Painful pasts

Torture is sadly common in many countries around the world. Daloni Carlisle talks to a physiotherapist working with survivors.

When Liz Hart asks patients about their chronic pain, what makes it worse and what makes it better, she has to tread very carefully. She is a physiotherapist with the Medical Foundation for the Care of Victims of Torture and her work involves helping people who have survived torture such as severe beatings or being kept in stress positions for long periods of time. The last thing she wants to do is interrogate her patients. ‘You have to be very aware of what might have happened to them,’ she says. ‘I find that initially a lot of people do not like being touched. You have to take time to build up trust and be very careful to explain everything you are doing and sensitive about asking people to take their clothes off,’she explains. Liz Hart joined the Medical Foundation eight years ago after a long and varied career in physiotherapy involving community work in inner London, Sudan and Gambia. She now works at the foundation part time as a member of a multidisciplinary team. Her patients come from all over the world, she says, but most are young men. ‘We get a few middle aged men - the elderly tend not to survive,’ she comments. It is hard to generalise as every patient is an individual but, she says: ‘They tend to be suffering with chronic pain and anxiety. A lot of them are hyperventilating, for example.’ Often she is helping patients to manage their pain. ‘I incorporate exercise and relaxation as well as functional activities,’ she explains. ‘For example, if they are having difficulty going to college, is it because they have difficulty sitting?’ In addition to her one-to-one work, she also runs sessions for NHS physios, teaching them how to work sensitively with torture survivors. ‘Actually, this is really a matter of good practice,’ she says, pointing out that physios in the NHS might be treating a torture survivor without realising it, as often people do not talk about their experiences. ‘It is all about explaining what you are doing and why and seeking informed consent,’ Liz Hart says.  Physios need to be aware too of what survivors of torture might be going through here in the UK. ‘They might have lost their whole family at home and be here alone and without support. ‘They might be going through the asylum system with all its uncertainties, unable to work and destitute. Physiotherapy might not be top of their priority list and what you can do for them might be minimal.’ Inevitably some patients do tell her about their experiences and although she stresses she is not a counsellor, merely a good listener, it can be hard. She has regular supervision from a medical psychologist. She says: ‘When you listen to people’s stories you just cannot imagine what they have been through and how they are coping here now with no language, no family and no friends. But they are the survivors, the ones who made it. Many more are languishing back home. You see amazing feats of human endurance in this job.’ 
  • The foundation’s Manchester centre is looking for more volunteer physios. Contact Jude Boyles, Medical Foundation, 1st Floor, North Square, 11-13 Spear Street, Manchester M1 1JU, tel 0161 236 5744 or email

Daloni Carlisle

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