Treating the psychological impact of the tsunami

© Christian Aslund Click for larger view On December 31, five days after the tsunami, the first Médecins Sans Frontières (MSF) team of two national psychologists arrived in Banda Aceh to assess the mental trauma caused by the disaster. Teams were already on the ground providing immediate medical relief but MSF experience in natural disasters understands the role and importance of mental health work with survivors. By January 5, a team of two international and four Indonesian psychologists, all experienced in providing emergency psychosocial support, were on the ground. To date, the team has carried out over 100 individual consultations as well as group therapy sessions for approximately 70 people affected by the tsunami. Members of the MSF mental health team travel with MSF mobile medical clinics working in multiple locations in Banda Aceh, at the tip of the Sumatra province, Lamno and Meulaboh on the western coast, and Sigli on the eastern coast. When people arrive with symptoms such as headaches, insomnia, gastric problems, anxiety, and other possible psychosomatic complaints, they are seen by the medical staff and then referred to the psychologist for individual consultations. A small tent near the clinic or a tarp mounted from the rear of an MSF vehicle offers a basic degree of confidentiality. Many times people arrive just to talk about their experiences and it is important that they talk to someone who was not affected by the disaster and is focused on listening to them. "The first problem we faced was a lack of information," said Laetitia de Schoutheete, MSF psychologist. "Only a few people were aware of what a tsunami actually is and what causes one. Many people make sense of the event by interpreting it as a divine punishment. When they also understand it is a natural phenomenon and that they can take measures to protect themselves from it, it really helps to reduce their anxiety." MSF is distributing leaflets in Indonesian and Acehnese language to explain what a tsunami is and what kind of reactions people might be having after being affected by it. Psychosomatic illnesses, changes in behaviour, emotional disturbances, and acute stress represent normal reactions to an extraordinary and unpredictable event. "In the first 72 hours after a disaster people are in a state of shock, then an acute phase of stress starts," said de Schoutheete. "People need to take back control of their lives as quickly as possible and get out of the feeling of being powerless. Once they've been able to survive, find a job, earn some money, satisfy basic needs and come back to life, people start to really realize what has happened to them. At first, people aren't even able to cry and they focus all their energy to find the way to survive. This prevents them from expressing the full extent of their sadness and loss for the moment. " The approach of the MSF psychologists is to use brief, solution-focused therapy. The first step is to help people make a connection between the stress they are under and the physical symptoms that they are experiencing by allowing them to open up and start to talk. The second step is let them find their own solutions for feeling better. During consultations, patients also learn how to relax themselves using breathing and relaxation techniques. "We ask if, during past three weeks, the patient made or did something that gave him or her the chance to feel a little bit better," said Faye, an MSF psychologist. "It is important that they start to use small positive moments they have experienced as their own resource to draw on whenever they need to. And it is also very important for us to listen to their expressions of emotion and sadness." In the coming weeks, four MSF psychological teams made up of one international and two national psychologists each will begin working in more fixed locations in Meulaboh, Sigli, Lamno, and Banda Aceh in cooperation with local public health facilities. "Listening houses" where people affected by the tsunami can come and rest or talk, informally or formally, will also be set up and MSF will work with the communities in each location to provide outreach to the most vulnerable and offer psychosocial activities in the community.