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Fariza Abu Seris, Physiotherapist
Introduction Abu Seris started her physiotherapy career in 1990 with a group of four other physiotherapists who today are her colleagues: Fatima Abu Awad, Najah Jibril, Rahmeh Assi and Mirvat Abdullah. They form a cohesive team, and have provided physiotherapy for thousands of patients over two intifadas. Abu Seris commutes between the three Nablus camps in shared taxis at her own expense. Because of Israeli-imposed closures and transportation problems, village residents are finding it difficult to reach the closest UNRWA Health Centres. During the IDF incursions to Nablus in March and April 2002, Abu Seris became a “de facto emergency nurse,” because she had earlier taken training courses in first aid. At the end of the IDF military operation she resumed her responsibilities as a physiotherapist because “physiotherapists have an important long-term role, which is not only physical but psychological as well.”
Communication and long-term involvement Abu Seris says one of the most important things in physiotherapy is contact with the patient. “The patient will not respond to treatment if there is no communication between us. The chances of improvement also depend on the patient’s state of mind.” She says “That is why I see my patients as a whole, not just as an injured body. I treat them psychologically before physically, because the diagnosis is often not the most important thing. A connection must be established at the very beginning.” With her usual serenity, she says “I cannot impose myself on the injured. It makes me enormously frustrated, but in some cases I have to retreat. The patient would not benefit from a physical care he is opposed to.” The five physiotherapists find that dealing with patients who “do not want to heal” is the most frustrating part of their profession. Abu Seris adds that it is easier to deal with young men, who usually are impatient to recover. “They want to heal quickly.” Abu Seris says children’s bodies react more quickly to physiotherapy, but their tolerance to pain during sessions is less, requiring more focus and concentration on the physiotherapists’ part. Women, she says, find it more difficult to recover psychologically, as they spend much of their time at home and do not socialise as much as men. “When men are injured during a confrontation with the IDF, they usually are proud of it, while women are usually hit by ‘accident’ and hence cannot count on the same social moral support. In addition, women feel guilty for not attending their families and domestic duties.” Only five percent of the clinic’s physiotherapy patients are women, she says. A personalised approach
Fariza treating a baby affected The physiotherapy team says that around 30 percent of the injuries they treat are intifada-related (rubber-coated steel balls or live bullets, shrapnel or beatings). When they started working 13 years ago in the first intifada, “injuries would usually be sustained by men 17 and older, unlike now, when they are much younger.” Although Abu Seris was 21 and had little experience, she says that “working as a physiotherapist during the first intifada was easier. Some types of injuries that we see now, we never saw then.” The most difficult patients to treat are those confined to a wheelchair as a result of injury. These patients need comprehensive treatment: physical, psychological, and occupational. They require a teamwork involving doctors, nurses, social workers and physiotherapists. Most UNRWA Health Centres offer this in rehabilitation programmes. The team members say: “The patients’ priority is to go back to their previous condition. Our priority is to make them self-reliant.” Most of these patients prefer the approach of UNRWA Health Centres because it offers the opportunity to be involved in all phases of treatment; the patient has a role to play in rehabilitation. “Most patients end up realising that this is the only way to go. We want them to be an interactive part of their treatment and that is why we see our role as guides rather than actors,” the physiotherapists say. Abu Seris knows the importance of psychology. Even when she knows that patients have not been exercising at home as promised, she says “I pretend I believe they have exercised. Patients have to be sincere with themselves, not with me. They eventually understand that they will only improve if they exercise at home.” On other occasions, she encourages patients to take a daily short walk, which would be equivalent to 15 minutes of exercising. “What I care about is that they exercise, not how they do it.” Pragmatically, Abu Seris says, “I cannot care for my patients more than they care about themselves.” Around twenty percent of patients referred to the team by doctors decline treatment. The therapists refer these cases to psychological counselling, the only way to treat other causes of depression and enable them to go back to physiotherapy. Unfortunately, due to budget restrictions, UNRWA now can only provide psychological counselling to children. In the absence of adult counselling, the five physiotherapists refer their patients to other injured people who have been through the same situation and recovered, so they can talk together about their anxieties and concerns. As part of her professional duties, Abu Seris also does home visits. However, she prefers treating her patients at UNRWA clinics. “I feel more concentrated at the clinic,” she says. However, home visits are necessary in the case of new or serious injuries, after a doctor’s diagnosis and referral. Home visits, Abu Seris says, “are a delicate process, because sometimes I feel like an intruder. All the members of the family sit around the patient, and it is sometimes embarrassing to ask them to leave. I have to do it because otherwise I would not be able to work.” A commitment Abu Seris, Abu Awad, Jibril, Assi and Abdullah say that physiotherapy in the West Bank still has to prove and assert itself as an essential part of medical and surgical treatment of trauma. They deplore the fact that physiotherapy is still considered as “additional therapy”, and that many people still do not know what it consists of. During this intifada, work has increased in the three Nablus refugee camps, especially in Balata, the biggest camp in the West Bank. The physiotherapy team has observed that although not all the injuries are directly related to the intifada and confrontations with the IDF, many are an indirect result of the situation. “Stress is an important factor in minor trauma… consultations for lower back pain have increased since the beginning of the intifada and we treat these as indirect intifada-related injuries.” There are also other psychological effects of the intifada. Many camp residents come to the Health Centre as an outlet for anxiety. They need to get out of their homes and feel that someone cares for them. “Even at the height of the incursion people came to the Health Centre for trivial issues. UNRWA health personnel never dismissed them despite the workload. We knew that although these people were not physically ill, they were psychologically ill,” Abu Seris says. Conclusion Abu Seris, Abu Awad, Jibril, Assi and Abdullah say physiotherapy is a draining job, both physically and psychologically. Each has a different way to release stress. Abu Seris is reluctant to talk about it. “I don’t talk about my job and its frustrations because I do not feel that anyone can help. Everybody has so many problems,” she says. The physiotherapists have been working at the UNRWA clinic for more than a decade, sometimes under difficult circumstances. The five women have kept their motivation and dedication intact through teamwork, communication with patients and commitment to their profession. “Working with the injured and the disabled makes me renew my energy and desire to work every day,” Abu Seris says.
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The five physiotherapists are used to dealing with different kinds of
patients and injuries: babies affected by congenital disabilities, youth
injured during confrontations or elderly people. While the seriousness
of the injury or illness varies, the therapists’ concentration and
attention is constant. Each treats an average of 50 patients a month,
three times a week, in sessions of 30 to 45 minutes. In cases of new or
serious injury, sessions are daily until the patient’s condition
stabilises.