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The Center for Victims of Torture
New Tactics July Online Dialogue: Staying Safe, SecurityResources for Human Rights Defenders
CRTS, BangladeshACET, BulgariaTPO, CambodiaCRAT, CameroonRCVTE, Ethiopia
ECAP, GuatemalaIMLU, Kenya
KRCT, KosovoSCRVTV, India
PEACE, NamibiaSACH, PakistanTRC, Palestine
CAPS, PeruICAR, Romania
CAPS, Sierra LeoneTCSVT, South Africa
ACTRVT, SudanACTV, Uganda
ICB ProjectPartner Centers
Join New Tactics for this important dialogue on Staying Safe: Se-curity Resources for Human Rights Defenders from July 21 -
27, 2010. Human rights defenders are often met with oppression,discrimination and violence. Human rights work is powerful and
necessary; it is important identify strategies and methods for protec-
tion of these defenders. This dialogue will bring together practitio-ners that work with human rights defenders developing security
strategies to share important resources and tools for the human
rights community.
For additional information, visit the New Tactics website.
Unfortunately, the solution previously described is
not as perfect as it may seem. While there may beno other immediate option in this scenario, there are
significant problems with using an ad hoc
(improvised or impromptu) interpreter, particularlyif the person is a family member or friend. This arti-
cle will outline the standards of practice for trained
interpreters and the problems that can arise if provid-
ers use ad hoc interpreters with torture survivors.
Accuracy and Complete Interpretation
The role of a trained interpreter is to provide clearcommunication between the client and the provider.
An interpreter should not add to or omit things fromthe information that is being shared in a session.
A friend or family member serving as interpreter
may have trouble in this role and find it difficult tofollow this guideline. Friends and family members
sometimes have their own ideas about what their
loved one needs or wants; they may feel compelled
to share their ideas about what the client needs ver-
sus allowing the client to articulate this for them-
(Continued on page 2)
A new client comes to your clinic in
search of help. He has a story to tell and
is desperate to communicate with some-
one who understands what he has experi-
enced. The problem? No one on staff
speaks a common language with him.Just then, a teenage boy walks in and
introduces himself, in your language, asthe son of the man before you. He offers
to interpret for you during the intake
process. How lucky! A problem has justbeen solved.
The Use of Trained Interpreters with Torture Survivors:A Worthwhile Challenge -Alison Beckman and Diane Long
http://
www.newtactics.org/en/
blog/new-tactics/
staying-safe-security-
resources-human-
rights-defenders
July 2010International Capacity Building
International Capacity Building
(ICB) Project NewsletterInside this issue
Pages 1-3: The Use ofTrained Interpreters: A
Worthwhile Challenge
Page 1: New Tactics JulyDialogue: Staying Safe,
Security Resources for Hu-man Rights Defenders
Page 2: Ways for Interpret-ers to Create Comfort &Safety
Page 3: Signs and Symp-
toms of Vicarious Trauma
Pages 4: Managing Stress& Anxiety: Helpful Things
for Interpreters to Do
Pages 5-8: SecondaryTrauma for Interpreters
Pages 9-10: Clinical Cor-ner: Personal Experiencewith Social Work (Peru)
*Spanish version Pages 11-12
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member of the opposition party.
Provision of a Consistent,Professional Role
A trained interpreter should main-tain a professional distance. All
parties should understand that theinterpreter has a very specificrole: to communicate information
between the client and the pro-vider. Interpreters are not there tobe the clients friend, confidante,
case-worker or parent.
With torture survivors, it is rec-
ommended to use the same inter-preter throughout treatment.
Through consistent professionalinteractions with an interpreter, a
client can come to trust the inter-
preter and provider and is better
(Continued on page 3)
selves. A family member may share informa-
tion about the client that the client does notwant to have transmitted, or, conversely, they
may omit information they do not want the pro-
vider to know. Untrained ad hoc interpreters
may censor clinically relevant information they
find embarrassing, offensive or frightening.
Confidentiality
A trained interpreter should maintain confi-dentiality. This means that any information
transmitted in the session should not beshared outside the treatment center, otherthan with specified staff/providers. Even the
simple fact that a client is coming to the treat-ment center is not to be shared with commu-nity members.
An ad hoc interpreter may not fully appreciate
the necessity of confidentiality when working
with a torture survivor. Many survivors fear
details of their torture leaking out into the
community and may be particularly sensitiveabout other community members learning
about their mental or physical health symp-
toms. They may worry an interpreter willshare intimate details from their experience
with others. This will inhibit the developmentof a trusting relationship. In a small commu-
nity where most people know each other, shar-
ing even small details about the content of asession would violate a clients right to pri-
vacy. What a client discloses may be more
limited as a result and negatively impact ther-apy. It is therefore vital that interpreters ad-
here to this guideline and clients know thattheir confidentiality will be respected.
Impartiality
An interpreter should be an impartial party- unbi-ased, neutral, and disinterested. This is not to sayan interpreter does not care about the client ordoes not want them to get help. Instead, it meansthe interpreter should not have a personal stake inwhat the client is transmitting. An interpreter
should not give advice or attempt to influence aclients decisions.
If using an ad hoc interpreter, an individuals
(Continued from page 1)
Ways for Interpreters to Create Safety and Comfort
for Themselves and their Clients
Be aware of personal needs and the needs of client. Attend to personal needs first (rest, nutrition, exercise, restroom break,
water, etc.).
Know your role.
Create a safe and comfortable physical environment.
Orient yourself to the places where you work and help clients orient to
the space as well.
Be open and friendly.
Explain your credentials and define your role for the client.
Maintain clear boundaries.
Do not give out personal information. Make sure clients have the phonenumbers and contact info they need.
Outside of the center, dont approach a client first.
Respect confidentiality. Have an attitude of non-judgment.
Be prepared. (Know the language, have the necessary tools.)
Pay attention to accuracy.
Take notes and explain the purpose/content of notes.
Let a client set their own pace.
Maintain professional behavior at all times.
Know where to go for support.
*List generated by CVT interpreters at August 2007 quarterly meeting.
