We Say “This is Not the End”

Winnie Chao is a physiotherapist, CVT Kalobeyei.

When I first begin working with a client here in the camp in Kalobeyei, I notice two barriers. The first is physical – many clients tell me that they have pain and that they do not wish to leave their homes. The second is emotional – they tell me they do not feel they have value in this world.

Both of these are things that I see change when clients come to us at CVT. Even though we have been facing the COVID-19 pandemic and have to work remotely with our clients, the clients have reported great improvement in terms of pain reduction, improved quality of sleep, improved functional ability, and they are grateful for the services and support during pandemic.

I have been working for CVT for more than two years, both here in Kakuma and also in Nairobi. I have my Bachelor’s degree in physiotherapy, and I previously worked in an outpatient clinic in Nairobi. I was interested to move to CVT, however, because I began working with survivors of torture during an internship with CVT. I began learning how to work with people who had been tortured, and I wanted to gain a clearer understanding. I saw that many clients didn’t want to do physiotherapy; they weren’t interested. I wanted to learn how to work with them effectively, and take on a new professional opportunity and expand my skills in diverse ways of managing patients.

In my work, we begin when a client comes in for an assessment and then proceed to lead physiotherapy groups. These consist of 10 sessions, after which we do three-month, six-month and one-year follow-up visits to see how clients are doing. Before the pandemic, we did these visits in person, but now we use phones to connect and to provide ongoing support and education. In between the end of the sessions and the scheduled visits, the clients do at-home exercises.

This process and schedule are very helpful because we commit to a kind of contract with the clients. You get to know the progress of clients very well and you can see clearly what programs can benefit them more. And I get the opportunity to see the impact of the work on clients. This is one thing that is very important in my work. We focus on specific exercises, and I find that with each client, I can see how they are improving in every session. I see improvements in functional ability and also in socialization, their ability to interact. This is so important with people who have survived torture.

As an example, one of my first clients had a long list of problems and didn’t believe she would get better. But she showed up and did the work. At the beginning of every session we did a check in, and I noticed that every day she reported that she had improved. I saw my client opening up. She said “I am able to feel.”

When she first arrived, she had a lot of back pain and told me she had lack of sleep. But after ten sessions, she had no more back pain. She was no longer using pain medication. Before CVT, she was carrying too big a load, and now she felt it was removed. She brought other clients for services.

Another client had been tortured, beaten, raped. At the intake, she told me she had pain all over her body. The CVT counselor noted that the client was also suffering from symptoms of post-traumatic stress disorder (PTSD). She felt in a very bad state. But she would come to the sessions. There were times when she didn’t participate, and said that she didn’t see her purpose. I noticed that she did not do many of the exercises, but she still kept coming. She wanted to be there. So we began to put the exercises to music. She started to engage with the others. She began to do the exercises. Then she would even share her phone to provide the music. She had been isolated; you could see her sadness. But then she was able to open up.

Most clients feel hopeless at first, but as they come they feel that they are improving and that they are able to do activities which they haven’t been able to do for a long time. One client could not get out to shop for anything but after she came she said she felt empowered. She told me she was able to deal with both her physical and emotional pain.

For most clients this is a big journey, a big change in their lives. I have seen that the members of every group are able to participate in physiotherapy; they all get there. People come out of pain and begin to see hope. They become optimistic and begin to work their goals. They say that seeing improvements as they came to sessions is what pushes them to keep coming. One client told me, “It’s unique – it improved my physical functioning.”

It is a journey for each client, from the first session through all the follow-ups. And we are always there for them. We tell clients, “If you have challenges, come back.”

We say “This is not the end.”