Article from New York Daily News:
When former Presidents Clinton and Bush arrived in Sri Lanka Saturday, the heat swelled like a Florida day. The two former U.S. chiefs, making their first-ever visit to this onetime vacation wonderland, came to survey the damage wrought in the region by the Christmas tsunami.
What awaited them was ruin and misery not unlike that in the wake of recent Florida hurricanes, but worse. While tragedies cannot be compared, some 40,000 people from this small island were swept into the sea or killed by the deadly tidal wave, and thousands more left deprived of their homes, livelihood and loved ones.
By the time the Presidents came, I’d already been in Sri Lanka for over a week, as part of a relief mission offering psychological first aid to the survivors living in camps and trying to rebuild their lives. Our mental health team set up in the town of Batticaloa, a 10-hour journey by van to the northeast coastal area hard hit by the tidal wave – and already suffering from years of civil war between a rebel group, the Tamil Tigers, and the government - leaving the people in twofold trauma.
The mission was organized by Fordham University psychology professor Ani Kalayjian, who spearheaded the Mental Health Outreach Project that has provided mental health support after disasters like earthquakes in Armenia, Turkey and Japan. Our initial seven-member team coordinated with UNITED SIKHS, a worldwide humanitarian organization, to set up a unique ongoing mental health program, working with Ananda Galappatti, the local psychosocial authority, and local psychosocial groups to deliver services and identify local people who can be trained to offer emotional support to those affected by the disaster.
Clinton and Bush’s visits to Sri Lanka, and the other Indian Ocean areas hit by the tsunami, was at the request of President Bush, to head up private sector fundraising for relief and reconstruction. On Sunday, they met with Sri Lankan President Chandrika Bandaranayake Kumarathunga and then set off to tour the town of Weligama on the southern tip of the island to visit a temporary shelter, see a water pump providing fresh water, and talk with an organization providing trauma counseling for children.
From our experiences in the camps in the past week, I knew what the Presidents would go through. It’s heart-wrenching to see how people who once lived in lovely seaside abodes now crowd into camps that are converted buildings or colleges, where large auditoriums are sectioned off by broken chairs to delineate families’ spaces.
Children, many not yet back at to school, jump into my arms, while others fight to grasp my hand. "Mommy," one orphaned girl calls me, as she wraps herself around my waist and looks up wistfully into my eyes. I wish I could adopt them all. I can give them a marble (the favorite toy here, as it is simple and easy to play with), but more important is a tight hug and a broad, loving smile.
How can you possibly give them all the love they need? I worry. There are 1,200 people in just one camp our team has worked in. I calm my frustration by remembering a story that President Bush Sr. told during his “1,000 Points of Light” campaign. A grandfather was walking on the beach with his grandson, picking up starfish as they lay drying and dying on the hot sand, and throwing them back in the water. “But grandpa,” the boy asked, looking at so many starfish, “How can you save all these starfish?” The grandpa answered, “If I save only one, that is good.”
Clinton’s charisma - I’ve seen it first hand during a visit with him in the oval office – will undoubtedly touch some hearts of these beautiful souls struggling – and coping with bravery and spirit.
The trauma counseling for children that the former chiefs will see is getting under way in some places on the island. Group play therapy is universal and applies to every culture, particularly drawing pictures as a good way for children to express feelings. I’ve had children draw their family, and themselves on a bridge (a technique developed by Israeli psychologists who certainly know a great deal about trauma from experiences in their country).
Then I ask each child to announce a quality that makes them feel special, and the group all repeats that quality back to them, in a show of acknowledgment - that brings a smile every time. “My mother told me I’m pretty,” said one girl. Several boys and girls feel proud that they work hard at school. Everyone claps.
While tradition here holds that people do not talk about their feelings, when given a chance to share their terrifying experiences, emotions poured out.
“Emotional release is important in every culture to purge intense sadness and fears in order to prevent long-term suffering,” says Kalayjian, who has developed a six step program to help survivors heal. The traumatologist knows expression helps, even from her personal experience recovering from long-term effects of genocide in Armenia.
