TRAUMA AND REHABILITATION 2005 REPORT

3/27/2017

Torture rehabilitation is a continuous project that TOHAV has been successfully implementing since 1995.  TOHAV Torture Rehabilitation Centre (TRC) was established for torture survivors in the home country and Kurdish areas where torture was particularly put into practice. Also during the conflict in south east of Turkey, there have been more than 3 million internally displaced people due to the forced evacuation and burning of Kurdish villages that are treated through TOHAV/TRC.

 

TOHAV/TRC is a reference centre that plans and coordinates medical, physical, physiological and social treatment programs to individuals and groups who have been subjected to torture or ill treatment at the several processes of custody or imprisonment.

 

  1. Aims of the project

 

  • to provide free-of-charge medical and psychological treatment for torture survivors and members of their families,
  • to monitor and document the physical and mental health of torture survivors;
  • advocate for the prevention of torture,
  • to offer education and training programmes for professionals and non-professionals who have no knowledge about the consequences of torture in Turkey;
  • raise public awareness of the issue,
  • publish annual statistical evaluation of results of treatment and rehabilitation processes of torture survivors
  • publish scientific researches on both the verification of torture and the possible solutions to the consequent problems.

 

2- Assistance provided at TOHAV Torture Rehabilitation Centre

 

TOHAV/ TRC provide help for the victims of torture with a professional staff of medical doctor, psychiatrist, psychologist, social worker, neurologist, physiotherapist and a large network of voluntary experts. Since establishment, TRC has been able to build a circle of volunteers, most of them are physicians, and these people have lent their professional support to TOHAV/TRC for treatment and rehabilitation of torture survivors.

 

The treatment activities are being carried out by the vision of preventing torture within the consideration of domestic and international documents such as Istanbul Protocol regardless of religion, gender, race, class and political opinion of the victim. TOHAV/TRC is an accredited member of International Rehabilitation Centers of Torture (IRCT) 

 

TRC offers treatment to minimum 250 patients every year. The treatment programme is set up based on a pre-diagnosis derived from the results of a physical examination upon admission of the patient. With each new admission, socio-demographic information is obtained from the applicant the torture suffered, and experiences, if any in prison. Thereafter the diagnosis is completed using other necessary examination methods such as laboratory tests, radiological examinations and specialist examinations. Finally, under the coordination of the doctor in charge of the centre an individual therapy programme is elaborated and applied for each patient. One of the experts of the team is a neurologist, who contributes to the examination and therapy programmes.

 

Services in basic specialties made available to the patients are physiotherapy and rehabilitation, urology, internal medicine, neurology, ENT diseases, gynecology, general surgery, neurosurgery, dentistry, orthopedics, cardiology, ophthalmology, and plastic surgery. During consultations laboratory tests are conducted and if necessary modern techniques in radiology, e.g. magnetic resonance imaging (MRI ) computerized tomography, (CT scan), ultrasonography, IVP and X-rays are used. In individual cases cintigraphy which is part of nuclear medicine as applied. In addition, particularly in physiotherapy neurology and psychiatry EEGs and EMGs of the patients are made on the instructions of the specialist. When recommended by the psychiatrist SEP VEP,BAEP and somnigrams (examination of sleep patterns) on the basis of TRASE can be done at examination centers having an agreement with TOHAV. 

 

The psychosocial support given to patients ensured by the social worker in particular, is an essential part of the assistance. The victims are assisted both upon, admission and during the treatment process in their social and rehabilitative needs that are defined through observations and discussions. At a later point in time, the patient’s family and social environment are involved. The social worker is an important bridge between the patients and the medical doctors/ therapists. She accompanies the patients during therapy; especially if surgery is planned she manages their appointments and accompanies them. If patients come to Istanbul for treatment from elsewhere, TOHAV assumes their travel expenses on request.

 

Based on the initial findings and depending on the patients condition psychological and psychiatric assistance is provided immediately. In the event of chronic cases, psychotherapeutically steps are determined once the patients consent has been obtained.

 

Therapy may include “psychological guidance” behavioral therapy, cognitive therapy and pharmacy-therapy. A meeting with the psychologist and psychiatrist is held after the initial examination in order to evaluate the emotional state of the patient. We utilize the cognitive behavioral method consists of imaginable exposure and cognitive restructuring. (Such as EMDR). In the future we want to use creative art therapies (painting, collage, etc) that increase the impact of therapeutic process such desensitization, cognitive reframing and habituation. Group therapy is held together with the physiotherapist and psychologist.

 

 Physical therapy is often combined with physiotherapy and medication. Since 2003, a substantial part of the physiotherapy treatment is provided at the centre itself.


 
Physiotherapy (individual therapy): 
Physiotherapy for some patient plays an important part of the treatment. Treatment methods must be carefully selected for each patient, not only to treat the specific problems, but also to avoid reminding the victim of his/her past ordeal. Our most frequently applied methods of treatment are hot packs, gentle massage or/and connective tissue massage, TENS machines (if no electrical torture). Physiotherapy is administrated in three 1-hour sessions in a week (totally three week)
Individual therapy also include following;
-       Create an individualized exercise programme for each patient.
-       Emphasize education in spinal and joint protection principles.
-       Teach how to avoid re-injury and reoccurrence of health problem 

 
Rehabilitation exercises and fitness programmes (Group therapy):
This treatment may take a long time, lasting for several months because of the combination of physical complaints and mental sequelae. Rehabilitation techniques are stress-tension reduction exercises, training of the muscles, and exercises for improvement of body awareness.
Stress-tension exorcises or relaxation techniques:
-           Breathing exercises
-           Progressive 
-           Muscle Relaxation(PMR)
-           Autogenic Relaxation Mind/Body techniques: Feldenkrais Awareness through Movement, 
-           Thai Chi yoga exercises and massage (suitable modified to the pain patient) 

 
Fitness programmes include, strength and flexibility training with attention to proper body mechanics and breathing techniques. Group therapy is administrated in 1 hour sessions a week and average period of treatment is between three and six mounts.