Introduction
The United Nations High Commissioner for Refugees (UNHCR) reported that by the end of 2021, there were 89.3 million people forced to flee their homes due to fear of conflict violence persecution and human rights violations so. This included 27.1 million refugees and 4.6 million asylum seekers worldwide in addition to the 53.2 million internally displaced persons. Turkey is currently the country with the highest number of internally displaced persons in the world hosting more than 3.8 million people.[1]
Displacement camps are temporary shelters built to protect and provide emergency assistance to people who have been forced to flee their homes as a result of war or violence. While camps are not meant to provide a permanent solution, they provide a safe haven for the displaced people and meet their basic needs such as food water with shelter medical care and other basic services in emergency situations.
In situations of long-term displacement, services provided in camps are expanded to include educational and livelihood opportunities and more permanent housing resources to help people rebuild life. These services are also offered to host communities.
There are camps for displaced people all over the world. Many of these camps were built quickly to meet the immediate needs of those who were forced to flee but have grown to accommodate hundreds of thousands of displaced people. Some of the world’s largest camps for displaced people include: Kutupalong-Balukhali Extension Area (Bangladesh) Bidi Bidi Refugee Camp (Uganda) Dadaab and Kakuma Refugee Camp (Kenya) Azraq and Zaatari Refugee Camp (Jordan) Nyarugusu Nduta and Mtendeli Refugee Camp (Tanzania) and Kebribeyah; Aw-barre and Sheder Refugee Camps (Ethiopia).
Data on Camps for Displaced Persons
According to the UNHCR, 6 million displaced people in the world live in camps which accounts for 22% of the world’s total displaced population. More than half of the displaced live in urban or semi-urban areas. Many of the displacement camps have been in operation for so many years that they especially such as cities with schools hospital shops and other facilities.[2] While many of the world’s displacement camps were intended to be temporary, many long-term situations in the world have had a large number of camps longer than planned.
Many of the larger camps were started in the 1980s and 1990s so there are generations of families who have spent their lives in camps for displaced people. According to the UNHCR Global Report 2021 the top host countries in the world are: Turkey (3.6 million) Colombia (1.8 million) . Pakistan and Uganda (both 1.5 million) and Germany (1.3 million). Over 80% of displaced persons are hosted in low and middle income countries and the average displaced person lives in approx twenty years of age. The top “source countries” of displaced people sources are: Syria (6.8 million) Venezuela (4.6 million) Afghanistan (2.7 million) South Sudan (2.4 million) and Myanmar (1.2 million).[2] The number of displaced persons from Ukraine has also increased significantly since the start of the conflict in March 2022 so this figure is not included in the UNHCR Global Report 2021. Current data shows that more than 5 million people have been forced to leave the country to seek protection in other countries and another 7 million have been internally displaced.[3]
People living in displacement camps face social and environmental health risks that can affect their well-being. For example poor water and sanitation lack of food lack of essential health care lack of primary health care providers and exposure to extreme heat.
The World Health Organization and UNHCR estimate that ten percent of displaced persons have some form of disability and these persons could benefit greatly from rehabilitation services.[4] In addition studies estimate between 15 and 44 percent of the displaced population they have suffered some torture. A systematic review by Sigvardsdotter et al.[5] found that an average of 27% of forced immigrants had a history of abuse. While the exact prevalence of abuse among IDPs living in camps is unknown, this is likely to vary from country to country initial sex and other factors. Torture survivors can benefit greatly from rehabilitation services such as those described in the Physiopedia article: Rehabilitation for Survivors of Torture.
Displaced people suffer from many non-communicable diseases. In some camps for IDPs operated by the International Committee of the Red Cross (ICRC), more than 17% of IDPs aged 18 and over have been diagnosed with diabetes .[6] The rehabilitation professionals who work in evacuation camps should be aware of the very high incidence of diabetes mellitus cardiovascular diseases and cancer among camp residents. They need to adapt their interventions to include education about self-care and the role of exercise and nutrition helping to prevent and treat these overlapping diseases. The incidence of posttraumatic stress disorder and anxiety disorders is higher in displaced persons than in the general population.[7][8] It is important that rehabilitation professionals are comfortable providing services to individuals with mental illness. Rehabilitation professionals who work with camp residents must also be familiar with “Trauma-Informed Care” and how to adapt their programs to meet the needs of displaced people who have experienced trauma experiences.[9][10][11]
Since many IDPs live in camps for years with very little chance of being resettled permanently it is crucial that the residents of these camps receive adequate medical care. This should also include rehabilitation services due to the high risk of many chronic diseases diseases that could benefit from rehabilitation services.
