Was Abdul faking it?
Why did I say that? — you have to read When It Hurts to know …
When I was assessing Abdul he had some moments where he was relaxed and very talkative (not to me but to the other staff). He had attracted onlookers with his shouting when I was touching his back.
Privacy of patient was 0 when I first arrived so imagine there are people - those relatives of the sick, hanging by the door and windows of the clinic to see this brown lady in action, until I introduced curtains.
At first I tried to touch him with different materials including tissue — he was shouting in pain. Then suspecting he’s faking it I was telling him “does it hurt here?” and he would wail and say “Yes.” even though I was not actually touching him, while my staffs were looking at me doing nothing.
Did it several times and always get the painful yes answer. The crying had stopped but still the grimace and the shouts were there.
Day 2 and after …
I told their case worker I need to work with him and try different methods to relieve the pain and teach him ways to at least not aggravate the pain. I asked them to bring him everyday to see if we can have results.
By day 2 I know that it is not so much as faking.
The pain was real and I saw that it’s not something I know I can resolve alone or even attempt to give reasons to because it was over my capacity.
The case was more psychological than physical that’s for sure.
The trauma experienced by Abdul and the continued reminder of that trauma by living in the camp manifested in painful back that only he can relieve if he can process it psychologically and the result can be seen in the resolution of his physical problem.
That was my conclusion.
I kept it to myself at first, thinking my staff would not understand it. I also decided to consult with colleagues in other medical field and see what they think of my case before I go on explaining my theory. But I was wrong, my staff also suspected the same but did not say anything, which I think was because they needed someone to confirm their own findings and move on.
I offered some solution that I thought might work if the patient would cooperate.
mapped the pain and the triggers so he’s aware of them
suggested alternative postural changes and activity modification to avoid triggering the pain.
massage on the back if he can tolerate it to relax the muscle (which was a big risk because of the pain) so I asked his wife to do it (she came on some days)
exercises — any movement of the joints above and below the injury can help relieve tightness and may offer relief in other parts of the body. I tried to make Abdul do some trunk exercises — he tried and when done very very slow did not trigger much of the pain
I asked Adama to observe not just his reaction to pain but to also observe the manner of movement – did it increase, decrease or no change, how many times he cry or shout or curse, how crease his face is when doing the exercise etc. The pain was hard to measure – when I asked Abdul the first time, he was saying 10/10, that hasn’t change until he stopped coming. But other tell-tale signs showed otherwise.
He was doing the exercises and told us (by the wife) that he agrees to have his back rubbed and shoulder massaged from time to time when at home.
He smiles more.
He was enjoying the attention and happy to show that he’s cooperative with us because he gets a lot of compliment.
He likes the excursion.
Life in the camp can be tough. Every family depended on each other and on the camp management. You’re literally in an open-prison because they are still alien in a foreign country – they don’t feel they belong.
The camp was a constant reminder of the ordeal they had to endure to escape being killed in Liberia. It was also a reminder that they are not from Sierra Leone because they live apart from the community. So I can understand that a lot of physical problems and complaints they have are from the psychological stresses they endure everyday and no one should blame them.
It’s as real as being hit by a car.
Observing him in all the activities we’ve done, the more he comes back to the clinic and do more routine movements the more he looked relaxed.
When I consulted with friends, we had common consensus that taking his mind away from the trigger of the pain will help him relax, which was exactly what the exercises and massage did to him. Plus my staffs are good story tellers they can take your worries away with their stories (I am fascinated with their voodoo stories), he eventually was able to understand his situation.
Month after month he came back to the clinic. He had shown progress but he still had that straight posture like being pulled from above. But he was less shouting, and eventually he stopped shouting, he learned to manage his reactions. He even smiled from time to time which was a good sign.
Abdul was candidate for medical repatriation sponsored by UNHCR backed by all the medical records he had. I think he was able to obtain approval and was repatriated for further treatment overseas. He would eventually be relocated with his family and start a new life. But I haven’t heard from him after that brief encounter.
If the relocation to another country brings a new promise to him – a good life, free with his family all his physical problem would go.
He can start over.