Helping Torture Survivors with Fear as Well as Pain

Tuesday, July 19, 2016

Maisoon Al-Bukhari is a senior physiotherapist, CVT Jordan.

After nearly four years on the physiotherapy team at CVT Jordan, Maisoon is leaving CVT to move to Germany.

When I work with survivors of torture, I keep in mind that they are not only dealing with pain and problems with mobility or functioning. They are also dealing with memories and fear. As a physiotherapist, I understand that a survivor who is unable to move in specific ways may be avoiding the torture position. At CVT, I help survivors move past these fears.

I had first heard of CVT during my fourth year at Jordan University, when a physiotherapist from CVT gave a lecture at school. This was the first I’d heard of doing physiotherapy for survivors of torture. She told us about the center, and the more I learned, the more I wished to work at CVT. I was interested in helping those people – they have lost a lot as a result of torture. It affects them physically and psychologically. Because I have always liked helping people, I was curious to learn how I could work at CVT, but because there were no open positions at that time, I preferred to start my career pathway in private centers and hospitals.

After I graduated with a physiotherapy degree, my first position was in a private center in Amman called Physio Medic, a clinic known for its excellence in physiotherapy for chronic cases and acute injuries. There, I treated many patients including children, adults and the elderly, focusing on manual therapy. But I never forgot about CVT. When a position opened, I applied and got the job.

I feel like I grew up at CVT. When I started, I was the only female physiotherapist on the team. A total of three men and I covered all cases. It was very busy for me in the beginning. We began to expand the work and the team as more Iraqi and Syrian refugees came to CVT for rehabilitative care, and I moved up to senior physiotherapist after a year and a half. Today there are 13 physiotherapists at CVT Jordan, and seven of them are women.

I have always appreciated how at CVT we do group therapy for clients; I had heard about the physiotherapy group model in the university and how it is effective, but at CVT, I applied it. We are dealing with girls, boys, women and men who have gone through the most horrific experiences and witnessed cruel human rights violations. They are often isolated and have lost many connections to other people. They often don’t have much social interaction as part of their daily lives. Then they begin working in the group and soon discover there’s harmony in the groups. They work and connect with each other, which helps improve their social interaction and gives them the opportunity to encourage each other. We make sure the physio program fits for each client by doing a thorough assessment at the beginning.

Many of our clients start with very poor self-regulation because of the torture they experienced, which means that they often have body awareness problems. They cannot explain what’s wrong, and many are depressed or have anxiety. In some cases, those who have survived torture cannot differentiate between the right and left side as a result of chronic pain. They may have sudden, jerky movements. They often have poor concentration levels and have difficulty in shifting from one activity to another. However, our physiotherapy groups run for 10 weeks, and by the 9th and 10th session, they have improved physical mobility, their body awareness and self-regulation levels have improved, and they are more functional in their lives overall.

After all they’ve been through, the survivors I work with still have hope. And at CVT, we give them more hope. We work on the physical part and help refugees get back to functioning. I have seen clients work through fears as well as pain. As an example, a survivor who may have been suspended as part of torture will have shoulder problems. Any activity that involves raising one’s arms will be very painful, even for simple motions like combing your hair. The survivor may have difficulty anytime the body moves into the torture position.

For these clients, we work on pain education. I work to help them understand that specific arm movements, for instance, will not cause damage to the shoulders. Clients need time. With physiotherapy, I help them stop avoiding these movements, which they fear not only because of the pain, but because they are reminded of the torture. Even if my physical assessment shows a client is capable of almost the full range of motion, he or she may be afraid to put themselves back into the torture position.

One technique I’ve used to ease clients into movements that they fear is to play games. I have them catch a ball and throw it back to me. With time, after we play with the ball, they no longer have the pain even with overhead activities or positions that caused them anxiety. I tell them to begin doing other activities again, too, encouraging them to do as much as they can for themselves. A survivor with shoulder problems, for example, may have had her daughter or someone else do simple tasks for her: combing her hair or helping with her clothing. After the exercises and play, and because they are more educated about their pain, clients become more independent – they can move without pain and take care of themselves again. In addition, many mothers become able to take better care of their children as well as themselves.

In a group setting, the clients start the cycle with each other and work together over ten sessions. By the last session, I hear them talking with each other about how much they have improved. We work with the counseling sessions at the same time, always working together to improve clients’ level of functioning and wellbeing. We build the mind-body connection in this way. I really enjoyed working in an interdisciplinary team, and I believe in its effect on the clients.

Survivors can improve. They become more aware of their body and start to care more about themselves. Many are very shy at first, not very interactive with each other. But by the 9th or 10th session, they are more interactive and more encouraged to reengage in their lives. Many clients take the exercises and teach them to their sisters or neighbors. The women do the exercises with their husbands and children; they practice partner stretching and partner strengthening exercises. Many groups become connected and continue to stay in touch after the sessions have ended. They become friends with each other.

Working with survivors gives me so much hope – I see it especially in the mothers I’ve treated. They come back to CVT feeling more connected to their children. The children’s sessions are very inspiring. Some of the children have been kidnapped or witnessed atrocities; at first I hear them talking about their difficulties and what happened. After the children joint sessions, which include the counselor and the physiotherapist, I hear them tell their parents how they are coping and feeling better. This gives me hope.

I love my work at CVT – I’m sad I’m leaving. I’m excited to start my future life, but what CVT has given me will stay with me. I’m very proud I worked here, and I thank my colleagues and trainers – everyone who works to make our job such a good one. I give special thanks to the physiotherapy team who are working very hard to make life for our clients better and more functional. CVT provided me with a very unique experience to work with Syrian and Iraqi refugees, and at the end of our cycles I see that we have inspired them. They give me hope.

http://www.cvt.org/blog/healing-and-human-rights/helping-torture-survivors-fear-well-pain