‘It’s not just physical, it’s a mental approach too’

UPDATE | Liverpool Hospital trial case study.

Fusing the emotional and physical: Trial patient Natiq Roman with translator Mohammed Hussein and Liverpool Hospital physiotherapist Bernadette Brady. Picture: Simon Bennett

Fusing the emotional and physical: Trial patient Natiq Roman with translator Mohammed Hussein and Liverpool Hospital physiotherapist Bernadette Brady. Picture: Simon Bennett

Natiq Roman came to Australia as a refugee from Iraq and suffers from severe emotional trauma.

The man now aged in his 60s was a former school principle in Iraq. 

Although he no longer works in education, he has certainly held onto formalities. When we met him for an interview he came wearing a suit.

We asked him if he wore it for the photos but we were told, he always wears a suit – even during his physiotherapy sessions.

Mr Roman couldn’t tell us about the experiences that happened in his home country, but he still had a sense of humour and something to smile about – through an innovative nine-month trial at Liverpool Hospital his injuries have significantly improved.

The Liverpool resident praised the staff who helped him when he participated in the Culturally Adapted Pain Management Program, including his translator and physiotherapist.

According to Bernadette Brady, a physiotherapist and a PHD student who helped to cultivate the new program, the trial which began one year ago has proved successful so far and the program is set to continue.

She said during the pain management program they focused on three different groups of patients.

She explained how it worked.

“It’s a small study but it had positive and encouraging findings – the biggest of which was we found patients were engaging in therapy a lot more. Whereas, what we saw from the usual care group was patients had high non-attendance rates and dropped out of treatment more often, which is not surprising if they don’t see its value,” she said.

“We found trauma issues made them more suspicious of therapy providers and trust was a big issue. So that was really important with how we interacted with our patients.” 

She said the trial explored how three cultural communities experienced pain across Fairfield and Liverpool Hospitals.

The trial included working with Vietnamese, Assyrian and Mandaean communities.

“What we found for the Assyrian community was pain was a biological problem so we needed to make sure the education, exercises and strategies for pain management would respect that belief. We talked about how movement could reduce loading on certain tissues, why we would want to strengthen parts of the body and why physical therapy is of use.

“For the Vietnamese community we found they viewed pain as an imbalance in the body’s energy system – Âm-Dương, which is the Vietnamese concept of Yin and Yang. So we needed to think about how we were going to frame management strategies and movement in a light that respected restoring the body’s harmony and energy systems. So we talked about exercise being classified as either Âm or Dương depending on the speed and the techniques we were using and so we incorporated that into our program.

“For the Mandaean communities, which is predominantly a refugee community here in South-west Sydney, the pain experience is very much part of broader issues of traumatic experiences. We needed to understand their fear and consider their heightened stress responses.”

She said during the trial Mr Roman was an example of how developing a rapport with staff made a huge difference, encouraging him to complete the treatment.

“So I think that therapeutic relationship was important to build the trust.”

Mr Roman suffered from pain in his neck, shoulders and lower back. Due to circumstances in Iraq, he had also suffered from two minor strokes.

“I had physiotherapy before but this program taught us how we can reduce pain using a physical and mental approach,” he said.

“There was a lot of support and I applied what we did here at home. Another difference with this program was I wasn’t rushing things like I was before.

“We did it once a week in groups, which included talking to other people and learning together – it was also an opportunity to improve my English skills,” he said chuckling.

Since completing the program he said he’s enjoyed the benefits.

“I couldn’t sleep well and my injuries affected my walk. I would get tired easily and couldn’t carry heavy things. Now I’m more relaxed and I can move better.”