Finding “Furaha” (Happiness) at CVT Kakuma
Justine Chepngetich is a physiotherapist (physical therapist) at CVT Kakuma. This article features direct quotes from some of the survivors she’s worked with at CVT this past year.
‘When I came to CVT, my back and legs hurt so much I could not stand without assistance. Now, I’m able to stand and do all my household activities without pain.”
I joined CVT Kakuma as a physiotherapist last year, eager to begin serving clients who are survivors of torture. Their experiences, though, seemed different from those of patients I’d worked with previously. I’d been working in a hospital setting, concentrating mostly on patients’ medical history, not their behavioral challenges or emotional wellbeing. Even after going through the CVT physiotherapy manual, I wondered how the techniques in which I specialize – for instance, breathing exercises that I’d used with bedridden and post-operative patients – would help clients who suffered from the trauma of torture.
When I started conducting intake interviews for CVT Kakuma’s first 10-weeklong group therapy session, I noticed that some of our prospective clients shared my reservations. I gave them an overview of CVT and explained how physical therapy not only addresses the physical wounds sustained from torture, but treats manifestations - sleeplessness and headaches, for example - of emotional stress. While most clients were intent on enrolling, some wondered how they would manage to complete the physical exercises our sessions involve, due to factors such as age and/or limited mobility.
When the first physical therapy session filled up and launched shortly thereafter, I presented CVT’s physiotherapy manual to the group. I wanted to communicate right away the information clients needed to know and understand, primarily the stages of trauma healing developed by noted psychiatrist Judith Herman. CVT Kakuma’s physiotherapy team demonstrated exercises clients would practice throughout the sessions, and as they observed, clients offered us both positive and negative feedback. Many of the participants in our session felt anxious, which isn’t unusual, and the degree to which they were familiar with physical therapy varied. Some clients said that they thought of physiotherapy as massage work; it was both helpful and encouraging to hear their initial thoughts.
”The chest pain I had was so severe I could not carry water--even carrying my baby was a problem. The breathing exercises helped greatly. Right now I can do my duties without any problem.”
We immediately and collectively set clear, attainable goals for the 10-week, once-a-week sessions, so the group felt supported, ready to work and confident about fulfilling their objectives. It was remarkable how smoothly everything went! Setting goals and basic rules for achieving them allowed clients to feel grounded in, and in control of, the healing process from the very beginning. And very quickly, the group developed a great rapport. Whenever we’d stop for refreshments, clients seemed uplifted. They were not only benefiting from physical therapy, but by the opportunity to socialize. They talked freely, promised to support each other and even came up with a name for their physical therapy group: Furaha, which means happiness.
I noticed strong attendance throughout the 10 group counseling sessions. The majority of participants attended, and those who had to miss a session often contacted us, the facilitators, to send their regrets. The most common conditions from which participants suffered were sleep disturbance, headaches, back pain, heel pain, chest pain and urinary incontinence. The benchmarks used to track the progress of the clients were functional ability, body functions and physicality, social participation and functioning, coping mechanisms and outlook and pain rating scale.
“My heels were in such pain I feared I would lose my foot one day. My first step in the morning was excruciating; the pain affected my movement at home and at work. But the exercises CVT taught really helped me. I do them in the morning and any time I was instructed.”
Clients reviewed the goals that they had set at the beginning of the sessions and assessed what they had and had not achieved in each of the categories above. They could then consult other group members and us, the facilitators, for guidance on how to make more progress. There weren’t many additional challenges during the process, confusion was minimal apart from questions about the standard refugee protocols enforced at Kalobeyei Settlement, where clients live, like the fingerprinting process -- clients are fingerprinted prior to food collection toward the end of the month; it’s a way for UNHCR to verify the total population of refugees, and to determine who, specifically, is present. Some of these rules and regulations are new to residents, and can take a while to understand.
To ensure that clients continued doing the exercises they learned - and doing them correctly - after the sessions ended, we gave clients a list of take-home exercises, which we call the home exercise program. Eventually, clients were able to conduct most of the session activities on their own, such as breathing exercises, to help regulate heart rate and general body awareness; warmups, to prepare the body for exercise by gradually increasing the individual’s heart rate and circulation; stretches, to improve range of motion, increase flexibility and lengthen muscles that have shortened; strengthening exercises, to gain strength in their bodies and go about daily activities freely; and Laura Mitchell relaxation exercises, to help with general relaxation of the body, heart regulation and improved sleep.
“At work the toilets are far from me, and I used to rush to them so fast. I felt ashamed when people saw me running to the toilet. Back at home I used to have a small tin beside where I sleep to use at night, but today I’m grateful for the exercises that I was given. My condition has improved and I will continue with the exercises.”
After completing CVT Kakuma’s first 10-week session, clients’ perceptions of CVT and physical therapy changed drastically. Many now consider CVT to be a hospital that heals the body and the mind without injections or drugs. They view exercise as medicine. They wish CVT could serve more people in Kalobeyei.
The perceptions among CVT clinicians changed, too. We learned that healing starts as soon as the first intake interview does, that clients appreciate knowing right away what physiotherapy means and entails, that a group’s success depends on cooperation and preparedness from the very beginning. I was also thrilled to see firsthand that the manual which at first gave me so many questions helped survivors at CVT find answers—even happiness.