The Use of Trained Interpreters (continued from page 1)
biases may influence what is being
interpreted. Neutrality is especially
difficult for family members. A clientwho is feeling anger that her parents
have abandoned her after she was
raped may not feel comfortable shar-
ing her story if the interpreter is a rela-
tive. When family members are used
as interpreters (especially children),
the details of the torture experience
can be very distressing. Clients may
choose not to share this information
for fear of alarming their families.
Interpreting may be also more challeng-
ing when the interpreters cultural val-ues or moral views differ from a client,
or if their life circumstances are in factvery similar. A client who is, say, de-
ciding to quit a political party for fear of
being tortured again will be less likelyto tell you if the interpreter is a fellow
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piece of providing sensitive, competentcare. Connecting with other ICB Centers
to learn how they work with interpreterscan be a way to begin thinking about how
to create an interpreter program if you do
not currently have one. Please feel free to
consult with CVT in the remaining months
of the ICB project regarding ideas for cre-
ating an interpreter program. Since inter-preter programs add a significant expense
to budgets, you will need to seek funding
opportunities to start and maintain an inter-
preter program.
Self-Care and On-Going Support for
Interpreters and other ProvidersVicarious trauma is a real issue for all
service providers, including interpreters.
Conscious attention should be given toways to promote self-care before, during
and after interpreting traumatic material.Interpreters can benefit from sharing self-care strategies with each other directly to
find solutions as a group.
An interpreter may sometimes need to de-
brief about a session, especially if the inter-preter themselves has been victimized in a
similar way or has witnessed violence. Thisshould only be done with trained providers
who are a part of the treatment team and
who, like interpreters, are required to re-spect client confidentiality. When interpret-
ers are viewed as part the treatment team, it
makes their roles clearer. This, along withopportunities to share experiences, helps to
counter some of the stress and isolation theymay feel. It also improves the quality of
interpreting. Practices and protocols for
managing symptoms of vicarious trauma
can be discussed and shared among allmembers of the treatment team. Talk with
others in the ICB project about options forproviding additional support.
References
DeAngelis, Tori. 2010. Found in translation. Moni-
tor. 42 (2). http://www.apa.org/monitor/2010/02/translation.aspx
International Medical Interpreters Association.
Medical interpreting standards of practice.Retrieved from http://www.imiaweb.org/
uploads/pages/102.pdf
Requesting and working with interpreters.Community Relations Commission May,
2006. http://www.crc.nsw.gov.au/data/assets/pdf_file/0015/2283/interpreter_book.pdf
The Center for Victims of Torture (2005).Working with torture survivors: Corecompetencies. In Healing the hurt (pp.19-38). Retrieved from http://www.cvt.org/
files/pg100/Healing_the_Hurt_Ch3.pdf
able to share the story of traumatic ex-
periences. Because torture impacts asurvivors ability to trust, the use of dif-
ferent interpreters is not recommended.
You may have to start over building
relationship with clients each time there
is a new interpreter. For the reasons out-
lined earlier, the professional distancerequired for interpreting does not exist
when using family members.
Interpreter Training
Training should include not only thebasics of how to provide professional
interpretation but also specific guide-lines for interpreting traumatic material.
Where do you find a trained interpreter?The answer to this question will vary
from country to country. Training op-portunities in different countries range
from a full University program in inter-
preting to no formal training opportuni-ties at all. In many places in the world,
there are no rules or regulations regard-
ing who can call themselves a trainedinterpreter. For these reasons, torture
treatment centers may need to provideon-going interpreter training in-house. It
is often beneficial to use role-plays based
on real-life scenarios that accurately re-
flect the challenges interpreters face.
The use of trained interpreters comeswith significant expense, coordination
and staff resources. Many Centers
across the world may not have the cur-
rent resources to support such a pro-
gram. However, for the reasons out-lined above, using trained interpreters
with torture survivors is an integral
(Continued from page 2)
The Use of Trained Interpreters (continued from page 2)
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International Capacity Building (ICB) Project Newsletter
Symptoms of posttraumatic
stress disorder:
Nightmares
Sleeplessness
Avoidance behavior
Irritability
Denial of clients trauma
Overidentification with client
No time and energy for oneself
Feelings of great vulnerability
Insignificant daily events areexperienced as threatening
Feelings of alienation Social withdrawal
Disconnection from loved ones
Loss of confidence that good is
still possible in the world
Generalized despair and hope-
lessness
Loss of feeling secure
Increased sensitivity to violence
Cynicism
Feeling disillusioned by humanity
Disrupted frame of reference
Changes in identity, worldview, spirituality
Diminished self capacities
Impaired ego resources
Alterations in sensory experi-
ences (intrusive imagery, disso-
ciation, depersonalization)
*(Lansen, Pearlman and Saakvitne, Wilson and
Lindy, Hoppe).
Signs and Symptoms of
Vicarious Traumatization
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You may feel physical responses:
Hypersensitivity to noise or touch
Headaches/dizziness
Muscle tension/pain
Intrusive thoughts or images
Elevated blood pressure
Mind racing
Stomach/throat tightening
Difficulty breathing
Heart beating faster
Difficulty sleeping/nightmares
Temperature changes
Muscle tremors or weakness
Numbness
Things that may help:
Sit in a chair and feel the points of contact (back, butt, feet). Notice all the
places where you are supported by the chair. Press thighs with hands and feel contact between hands and thighs.
Feel the pressure into your legs and then down into your feet.
Become aware of breathing. Notice your breath moving in and out.
Sit on the floor. Feel your body on the floor, supported by the ground.
Look around. Find 6 objects and name their color or shape.
Tap the skin of your entire body slowly or squeeze muscles gently.
Contract muscles of arms and legs. Hold for a 5-count and release.
Notice sensations as they change.
Use positive self-talk to remind yourself of the here and now.
Page 4
You may feel emotional & social
responses:
Isolation
Boredom
Confusion
Sadness
Lack of purpose
Agitation/Irritability
Helpful things to do may include:
Foster connections with other people.
Do things you enjoy.
Create purposeful activities and
routines.
Use physical activity to calm yourselfor to improve concentration.
Go for a walk or spend time innature.
Focus on soothing images or
practice meditation.
Use your hands for gardening, wood-
working, arts and crafts, etc.
Renew spiritual practices.
Seek counseling and support.
What factors create the most stress for you in your role as an interpreter ?**The following responses were given by interpreters at CVT, August 10, 2007.
Time constraints, rushing, jobs going overtime.
