Physiotherapy Supports Healing – Even in the Pandemic

Joseph Wesonga is a physiotherapist/trainer at CVT Kakuma.

Many people do not know how important it is to understand pain. Understanding how the body and the mind work together is one of the most important elements in my field – using physiotherapy to help survivors of torture. When a torturer says to a person, “You’ll never recover,” that message gets planted. The individual may be fully healed later on, but the pain is still there. They don’t believe they are healed.

So physiotherapy helps them understand their pain, understand that they have healed. The pain goes down.

I work with the physiotherapy team alongside the mental health counselors in the Kalobeyei settlement in Kenya. Today we are facing the COVID-19 pandemic, which has required us to pause our in-person sessions with survivors. To help with this situation, we have reached out to all clients and ensured they have the tools and communication channels to continue their healing work.

The outbreak of COVID-19 Has been a game changer in our management of our physiotherapy activity at CVT. Being a human rights organization, the safety of the clients and the staff is our first priority. We have trained our staff on the preventive precautions to take for their personal safety and that of our clients.

New innovative adaptations have been developed to manage our activities remotely, with the client taking the central stage in their own management. We developed a stimulation package of simple, well-designed therapeutic activities that a client can do on her own with little instructions given through the phone by a physiotherapist. Graduated home-based exercise program handouts have also been given to each of our clients to continue with the exercises.

Trainings on well-being for both staff and clients have been and are still being given to support them during this stressful moment when each one is affected with this pandemic. Anxiety, general malaise, fatigue, loss of concentration, headaches, generalized pain and other symptoms are emerging in the population as a result of the uncertainty of COVID-19. This has effects on both the mental and physical well-being.

Over my career, I have worked to remain adaptable to the current situation, and this pandemic is no different. I started my career in Physiotherapy and specialized in Community Based Rehabilitation. My focus was on care for people with disabilities in primary health care settings. I then moved on to Community Health and Development courses and work. I got my Master’s degree to ground me, to help me understand general health of the population and the underlying determinates of health, and in particular, health issues associated with disabilities and the vulnerable in society.

I have an interest in the trends of diseases and methods of building the health status of people in many different contexts in the world. I took a course in Britain on international understanding with bias on   mobilization and assisting communities to have access to services especially regarding mental health issues in the community. I was finding through my work that vulnerable people were being ignored. I did not see services for mental health available to them on a formal basis.

I became interested in helping survivors of torture. The first time I worked with survivors was in Sri Lanka, among people in the north who had experienced torture. At that time the group I was with was using techniques to try to divert their minds from trauma. I saw among this group of survivors of the war in that region, that people really suffer psychologically. From there I met with the Danish torture rehabilitation organization Dignity. I started integrating ideas about suffering and stress and about mental health into my work in physiotherapy.

I also worked in the Dadaab refugee camp, where CVT was my neighbor. I was focused on physiotherapy but found I was referring refugees to CVT for a number of traumatic circumstances which had deeply affected them: 1.the events that forced them to leave their homes, 2. the journey they undertook to make it to the camp, and 3. the troubles and difficult environment there in the camp.

I found that in order for clients to look at their stress, often they had to confront their losses. In Dadaab during the emergencies, people were in very bad conditions. They had seen children dying, horrifying injuries and many atrocities. They needed help to get service.

I find that is the case here in my work with CVT in the Kalobeyei settlements. Survivors faced traumatization in war and terrible problems that forced them to leave home. Then the camps here in Kenya have very harsh conditions, even before the pandemic. The weather is extremely hot and most clients are pastoralists. The locals are sometimes hostile, and refugees have been beaten, killed and raped when they have gone out to try to get firewood.

Now, when clients come to CVT, there is support. As a physiotherapy team, we work closely with the mental health counselors so that the needs of the mind and body are taken care of. That’s the beauty of it: combining learning about trauma with physiotherapy tools gives clients both sides of the coin.

When we give service to people, we see them changing their lives from worse to better, and we see them become productive. This is important. This supports families going forward and supports the overall well-being of the community. I have seen clients go through the CVT care sessions and begin really becoming active in many ways –  some become elected leaders in their communities, some become employed. They go back to school, learn skills, and they share what they learn in CVT counseling and physiotherapy sessions with their families. For many, they have never shared their personal stories with family, but now they are able to cope.

Seeing changes in clients is very meaningful. There are certain things I did not know I could bring about in terms of well-being – I’ve seen people change from gloomy at the first session to full of life by the end of the cycle. When a client first comes to us at the assessment, you may see someone who is not willing to give us much information. Clients are initially protective of their information, but as trust builds, they start to open up. With the additional information shared, the physio team can help clients even more with sensitive issues, such as with incontinence and sexual dysfunction. They continue with the activities and by the third or fourth session they open up. I did not expect this. They way people open up is like a flower – they have never spoken like this before and now they are beginning to heal.

Working with CVT has also supported my professional growth. When I began, I brought in my experience as a former area manager while we were building the new program here in Kakuma from the ground up. This helped CVT. I had field start-up experience and could consult on issues related to things far beyond physiotherapy, such as security, construction, buildings, infrastructure and more. This program of CVT Kakuma started off with no electricity, no buildings, no internet. We had to build relationships to get services and get started.

In addition, CVT brings teams together for collaboration and consultation. I visited our program in Bidi Bidi, Uganda, earlier this year and led a week-long training with CVT staff there. We are working towards integrating a bit of physiotherapy into the mental health care being offered there. The team had identified a need for physiotherapy – because of previous work of the wider CVT clinical teams, they felt that they were addressing the mind but not the body. A component was missing. They saw clients’ physical response to stress, with symptoms like headaches, sleep problems, and inability to control pain. In particular, people with history of sexual or gender-based violence and rape often have difficulties with the pelvic floor muscle control, leading to incontinence.

The team wanted to learn exercises to help clients manage themselves. When a client’s problem is in the mind, his muscles tense up and posture becomes impaired; simple things like walking can become uncertain or clumsy. So we shared exercises to help people connect the mind and body. We give body awareness exercises, relaxation exercises, coordination and body strengthening exercises.

We have also arranged visits from colleagues in CVT Jordan for collaboration and work on a new, four-hour Trauma Resiliency Workshop. This is an offering we can give to people who have survived war trauma other than torture, who also need care. We are looking at this kind of service for the host community here in Kakuma – we know many people are undergoing stressful situations, including domestic violence, poverty, rape, stressors, clan or tribal conflict.

When clients go through the CVT sessions, they change their lives. We see them begin to share with colleagues in the group. We see that they can talk and even joke. Then, later some will come to you and are able to tell you more stories and some of their problems – things they were ashamed of, like incontinence. We then get a chance to try to assist them.

The first weeks here in Kakuma, we didn’t even have a building. We started from nothing. It’s all happening now. We’ve left a mark in the community.

I’m proud to be associated with the program and to build people’s capacity. In addition we have built a network – we keep in touch with the host community. Everybody here is aware of CVT and the services we give, and people speak very positively about our program. This makes me happy and proud of CVT.

Now, we made it.