According to the UNHCR Comprehensive Refugee Response Framework: From the New York Declaration to the Global Compact on Refugees part #59, the world community has a fundamental responsibility to meet the needs of child survivors of torture and other forms of trauma solve and help those with special puzzles needs including those with disabilities. It is therefore the responsibility of rehabilitation professionals to help manage residents of displacement camps. According to Article 26 of the Universal Declaration of Human Rights, many IDPs have been injured by war such as as amputations spinal cord injuries head injuries and other traumatic injuries requiring appropriate rehabilitation services.[12]
An important role for staff working in displaced persons camps is to provide training for community care workers working for other nongovernmental organizations (NGOs). This training enables these local employees to understand who they need to identify additional support from preparation. Additionally because many displaced persons may not receive much needed rehabilitation due to lack of staff it is beneficial for rehabilitation professionals to provide psychoeducation and psychological first aid to teacher counselors and other practitioners within in the camps. Ideally, this tutorial will include some basic concepts about exercise pain reduction and sexual hygiene so that other caregivers can help those who are unable to access rehabilitation services.
Since many displaced persons living in camps have complex needs it is important for staff working in camps to develop with local leaders and colleagues working in other NGOs strong relationships. They need to learn how to refer appropriate personnel to other medical services educational counseling social and safety programs and to meet many other needs.[9][11]
Another potential role for camp staff is to help create opportunities for displaced people of all ages and genders to participate in physical activities such as walking running cycling and football (soccer) as well as stretching. Several in vivo studies activities for displaced persons with post-traumatic stress disorder and pain have found participants to benefit from activity.[13][14]
Sensitivity should be exercised when organizing team exercises in an effort to achieve ethnically mixed teams. This can help reduce feelings of exclusion and nationalism. Additionally it is useful to provide a variety of exercises so that participants have options.[14] If possible, offer separate programs for men women and children. In some camps for displaced persons, there are specific NGOs that focus on exercises such as Right to Use. But rehabilitation professionals can still play an important role in helping to improve and support fitness schedules.
Group rehabilitation sessions can be very useful for those living in displaced persons camps. Groups can help build trust and communication and help individuals encourage and support each other. There is plenty of research showing that group exercise can be just as effective as individual physical therapy for those with musculoskeletal pain and injuries including a study in Cambodia.[15][16] Given the lack of trained rehabilitation staff working in displacement camps around the world working with groups can also be an effective strategy involving reaching more patients.
According to the UNHCR, half of the world’s displaced people are under the age of 18. Rehabilitation actors should strive to provide needed services to children as well as adults. They can work with other NGOs schools and family members to better engage children displaced from their homes.
Since 80 to 85 percent of displaced persons are housed in developing countries, the rehabilitation team will ideally provide services to local host communities and likewise, host communities are generally free of resources and poverty.
The influx of displaced people has had a significant impact on the socio-economic and health conditions of many countries. The increasing number of displaced persons has increased the pressure and demands on both primary and secondary health care in all rehabilitation services.[17][18] [19][20] There is also a shift toward evidence-based research-based medical management guided by the principles of effort saving time with patient focus and efficiency. Research also shows that patient expectations have changed as patients have become active participants rather than passive recipients of care. Healthcare professionals should therefore ensure that there is sufficient availability of health and rehabilitation professionals to provide quality and timely services to patients.[21][22]
Chronic Pain and Sleep Issues
There are many studies showing that displaced people experience more pain than the general population.[22][23][24] However, very few studies have only been conducted in camp settings so it is difficult to know exactly how prevalent pain issues are in displaced people. The Central Institute for Victims of Torture (CVT) conducted large-scale representative surveys of its programs in Kenya Ethiopia and Uganda (there were over 500 interviewees per survey):
- In a 2018 representative survey of refugee and displaced communities conducted by CVT in Kalobeyei Settlement just outside Kakuma Camp, 35% of displaced people live in refugee communities 32% of residents surveyed indicated chronic pain. In the same survey, 51% of displaced people and 44% of host communities reported problems sleeping.[25]
- In a similar survey from 2017 conducted by CVT workers in two camps in Ethiopia, 44% of respondents reported difficulty sleeping and 28% displaced have Adi Harush Camp and 31% in Mai Ani Camp reported chronic pain. 26] .
- In a 2020 CVT representative survey of IDPs in Bidi Bidi settlement in Uganda, 56% of IDPs reported difficulty sleeping and 51% reported have chronic pain issues.[27]
It is important that rehabilitation care professionals who work with displaced persons both inside and outside camps focus on pain education and the provision of alternative pain management and psychoeducation. [10][16][22][23][2 The following Physiopedia pages have Evidence Based Assessment of Pain in Displaced Persons and Evidence-Based Pain Management in Displaced Persons provides a comprehensive discussion of this topic area.
As noted in the studies above, sleep disorders are common in the displaced population. Evacuation camps are often noisy and crowded. Several family members can be crammed into one small room for sleeping and may not have comfortable beds or electricity to heat / cool the room. These luggage and safety issues can also make sex very difficult. However, it is important for rehabilitation professionals to work with clients in this context to improve posture and comfort and teach them relaxation and floor techniques and other techniques to improve sleep ahotew.[28][29][30]
Gender-Based Violence
It is important to recognize that many evacuees have issues with incontinence and painful sexual function. Issues of incontinence and sexual function often occur as a result of gender-based violence. These are areas where some cosmetology professionals can help to deal with it. For more information on these topics, please see these Physiopedia pages: Reflections on working with survivors of sexual violence and reflections on working with LGBTQIA+ Immigrants.
