International Affairs

Victims of Torture

SINCE 1984, torture vict ims who have been granted asylum in Den- mark have been eligible for treat- ment of their sequelae of torture at the International Rehabilitation and Research Centre for Torture Victims (RCT). Studies of torture victims done by Danish physicians in the

1970s revealed their need for special treatment. Conse- quently, the Department of Neurology of the Copenhagen University Hospital began treating victims of torture in 1980.1-3 This column concentrates on the sequelae of tor- ture and the treatment of torture victims, including the nursing aspects. 4

The RCT opened its own premises in two small houses near the Copenhagen University Hospital in May 1984 as a private institution supported by funds from the Danish government and private foundations. Its purposes are to rehabilitate torture victims and their families and to study the sequelae of torture. Other important tasks are training health staff to treat these victims and collecting and docu- menting information and torture-related literature from around the world.

In the 1970s, victims of torture came mainly from Latin America, whereas in the 1980s, they have come primarily from Turkey and the Middle East. Generally speaking, those who have been tortured are strong, vigorous people who struggled for a particular cause, such as greater social justice or religious freedom in their homeland. Their tor- turers sought to ~rreak down and destroy the victims' iden- tities through profound and excruciating humiliation.

The mental element and the mental sequelae are the worst aspects of torture. Most victims experience similar

LONE JACOBSEN, R N Chief Nurse, The International Rehabilitation and Research

Centre for Torture Viaims, and Department of Neurology Copenhagen University Hospital, DK-21 O0 Copenhagen ~, Denmark

Assistant Editor's Note: International Affairs, a column re- flecting worldwide nursing views and issues, will continue to build on the excellent ground-breaking work of Dr. Olga An- druskiw. This last column under her direction, Victims of Tor- ture, provides a bridge to this year's columns on moral and ethical concerns undergirding international nursing. These columns will be written by nurses from various parts of the world who will express their viewpoints on global issues affecting the health of the people.. I hope you will be challenged and stimulated by this column.--JoANN GuTrENnErtG, PHD, RN, FAAN.

types of mental sequelae: they feel anxious and depressed, have constant nightmares about confinement and torture, and are unable to sleep. Their memory is impaired, and they find it hard to concentrate. Fatigue, headaches, and sexual disturbances are also part of their symptoms. It is a shock for them that they feel changed and do not recognize themselves. Some isolate themselves; others become ag- gressive or respond in ways that are atypical.

The physical sequelae depend on the methods of torture. Victims have had permanent loss of hearing caused by si- multaneous blows on both ears (telephone torture), fistuli- zation and abscesses in the rectum as a consequence of anal torture, pains when walking resulting from beating with sticks on the soles of the feet (falanga), and even loss of limbs following severe blows or stabbing with bayonets.

Victims often have physical complaint s such as muscular tension, pains in the urinary system, arid gastritis. They are afraid their organs have bee n permanently damaged during torture because their tortu'rers told them this would happen. To exclude the possibility that these complaints have pathologic causes, the victims undergo a standard ex- amination program.

The treatment carried out by the RCT as an interdisci- pl inary team includes psychotherapy, general somatic treatment, nursing care, physiotherapy, dental treatment, and social counseling. Based on a holistic view of the pa- tient, psychotherapy and somatic treatment are carried out simultaneously, and examination and treatment are offered to spouses and children as well.

Psychotherapy is the core of treatment. During sessions, the victim recalls and analyzes the torture and its most humil ia t ing aspects. This process is harrowing, but it helps free the victim of their haunting memories and the guilt many of them feel.

The nurse is an essential factor in the therapeutic envi- ronment, where trust between patient (victim) and thera- pist is absolutely vital if any treatment or therapy is to succeed. The nurse supports the patients in difficult situa- tions, especially those that are reminiscent of the torture. In addition, nurses also participate in the RCT's interdisci- plinary research program and in training other health staff.

The fundamental concept of nursing at the RCT is to encourag~ frank communication so that the patient can de- termine his or her own role in the treatment process. Orem's theory of self-care ~ is the basis for nursing care at the RCT. The goal is to support the patients' efforts to restore and maintain their health wherever possible.

Avoiding, as much as possible, situations that might remind the victims of their torture is basic to treatment.

