The office is small, and in the corner there is a sofa that takes up most of the space in the room, with the windows only letting in a small amount of light. Physiotherapist Muammar Fuad is sitting at his desk alternately looking up from his computer. His flickering look creates a slightly nervous atmosphere, but as soon as he begins to speak it is clear that this is a very competent and confident physiotherapist. He has a lot of skill and even more advice that he wants to share with other working in the field of victims of torture and traumatised people.
Muammar completed his education as a physiotherapist in 2006, and in the first years of his career he worked with disabled people. Later on, he started working with the Institute for Family Health (IFH) in the second phase of a partnership between IFH and the Danish Institute Against Torture (DIGNITY). The partnership was part of the Back to Life programme that started in 2008. The initiative was a reaction to the many Iraqi refugees that came to Jordan who had suffered, been mistreated or even tortured during the Iraq War. Later, the arrival of many Syrian refugees made IFH even more relevant.
The partnership between IFH and DIGNITY is focused on building capacity amongst the local professionals who work with traumatised people and survivors of torture. In particular, PTSD caused by fleeing war zones and traumas caused by torture require extremely specialised and integrative treatment to ensure successful rehabilitation and reintegration into society. This integrative treatment is now being used at IFH by the professional staff – including Muammar Fuad.
Muammar started working with torture cases as a physiotherapist at IFH in 2010. And in his own words he felt “lost” in the beginning. There was no support system and he lacked information and knowledge about the subject. People who are victims of torture have a very different personality and psyche compared to Muammar’s previous patients, and he found them difficult to understand and deal with.
In general, the psychological aspects had not been a priority in his previous work, since physiotherapy is physical and Muammar would treat his patients solely by using his hands. The situation is very different when it comes to victims of torture. According to Muammar, listening is an important aspect when treating this group of people. But treating victims of torture was not something he had been trained in while studying physiotherapy. The psychological aspects of pain were completely absent from his training. In Muammar’s own opinion, he did not listen enough to his patients when he first started treating traumatised people and victims of torture.
It was a difficult start for a young and inexperienced physiotherapist like Muammar. He had so many questions and often felt insecure, so he asked colleagues and experts for advice. There was one psychologist in particular at IFH who meant a lot to him in the beginning – and she still does. She helped Muammar understand his patient’s psyche and feelings and how to treat and talk to people with traumas. She gave him another important piece of advice – take care of yourself. She explained how to deal with stress and the risk of feeling burnt out – both aspects that Muammar had never thought about. And it was not until he started experiencing this that he began to take these aspects seriously. Working with these difficult cases and listening to the serious stories was hard.
“When I heard about psychosomatic pain, I was somewhere between being sceptical and feeling hopeful, but after seeing many of these cases, psychosomatic pain is a real thing to me.”
Physiotherapist, IFH (torture rehabilitation)
Muammar also received supervision from the healthcare personnel working at DIGNITY’s rehabilitation unit in Denmark. This was mostly done via Skype, but Muammar could also exchange know-how and get advice when the Danish healthcare personnel visited IFH. He told Danish personnel that he felt lost and needed advice. Through these sessions, Muammar became aware of pain management techniques. He was also helped to better understand and treat psychosomatic pain – pain that lacks an obvious physical cause.
Muammar admits that when he first heard of this phenomena he was somewhere between sceptical and hopeful, but today he feels different. “Seeing so many of these cases, psychosomatic pain is a real thing for me.”
Muammar – the expertToday, Muammar is far from being lost. He is a confident physiotherapist – knowledgeable about torture cases while still being able to know when it is time for him to look after himself and his own mental health. First and foremost, Muammar knows when he is close to being burnt out. In these situations, he rushes to his therapist colleagues to get advice about self-care – like playing with his kids and going away on holiday for a while. Muammar does his best to follow the advice, because he knows that he can only be a good physiotherapist if he is feeling well and has the mental strength to help people. Muammar is now an expert on working with victims of torture. In cooperation with DIGNITY, he did a full day of teaching Jordanian medical students on treating victims of torture. He speaks generally about his expertise and about how he prefers group therapy as a method of rehabilitation. In these settings, the patient can feel “normal” and see others in the same situation. This is important, because many victims of torture are embarrassed and feel alone in their situation. Moreover, the patients can share experiences and hear success stories where people have defeated problems with sleep or where they have succeeded in reducing symptoms or injuries.
Muammar is a naturally empathic person, and to him it is always important to normalise a situation – regardless of what his patient is going through. He tries to teach them about pain and passes on his knowledge. Explaining his own development: “I didn’t listen in the beginning – now I’m a great listener, teacher, and therapist.”
In the same way as Muammar is a supporter of group therapy, it is his priority to share his experiences as a physiotherapist with personnel who work in other areas of healthcare. Even the most experienced expert needs counselling, and Muammar is not too proud to admit that he still needs guidance from experts and professionals sometimes. Furthermore, the young physiotherapist is still keen to learn and participate in workshops to exchange knowledge. He still feels that he can be better at self-help and dealing with stress. In the beginning of March, he participated in a workshop where a physiotherapist from DIGNITY’s headquarters in Denmark was teaching the newest methods of pain treatment.
“It is always good to be reminded of things, and during this workshop I’ve learned new things from Anne-Mette (physiotherapist at DIGNITY’s rehabilitation unit) that I didn’t know prior to the workshop.”
The fight continues
Muammar is part of a larger team that helps victims of torture reintegrate into society – to be active citizens, spouses, parents, employees, etc. This interdisciplinary team at IFH has helped numerous victims of torture. The need for rehabilitating victims of torture in a country like Jordan is enormous, as traumatised refugees represent such a large part of the population. The trauma affects their ability to contribute to society and be part of a functioning family.
The scars on body and soul can be devastating. Many victims suffer from chronic pain, depression, anxiety, or PSTD. It can be a challenge just to reach all the people who need IFH’s help and support because of stigma in society – or because basic human needs like food and housing have to be met before they can think of treatment.
There are many challenges when working in this field, and Muammar is challenged by the fact that he cannot meet his patient’s needs because of various issues, such as the lack of financial support. The risk of secondary trauma or burnout is a continuing challenge. However, Muammar continues to work hard and motivate, and he does it well with empathy, expertise, and courage. Last but not least, he passes all this along to his colleagues and other practitioners. However, his hope is that the treatment of torture will one day be part of the curriculum in healthcare education in Jordan.