|19 February 2005||Saturday, 8 Phalgun, Nanakshahi|
Batticaloa, Sri Lanka, February 19, 2005: While financial aide has been pouring into the small island country of Sri Lanka after the Christmas-day tragic tsunami, and various international aid organizations are providing aid for basic needs of purified water, food, clothes and medical supplies, the emotional needs of thousands of people who lost loved ones, homes and livelihood is just beginning to be addressed.
UNITED SIKHS, a worldwide humanitarian organization is collaborating with the Mental Health Outreach Project (MHOP), a disaster relief organization of mental heath professionals headquartered in New York and spearheaded by Dr. Anie Kalayjian, member of the United Nations Committee on Human Rights, to work with local Sri Lankan authorities and psychosocial workers to provide ongoing psychological support to the thousands of people affected by the disaster.
The first team arrived in Sri Lanka on February 9th. Successive teams will maintain the continuity of the efforts. After meeting with the Minister of Health and other officials from UNFPA in Colombo, the first team took a 10-hour journey to the northeastern side of the island to the town of Batticaloa, hard hit by the tidal wave and suffering from years of civil war.
The MHOP team is being hosted by the UNITED SIKHS team amongst whom is Vikram Singh, a psychology graduate from Malaysia, who brings to the group his experience of counseling Tsunami survivors in Aceh. Vickram who was a member of the UNITED SIKHS relief team operating in Aceh under a umbrella group, Global Sikhs, says, “The counseling experience o Batticaloa has been overwhelming. Yesterday we had a two hour session with a group of survivors including men, who broke down and cried. They said they were very happy that we are with them and asked us to visit them everyday.”
“This joint effort came to fruition when Dr Kalayjian teamed up with UNITED SIKHS’ to provide counseling services in the Sri Lanka’s Tsunami hit areas where we are operating,” says Harvinder Singh, UNITED SIKHS Team Leader in Batticaloa. “We wanted to provide something other than material supplies, which the survivors were receiving enough of. As other ai agencies begi to leave we will stay for another few months to ensure that counseling care is delivered to the survivors,” he says.
Ananda Galappatti who coordinates the psycho-social services for survivors in Batticaloa says he appreciated the efforts that the UNITED SIKHS team has made to ensure that there is a longer term broad vision of rehabilitation for the survivors.
The team has been conducting group therapy sessions with children and adults living in selected camps. These shelters for displaced families are temporary living quarters set up in large buildings or colleges, the latter preventing students from resuming their studies and thereby requiring quick relocation.
“These people have been living under long-term trauma and now the tsunami has added acute trauma,” says Kalayjian who is also adjunct professor of psychology at Fordham University in New York. “There is so much to be done to help heal the deep sadness of the people in this region over their unimaginably extensive losses. While no statistics are currently available about the amount of people in Sri Lanka currently suffering from the clinical syndrome of post-traumatic stress, it is clear that people can benefit from expressing feelings and getting emotional support.”
“The outpouring of emotion has been intense,” adds Kalayjian, who has provided mental health support after disasters like earthquakes in Armenia, Turkey and Japan and notes that despite any cultural differences, there are many commonalities in how people react after disasters and what helps. Even in cultures not used to talking about feelings, psychological first aid is effective in easing intense sadness and fears in order to prevent long-term suffering.
The team has been conducting group and individual support sessions for those in the camps affected by the tsunami.
The losses are profound. A mother, who survived when a wave catapulted her over a fence but lost her husband, three children, and her parents, cried about the loss and persistent thoughts of her son being ripped from her arms by the raging waters. A 30 year old man who lost 20 members of his family including his wife and two children said, “I was holding my two children one under each arm when the second wave hit and snatched them from me. I can still hear my daughter’s voice calling on me, saying, ‘Father, help me’.”
Frequently expressed feelings were of fear, sadness, guilt, flashbacks, some anger and reoccurring nightmares. Preliminary findings revealed that 98 percent of the people from age eight to over sixty were afraid of the sea and that the tsunami will reoccur. Survivor guilt was also common; 85 percent of people expressed feelings of guilt that they could not save their loved ones who died, many of whom were washed out to sea.
“In this culture, as in many others, physical complaints are more common, including headaches, stomachaches, chest pain and difficult breathing, but these are often expressions of sadness and emotional pain,” says Dr. Judy Kuriansky, team member who is an adjunct professor pf psychology at Columbia University and representative to the United Nations on behalf of two international psychological associations. Kuriansky, who has provided mental health support after bombings in Jerusalem, SARS in China and post 9’11 at Ground Zero and the Family Assistance Center, and was featured in the Red Cross PSA campaign, encouraged one father whose eight-year old son is refusing to eat, to help him express sad feelings over losing his mother and siblings, since eating disorders are often a symptom of unexpressed unacceptable feelings.
Kuriansky adds, “Most of the people are impressively resilient, showing how strong they are in coping with such extreme unimaginable loss.” A focus of the group sessions has been on identifying strengths, finding new meaning in life and identifying what is being recognized as “post-traumatic growth.” Young children were congratulated for being able to survive, by running to safer ground, climbing houses, coconut or banyan trees, or hanging on to logs. Another young man was encouraged to be proud of how strong and heroic he was, despite his slight frame, to carry a heavy older woman to safety. “If you can survive this, know that you can face anything, and do anything,” they were told.