The Center for Victims of Torture offers exercise group sessions that are broken down by gender. During these group meetings, physical therapists discuss pelvic floor haws / issues in order to keep them in order. The therapists do not separate known survivors of gender-based violence those who do not. Instead for example all displaced men are given psychoeducation on ways to reduce simple sex. Similarly, information is provided to all displaced persons in the group on ways to reduce urinary incontinence and premature bowel incontinence and constipation and painful sexual activity. Rehabilitation staff at the Center for Victims of Torture have found that clients are generally very receptive to learning how to improve these issues through techniques such as: physical therapy strengthen and relax their spine; improving resource efficiency food and drink; learning techniques of body stillness when they feel the need to perform relaxation exercises and change positions when engaging in sexual activities. There are some excellent studies and articles on the effectiveness of these activities at both group and individual levels physical therapy sessions.[31][32][33][34][35][36]
Shortage of Rehabilitation Professionals
The World Health Organization (WHO) estimates that for every one million people living in low- or middle-income countries, qualified rehabilitation professionals including speech language therapists and physical therapy including less than ten experts. Extreme rarity physiotherapists and other rehabilitation therapists in displaced persons camps. To help fill this gap WHO developed the program of Community-Based Rehabilitation (CBR). CBR programs exist in more than 90 countries and many operate in camps for displaced people. WHO talks about it three professional levels in a CBR system:[37]
- Volunteers at the grassroots level undergo initial training for several weeks, followed by ongoing supervision
- mid-level workers with some form of certification
- Professional level therapists
The shortage of rehabilitation professionals presents ethical concerns, and sometimes CBR workers, such as rehabilitation assistants, are called upon to perform tasks that may be outside the scope of their practice.
An initial preprint by Mitchell-Gillespie et al. [38] described the use of telemedicine in a displaced persons camp in Jordan. With the outbreak of COVID-19, qualified rehabilitation professionals are frequently leaving camps for displaced persons. This makes community rehabilitation workers such as rehabilitation assistants (who often displaced people living in camps) as the only rehabilitation workers on site. In these cases, telemedicine can be a useful solution.
In a study by Mitchell-Gillespie et al. [38] CBR staff working on-site at a Jordanian camp used Zoom for telemedicine sessions, while occupational therapists working in the US provided remote clinical support during the call. Occupational therapists can observe and Participate in meetings in real time via iPad video. [38] Thus, a qualified therapist is remotely “present” throughout the session to observe assistance and participate in the session. Potential barriers to the use of telemedicine in IDP camps include Inconsistent internet connection. However, a study by Mitchell-Gillespie et al. [38] showed that telemedicine was popular with both clients and staff.
Rehabilitation assistant in a camp for the displaced
Rehabilitation assistants support rehabilitation professionals in a number of clinical and non-clinical tasks, both in long-term and short-term camps. Being able to work alongside a rehabilitation assistant frees rehabilitation professionals to focus on more complex tasks in order to best meet Customer demand. About 80 percent of community rehabilitation organizations employ rehabilitation assistants. On average, these assistants provided 36 percent of direct care services. There are over 300 job titles used to describe support staff or assistants. [19][21][39] For this paper, the term Rehabilitation assistant is used to describe those who work with professionally qualified rehabilitation professionals.
There is a growing trend to leverage available human resources in community-based rehabilitation programs and build capacity for long-term program sustainability for displaced people. A male rehab assistant, one of two of the first batch of rehab assistants The Kakuma Center for Torture Victims stated:
My goal and dream is to be someone who can change the world – helping many people with physical problems and those tortured by war, violence and other conflicts. When I take the time to reflect on what’s going on and how people My country and without any assistance it is clear that my future is to apply all my experiential skills and knowledge to my country or a different country. Many people experience problems including pain, which is often caused by them doing things the wrong way, including How they sit, how they sleep and how they walk. Many of them had trouble sleeping with bladder or bowel control, and many had sexual problems. I learned techniques and ways to help those who are not in good shape. no matter where i’m going All my experiential skills and knowledge should be used to help those in need in the community. Quoting Kalobeyei Camp – Kakuma Kenya (Amani) Center for Torture Victims Rehabilitation Assistant.
However, it is also important to ensure that rehabilitation assistants receive proper training and supervision. They should not be required to engage in activities beyond their competence and/or regulations in their country for specific rehabilitation professionals where the camp is located.
