Back in 2014, Wala’a Awwad started working at CVT Jordan as a junior physiotherapist, and in the years that followed she worked her way up to her current role as physiotherapist/trainer. From her work with survivors, she has a deep understanding of the importance of trauma-focused physiotherapy (PT) after seeing the very meaningful changes experienced by clients. Wala’a today brings her highly specialized skills to her team of physiotherapists and also to students and physios who are new to the profession.

Wala’a met with Grace Ogihara, CVT senior graphic designer, to talk about her work and share insights on the role of physiotherapy for healing trauma.

Training Physiotherapists on Trauma-Focused Skills

Wala’a heard about CVT when a guest lecturer from CVT spoke at her university about physiotherapy’s role in the rehabilitation of torture survivors. She did some research about CVT and felt that working with survivors would be challenging but also rewarding, a way to contribute to someone having a better life. “When you see how pervasive trauma is, I feel like it’s important to find a way to support alleviating the suffering of those affected by trauma,” she said.

In photo: Kamal Khalifa, physiotherapist/trainer; Randa Haifawi, psychotherapist/trainer; Wala’a Awwad, physiotherapist/trainer; Lina Al Haj Hasan, former associate psychotherapist/trainer.

Today she supervises a group of physiotherapists, handling hiring, coaching, mentoring staff, working on their capacity building and promoting self-care. Part of supervision is clinical management, doing assessments and designing and implementing programs for physiotherapists and the interdisciplinary team at CVT Jordan, which includes physios, psychosocial therapists and social workers.

And increasingly, she conducts training on trauma-focused physiotherapy. “There are not many people who are specialized in trauma-focused physiotherapy,” she said. “The more I train others, the more I have seen a huge gap there. It’s interesting to me to contribute to the capacity building of other staff.”

There are not many people who are specialized in trauma-focused physiotherapy.”

Wala’a Awwad, physiotherapist/trainer

Wala’a and the team train university students as well as staff at other organizations, where CVT Jordan also provides self-care training. Wala’a finds that training students is different from training professionals who have been working in humanitarian fields, whether the topic is self-care or trauma-focused physiotherapy. She takes steps to adapt her trainings and materials to the right level for each audience.

“When we train professionals, the needs assessment might be a little different, focused on a few areas where they really want to learn specifically,” Wala’a said. “But teaching at universities is more of building a base, setting up all the areas that are key, relevant and important, to enable the PT and put them on the road to support other trauma survivors later, when they’re working in the field.”

In recent years, Wala’a and the team built a full trauma-focused physiotherapy curriculum, including needs assessments, interviews with instructors, a curriculum review of the university, and identification of gaps in the curriculum. Response has been very positive, and the implications over the longer term are important for the field as a whole.

“CVT has been thinking about this,” Wala’a said, “because when CVT hired physiotherapists, they really needed significant training and capacity building to be able to manage the needs of complex trauma/torture survivors. It’s not something we learned at university.”

The need is different when you have a fractured knee from torture compared to a fracture that happened when you were playing around with friends.”

Wala’a Awwad

She mentioned that the needs of the refugee population are very different from other people who seek physiotherapy care for a variety of injuries. “The need is different when you have a fractured knee from torture compared to a fracture that happened when you were playing around with friends,” she said.

Wala’a also noted that in Amman there is a large refugee population, so it is very likely that a physiotherapist will end up treating a refugee who has survived torture. “Building the capacity of physiotherapists in Jordan to meet the needs of these complex trauma survivors is very important,” she said. “Trauma from armed conflict is one kind of trauma, but what we’re teaching can be applied to other kinds of trauma, such as domestic violence, etc. Trauma is pervasive. We’re specialized in the trauma from torture and conflict, but our approach can be applied to other trauma survivors.”

The Importance of the Body-Mind Connection

Wala’a spoke about how important it is to help clients understand the ways trauma affects people’s minds and bodies. “Trauma impacts the body as much as it impacts the mind, and there are all sorts of adaptations when trauma happens to the body,” she said. “Addressing just the mental and not the physical side of trauma is only addressing one part of the issue.”

Addressing just the mental and not the physical side of trauma is only addressing one part of the issue.”

Wala’a Awwad

She said that the team at CVT Jordan focuses on biopsychosocial services “because you can’t separate your mind from your body, from your soul, from your social life.” She said that because trauma affects people so broadly, the treatment should consider both the physical and psychological aspects and provide holistic services to clients.

“There’s also a huge impact of what we’re doing as physiotherapists on the lives of our clients. The outcomes are not only physical, not limited to just improved range of motion for joints or decreasing pain,” she said. “When you work on the body after trauma and it goes through the process of healing, it impacts their social lives and their mental health.”

Stories of Success and Hope

Clients build coping skills and Wala’a sees positive results for thousands of clients, “success stories like grandma being able to hold her grandchild for the first time after therapy, women regaining roles of mother in their families, seeing how children can play with siblings/friends.”

She appreciates being able to see the ways she is contributing to people’s lives and providing them with resources, tools and knowledge so that they’re able to control their lives and symptoms. Clients are very different at their last session compared to the way they were at their first.

“It’s something that I’m proud of,” she said. “When you see the suffering of others and how they change, you see the world in a different way. Your priorities might look different after working with trauma survivors. You learn to be more adaptable, you problem-solve more, you have more strength.”

Wala’a finds that healing is part of what CVT is doing to contribute to justice, supporting clients on that journey while providing support to alleviate their physical and psychological suffering. “The healing we provide contributes to that,” she said, and it contributes to the wellbeing of the wider community. “I have always thought of justice as the north star that guides humanity through the darkest of night – every soul has the worth of fairness and equity.”

They taught me how to not stop and persevere. This gives me hope.”

Wala’a Awwad

Even with all the challenges clients face, Wala’a said she’s gained a lot of hope and strength from them.  “They’re still trying to build a life for themselves and their children, which I find inspiring. They’re smiling at their therapists; they’re believing things will work out for them in the end. That things will change. They’re hopeful for their futures,” she said.

 “They taught me how to not stop and persevere. This gives me hope.”