“People’s faith has been tested,” notes Kalayjian. One man told the group that he could not pray since the tsunami because he had lost his faith in God, but that the exercise in the group where people stated their hopes was the first time he was able to pray again.
To address children’s nightmares, Kuriansky led a group teaching them to change the ending of a dream. One little girl who kept dreaming about herself in a coconut tree watching her mother being washed out to sea crying for help, reframed the dream so that her mother was smiling at her saying, “Even if I die, know that I am okay and you must live and be happy.”
Children are taught simple breathing exercises to reduce their anxiety, and encouraged to allow themselves to express their feelings. One young girl whose grandmother told her not to cry role-played with the counselor to ask her grandmother to hold her while she cries, knowing that once the sad feelings are expressed, you can be happy and play again.
To help the children feel safe, they are taught an exercise whereby they hold their hands to their heart and repeat, “I am safe,” and then turn to a friend and say, “you are safe.”
Fears of going to the sea have been addressed by relaxation and imagery techniques including “in vivo desensitization.” A group of survivors, from age six to sixty were taught a relaxation routine and went together in a van to the ocean, where they practiced the techniques and played. All of the participants reported a reduction in their fear level, and an even lower level the next day. All but one later reported being able to sleep peacefully for the first time since the disaster.
The group thanked the counselor for the healing experience, and identified that going with her gave them strength to overcome their fear. Moved by their courage and beauty of soul, Kuriansky said, “It is not any technique that makes the difference, it is coming with an open heart and love, and sharing that love that makes people feel comfort and some joy again.”
Other mental health professionals working in this region include two Portuguese psychologists, who were particularly drawn to the Sri Lankan seaside community that has roots form Portugal.
Several other mental health workers from America and other countries who have come to the country have stayed in the western side of the island, and for a short time. The UNITED SIKHS/MHOP team is unique in establishing continuity with teams coming in shifts from the United States to the northeastern area of Batticaloa. The mental health team is coordinating with the few resources in the region that includes one psychiatrist, Dr. Ganeshan, who is responsible for over 1.7 million people, and local Sri Lankan counselors who are part of the psychosocial organization SHADE, assigned to the area for a six months period.
Other members of the first American team include Drs. Christine Hoven and Donald Mandel of Columbia University, Nicole Moore of Fordham University, Hishara Godakanda of University of Houston-Clear Lake, and Lousine Shamamian of BBC. Says Godakanda, a family therapist and Sri Lankan native, “I feel very blessed to be able to come back to my country to help my people in this terribly tragic time.”
“This must be a long-term effort,” says Kalayjian, “since the needs of the people will be long-term for generations to come, since while families have been fractured and entire generations of children or adults wiped out.”
The team has assessed several needs besides psychological first aid, that includes funeral services, as a vast number of survivors have never located the bodies of their lost loved ones and therefore have not been able to go through mourning process. The team identified one group of six men, all of whom cried over losses of their wives and children during one group session, who all were enthusiastic about participating in a burial ceremony. Being that all of the men are Hindu, the team is organizing a burial ceremony following religious tradition. Other funeral arrangements are being worked out for other religious groups.
Another need is for public education, especially in the remote areas of the island. Given the pervasive fears and questions about what a tsunami is, and widespread rumors that circulate among the camps that another tsunami is coming, it has become obvious to the team that a countrywide education campaign would be helpful to reach the outlying remote communities to teach the people the facts, and also to deal with feelings.
Kuriansky, well known as “Dr. Judy” for her decades of advice-giving on radio and TV and in newspaper and magazines worldwide, and who has done many shows and written many articles in international newspapers about coping with the aftermath of disasters, recommends that electronic and print media be enlisted for such public educational purposes and is willing to work with local media in such a campaign. Prevention in terms of disaster preparedness should also be part of that effort.
Kalayjian adds, “We want to encourage people to donate funds to the mental health relief effort, and to alert the public and all relief organizations to the importance of including mental health support in the initial phases of the disaster.”
The team is identifying local people, including translators, with good communication skills and innate sensitivity who can be trained to do support groups. One translator, a local basketball coach who has been doing an excellent job, congratulates the American team for their work. “You are making quite a difference for our people and the results are almost 100 percent success. This type of work should have been started sooner.” Married to a school career guidance counselor, Malcolm says humorously, “I’m getting even better at helping people than my wife.”
Another translator, Sudhan, a 25-year old computer technician, who was living in one of the camps when he was identified as having the necessary skills, says, “My uncle and two cousins died in the tsunami and our whole house was washed away, even the 10 computers and laptops I was fixing for people, but I don’t care about any possessions. I don’t care if I have any money, any clothes or things. I only care that I am helping people.”
In a closing ritual in the group session, yarn or material creates a web of colors connecting the participants. “It shows that we are all one family,” said one ten year old girl. Another older man said, “The tsunami took us no matter what religion we are, and now we are one no matter who we are.”
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