Training of Rehabilitation Assistants
Every organization takes a different approach depending on its mandate. However, each organization has a training program in place to ensure that rehabilitation assistants learn the necessary basic rehabilitation principles and techniques. In Kenya, the training of rehabilitation assistants has Not yet recognized by regulatory bodies, a standardized curriculum is currently being developed. If the role of Rehabilitation Assistant is recognized in Kenya, it will be easier for Rehabilitation Assistants to use the knowledge and skills they possess to gain entry into tertiary institutions acquisition.
Depending on the NGO they work for as rehabilitation assistants, they undergo rigorous training within the first 3 to 12 months of recruitment. This is done by advanced rehabilitation assistants and rehabilitation professionals such as physical therapists and occupational therapist. During this time, they are assigned non-clinical duties such as welcoming and receiving clients, preparing treatment areas, taking stock, etc. The delegation of responsibility depends on the experience and training background of the rehabilitation professional Timing of interaction between the rehabilitation assistant and the pair [37]
Roles of Rehabilitation Assistants
Roles vary by organization and country. It is crucial that NGOs and rehabilitation teams supervising rehabilitation assistants ensure that they do not work beyond their level of training and their specific scope (which depends on permitted by the specific rehabilitation organization in the country in which they work). Common job duties for rehabilitation assistants working in the physical therapy field include, but are not limited to:
- Work with patients to achieve individual rehabilitation goals as prescribed by rehabilitation professionals.
- Support and monitor patients with activities of daily living.
- Promoting patient rights and identity.
- Helps rehabilitation professionals monitor a client’s progress.
- Provide rehabilitation professionals with feedback on patient progress and service delivery.
- Assist clinicians in providing appropriate equipment and safe use of equipment for patients and caregivers.
- Educate patients on how to exercise properly by clearly stating the postural frequency benefits of the exercise, among other things.
- Participate in community outreach to increase recovery awareness.
- Ensure that the cleanliness and safety of the department’s treatment equipment is maintained.
- Help maintain records of work performed with patients. [38]
Advantages of a Rehabilitation Assistant
Useful in Inter-Professional Linkages
In a camp setting, patients have a variety of needs, including shelter and protection, collection and distribution of firewood soap and sanitary napkins eligibility testing, health care, and school and work. Often there are mandatory activities such as fingerprinting by UNHCR staff Work done to get rations and tokens for displaced people. These competing needs may prevent clients from participating in rehabilitation activities. Rehabilitation assistants are often able to connect with other interagency staff and work with clients to set up or reschedule appointments so that Clients can receive multiple services on the same day. This helps them improve recovery attendance.
The rehabilitation assistant is seen as the focal point for providing care and acts as a conduit for the client.
Provide Faster, More Accessible Care
Most rehabilitation assistants are also displaced persons living in the same camps as the patients. This enables them to interact with patients and provide culturally sensitive and timely care. Rehab assistants can also follow up with patients at home. therefore In consultation with a qualified rehab professional, they can provide further support for a home exercise program and help meet the client’s needs with simple modifications and recommendations. Take care to consult a national rehabilitation professional and do not exceed Scope of Practice for Rehabilitation Assistants.
Rehabilitation assistants live in camp with clients. Our clients come from a variety of countries and cultures, and you may find rehab assistants from the same country, or even the same culture. For rehabilitation assistants, it is easy to understand some Customer behavior and problems. The recovery assistant respects the privacy of the client, you may find that within a week we can meet on the way in the community, maybe the client has some questions, the recovery assistant can guide the client. many of clients know where some rehab assistants live, and some rehab assistants know where some clients live. You may find that we did some exercises in the meeting, maybe the client didn’t quite understand, so The client may have time to ask questions, and the recovery assistant may have time to explain to the client and tell them what to do. This is an advantage for rehab assistants and clients living in the same camp. ” Quote from a rehabilitation assistant Kalobeyei Camp-Kakuma Kenya (Amani) Center for Torture Victims.
Provide Protocol-Based Care
Many organizations have developed health care policies that outline how common conditions should be dealt with. This has contributed to improved patient care. There are also policies and recommendations to ensure that maintenance professionals are screening for Red Flags that would otherwise be required referral to other physicians.
Provide Rehabilitation and Internal Care – Together with Health and Social Care
If patients need additional services in addition to rehabilitation (e.g. shelter and protective social support and medical management) these care assistants are able to accompany these clients and help make recommendations. If patients are unable to access rehabilitation centers (i.e. residential too far to walk to the clinic they cannot afford motorcycle fare which is usually only one trip at camps) rehabilitation aides are sometimes able to provide exercise programs that are conducted at home for under the guidance of a rehabilitation specialist.
Mobilisation and Community Sensitisation
Rehabilitation assistants play an important role in creating a sense of community. They generally have a good understanding of cultural differences and communication barriers and are often multilingual. Together with rehabilitation professionals they are able to mobilize the community’s feelings messages to meet the needs of different target groups. Most concerned people (another term for people living in camps) especially newcomers should also be informed about health facilities in the camp. Rehabilitators can identify troubled people and healthcare needs in the community and help refer them to services they may need.