Listening to some of the stories.
Other peoples stress has caused panic attacks.
Stress related to parenting.
Hard not to relate client experiences to personal experiences.
Intrusive thoughts, nightmares.
Clients becoming very dependent when they have little support.
Difficulty setting boundaries with clients and friends.
Rushing and running around between appointments.
Too much repetition. Having to ask clients to repeat the
same subject matter over and over is stressful for clientsand for interpreters.
Lack of supportive systems for clients when they leave the
center, imagining what is happening for the client.
Frustration dealing with administration and paperwork. Its difficult to say things in the first person, because it
becomes a part of you.
Seeing the things that get left out, being tempted to add additional
material.
When you know things that would benefit the client but its against
the rules to do anything.
When we interpret the questions and clients do not respond, the
interpreter is called into question.
Feeling helpless, not being able to fix things from the past.
When there isnt an equal level of communication between client and
provider, i.e. attorneys use legalese and other providers use language
that is too difficult and alienating.
Clients talk directly to the interpreter and it is difficult to direct atten-
tion back to provider.
Recognizing clients needs and not being in a position to make adifference.
Noticing where systems and structures are not meeting client needs. Feelings of helplessness - It is not our job to help solve the
problems.
The Center for Victims of Torture
Managing Stress & Anxiety: Helpful Things for Interpreters to Do -From Diane Long, CVT
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International Capacity Building (ICB) Project Newsletter
The Institute for Study of Psychoso-cial Trauma (ISPT) is a non-profit
organization based in California,
providing psychological treatmentto refugees affected by war trauma
and the aftermath of torture sincethe early 1980s. ISPT has trained
clinicians and other health personnelthroughout the U.S., South and Cen-tral America, staff in an Interna-
tional Court, and international hu-man rights lawyers and field work-
ers. They work with human-induced trauma caused by experi-encing or witnessing acts of war,
genocide, religious, political or eth-nic persecution, domestic abuse,
incest, rape, genital mutilation, andhuman trafficking. Their main em-
phasis, however, has been servingsurvivors of war and physical, psy-chological and sexual torture.
While their initial work with secon-dary trauma was focused exclusively
on primary responders and clinicians,it has expanded in the last eight yearsto include interpreters and membersof the legal profession.
It is now well established that inter-preters are among those vulnerableto experiencing secondary trauma,
just as associates of trauma survi-vors, primary responders, disasterworkers, victim assistance special-
ists, nurses, physicians, psycho-therapists, and others.
Psychological trauma
Psychological trauma refers to anexperience that is emotionally pain-
ful, distressful, or shocking. It cre-ates a psychological wound that
may lead to substantial negative
impact to a persons physiological,psychosocial and family systems.
The consequences of trauma vary widely accordingto diverse variables, such as the victims age, the
pretrauma psychosocial context, the nature and se-
verity of the trauma, and the support received fol-lowing the trauma. Some common symptoms of
trauma (and PTSD) include fear, helplessness, hor-ror, anger, rage, sleep disturbances, alterations in
memory, irritability, difficulty concentrating, re-experiencing traumatic events, avoidance or numb-ing to avoid thoughts and feelings connected with
the traumatic events, detachment, and estrangementfrom others.
Psychological trauma creates an emotional woundthat may harm a persons physiological and psy-
chological systems. Severe traumatic events in-volve extreme stress that overwhelms the ability to
cope, and shatters habitual categories of perceptionand understanding. Trauma may entail different
losses, such as those of sense of self, meaning andhope. This experience of loss often varies accordingto ethnic, cultural and religious differences and the
national or sociopolitical context in which it occurs.These losses usually lead to feelings of depression.If interviewed superficially, a traumatized person
may be diagnosed with a major depressive disorder,and the trauma symptoms may be overlooked.
Secondary trauma
Many of the experiences and symptoms describedabove are also commonly reported by caregiversand other providers that interact with traumatized
patients or clients. Therefore, Figley and othersintroduced the concept of secondary trauma, alsoknown as vicarious traumatization, event counter-
transference, and compassion fatigue. Secondarytrauma refers to the psychological signs and symp-
toms that result from ongoing involvement withtraumatized clients. Professionals that engage withempathy and care with people that have enduredsevere trauma may experience psychological diffi-culties produced by the survivors account of their
traumatic experience and the professionals reac-tions to such accounts. By becoming a witness to
these atrocities, these may become part of the pro-
viders consciousness, leading to a potential incor-poration of their clients traumatic experiences.Therefore, professionals may experience, to a lesser
degree,some of
the same
symptoms as those impacted byprimary trauma. As previously
stated, these may include fear,helplessness, horror, anger, rage,
sleep disturbances, alterations inmemory, irritability, difficulty con-centrating, avoidance or numbing
to avoid thoughts and feelings con-nected with traumatic events, de-
tachment, and estrangement fromothers. In addition, they may un-dergo intense emotional reactions,
ranging from denial to over-identification. Experience with
particularly severely traumatizedclients, combined with frequent
confrontations may influencetherapists in-session reactions. Forexample, a significant part of the
clinical literature shows thatwounded healers are less effec-tive in helping traumatized clients.
At the same time, they may showparticular strengths in workingwith survivors.
A wounded healer may attain adeeper understanding of the dy-namics of a specific trauma as adirect result of having endured a
comparable traumatic experience.Clinicians dealing with human-induced trauma have long under-
stood the usefulness of psychother-apy with victims of primary
trauma. More recently, they haverecognized their own vulnerabilityto secondary trauma while workingwith traumatized individuals, in-cluding victims and witnesses at
war crimes tribunals. However, thesecondary trauma of the interpreter
has hardly been addressed, despite
them being clearly vulnerable tosecondary trauma. Being exposed
(Continued on page 6)
Clinical Perspective: Secondary Trauma for Caregivers/Interpreters*From Secondary Trauma in the Legal Professions, A Clinical Perspective
by Yael Fischman, PhD; Director, Institute for Study of Psychosocial Trauma, California
(TORTURE Volume 18, Number 2, 2008)
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International Capacity Building (ICB) Project Newsletter
Clinical Perspective:Secondary Trauma for Interpreters (continued from page 5)
daily to detailed traumatic narratives is ex-tremely demanding and adds an important
emotional dimension to their work.
