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Notes from the Ground

A Hybrid Physiotherapy Approach to Care During the Pandemic at CVT Kalobeyei

Published February 9, 2021
CVT Kalobeyei building.

By Taneasha White, contributing writer

The COVID-19 pandemic caused a massive global shift, forcing many to not only rethink the way their days are structured, but the way their work is done. This worldwide crisis has brought a lot of fear and strained relationships, and resulted in severe loss for many families. We are also forced to reconcile that even with all of this heaviness, the pandemic provided a push for innovation, and forced many to think more strategically about accessibility.

CVT’s focus is on providing support and rehabilitation to survivors of torture, often from war-related conflict in their countries of origin. Survivor responses to violence and torture vary, with both mental and physical symptoms that need to be addressed. Because of this, the importance of psychosocial and physical wellness are held within the programming, as several CVT locations offer both counseling and physiotherapy opportunities. Stanley Malonza, physiotherapy supervisor, CVT Kalobeyei, says, “We work very closely with the psychosocial counselors because we know that experiences that affect the body, also affect the mind. And experiences that affect the mind, also affect the body.”

Note: Click to watch a video overview of the CVT Kalobeyei hybrid physio program.

What is Physiotherapy?

While at a distance, CVT’s implementation of physiotherapy may look similar to general physical therapy, in practice there are important distinctions. CVT utilizes specific protocols that were created for survivors of torture and violence, so all therapy practitioners are trained in trauma-informed care specific to the outcomes of torture and the methods that best address them. Stanley says, “When delivering our services, the physiotherapist is always mindful of the concept of re-traumatization. We don’t use a majority of physiotherapy machines and equipment that utilize electricity. Our interventions are customized and tailored to individual needs and culture.”

Data shows that the mind and body are inextricably linked, as emotional trauma can result in physical pain or complication. Stanley shares that trauma can affect survivors’ quality of life, including examples of issues with balance, breathing complications, general malaise and fatigue, incontinence, headaches and inability to concentrate, and chronic pain — all informing how well one can function within the community. Winnie Chao, physiotherapist, CVT Kalobeyei, says, “Physiotherapy addresses not only the physical sequelae of torture and war injuries but also the physical manifestation of severe emotional distress. This affects one’s functional ability, social and community participation, quality of sleep and sexual life.  CVT physiotherapy uses specialized therapeutic intervention to enable survivors to wholly reclaim their lives thus becoming more productive in the community.”

Necessary Changes

Prior to 2020, the CVT team conducted physiotherapy sessions at their Kalobeyei, Kenya, site in groups of 10-12 individuals. Sessions were held once a week for a total of ten weeks. Physiotherapists and rehabilitation assistants were available for hands-on instruction and to answer any questions, ultimately forming connections with clients they see on a regular basis. When questions of safety during Coronavirus emerged, there was a swift pivot to the method we have seen a lot this year — teletherapy. “Before the pandemic, we were providing in-person services. One of the group cycles was halfway completed in mid-March 2020 when all CVT fieldwork in Kenya was indefinitely suspended,” says Stanley.

This version of the physiotherapy program was an adjustment, and came with some challenges. Stanley says, “The cycle was altered. It was a hard time for both the staff and beneficiaries with a cloud of uncertainty, but the CVT clinical advisers and trainers were quick to develop a wellbeing check-in document. Both counseling and physiotherapy teams switched to phone calls. We continued supporting the ongoing groups remotely via the phones. This was faced with several limitations and challenges because some beneficiaries had no phones, others could not be reached despite having provided contacts, others need interpretation.”

Despite this, the CVT therapy team put their heads together to ensure quality was not lost and that their clients were taken care of. Because individual clients had differing access to smartphones and translation, CVT opted to try a pilot program of virtual sessions. These sessions were a hybrid of virtual and in-person, with an on-the-ground assistant being present for any immediate needs or translation, while the physiotherapists connected with the clients through a Zoom video call. In addition to this change in instruction method, the physiotherapy sessions were also limited to one client at a time, enabling the programs to last for six weeks instead of ten. In an effort to limit exposure rate, each session was also limited to 45 minutes each week.

Stanley shares that even though the survivors missed the warmth of the group gatherings, the trust that was built led to successful virtual sessions. Clients had ample notice prior to the switch, and were receptive to the change, showing up in great numbers during the pilot. “The clients have adjusted well because we did a lot of community awareness and sensitization. We passed the information through the community leaders and they were able to take up the new style positively. Amazingly, we got a good turn out and cycle completion rate of 85% and a minimal dropout rate of 15%,” says Stanley.

This COVID-19 pandemic is ongoing, and continues to teach us lessons along the way. The CVT team intends to bring back their in-person sessions when it is safe to do so, but this experience proved to not only be a lesson in flexibility, but a verification of the strength of survivors. Stanley says, “We must always think outside the box and most of the time we have the power and ideas to do so. We should not be afraid to bring change. Covid-19 has proven to me the resilience of refugees and their ability to cope through thick and thin, when darkness rolls, when they must strive to see the light. It is also a clear demonstration to us of the value of freedom, what it means not to be able to move, travel, be with those we love, to feel safe and live in dignity.”

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