Some clients are indeed afraid to seek help. So we follow them (go to them) in the community. The story of a rehabilitation assistant at Kalobeyei Camp – Kakuma Kenya (Jeremy) Center for Victims of Torture.
Supervision of Rehabilitation Assistants
Rehabilitation assistants have different levels of supervision requirements. The frequency and quantity of supervision depends on the nature of their employer’s plan for the job and their specific skills. Rehabilitation assistants working in NGOs dealing with torture and trauma work need closer supervision. In most rehabilitation-assisted organizations are mentored and supported by a qualified professional. They get both individual and group care.
WHO estimates that there are less than ten rehabilitation professionals (occupational physiotherapists and speech therapists etc.) per million people living in low- and middle-income countries situation is in the middle so it is clear that there are not enough cosmetologists to meet the needs of all they would benefit from access to rehabilitation services. Community care workers and assistants help fill important gaps in services.[37]
Quotes from Rehabilitation Assistants
It is important for rehabilitation professionals to read first-person identification of displaced persons in order to try to better understand the experience of displaced persons. The following are several quotes from rehabilitation aides from the Center for Victims of Torture who themselves are displaced people living in Kalobeyei Settlement and are often former clients themselves.
I was a little nervous about the project because CVT clients are survivors of abuse and I am a survivor. CVT was the solution – We were given weekly checkups and also training on how to look after ourselves in and out of work so that we were not influenced by client history. Quote from a female rehabilitation assistant at Kalobeyei Camp – Kakuma Kenya (Chukulisa) Center for Victims of Torture
Respect is very important when working with others because it helps to maintain good communication and peace in the workplace. I empathize with my clients because I know the suffering my clients go through. There is a huge impact in the community from patients who have attended fitness sessions; they recover and long-standing pain and injury gets managed. They find ways to manage their symptoms and become productive members of the community. Quotes from a rehabilitation assistant at Kalobeyei Camp – Kakuma Kenya (Jeremy) Center for Victims of Wait.
The physiotherapist should know that many refugees have been abused and some of them have money some went to school and some are working with the government and other NGOs. In order to help them, the physical therapist needs to know how they have lived and understand the causes of. trouble or pain they are experiencing. If the physiotherapists can research what is happening in different countries and cultures in Africa it can be easier to help the patients. Quotes from a rehabilitation facilitator at Kalobeyei Camp – Kakuma Kenya (Amani) Center for Victims of Wait.
Challenges for Rehabilitation Assistants
It is important that support assistants are supported to continuously improve their skills and not be put in a situation where they are asked to work beyond their role. “They should be adequately supported to acquire contextual skills and skill and in some cases a jack of all trades”.[19]
Another issue for rehabilitation assistants is that it can be difficult to establish and maintain boundaries when living in the same camp as clients. In one of the quotes above (see Provide Faster More Accessible Care section), rehabilitation aide Amani says that those who are sick know where rehabilitation assistants live and sometimes visit their homes for advice and information on rehabilitation. While this has advantages for grooming it can also be challenging for grooming assistants. During the COVID-19 pandemic it was even more of a problem. It’s hard to do that both maintain physical distance and safe practices but are still accessible to clients. It’s also hard to show where they care but maintain a separation between their work and home life. Restoration workers who work in camps often live in an upstairs room with others NGO workers. So they have a more natural work-life balance and separation than many of the rehab assistants who are always at camps.
Self-Care for those Working in Camps
It is important for physical therapists working and living in camps to pay close attention to their self-care needs. Often these are lonely positions so cosmetologists are away from their family and friends. The task can be very difficult and they rely on a great human suffering and unmet needs of the clients.
There are many blog podcasts with free online courses Facebook groups and other resources for rehabilitation professionals and others working in humanitarian settings that may be helpful. One example is the “Wake Up in the Night” Podcast by UNHCR. This podcast has episodes of humanitarian workers including the joys and challenges of their work and their actions for understanding and comfort.[40]
There is a global Facebook group for physical therapists working with refugees and torture survivors and more than 200 physical therapists from more than 30 countries. For information on joining the group, please send a Facebook Message or Facebook friend request to Laura Pizer Gueron physical therapist. Physiotherapists share resources in a private session in this group.
The website ProQOL.org (Professional Quality of Life) is dedicated to helping humanitarian workers, including rehabilitation professionals, to assess their current situation and seek resources to improve their own care. There is a practice that cosmetologists can fill for about 10 minutes. This measure provides validated and reliable scores in three areas namely:
- Burnout
- Compassion Fatigue and Compassion Satisfaction
- Secondary Stress-induced Sadness/Trauma-induced Protection and Adjustment-induced Adaptation.
Here is the link to the English Language Version[41] – the ProQOL is available in official versions in 26 different languages.
Some NGOs have their staff complete the ProQOL Measure quarterly through the Pocket Card or at other appropriate times so that they can get a sense of their baseline scores across all three scales. By installing it regularly they will get an early warning if they are starting to have problems with it one or more locations so that assistance can be obtained as needed.
