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Staff Insights

Changing Perceptions About Pain Through Physiotherapy

Published February 28, 2018

Jeniffer Chepkemoi is a physiotherapy supervisor at CVT Nairobi.

In my physiotherapy work with survivors of torture, I focus not only on individuals’ pain and mobility concerns, but on their perception of pain. Torture survivors have suffered very specific cruelty, and I have come to understand the importance of addressing physical symptoms with techniques that go beyond medical interventions only. For survivors, the pain is real. The person was injured. But it is often their perception that makes them believe they can’t do things.

Because of this, at CVT we educate them about pain, about chronic pain. In a way, we help focus the mind – we help clients to see their issues with pain in a new way, with less fear of movement. We help them get to that feeling that “I can do it.” When you teach someone about pain, you help them understand that what stops them is their perception.

To make this happen, I first listen to the client. I accept what they say. Then I ask them to allow me to try. I let them know that I can offer them something, and I take them slowly. I learned you cannot just tell clients “You can do it.” It’s not that kind of encouragement they need. In fact, they might think you want to hurt them more. Instead, I work slowly with them and let them experience that the exercises and practices are working.

There can be challenges, and I tell them about this. As an example, I had a client who said “I have back pain and I can’t achieve anything here. My back is simply like that; give me medication or a corset or back brace for support.” So I tried to talk to him. I said “You may be right. Let me see. Let’s walk just a short distance.” Before long, he was able to sit; then he was able to move.

I have been a physiotherapist at CVT since our early days in Nairobi when there were only two of us physios and a trainer. Now as a supervisor, I continue to work with clients and conduct intakes and assessments to see if people are ready to join our 10-week physiotherapy cycle, as well as providing supervision to my colleagues. Together, we watch for progress and signs of problems in the group sessions.

We see so much progress. Often after eight weeks, clients are feeling so much better, they want to look for work. That is often a great distance from how they felt when they first came to CVT.

Clients come to us in great pain. We educate them that the pain isn’t permanent. In many cases, the torturers told them that they were done, finished. Through our sessions, the clients learn this is not true. Their physical progress defies the torturers’ words.

As an example, a client who could not even face others when she first arrived started doing the exercises. At first, she could not even bend nor do any back movement. She said “My back is rotten.” She believed this was true. So I told her if that was true, she would be dead. I explained about the spine, how it cannot be rotten.

We educate clients about the body, about pain. I told her, “You’re not dead.” After five weeks, she came a long way. She was doing the exercises. Before this time, she didn’t care about herself, she didn’t even do her hair. But this time through the sessions, she was free. She began looking for work. She gave herself hope.

In my work, I listen to what clients say, but I also pay close attention to what they do not say. Many of our clients have survived rape, many extreme cases. When we do an intake interview, some will tell you; many do not. We ask about incontinence and sexual dysfunction, but many clients do not say they have a problem. So when sessions begin, there are some post-rape symptoms we begin to notice. We work with them gradually and many begin to open up. You pick up on it as you go.

In our clinical model, at the fourth of ten sessions we begin to talk about issues, the things they used to do but now they cannot, the things that they lost as a result of torture. We do a lot of exercises without talking, and this leads to people feeling comfortable with sharing. For many clients, these things are very private; they keep it close. It’s up to the individual; they can discuss it or not. They begin to trust and they come to see that they can open up, even about sexual issues and incontinence.

We are always learning from clients. For example, we have noticed some therapeutic benefits for pregnant women who come to CVT for care. They can stay with us right up until birth, and they are happy to see that they can do exercises. They face particular challenges because they are refugees, living outside their home environment. They can get complications after birth which result from the changes in their lifestyle and habits. Here in Nairobi, they are not active as they would have been back in their home country. We help get them more active. We teach some pelvic floor exercises to help with the birth. It also helps over the longer term. This work is always very interesting.

After I completed my physio training, I went to work in a hospital in Northern Uganda, where we saw patients who were internally displaced persons (IDPs), many of whom had been through torture during the war. They would come to the hospital and tell what happened even though we were just addressing their medical needs and not their torture cases – I could see there was a huge need. When I finally read about CVT beginning to offer physio for torture survivors in Nairobi, I was so interested. I decided to move to CVT Nairobi to work with survivors of torture – CVT is the only organization dedicated to treating survivors of torture in Nairobi. I learned that you cannot address physical symptoms with medical interventions only. When I see people come in for care I see how they feel. Then, sometimes after only five weeks, they are totally different. They can do things they could not. When the cycle ends, they don’t want to leave CVT, they want to keep coming.

I ask, What if CVT was not here?

CVT’s work in Nairobi is made possible by a grant from the U.S. State Department’s Bureau of Population, Refugees and Migration; the United Nations Voluntary Fund for Victims of Torture; and the S.L. Gimbel Advised Fund at The Community Foundation – Inland Southern California.

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