However, interpreters are not traditionally
trained to address work-related emotions oracknowledge the potentially traumatic im-pact that their work may have on them and,by extension, on their clients. In some in-
stances, they may feel overwhelmed by uni-dentified emotions. Interpreters may experi-ence symptoms such as those described
above, and may also undergo intense emo-
tional reactions, ranging from denial to over-identification. These feelings are particularlyconflicting when they are neither labeled nor
voiced and may lead them, for example, tounknowingly detach. In such cases they dis-tance themselves from their clients, with-
drawing empathy and a supportive stance.
Secondary trauma: examples
The following examples included in this section
might be helpful to readers unfamiliar with theactual experience of secondary trauma.
Literal statements from interpreters in groupprocesses which I developed and co-led in-
clude: How do I get out of the feeling that Ididnt help the client?; How can I cope
when I feel overwhelmed by the narrative thatI have to translate?; Can you give me tools todeal with my sadness? When interpreters
have themselves been victims of primarytrauma, their risk of retraumatization is very
high. Interpreters still affected by primarytrauma have reported stomach aches,
heartache, feeling exhausted after a session
translating for a human rights attorney, inabil-ity to stop thinking about the reported trauma
several hours or even days after interpreting,increased intake of alcohol or junk foodfollowing a work session. Statements recordedinclude:
I feel flooded by memories of what went on inmy country; I get scared of what information
(Continued from page 5) will come up next and what I will have to deal
with in the following session.
A psycho-educational model to address
secondary trauma
Williams & Sommer, Pearlman and othershave used specific approaches to addresssecondary trauma. Most share some basicprinciples such as the importance of self
care, the need to develop awareness ofsigns of excessive stress, and the need toidentify personal triggers for secondary
trauma. Some clinicians also propose de-
briefing following particularly painfultrauma-related interviews, to facilitate theproviders release of thoughts and feelings
that might not otherwise be expressed.Understanding that education and accurateinformation are important elements in the
prevention of secondary trauma, I devel-oped a psycho-educational model for pre-
vention and early intervention for legal
professionals, primary responders, psycho-therapists, and others that may be vulner-
able to secondary trauma.
When workingwith providers wholive and work in
societies wherewar, terrorism or
human rights vio-lations are occur-ring, we need to be
aware that theycommonly share an experience of primary
trauma with their clients. It is important tounderstand that this creates unique difficul-
ties in the provision of services. For exam-
ple, in situations such as those of primaryresponders, human rights lawyers or psy-
chotherapists, they might be facing theirown primary trauma, while also incorporat-ing their clients traumatic experiences.This creates problems such as blurring of
boundaries, potential exacerbation of emo-tional responses and issues of personalsafety. Such problems may hinder the inter-
preter or clinicians ability to set limits in
their work, take care of their ownphysical and emotional health, and
even allow themselves to be mindfulof their personal reactions to trauma.It is therefore crucial to focus on the
physical and mental wellbeing of pro-viders, explore creative means for
self-care and the release of emotionsand personal feelings, and provide
supervision to help minimize the blur-ring of boundaries. Group training orsupervision may also function as a
support system.
Here is a step-by-step description of
the topics ad-dressed in lec-
tures, discussionsor process ses-sions and smallgroups that can beused to address
secondary trauma. These are intro-duced below in the order in whichthey take place.
1. The training starts with lecturesand interactive sessions to teach theconcepts of trauma, retraumatiza-
tion and secondary trauma; this is
followed by a discussion of individ-ual, family, and community effects
of traumatic events and how theseinteract with the work of providers.
2. The next step is a lecture and
open discussion of the processthrough which caretakers developsymptoms that parallel those of their
clients and of the way in which theirbehavior is impacted by such symp-
toms; consideration of emotional
changes and their impact on theiroutlook on life; attention to behav-
ioral changes following secondarytraumatization, including disruption
in relations with spouses or partners,children, co-workers, supervisors,and friends.
3. The previous topics are followed
by a discussion of common secon-
(Continued on page 7)
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International Capacity Building (ICB) Project Newsletter
Clinical Perspective:Secondary Trauma for Interpreters (continued from page 6)
dary trauma symptoms such as irritability, hy-pervigilance and numbing as well as of the po-
tential for dangerous behaviors such as recklessdriving, alcohol or drug abuse. All the informa-tion discussed is based on an understanding of
the cultural meaning of trauma and healingwithin the group with which we work, andawareness of culturally appropriate ways to de-velop and foster resilience whenever that is pos-
sible. Although our team is not completely mul-ticultural, we actively try to educate ourselveswithin possibilities on the meaning ascribed to
trauma in different cultures.
4. Following the examination of the impact ofsecondary traumatization on the individual
caregiver, lead a discussion about the ethicalresponsibility of traumatized professionals toaddress personal healing needs. Awareness of
potential counterproductive responses rangingall the way from excessive distancing to over-
identifying with their clients contribute to a
better understanding of how secondary traumamay affect a providers decision-making proc-
ess, lead to inhibited listening, ameliorate theability to maintain appropriate boundaries and
to render effective services.
5. Subsequent to such analysis, offer educa-
tion to facilitate early identification of symp-toms of secondary traumatization, and ap-
proaches to prevent further traumatization.Examples that lead to a mentality of preven-tion include suggestions such as: Learn to
identify changes in your mood. Are you feel-ing angry very frequently? Do you often feel
that you are about to cry? Given the workyou are currently doing, these may be signs
of secondary trauma; do not ignore them. Try
to make some time for activities that distractyou from your everyday routine, such as
spending time outdoors, playing with friends,children or pets, engaging in some artisticpursuit, etc. Also, practice observing yourmood changes. The more you observe these
changes, the more control you will eventu-ally acquire over your moods.
Learn to identify changes in your behavior.
(Continued from page 6) Do you get frustrated very frequently? Are
you becoming impatient with your family,friends, co-workers? Have you increased
your alcohol intake? Are you fighting a lotwith your spouse or significant other? Doyou have a desire to attack them physically
or feel that you cannot control your temperwhen you are around them? In your presentcircumstances, these also might be signs ofsecondary trauma. They may indicate that
you need to take time out, get support fromfriends, or talk to a psychotherapist.
