Discretion is a high priority inside a Swiss Red Cross outpatient clinic in Bern where people come to try to bring stability back into their lives.This content was published on June 15, 2009 - 08:06
It's on the second floor of a modern but humble complex just outside the city where they seek support as victims of torture and war.
It's there that a staff of about 20 specialists provides the know-how that will help many of them back to a life with some meaning.
"We take care of all people – men, women and children – who have had experience of torture, or have been traumatised by war in their home country," Angelika Louis, who is head of the centre's outpatient clinic, told swissinfo.ch.
"They come from all over the world and we treat between 310 and 320 people a year."
The centre could be used to help any Guantanamo detainees who are accepted by Switzerland in the future, the president of the Swiss Red Cross, René Rhinow, has said.
According to a study, one in four persons who is recognised as a refugee in Switzerland suffers from the repercussions of systematic violence.
Not surprisingly, it is not easy for the patients to recount all the details of the cruelty they have experienced at the hands of others and that is not necessary.
And although they are specialists, it is not easy for the staff to hear about all the horrors the patients have suffered.
Patients come to the clinic voluntarily because they have either heard about it from their local communities, they have been sent by doctors or by institutions that deal with refugees or social services.
In many cases, they are suffering from severe traumatisation.
"You can see cases of posttraumatic stress disorder, that means people remember traumatic events, they are full of anxiety, they have a hyper arousal," the head of the clinic's medicine and therapy, Brigitte Ambühl, told swissinfo. "That means they live in a situation where any moment they believe they could be dead."
"They are full of mistrust, they avoid social contact and they live sometimes like in a prison."
In these situations, they also have medical problems like high blood pressure or chronic pain. Some people are also severely depressed. And not surprisingly, it's very difficult to know the best way to treat them.
"We do an examination at the beginning and listen to their story... not the whole story but as much as they and we can bear. Then we make a therapy plan or a treatment plan," Ambühl said.
There are three parts to this - medical treatment, psychotherapy and social counselling.
"We advise people which would be the best way. For people with chronic pain or problems with concentration, we offer therapy in small groups with physiotherapists and psychologists."
They are trained in coping strategies, in other words that people employ to master, tolerate, reduce, or minimize stressful events and bad memories.
"Mostly for children we have groups that play and hear fairy tales so that they can act out the traumatic events and we can give them back the resources to cope with them," Ambühl said.
Victims who come to the outpatient clinic have suffered physically but mostly psychologically.
"You can't see it, they can't show it... and they have it all their lives. That's the aim of torture, not to damage the body but to give them psychological deficits.
"If they come to us, they come full of hope that we can help them to get out but that's an illusion. They have to live with it. That's one part of the therapy, which we call mourning. They have to mourn their losses and to accept them," Ambühl explained.
One of the first steps in treating patients is to ask them how they could survive under such extreme conditions. The outpatient clinic does not call them victims, but survivors and has to be very careful in the relationship.
"They don't trust human beings any more. If you open the window, you have to announce it because otherwise you might harm them. It's all a sensitive beginning. It's the basis of the relationship."
It's not only a big strain on the patients but also on the staff who look after them.
"Yes, that's true. For me personally, it's interesting to listen to what human beings are capable of doing [to each other] and the other part is to shiver with them. Every time it is a new shock... for me too... because I empathise with them," Ambühl said.
Louis points out that, unfortunately, demand for such outpatient clinics is not likely to decline because of the political situation around the world. And then there is the thorny problem of finance.
"Our biggest problem is financing. We have several partners who help us run this institution. It's very hard. The current economic climate is not favourable to our demands for money," she said.
Robert Brookes, swissinfo.ch
Outpatient clinic for victims of torture and war SRC
The clinic enables those affected to work through their traumatic experiences, develop their personal skills and consolidate family and social resources.
It says that regaining good health, self-determination and dignity is a key condition for these people to become integrated into society.
The counselling and training services for professionals working in this sector provide specific support. The aim is to give traumatised people and their families competent counselling and care.
The public is made aware of the issue in targeted campaigns that aim to promote understanding of migrants who are suffering from violence-induced trauma.
The clinic has an annual budget of around SFr3 million ($2.8 million). Most of its funding comes from the Swiss Red Cross but it also relies on donations from a number of sources.
Its staff includes doctors, psychiatrists, body therapists, psychologists and social counsellors who work in interactive teams.
In Switzerland, the exchange of knowledge and experience is based on contacts between the clinic in Bern and therapy centres in Zurich, Geneva and Lausanne.
The clinic also works in close cooperation with various university institutions. In Bern, it maintains professional cooperation with the Lindenhof hospital.
At the European level, the clinic cultivates regular professional exchanges with other rehabilitation centres for the victims of torture and war.
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