Phantom in the Mirror

COPE Visitors’ Center Sheds Light on Lingering War Danger in Peaceful Laos

By Dave Fox
Vientiane, Laos

The Second Indochina War ended more than three decades ago, but more than a third of Laos is still “contaminated” with unexploded land mines and cluster bombs, according to COPE, the Cooperative Orthotic and Prosthetic Enterprise.

The COPE visitors' center in Vientiane, Laos.

The COPE visitors’ center in Vientiane, Laos, offers information on unexploded bombs in Laos and works to rehabilitate victims.

COPE is the primary provider in Laos of prosthetic limbs, wheelchairs, and other assistance to the victims of unexploded ordinance or “UXO.” The organization works to educate Laotians about UXO dangers. It also runs a visitors’ center, offering a sad mix of culture and war history in an exhibit designed to increase international awareness.

“People have become reliant on the scrap trade,” reads one sign at the exhibit, “and although it is officially illegal, whole communities including children search the ground.”


In rural Laos, villagers sometimes fashion pots and other household items from old bombshells.

Nearly a quarter of all UXO injuries come from scrap metal collecting, according to COPE statistics. Dealers pay 1,000 to 2,000 Laotian kip – 12 to 25 US cents – per kilo of metal.

The center offers a short film about UXO dangers, a full-scale model of a rural Laotian house including cooking pots and other items made from bombshells, and a display of homemade artificial limbs. The most dramatic part of the exhibit, for me, was a “mirror box,” a simple device that helps victims of so-called “phantom pain.”

Phantom pain occurs when nerves send bogus pain signals to the brain. It can happen after a person loses a limb. Their hand or foot is gone, yet they feel a variety of sensations as if it were still there – from throbbing to burning to itching.

mirror box

The mirror box: The arm with a hand is inserted in the exposed compartment. The arm that is missing a hand is inserted in the covered compartment. The person can then scratch the mirror on the center vertical panel, creating the illusion of scratching a phantom itch.

The mirror box consists of two compartments – one covered, one uncovered. Patients insert both arms – with their functioning hand visible, and their arm with the missing hand covered. A mirror gives the image that both arms still have hands attached. Users of the device can then “scratch” their reflection, which fools the brain into thinking the uncomfortable phantom pain sensations are being addressed.

I was drawn to the box for personal reasons, having been diagnosed several years ago with a different phantom pain condition called Reflex Sympathetic Dystrophy. Very long story short, I sustained a minor hairline fracture in my foot, and was told I’d be fine in a couple of weeks. But nearly three months later, the pain was still unbearable. My foot was discolored, swollen, and showing no signs of improvement.

Once diagnosed, I made a full recovery. Part of my treatment involved beginning to walk again in spite of the pain. My doctor assured me that while it would hurt like hell, it would not damage my body. My brain needed to be retrained that everything was okay, and that the nerve signals from my foot did not need to be interpreted as pain.

(I wrote a column about my diagnosis and recovery in 2008. You can read it here.)

COPE Laos artificial legs

From the exhibit: “If people are not aware that services are not available, they still have to find ways to be able to move around. These “home made” legs were collected from patients over the last few years. Hanging above them are legs returned to COPE after being worn out. On average, a leg lasts for two years, six to nine months for growing children.”

The mirror box retrains the brain in a different way, through visual cues. But here’s the freaky thing: If you have two fully functional hands, this simple contraption can confuse you. The exhibit instructs you to insert your hands, and open and close them at the same time. What you see is what you should see – two hands opening and closing. Only what you perceive visually as your right hand opening and closing is actually a mirror image of your left hand. You are then instructed to open and close just one hand at a time. Depending on which you choose to move, you see either both or neither of them contracting.

I know – this probably doesn’t sound so enthralling. But I experienced bizarre sensations afterward. Leaving the museum, I felt off balance. My right hand felt twitchy – like I needed to keep moving it to be sure it worked. After a few minutes, the sensation spread – into my shoulder, throughout the right side of my body, even into my eye. I felt anxious, needing to do something to stop the sensations in the same way an amputee might want to scratch a missing hand or foot.

I wandered through a residential neighborhood, trying to distract myself. I finally figured out a solution. My sensations were caused by my body doing one thing while my eyes interpreted something different. I needed to repeat the mirror box exercise without the mirror box.

So I stopped on the sidewalk, held out my hands, and looked at them as I opened and closed them. Within a minute, my discomfort was gone.

People who lose limbs to UXO don’t have it so easy. COPE helps them adapt to their conditions, and educates others so they don’t become victims.

If you visit Vientiane, COPE is a five-minute taxi/tuktuk ride, or a 30-minute walk from the city center. Admission is free, though they accept donations to help fund their work with UXO victims. If you won’t be visiting Laos anytime soon, you can learn more and donate online at

Published on Tuesday, June 26, 2012

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