6. This section is followed by a lecture ondiverse approaches to self-care which con-
tribute to both prevent secondary traumati-zation and attempt to reverse its effects as
needed. Some of these approaches empha-size the importance of incorporating bal-anced nutrition, physical exercise and a
short, interesting, inspiring, or relaxingactivity into everyday life. Also, highlight
the importance of obtaining supervisionfrom someone that understands the dynam-
ics of work with traumatized clients, as
well as ongoing discussion groups withpeers whenever possible. The support of
professional peers provides nonjudgmentallistening, objective feedback, and addi-tional professional perspectives.A central aspect of the presentation on the
topic of self-care involves organizingsmall process groups to recapitulate thereasons that lead each professional to
trauma work. This is followed by question-
ing whether such reasons are stillvalid, in order to evaluate potentialoccupations in a related field that
does not necessarily involvetrauma. For those who decide tocontinue their employment in the
field of trauma, its highly recom-mended to limit direct involvementwith survivors of trauma and toattempt to combine it with other
lines of work. If the original moti-vation to choose this line of profes-sional work remains in place, par-
ticipants are invited to reflect onthe two sides of trauma work. On
the one hand, it deals with the
dark side of life. On the other, itgrants us the privilege to bringlight into darkness, challenge thosein power who adhere to a world-
view that creates horror and de-spair, fight injustice, or to try tofulfill an inner commitment of
healing the world. It also allows usto appreciate the courage and resil-
ience of those who have enduredharrowing experiences.
7. At this stage the amount of expo-sure to the subject usually allows
participants to safely move intosmall process groups to consider
individual variables that may in-crease the vulnerability to secondarytrauma. These include personal
trauma history, degree of integrationof traumatic experiences, and lack
of necessary support from the socialand family milieu.
When there is acknowledgement oflack of social or family support, try
to decrease feelings of frustrationand loneliness by clarifying that it
is not realistic to expect immediatesupport or understanding from
family and friends. It may take
them some time to acknowledgethe pain involved in trauma work,
and people who are not familiarwith trauma need help to graduallyunderstand and develop the ability
to process the information that isshared with them. (Confidentiality
(Continued on page 8)
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Clinical Perspective: Secondary Trauma for Interpreters(continued from page 7)
regarding identification and specific circum-stances of clients is always emphasized).
In addition, attempt to normalize expectedreactions such as anger, outrage and hope-
lessness that result from continued exposureto the helplessness of traumatized victims.When these emotions emerge, put forward
the option of joining local organizations thatfocus on preventing the specific crimes that
cause major negative impact in each pro-
vider. This offers a positive channel to ex-press anger and helps counteract feelings of
hopelessness.
Conclusions
Even though secondary trauma is not a uni-
versal phenomenon that impacts all profes-sionals interacting with trauma, the problem
is frequent enough to merit serious attention.Secondary trauma may affect a providersdecision-making process, lead to inhibited
listening, decrease the ability to maintainappropriate boundaries and to render effec-
tive services. Also, many professionals bur-dened by secondary trauma abandon their
work with trauma survivors in order to avoid
serious emotional distress. It is important tokeep in mind that particularly vulnerable
individuals, such as those with a history ofunresolved primary trauma, may need indi-vidual or group psychotherapy in addition toeducation and self care.
Prevention and education appear as a verycost-effective approach to avoid the negative
(Continued from page 7) consequences of secondary trauma affecting
providers, and by extension, ser vice users.Education is also a simple way to remind
interpreters and clinical professionals aboutthe risks of retraumatization, and to bringinto focus the dangers involved in retrauma-
tizing clients through inadequate, untimelyor insensitive questions.
An emphasis on group work provides a
safe forum to discuss important practicalissues as well as existential dilemmas thatmay intensify symptoms of secondary
trauma. The psycho-educational model
described above has proved to be a valu-able method to identify, prevent or dimin-ish the effects of secondary trauma. A cen-
tral focus of this model is the clarificationof personal motivations leading profes-sionals to trauma work and its connection
to purpose, meaning, worldview and thespiritual dimensions of trauma. It also al-
lows us to remind providers that while we
cannot undo what happened to those weserve, we can attempt to heal and restore.
ReferencesDiagnostic and Statistical Manual of Mental Disor-ders. 4th ed. Washington: American Psychiatric
Association, 1996.
Figley CR. Psychosocial adjustment among Viet-
nam veterans: an overview of the research. In:Figley CR, ed. Stress disorders among Vietnam
veterans. Theory, research and treatment. NewYork: Brunner/Mazel, 1978.
Figley CR. Catastrophe: an overview of familyreactions. In: Figley CR, McCubbin HI, eds. Stress
in the family. Coping with catastrophe (v. 2). NewYork: Brunner/Mazel, 1983.
McCann L, Pearlman LA. Vicarious trau-matization: a framework for understandingthe psychological effects of working with
victims. J Trauma Stress 1990;3:134-49.
Danieli Y. Countertransference, traumaand training. In: Wilson JP, Lindy JD, eds.
Countertransference treatment of post-traumatic stress disorder. New York: Guil-ford Press, 1994:368-88.
Figley CR. Compassion fatigue. Toward a
new understanding of the costs of caring.In: Stamm BH, ed. Secondary traumatic
stress. Self-care issues for clinicians, re-searchers and educators. Maryland: SidranPress, 1995.
Smith A et al. How therapists cope withclients traumatic experiences. Torture2007;17:203-15.
Holmgren H, Sondergaard H, Elkit A.Stress and coping in traumatised interpret-ers. A pilot study of refugee interpretersworking for a humanitarian organization.Intervention. 2003;1(3):22-7.
Levin AP, Greisberg S. Vicarious trauma
in attorneys. Pace Law Review2003;24:245.
Parker LM. Increasing law students effec-
tiveness when presenting traumatizedclients. A case study of the Katherine &George Alexander Community Law Cen-
ter. Georgetown Immigration Law J2007;21:2.
Williams MB, Sommer JF. Self care and
the vulnerable therapist. In: Stamm BH,ed. Secondary traumatic stress. Self-careissues for clinicians, researchers & educa-
tors. Maryland: Sidran Press, 1995:230-46.
Pearlman LA. Self care for trauma thera-pists. Ameliorating vicarious traumatiza-
tion. In: Stamm BH, ed. Secondary trau-
matic stress. Self-care issues for clinicians,researchers & educators. Maryland: SidranPress, 1995:51-64.