Disaster Ready[42] has over 1000 free resources for humanitarian workers including many online courses and you can create a free account. While Disaster Ready is not designed for physiotherapists in particular there are several on-site courses on negotiating self-care safety measures planning systems etc. would be of assistance to staff working in camp or urban refugee situations.
The Headington Institute[43] also has many free online resources for humanitarian workers including self-care training and other topics designed to help the aides enjoy and be as effective in exercise as possible.
“50 Shades of Aid” is a new Facebook group targeting humanitarian workers including cosmetologists whose members share ideas and support. To join this private group, send a message to the organizers.
Challenges in Rehabilitating Rehabilitation Services in Long-Term Camps
Language
In some camps, such as Kakuma in northwestern Kenya, more than 30 languages are spoken by the campers. It can be difficult for NGOs to hire and train interpreters in all the languages they need so that rehabilitation workers can effectively communicate with their clients. It it is advisable to hire multilingual rehabilitation assistants as well so that they can translate during meetings that are also led by the rehabilitation specialist.
Cultural-Spiritual Beliefs Illness Cognition and Pain Disclosure
Camp staff will often work with people from many different cultural and religious backgrounds. Each client may have a different perception of the illness metaphor for pain. It is therefore important for cosmetic professionals to understand these beliefs as much as possible so that appropriate instruction can be provided and appropriate metaphors used when working to address issues related to pain and other issues. Many NGOs develop strong relationships with local leaders from displaced communities so that they can continue to learn and let them be careful.
“When the patients visit our facility, we lead them through a set of exercises as directed and instructed by the physiotherapist. As a refugee I am also better able to communicate with clients because I understand the culture and vocabulary I need to use when providing guidance and health education.” Statement by a rehabilitation assistant at Kalobeyei camp-Kakuma Kenya. (Jeremy) Institute for Victims.
Access and Awareness of Rehabilitation Services
Many camps have multiple NGOs offering a wide range of services. Cosmetologists are generally in short supply as mentioned earlier. It can therefore be difficult for a team that is often too difficult to rehabilitate to create a sufficient sense of community. It can also be a slow motion it is difficult for rehabilitation team members to make themselves known so that other NGOs can ensure that these NGOs refer their clients for rehabilitation work. By conducting external training on topics of interest to employees of other companies such as self-care sexual pain relief fit body engineers and restoration professionals on such topics can make them more visible in the camp.
Conclusion
Workers working in displacement camps often find their work very rewarding. They need to be highly skilled clinicians who can learn to work closely with other disciplines within and outside of health care such as mentors and educators to be effective meet the needs of their clients. In many camps they will undergo supervised training and learn from rehabilitation assistants who are members of actual displaced communities living in the camps. Ideally, the relationship between assisted rehabilitators and rehabilitators employees need to be more mutual and respect each other where both learn from each other.
References
- ↑ United Nations High Commissioner for Refugees (UNHCR): Global Trends. Forced Displacement in 2021. Available from: https://www.unhcr.org/globaltrends[Accessed 23 June 2022]
- ↑ Jump up to:2.0 2.1 2.2 UNHCR. Figures at a Glance. Available from: https://www.unhcr.org/en-ie/figures-at-a-glance.html [Accessed 24 June 2022]
- ↑ UNHCR. Ukraine Refugee Situation Portal. Available from: https://data.unhcr.org/en/situations/ukraine#_ga=2.174995874.1898281340.1656069316-885200820.1645807158(Accessed 24 June 202).
- ↑ World Health Organisation Regional Office for Europe. Health Evidence Network Synthesis Report 44 – Public health aspects of migrant health: a review of the evidence on health status for refugees and asylum seekers in the European Region. 2015. Available from:http://www.euro.who.int/__data/assets/pdf_file/0004/289246/WHO-HEN-Report-A5-2-Refugees_FINAL.pdf[Accessed 25 September 2020]
- ↑ Sigvardsdotter E, Vaez M, Rydholm Hedman AM, Saboonchi F. Prevalence of torture and other war-related traumatic events in forced migrants: A systematic review. Torture 2016;26(2):41-73.
- ↑ Aebischer Perone SA, Martinez E, du Moriter S, Rossi Ro, Pahud M, Urbaniak V, et al. Non-communicable diseases in humanitarian settings: Ten essential questions. Conf Health 2017; 11(17), 1-11. doi.org.10.1186/s13031-017-0119-8
- ↑ World Health Organization. Report on the Health of Refugees and Migrants in the WHO European Region. Geneva. World Health Organization, 2018; Available from: http://www.euro.who.int/data/assets/ [Accessed 25 September 2020]
- ↑ Bradby H, Humphris R, Newall D, Phillimore J. Public health aspects of migrant health: A review of the evidence on health status for refugees and asylum seekers in the European region. Health Evidence Network Synthesis Report, 2015; 44. Copenhagen: WHO Regional Office For Europe.
