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