After expressing feelings, taking some action to reduce fears helps. In a psychological technique called “in vivo desensitization,” the counselor goes through the steps of the dreaded experience with the person who has a fear. Typical to combat fear of flying, for example, the therapist would actually go with the person onto an airplane. Since nearly all the survivors in the camps expressed fear of returning to the sea, with ten children and some parents, I piled into our van off to the beach, at steps along the way, practicing stress-reducing breathing techniques and repeating “I am safe, you are safe, we are safe,” and then playing.
The next day, all of the members of the group say they slept peacefully for the first time. Associating the sea with joy, rather than pain, is healing.
A few days later I took the group to the beach again, this time with another group who expressed fears of returning to the sea – to pass along the healing.
At the beach, we pass artificial sand dunes made of piles of remnants of TV sets, electrical sockets and scraps of clothing created by the swirling tsunami waters, and reach the site of one of the women’s houses. I pick up a torn scrap of gold Indian silk, once her beautiful sari, and a red-suited Santa Claus stuffed toy – a gift on that fateful Christmas that the tsunami hit. One of the children warns me not to pick it up because it is dirty from all the sewage, but I encourage them to help me wash it in the sea, as a ritual of transforming ruin into renewal.
As the mental health resources of the country have been minimal - with reportedly only a few dozen trained workers in the country of millions and only one psychiatrist in the northeast district where I was – recruiting local helpers is key. Implementing services is an overwhelming task, but being done with great care, by local authorities like Galappatti, and the district officer of the Consortium of Humanitarian Agencies, Sylvester Solomon. As the local psychosocial group, Shade, knows, listening and empathy are basic, but effective.
Despite the cultural tradition of not talking about feelings – complaints are physical, like headaches, stomach aches, difficulty breathing – given a chance, emotions pour out. Sad but sweet faces and heart-wrenching stories now echo in my head as much as nightmares of the raging sea torture theirs.
The night before the former Presidents’ visit, as I sipped wine and danced in the disco at the five-star Mount Lavinia Hotel in Colombo, my mind drifted to 13-year-old Nialini, who at that time I imagined was trying to fall asleep while lying on a mat on the stone floor. I clutched at the pink hairclip I am wearing, wishing that I had given it to her.
Images of their losses flood me. 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 twenty 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.’”
A preliminary assessment showed that frequently expressed feelings were of fear, sadness, guilt, flashbacks, and recurring nightmares. Nearly all the people from age eight to over sixty were afraid of the sea and that the tsunami will reoccur. Survivor guilt was also common; eighty-five 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.
A focus of our 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. A 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 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, I 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.
Ultimately, I know from doing mental health relief at so many disaster sites around the world, that it is not the technique that makes the difference, but it is coming with an open heart and love. Sharing love makes people feel comfort and some joy again.
The humanitarian effort is progressing, despite a background of politics that always plays center stage. One newspaper story reported how the Indian government was concerned about the U.S. deployment because of heavy Indian Oil Corporation investment in the region.
Politics aside, it’s high time to care for people’s hearts. Our team has identified several needs besides psychological first aid, including funeral services, since a vast number of survivors have never located the bodies of their lost loved ones and therefore have not been able to go through the mourning process.
Another need is for public education, especially in the remote areas of the island, given pervasive fears and questions about what a tsunami is, and widespread rumors that circulate in the camps that another tsunami is coming. After an earthquake in Australia, a radio station suspended its regular programming for me to take calls from listeners about overcoming fears like children’s school phobia and older people’s fear of going out of the house.
Financial aid has poured into the entire Indian Ocean region affected -- $500 million from Japan, $350 million from America, more millions from Australia and Germany - but some of that money needs to be funneled into the all-too-neglected area of mental health. “While jobs, food, shelter and medical care are certainly essential, we want to encourage people to donate funds to the mental health relief effort to insure emotional healing,” says Kalayjian.
Some of that money can go to identifying local people, including translators, with good communication skills and innate sensitivity who can be trained to offer support to others. Malcolm the basketball coach turned translator, married to a school career guidance counselor, says with pride, “I’m getting even better at helping people than my wife.”
Another translator, Sudhan, a 25-year old computer technician, 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 ten 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 group ritual - one of my favorite techniques that I use around the world in disaster areas – people stand in a circle and throw multi-colored balls of yarn to each other, creating a web. One ten-year old girl expressed the intention perfectly: “It shows that we are all one family.” An older man also got it, and said, “The tsunami took us no matter what religion we are, and now we are one, no matter who we are.”