- ↑ Jump up to:9.0 9.1 Stammel S, Knaevelsud C. Schock K, Walther LCS, Wenk-Ansohm MP, Bottche M. Multidisciplinary treatment for traumatized refugees in a naturalistic setting: Symptom courses and predictors. Eur J Psychotraum 2017;8(2). Available from:https://doi.10.1080/20008198.2017.1377552 [Accessed 25 September 2020]
- ↑ Jump up to:10.0 10.1 Dibaj II, Halvorsen JO< Kennair LEO, Stenmak HI. An evaluation of combined narrative exposure therapy and physiotherapy for comorbid PTSD and chronic pain in torture survivors. Torture 2017;27(1:13-27)
- ↑ Jump up to:11.0 11.1 McGowan E, Beamish N, Stokes E, Lowe R. Core competencies for physiotherapists working with refugees: A scoping review. Physiotherapy 2020;108:10-21. Available from: https://doi.org/10.1016/j.physio.2019.01.002 [Accessed 25 September 2020]
- ↑ UNHCR. Global Compact on Refugees. 2 October 2018. Available from: https://www.unhcr.org/gcr/GCR.English.pdf [Accessed 25 September 2020]
- ↑ Nilsson H, Saboonchi F, Gustavsson C, Malm A, Gottvall M. Trauma-afflicted refugees’ experiences of participating in physical activity and exercise treatment: A qualitative study based on focus group discussions. Eur J Psychotraumatol 2019;10(1):1699327. Available from:https://www.doi.org:10.1080/200008198.2019.1699327 [Accessed 25 September 2020]
- ↑ Jump up to:14.0 14.1 Knappe F, Colledge F, Gerber M. Challenges associated with the implementation of an exercise and sport intervention program in a Greek refugee camp: A report of professional practice. Int J Env Res Pub Health. 2019; 16(4926):1-19. Available from: https://www.doi:10.3390/jerph16244926 [Accessed 25 September 2020]
- ↑ O’Keefie M, Hayes A, McCreesh K, Purtill H, O’Sullivan, K. Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis. Brit J Sports Med 2017;51(2):126-132. Available from: https://doi.org/10.1136/bjsports-2015-045410 [Accessed 25 September 2020]
- ↑ Jump up to:16.0 16.1 Harlacher U, Polatin P, Taing S, Phana P, Sok P, Sotherra C. Education as a treatment for chronic pain in survivors of trauma in Cambodia: Results of a randomized controlled outcome trial. Int J Conf Violence 2019;13:1-26. Available from: https://doi.org/10.4119/UNI9/ijcv.655 [Accessed 25 September 2020]
- ↑ Crosby SS. Primary care management of non-English-speaking refugees who have experienced trauma: A clinical review. JAMA 2013; 310(5): 519-528. Available from: https://doi.org/10.1001/jama2013.8788 [Accessed 25 September 2020]
- ↑ 21. McMurray J, Breward K, Breward M, Alder R, Arya N. Integrated primary care improves access to healthcare for newly arrived refugees in Canada. J Imm Min Health 2014; 16(4):576-585. Available from: https://doi.org/10.1007/s10903-013-9954-x [Accessed 25 September 2020]
- ↑ Jump up to:19.0 19.1 19.2 Rolfe G, Jackson N, Gardner L, Jasper M, Gale A. Developing the role of the generic healthcare support worker: Phase 1 of an action research study. Int J Nurs Stud 1999;36:323–334
- ↑ Cheng IH, Vasi S, Wahidi S, Russel lG. Rites of passage: improving refugee access to general practice services. Aust Fam Phys, 2015; 44:503–507.
- ↑ Jump up to:21.0 21.1 Saks M, Allsop J. Social policy, professional regulation and health support work in the United Kingdom. Soc Pol Soc 2007; 6:165–177.
- ↑ Jump up to:22.0 22.1 22.2 Amris K, Jones L, Williams A. Pain from torture: Assessment and management. Pain Rep 2019;4(6):e794. Available from:https://doi.org.10.1097/PR9.0000000000000794 [Accessed 25 September 2020]
- ↑ Jump up to:23.0 23.1 Nordin I, Perrin S. Pain and posttraumatic stress disorder in refugees who survived torture: The role of pain catastrophizing and trauma-related beliefs. Eur J Pain 2019;23:1497-1506. Available from: https://doi.10.1002/ejp.1415 [Accessed 25 September 2020]
- ↑ Jump up to:24.0 24.1 Tsur N, Defrin R, Shahar G, Solomon Z. Dysfunctional pain perception and modulation among torture survivors: The role of pain personification. J Aff Dis 2020;46(4):15(265:10-17. Available from: https://www.hhri-gbv-manual.org or https://doi.10.1016.j.jad.2020.01.031 [Accessed 25 September 2020]
- ↑ Jump up to:25.0 25.1 Golden S. Assessing mental health in Kalobeyei: A representative survey of refugees and host communities. St. Paul, MN. The Center for Victims of Torture 2018;1-40.
