The Numbers Tell Torture Survivors’ Stories of Healing

Tuesday, July 25, 2017

Esayas Kiflom is program evaluation officer, CVT Ethiopia

In my work analyzing data, I don’t often meet the survivors we care for face to face, but their stories matter to me and inform our work. I work with client data every day; it is my role to read the history of every survivor we see here in the refugee camps in northern Ethiopia. No other roles at CVT have this responsibility. It is really challenging to read the trauma and torture stories; yet, here is where I feel I am part of the rehabilitation process.

I work on monitoring and evaluation, which measures the progress clients make through CVT’s therapeutic work. To measure this, we do an assessment during clients’ intake process, and then we follow up and collect information after clients have completed their counseling. When I compile these numbers, I see the picture of healing. The numbers show the level of symptoms, which include symptoms of depression and post-traumatic stress disorder (PTSD), for example, before and after clients have finished the group counseling sessions. And clients show notable improvement on their symptom levels. In these numbers, they see that they have moved from a very dark place to a lighter place. They have transformed to a better life. With my numbers, I show that this is happening.

Before I joined CVT, I worked as a socioeconomic researcher at the Relief Society of Tigray, an Ethiopian NGO. While there, I conducted surveys and assessments related to socioeconomics, nutrition, livelihood, health, agriculture and more. The job involved a lot of data analysis and data entry. In this role, however, changes experienced by beneficiaries were not visible to me. I was told that at CVT, I would be able to do something really unique – I would be able to look at changes, as we say, in the face. CVT has research built right into the organization and our processes. So I was really glad to join CVT.

The job is a lot of analysis. In addition to monitoring and evaluation, I also prepare monthly and quarterly reports for funders and the Ethiopian agency responsible for the camps, and I work on internal training on use of the data forms, so that the clinical team collects data properly. It’s my job to review every assessment they do, so I work with the clinicians on accuracy and corrections. This is another area that is rewarding for me: after I conduct two or three trainings, I see a change in the way information is gathered for clients. I feel good that I’m part of that change.

The client data analysis is the largest part of my job. I regularly see that after going through the group counseling sessions, most clients agree that the clinical information has helped. Among clients who consent to share their data, we see 92% improvement in symptoms. As an example, there could be a few cases of suicidal ideation – sometimes a few people had thought of harming themselves. But by the end of counseling, when we conduct an assessment, the thoughts are eliminated. These people take steps to rebuild their lives; they connect with the community and some perhaps try to find a job in the camp. That is real progress. And for me, when I see that someone who was thinking of suicide has no more thoughts of this – that is very rewarding personally.

Most adult cases here at CVT Ethiopia are survivors of torture, and we see large numbers of minors. One of the biggest challenges in collecting data here is many clients do secondary migration – they leave the refugee camp and move on to Sudan or Egypt or other places. It can be hard to find clients for their three-month and six-month follow up assessment. This is a challenge.

The best results we get are reductions in clinical symptoms. For adults we assess five categories of symptoms: behavior, PTSD, depression, anxiety and physical. Because we do not provide physiotherapy here at CVT Ethiopia, we focus closely on changes in levels of PTSD, depression and anxiety. The improvement is most significant here – most clients show good function here after counseling.

All these things are hard to measure; many of these things are feelings. To measure feelings, for every symptom we ask questions about what they have felt over the past two weeks. To help determine the level of a feeling, we ask clients to look at an image of a glass with different levels of water – one is nearly empty, one is half full, etc. We ask them to indicate the level at which they are feeling a particular symptom, such as a headache, physical pain, crying easily and other symptoms. We get good data from this tool, and it is very rewarding when I see in the numbers that clients are changed for good from the counseling.

Image: A portion of the CVT Ethiopia Client Assessment measurement tool, in English and Tigrigna.

We also ask incoming clients who told them about CVT or referred them. Many times, the client will say “A CVT worker told me about CVT.” Now, more and more we are hearing “A former CVT client told me to come.” Our former clients are in a good position to tell others. If we keep doing what we’re doing, we will have more.

AT CVT, we think about self-care. I read all the clients’ stories, which can be very difficult. But I have an advisor to speak to about this, and an outside clinician visits the center every three months to help take care of us. Also, as part of our self-care program, the staff sets aside time to go somewhere together, where we play games, have discussion and have fun.

This work is very meaningful to me.

 

CVT’s work with Eritrean refugees in Ethiopia is funded by a grant from the U.S. State Department’s Bureau of Population, Refugees, and Migration.

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