Fischman Y. Interacting with trauma.Clinicians responses to the psychologicalaftereffects of political repression. Am JOrthopsychiatry 1991;61:179-85.
Fischman Y. Meta-clinical issues in thetreatment of psychopolitical trauma. Am JOrthopsychiatry 1998; 68:27-38.
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Clinical Corner: Personal Experience with Social Work (PERU)*Interview with Ericka Jimenez, The Center for Psychosocial Treatment (CAPS)
Where do you work?I work in the Center for Psychosocial
Care (CAPS).
What is your position?Social Worker
Who are your primary clients?
Victims of political violence and their family members
What do you work on from day to day? The work is varied:consultations, orientations, referrals, family orientations and in-terventions, home visits, community work, workshops with
youth and children of those affected.
What skills do you use in your job that you find are most important?To perform this work, I believe that one must take on an absolute
compromise with human dignity, with everything that the disadvan-taged encounter (this population is victimized each day, whether it be
by society or by their own selves); they should be approached with anattitude of respect toward their culture and their values, even when
they are different than ones own. One should be capable of creatingand developing models of prevention and intervention in the socialproblems in which they find themselves.
I consider it to be essential that one should have a spirit of soli-darity that is reflected in their disposition while listening eachday, making the person feel important and unique, with individ-ual abilities and skills, with a respect for human rights. Theskills for the latter include a capacity for adapting to diversesituations because each case that I deal with is different. Anothernecessity is to have the capacity to understand personal andgroup problems objectively, without bias of the diverse problemseach patient has. It is also important to work with a good amount
of creativity, imagination and initiative to come up with alterna-tive solutions. We cannot overlook the responsibility, the group
and community leadership that is required, social solidarity, ini-tiative to maintain acceptance and promotion of interdisciplinary
work with tolerance and an openness to change.
What do you most enjoy about your job? Facilitating people in apath of discovering and developing their potential and abilities.
It is a success to help a person realize that he is able to emergefrom a problematic situation through his own means and re-sources, that is helping him discover for himself and to know thatwe only went down those paths so we can arrive at this conclu-
sion. This assures us that the change is sustainable at this time,and is not just a momentary or temporary solution.
What do you find most challenging in your job? Per-
haps dealing with the mindset of the people, the work ofre-education, sensitization and consciousness-raising is
not easy. The process for a person to change his/hermanner of thinking requires time and an attitude to not
throw in the towel and to continue betting on success.I am convinced that if a person achieves this, it willchange his/her way of living, and he will have influencein his family and therefore in his community. A person
is a family, and this is the focus: the family, startingfrom the individual.
Are there particular methods you use in your work thatyou find most helpful/successful for your clients? Yes,
we work in coordination with other institutions or inter-institutional networks through referrals that are made forspecific cases that the institution cannot cover. Exam-ples include the areas of physical, educational and occu-
pational health. Contacts have been made with particu-lar institutions or government agencies in order to pro-
vide the support necessary to cover a specific need.
From the area of SocialCare, we work withmethods of individualcases, families, groups
and communities. Foreach group a methodol-ogy, instruments, spe-cific tools are employed. For example, in family inter-ventions specific objectives are: complete a diagnosis ofthe function of the familial relationships of the client,complete an analysis of the relationship patterns of thefamilial system, to sensitize the family to the effects oftorture and strategically intervening in the system, giv-
ing recommendations and models to make it better.
Additionally, informative material is distributed and if itis necessary a referral is made to other institutions de-
pending on the defined needs of the patient. Techniquesof observation, home visits, interviews are employed and
in general the methodology is dynamic and participatoryfor each member. During the intervention, the family is
able to play, paint, jump and be dynamic in the way theyachieve their established goals. It is very gratifying toobserve families that have never played or paainted to-gether and initially had no interest in it, who finally begin
to interact and realize that there are other things to dis-cover and other spaces to explore and to see their faces
(Continued on page 10)
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Clinical Corner: Personal Experience with Social Work (continued from page 5)
full of happiness really is something
indescribable. .
Are there people in your organiza-
tion that you collaborate with inyour work, and what do you workon together? Yes, we work hand inhand with the different areas within
the institution with an interdiscipli-nary team that allows us to address
different themes from different per-spectives.
Do you collaborate with profession-
als from other organizations in yourwork? Yes, we work in networkswith different institutions commit-ted to the development and well-being of the clients. The connectionwith other human rights institutionsallows us to intervene and later give
treatment in that institution. In gen-eral, in the first contact we try to
educate about the need to bring inmental health care.
Are there particular factors that you
find to be limiting in the work thatyou do? In certain areas the gov-
ernment doesnt provide the facili-ties in the areas of rehabilitation forthis population.
Can you please provide an exampleof a time when you were particu-larly proud of the work you do/did?
(Continued from page 9) Various cases came to mind, but one thatwill stay with me is that of a young girl who,
for this occasion we will call Maria. Mariais a young girl from Ayachucho who sawher father tortured in the Plaza of Arms in
her community. She found him hours afterhe had been mutilated by the terrorist move-ment Sendero Luminoso (Bright Path).
She came with her family to Lima, fleeingfrom all of the tragedy in their homeland.
She never talks about the subject, and muchless receives any type of treatment to miti-gate this pain. After 10 years of life, Mariahad already experienced 20 and was show-
ing bodily ailments. She couldnt count onsupport from her family and for this sheturned to CAPS. Maria arrived one after-
noon and I noticed that she was in delicatehealth; anxious, with an accelerated heart
rate and the beginnings of baldness, in ad-dition to having swollen legs for which she
requested some medication (I asked forsupport, as the Health insurance would notcover the treatment for the illness).
Upon seeing the alarming state of herhealth, I opted to take her to the nearest
medical center, where the doctor who sawher became alarmed at the critical state ofhealth of the patient. The doctor asked me,Are you a relative? Will you bar the re-sponsibility if something should happen tothe young girl? Immediately I assumedthis responsibility, until we were able to
contact the girls family with whom I spokewith about the facilities and the care. The
doctor mentioned that Maria could have acardiac arrest at any moment, and that itwas a miracle that the girl was walking andconscious. Immediately I took her to a
capital hospital for emergencies, wherethey admitted her. She had high blood
pressure and had a soaring fever.