- ↑ Golden S. Assessing refugee mental health in Ethiopia: A representative survey of Aid Harush and Mai Ani Camps. St. Paul, MN. The Center for Victims of Trauma 2017. Available from: https://www.cvt.org/sites/default/files/attachments/u93/downloads/Assessing_Refugee_Mental_Health_in_Ethiopia_letter_v1.pdf [Accessed 25 September 2020]
- ↑ Elshafie R. Assessing mental health in Bidi Bidi, Uganda: A representative survey of South Sudanese refugees in Zone 5. St. Paul, MN. The Center for Victims of Torture 2020. Available from:https://www.cvt.org/sites/default/files/attachments/u93/downloads/cvtbidi_bidi_2019_mhpss_survey_report.pdf [Accessed 25 September 2020]
- ↑ Jump up to:28.0 28.1 Nielsen H. Interventions for physiotherapists working with torture survivors, with special focus on chronic pain, PTSD, sleep issues. Dignity Publication Series on Torture and Organized Violence—Praxis Paper 2014.
- ↑ Sandahl H, Jennum P, Baandrup L, Pschmann IS, Carlsson J. Treatment of sleep disturbances in trauma-affected refugees: Study protocol for a randomised controlled trial. Trials 2017:18(520). Available from:https://doi.org/10.1186/s13063-017-2260-5 [Accessed 25 September 2020]
- ↑ Siengsukon CF, Al-dughmi M, Stevens S. Sleep health promotion: Practical information for physical therapists. Phys Ther 2017;97(8):826-836. Available from: https://doi.org/10.1093/ptj/pzx057 [Accessed 25 September 2020]
- ↑ Albert H. Psychosomatic group treatment helps women with chronic pelvic pain. J Psych Ob Gyn 1999;20(4):216-225. Available from: https://doi.org.10.3109/01673829909075598 [ACcessed 25 September 2020]
- ↑ Dermain S, Smith JF, Hiller L, Dziedzic K. Comparison of group and individual physiotherapy for female urinary incontinence in primary care: A pilot study. Physiotherapy 2001;87(5):235-242. Available from: https://doi.org/10.1016/S0031-9406(05)60784-5 [Accessed 25 September 2020]
- ↑ Dorey G, Speakmen M, Feneley FCL, Swinkels A, Dunn. Pelvic floor exercises for erectile dysfunction. Brit J Ur Int 2005;96(4):595-597. Available from: https://doi.org/10.1111/j.1464-410x.2005.05690.x [Accessed 25 September 2020]
- ↑ Myers C, Smith M. Pelvic floor muscle training training improves erectile dysfunction and premature ejaculation: A systemic review. Physiotherapy 2019;105(2);235-243. Available from:https://doi.org/10.1016/j.physio.2019.01.002 [Accessed 25 September 2020]
- ↑ Rosenberg TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic foor rehabilitation in treatment: A literature review. Uro Phys Priv Prac 2007. Available from: https://doi:10.1111/j.1743-6109.2006.00339 [Accessed 25 September 2020]
- ↑ Ussing A, Dahn, II, Due U, Sorensen M, Petrsen J, Bandholm T. Efficacy of supervised pelvic floor muscle training and biofeedback vs. attention-conrol treatment with fecal incontinence. Clin Gast Hep 2019;17:2253-2261.
- ↑ Jump up to:37.0 37.1 37.2 The World Health Organization. The Need to Scale Up Rehabilitation. Rehabilitation 2030: A Call for Action. 2018.
- ↑ Jump up to:38.0 38.1 38.2 38.3 38.4 Mitchell-Gillespie B, Hashim H, Griffin M, AlHeresh R. Sustainable support solutions for Community-Based Rehabilitation Workers in refugee camps: Piloting telehealth acceptability and implementation. 2020. Research Square-preliminary report. Available from: https://doi.org/10.21203/rs.3.rs-34117/v1;1-21 [Accessed 25 September 2020]
- ↑ Moran, AM, Nancarrow, SA, Wiseman L, Maher,K, Boyce RA, Borthwick AM, Murphy K. Assisting role redesign: A qualitative evaluation of the implementation of a podiatry assistant role to a community health setting ultilising a traineeship approach. J of Foot and Ankle Res 2012;5(30). Available from: https://doi.org/10.1186/1757-1146-5-30 [Accessed 25 September 2020[
- ↑ UNHCR. AWAKE AT NIGHT – A Podcast with Melissa Fleming. Available from: https://www.unhcr.org/awakeatnight/ [Accessed 25 September 2020]
- ↑ Pro QOL. Professional Quality of Life Measure (ProQOL 5.0). Available from: https://proqol.org/proqol-measure [accessed 2 July 2022]
- ↑ Disaster Ready. Available from;https://www.disasterready.org/courses [accessed 23 June 2022]
- ↑ The Headington Institute. Available fromhttps://www.headington-institute.org/ [accessed 2 July 2022]