Continued on page 68

6 JOURNAL OF PROFESSIONAL NURSING • JANUARY--FEBRUARY 1988

68 JOURNAL OF PROFESSIONAL N U RSIN G • JANUARY--FEBRUARY 1988

From Our Columnists, continued

Public Policy, Continued from page 3

• Nurse Anesthetist Traineeships are awarded to eli- gible institutions for financial support of registered nurses enrolled in approved nurse anesthetist training programs. Traineeships provide for tuition anti fees of the institution and stipends of up to $6,522 per year for a maximum of 18 months of study.

• Postbaccalaureate Faculty Fellowship Grants are awarded to eligible schools of nursing to cover the cost of postbaccalaureate fellowships for faculty to complete their master's or doctoral education, in- cluding a study, thesis, or dissertation in specified areas. Fellowships cover the cost of tuition and fees of the school and may provide a stipend for full- t ime study.

• Professional Nurse Traineeships are awarded to currently licensed registered nurses through grants to institutions providing master's and doctoral de- gree programs to educate nurses to serve as nurse prac t i t ioners , admin i s t r a to r s , educators , re- searchers, or other nursing specialists, and as nurse midwives. Traineeships are awarded for a max- imum of 36 months of full-time study and provide for tuition, fees, and stipends of up to $6,522 per year.

During FY '87, the Division of Nursing awarded approxi- mately $53.8 million for these grant programs.

Nurses are a national resource and a key element in the successful development of the health care system of to- morrow. Efforts must be made to ensure a continuing supply of entrants into the profession and to clarify and realign nursing roles to meet the requirements of changing nursing practice. Imbalances in both geographic and spe- cialty distribution of nursing services must be alleviated. The federal government should continue its assessment of nursing personnel resources through the conduct of na- tional studies of nurse supply, education, and practice to ensure sound policy decisions critical to the delivery of quality nursing services to the nation.

Reference

Institute of Medicine, Division of Health Care Services: Nursing and Nursing Education: Public Policies and Pri- vate Actions. Washington, DC, National Academy Press, 1983.

Education, Continued from page 5

difference in the promotion of health and the alleviation of human suffering.

References

1. Schlotfeldt RM: Resolution of issues: an imperative for creating nursing's future. J Prof Nurs 3:136-142, 1987

2. Silva M: Research testing nursing theory: state of the art. Adv Nurs Sci 9: ! - 11, 1986

3. Donaldson S, Crowley D: The discipline of nursing. Nuts Outlook 26:113-120, 1978

4. Conway M: Toward greater specificity in defining nursing's metaparadigm. Adv Nurs Sci 7(4):73-81, 1985

5. Kritek P: Futurism as a strategy for shaping social welfare •olicv. Presented at 1987 National Forum on Doctoral Ed- ucation in Nursing, Pittsburgh, PA, June 25, 1987

6. Newman M, Autio S: Nursing in a Prospective Payment System Health Care Environment. Minneapolis, MN, Uni- versity of Minnesota, 1986, p 14

International Affairs, Continued from page 6

For example, during interviews, the nurse must be aware that patients, as part of their torture, were exposed to long and very exacting interrogations. Thus, interviews should be as short as possible, and stereotypical questioning and glaring light should be avoided. As many examinations and treatments as possible are conducted at the RCT, and patients are hospitalized only for surgery, very poor phys- ical or mental conditions, and taxing examinations such as gastroscopy or rectoscopy.

Victims who had been subjecte d to electrical torture and who either had seen their own blood or had been ordered to wash their own or others' blood from walls or scrub the floors after friends had been executed may react with anx- iety or panic when given a blood test or an electrocardio- gram. These examinations are performed by the nurse in rooms that look as lit t le like a clinic as possible. Wait ing can also cause severe anxiety.

Examinations that involve inspecting the cavities of the body by means of scopes can create fear or anxiety, so gen- eral anesthesia is sometimes used. Many of the patients, however, are afraid of being anesthetized, so a nurse always accompanies them to surgery and stays with them until they fall asleep. The nurse is the patients' guarantee that they will not be strapped down or have their noses and mouths covered while still awake.

Education and guidance help patients restore their own health and prevent illness. Some patients will have lost considerable weight during imprisonment and torture. Moreover, their experience as exiles in a foreign country with an alien culture can be difficult. In many cases, victims have acquired unwise eating habits and loss of ap- petite. Patients and their families are instructed in nutri- tion and health by the nurse.

The RCT also functions as a research center. One of its projects records and evaluates the effect of the existing in- terdisciplinary treatment model. Nursing-related activities using Orem's model are recorded. Training and sharing information are given a high pr ior i ty and include all members of the team, both nationally and internationally. SO far, five international seminars have been held, in- cluding seminars for third-world countries. These teaching