Around 11 oclock at night, we were given theresults. She had severe hyperthyroidism, andshe was experiencing edema and a loss of equi-librium (she had gone a year without medica-tion due to lack of financial resources).
I remember that the next day I needed to
talk with the chief doctor to enforce thegirls right to receive care free of
charge from her insurance, becausethey did not want to provide her medi-cation. It really became a battle with
the insurance so they would providethe girl with the medication sheneeded. Those two months were vital,Maria got better, she gained weight and
it was an achievement. In reality,Maria was saved from death.
Are there any other specific examples ofwork you have done that you would liketo share? A case comes to mind about
a boy, from the community Ashaninka(central jungle). He was deaf, mute,infected with parasites, anemic, and had
not yet developed speech and neverwent to rehabilitation therapy. His par-
ents mentioned that when he was only afew months old, they had to flee the
forest to avoid being found by the ter-rorist groups, they all had to be silentand when the boy was crying, themother pressed him to her chest so the
crying wouldnt be heard and theywouldnt be discovered in their hiding
place. Since that time, they never againheard him cry, much less talk.
It had to be determined whether theillness was natural, or was a result fromtrauma. Relevant psychological testswere done at CAPS and biological tests
done at a specialized center.
As we imagined, the parents were ex-tremely poor and illiterate and did nothave money to support the care. CAPSwas also unable to cover the costs of the
physical health care, so we looked forsupport from other institutions. They
were able to perform the tests, and laterprovided rehabilitation care and hearingaids which he received totally free.Now the boy has been welcomed in by afamily, is going to high school, has de-veloped his speech and abilities thatwere not thought to be possible.
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International Capacity Building (ICB) Project Newsletter
tener la capacidad de comprender los problemas
personales y grupales considerando las variableshumanas y sociales y contar con una percepcin
objetiva sin parcialidades de las diversas proble-
mticas que tiene cada usuario, contar con mu-
cha creatividad, imaginacin e iniciativa para
proponer alternativas de solucin, no podemos
dejar de lado la responsabilidad, el liderazgo
para la conduccin de grupos y comunidadesque lo requieran, solidaridad social, iniciativa
para mantenerse actualizado, aceptacin y pro-
mocin del trabajo interdisciplinario con apertu-
ra al cambio y tolerancia.
Qu disfruta ms usted sobre su trabajo? Faci-litar a las personas el camino para descubrir y
desarrollar sus potencialidades y capacidades. Es
un logro hacer que la persona se de cuenta que
puede lograr salir de su situacin problemtica
con sus propios medios y recursos, es decir ayu-
darla a descubrirse por si misma y saber que
nosotros solo fuimos los canales para que llegue
a esa conclusin. Esto nos asegura que el cambio
es sostenible en el tiempo y no solo una solucinmomentnea o meditica.
Qu le parece ms difcil en su trabajo? Tal vezlidiar con el pensamiento de las personas, el trabajo
de reeducacin, sensibilizacin y concientizacinno es fcil, como mencion antes, el proceso para
que la persona logre cambiar su manera de pensar
requiere tiempo y disposicin a no tirar la toallay seguir apostando a que lo lograr.
Estoy convencida que si la persona lo logra,cambiar su manera de vivir y ser de influencia
en su familia y por ende en su comunidad. Unapersona es una familia y ese es el enfoque, la
familia, partiendo desde el individuo
Existen mtodos especficos que usa usted en
su trabajo que encuentra lo ms ayudantes / exi-
tosos por sus clientes? Si, el trabajo en coordi-nacin con otras instituciones o redes interinsti-
tucionales que son las derivaciones que se reali-zan para casos especficos que la institucin no
logra cubrir, como por ejemplo el
rea de salud fsica, educativa y labo-ral.
Para este fin se hacen los contactos
respectivos con instituciones particu-
lares o estatales para que brinden el
apoyo necesario para cubrir la necesi-
dad especfica.
Desde el rea de Atencin Social traba-
jamos con el mtodo de casos, familia,
grupo y comunidad. Para cada grupo
se emplean metodologa, instrumentos
y herramientas especficas, por ejem-plo en las intervenciones de familia
cuyos objetivos especficos son: realizar
un diagnstico del funcionamiento de
las relaciones familiares del afectado, el
analizar los patrones de relacin del
sistema familiar, sensibilizar a la fami-
lia sobre los efectos de la tortura e inter-
venir estratgicamente en el sistema
dando recomendaciones y pautas parasu mejoramiento
Adems se entrega materiales infor-mativos y si es necesario se hace la
derivacin a diversas institucionesdependiendo de las necesidades de-
tectadas. Se emplear la tcnica de la
observacin, la visita domiciliaria, laentrevista y siempre por lo general la
metodologa es dinmica y participa-
tiva con cada miembro, durante laintervencin la familia puede jugar,
pintar, saltar, hacer dinmicas con elfin de lograr los objetivos propuestos,
es muy gratificante observar a fami-
lias que nunca han jugado o pintadocomo conjunto y que lo hacen en un
principio sin inters pero que al final
inician a interactuar y a darse cuentaque hay otras cosas que descubrir u
otros espacios por explorar y el ver
(Continued on page 12)
This Newsletter was made possible by the generous support of the American people through the Office of Private and Volun-tary Cooperation, Bureau for Humanitarian Response, US Agency for International Development, under the terms of Match-ing Grant Agreement No. FAO-G-00-00-00043-00. The opinions expressed herein are those of the author(s) and do notnecessarily reflect the views of the US Agency for International Development or the United States Government.
Dnde trabaja usted?
Trabajo en el Centro de AtencinPsicosocial CAPS.
Cul es su positin?
Trabajadora Social
Quines son sus clientes
principales?
Victimas de Violencia Poltica y
sus familiares
Qu trabajo hace da a da? Eltrabajo es variado, Consejerias,
orientaciones, derivaciones, orien-taciones e intervenciones familia-
res, visitas domiciliarias, trabajo
comunitario, talleres con jveneshijos de afectados.
