherapists during the COVID-19 pandemic at two tertiary hospitals in Southern Malawi: A phenomenological qualitative study
This phenomenological study of 11 frontline physiotherapists at two tertiary hospitals in Southern Malawi reveals that while their interventions were often lifesaving and led to increased professional recognition, they simultaneously faced significant challenges including staff shortages, inadequate equipment, and a lack of specific guidelines, underscoring the urgent need for improved interdisciplinary collaboration, training, and resource allocation to strengthen future pandemic preparedness.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a virus sweeps through a population, the medical response usually focuses on the immediate threat: stopping the infection and keeping the heart and lungs working. In this crisis, doctors and nurses are the first line of defense, but there is another group of specialists who work on the body's ability to recover and move again. These are physiotherapists. Their job is to help people regain strength, breathe easier, and return to their daily lives after an illness has left them weak. During a pandemic, when hospitals are overwhelmed and patients struggle to breathe, the role of these specialists becomes critical, yet often invisible. They work alongside the medical team to clear fluid from the lungs, teach patients how to sit up and move safely, and prevent the body from wasting away during long stays in bed. Understanding how these professionals navigate a crisis is essential, not just for the patients they treat, but for preparing the entire healthcare system for the next emergency.
In the southern region of Malawi, a team of researchers set out to listen to the stories of physiotherapists who worked on the front lines during the COVID-19 pandemic. They focused on two major hospitals, Queen Elizabeth Central Hospital and Zomba Central Hospital, where the sickest patients from the area were sent for care. Between May and June 2024, the researchers sat down with eleven physiotherapists who had cared for patients with the virus. They did not use surveys or checklists; instead, they held long, open conversations, asking the therapists to describe their days, their fears, and the moments where their work made a difference. The goal was to capture the full reality of their experience, from the triumphs of saving a life to the frustrations of missing equipment.
The stories that emerged were a mix of profound success and deep struggle. On the positive side, the therapists described how their work directly helped patients recover faster. By guiding patients through breathing exercises and helping them move, they shortened the time patients needed to stay in the hospital. This was vital because the hospitals were crowded, and every bed freed up meant space for another person in need. In some of the most dramatic moments, the therapists acted as lifesavers when oxygen supplies ran out. One therapist recalled a time at a temporary isolation center when the oxygen concentrators stopped working. With no cylinders to replace them, the team turned patients onto their stomachs, a technique that helps the lungs fill with air more effectively. This simple adjustment kept patients alive until new oxygen arrived, proving that their skills could bridge the gap when resources failed.
As the pandemic progressed, the work of these therapists began to change how others viewed their profession. Before the crisis, many doctors and nurses did not fully understand what physiotherapists did or why they were needed in a respiratory ward. But as the therapists demonstrated their ability to improve patient outcomes, attitudes shifted. Colleagues started to see them as essential partners rather than just support staff. This new respect even extended beyond the public hospitals; private clinics began sending their patients to these central hospitals specifically to receive rehabilitation care. The crisis had inadvertently given the profession a new visibility and a stronger voice within the medical community.
However, this recognition came with significant costs and challenges. The therapists often felt like outsiders in their own teams. They described a lack of communication, where doctors and nurses would hold their own meetings without including the rehabilitation staff. This separation meant that important information about a patient's condition was not shared, and opportunities for early treatment were missed. Many therapists felt their role was misunderstood, with some colleagues questioning why they needed to enter the high-risk isolation tents at all. They were not always included in the initial government plans to hire extra staff for the pandemic, and when medals and awards were given to healthcare heroes, physiotherapists were frequently left out of the ceremony.
The environment in which they worked was often dangerous and under-resourced. They frequently lacked the personal protective equipment needed to stay safe from the virus, leading to strikes just to get basic gear. There were not enough therapists to go around; one professional described being responsible for forty patients who were struggling to breathe at the same time. They also worked without clear guidelines or training specific to the new virus. The training they received was often too general, leaving them to figure out the best ways to treat COVID-19 patients on their own. The absence of a standard plan meant that every therapist had to improvise, creating inconsistency in the care patients received.
The researchers concluded that while the physiotherapists in Malawi showed incredible resilience and skill, the system that supported them was not ready for such a shock. The study suggests that to prepare for future outbreaks, the healthcare system needs to do more than just hire more staff. It must create specific training programs for rehabilitation professionals, ensure they have the right tools and safety gear, and include them fully in the decision-making process from the very beginning. By fixing these gaps, the country can build a stronger network of care where every member of the team, from the surgeon to the physiotherapist, is ready to work together when the next crisis arrives.
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