Mission: chronic pain ~ Part 1
In September I travelled to Gaza to deliver teaching and training on chronic pain. The mission was organised by Medical Aid for Palestinians (MAP).
On being asked, my initial reaction was excitement. Then concern.
How safe would it be?
There are real risks in a conflict zone.
I needed to get it clear in my thinking, so who better to ask than David Nott. He works upstairs.
I’d barely got the sentence out of my mouth when David said, “You’ve got to go”.
He told me about Gaza and the experience I could have. And that was it.
I said yes.
Preparing to go: the lie of the land
Before the mission, we had an online training session to meet the physiotherapy team in Gaza and to introduce the approach and material.
There was a specific request to focus on chronic pain and a desire to update thinking, treatment and management practices. Whilst the physiotherapists are well educated, opportunities for on-going training are minimal. And as is the case worldwide, pain education for healthcare professionals is minimal, despite pain being the main reason people seek help.
The need to address the problem of chronic pain that is entwined with trauma in Gaza is enormous.
To start, I wanted to understand the team’s position so that I could tailor our work together: their beliefs, their practices, the context, patient’s beliefs and expectations. We needed to build a strong working relationship grounded in trust, open communication and empathy. That was the first step.
I discovered that the biomedical model was strong. This is no different to other healthcare systems around the world that work this way–I reassured them. But for chronic pain and other chronic conditions, the biomedical model does not work. In many cases, it contributes to the chronicity by taking the person down the wrong path.
A healthcare system sits within a society. Again, as in other parts of the world, Gaza is a society that believes in the biomedical model, despite it failing to deliver. Patients believe that there must be something ‘physically’ wrong when they feel pain, and the search begins. When nothing can be found to explain the pain this does not deter the on-going quest to discover something structural or pathological. This is the wrong path.
Diagnostics are important. But once any serious pathology or disease has been discounted, the focus needs to be on helping the person understand pain, themselves and what they can do to move forward.
There is a real challenge for therapists when the patient is fixated on a physical cause for their pain. How do you help them rethink and shift their beliefs, which are necessary to ease and overcome pain?
I discovered in Gaza many patients have firm beliefs and expectations about the treatment they will receive: largely passive. Modalities applied to them such as massage, heat, ultrasound. They are often prescribed by doctors and sent along to the physio department clutching not only a piece of paper with instructions (removing autonomy of the therapist) but a belief that these things will help. Powerful beliefs.
This was the work.
And I needed to find a bridge.
A meeting point.
I packed my bag. I packed my mind (embodied of course).
We set off to Israel, from where you make the crossing to Gaza.
To be continued… Part 2: the journey and what I soon discovered about the people of Gaza.
💥 I am Richmond. I help you understand, ease and overcome your chronic pain by living life and using practical skills and tools.
💥 And mentor clinicians/therapists who help people who are suffering 😊.
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