Cuales habilidades que se utilizanen su trabajo son lo ms importan-
tes? Para ejercer esta labor, creo
que se debe asumir un compromi-so absoluto con la dignidad huma-
na, sobre todo con los que se en-
cuentran en desventaja (esta pobla-cin es vctima y es victimizada
cada da ya sea por la sociedad opor ellos mismos), se les debe tratar
con una actitud de respeto hacia sucultura y sus valores an cuando
resulten diferentes a los suyos, se
debe ser capaz de crear y desarro-llar modelos de prevencin e inter-
vencin en la problemtica social
en la que se encuentran.
Considero elemental que se debe
contar con un espritu solidario quese refleje en la disposicin cada
da de escuchar, de hacer sentir a la
persona como importante y nica
con capacidades y habilidades, con
el respeto a los derechos humanos.
Las habilidades para este fin son la
capacidad de adaptacin a situa-
ciones diversas ya que cada caso
que se trata es diferente, otra es
Clnica Rincn: La experiencia personal con el Trabajo Social (Per)*Entrevista con Ericka Jimenez, Centro de Atencin Psicosocial (CAPS)
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La experiencia personal con el Trabajo Social (continued from page 7)
International Capacity Building (ICB) Project Newsletter
Vino junto con su familia a Lima, huyen-do de toda la tragedia vivida en su tierra
natal, nunca hablo del tema ni muchomenos llevo algn tipo de tratamiento
para mitigar ese dolor. Al cabo de 10 aos
Mara ya tenia 20 y presentaba dolenciascorporales, no contaba con el apoyo de su
familia y es all donde recurre al CAPS.
Llega la paciente Mara, una tarde y notque se encontraba delicada de salud, bas-
tante ansiosa, con ritmo cardiaco acelera-do, notable baja de peso, ojos saltones e
inicio de calvicie adems de tener las pier-
nas hinchadas para lo cual me pidi algu-na medicacin (pide apoyo puesto que el
Seguro de salud no le cubre tratamientode la enfermedad)
Al ver el estado alarmante de salud, seopt por llevarla al centro mdico ms
cercano, donde el mdico que la revis, se
alarm por el estado crtico de salud en elque se encontraba la paciente. De inme-
diato recuerdo que el mdico pregunto
usted es el familiar? se har cargo si le
pasa algo a la joven?, inmediatamente se
asumi la responsabilidad, hasta lograr
contactar a los familiares de la joven con
quienes se dialog para que brinden lasfacilidades y el cuidado respectivo. El
mdico mencion que Mara poda hacer
un paro cardiaco en cualquier momento y
que era un milagro que la joven este aun
caminando y lcida, de inmediato la llev
por emergencia a un hospital capitalino en
donde la internaron, tenia la presin alta y
volaba en fiebre
Alrededor de las 11 de la noche dieron los
resultados y era un hipertiroidismo severo,
estaba haciendo un edema y se haba des-
compensado, ya que hacia un ao que le
detectaron la enfermedad y no estaba medi-
cndose por falta de recursos econmicos.
Recuerdo que al da siguiente se tuvo que
hablar con el mdico jefe y hacer valer el
derecho de la joven a ser atendida de formagratuita por su seguro, ya que no le queran
suministrar la medicacin correspondiente,realmente fue una batalla con el seguro para
que se le brinde la medicacin quenecesitaba. Esos 2 meses fueron vita-
les, Mara mejoro, subi de peso y sevio un logro.. Realmente se salv a
Mara de la muerte.
Hay otros ejemplos especficos del
trabajo que Usted ha hecho que
quiere compartir? A mi mente elcaso de un nio, de la comunidad
Ashaninka (selva central) sordo mu-do, infectado con parsitos, anmi-
co, que no haba desarrollado el len-
guaje pues nunca fue a una terapia
de rehabilitacin, comentan sus pa-dres, que cuando tena meses de
nacido, tuvieron que huir al monte
(espesura de la selva) para no ser
encontrados por los grupos terroris-
tas, todos haban de hacer silencio y
cuando el nio lloraba, lo que hacia
la madre era apretarlo junto a supecho para que no sea escuchado el
llanto y no sean descubiertos en el
lugar de escondite. Desde ese tiem-
po no volvieron a escucharlo llorar,
ni mucho menos hablar.
Lo que se quera era descartar si el
mal era orgnico o si era producto
del trauma. Se hicieron los exme-
nes respectivos en el CAPS por la
parte psicolgica y en un centro es-
pecializado para lo orgnico.
Como nos imaginaremos, los padres
eran pobres extremos e iletrados por lotanto no contaban con dinero para la
atencin, el CAPS tampoco podra
cubrir los gastos en salud fsica, asque se busc el apoyo de otras institu-
ciones, se logr que le hicieran los
exmenes de descarte y posteriormen-
te que se le brinde la atencin de reha-
bilitacin hasta las prtesis auditivasque requera totalmente gratuito. Aho-
ra el nio ha sido acogido por una
familia, va al colegio, ha desarrolladoel habla y habilidades que no se crean
posible desarrollar.
sus caras de alegra realmente es algo indes-
criptible.
Hay personas en su organizacin con quie-nes colabora en su trabajo, y en que trabajan
juntos? Si, trabajamos de la mano con las
diferentes reas dentro de la institucin conun equipo multidisciplinario que permite
abordar los diferentes temas desde diferen-
tes perspectivas.
Colabora usted con profesionales de otras
organizaciones en su trabajo? Si, el trabajo en
redes o con diferentes instituciones compro-
metidas con el desarrollo y bienestar de losafectados es constante y reciproco. De las otras
instituciones de DDHH nos derivan casos para
poder intervenir y posteriormente dar trata-
miento en la institucin, por lo general el pri-
mer contacto es para sensibilizar sobre la nece-
sidad de llevar una atencin en salud mental.
Existen factores especficos que limitan eltrabajo que hace usted? Bueno por parte del
Estado que no brinda las facilidades en los
temas de reparacin para esta poblacin.
Usted por favor da un ejemplo de un tiem-po cuando se siento especialmente orgulloso
del trabajo que hace / hizo? Se vienen va-
rios casos a mi mente pero uno que quedaragrabado es el de una joven al que vamos a
llamar en esta ocasin Mara. Mara esuna joven de Ayacucho que vio como a su
padre lo torturaron en la Plaza de Armas de
su comunidad y se enter horas despus quefue cercenado por el movimiento terrorista
Sendero Luminoso.
(Continued from page 11)
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