National Plan of Action to support traumatized tsunami survivors
is on the table
Helping them to live again
By Kumudini Hettiarachchi
She was a teacher in the interior of the country
leading a routine life. She was happily married with two grown up
children - a son and a daughter. That was before December 26. The
day the tsunami struck, she and her children had gone south because
her husband was working there. On the morning of that tragic day,
her husband and son had gone to the beach and she and her daughter
were preparing to join them.
were in a room in the house by the beach and her daughter was combing
her hair when the killer waves crashed in with all the fury only
nature can muster. As her daughter was swept away by the monster
waves, her pleading gaze locked with her mother's eyes. That was
the last her mother saw of her. The bodies of all three members
of her family - husband, son and daughter have not been found.
naturally, has changed drastically for this teacher. At times she
is suicidal and at other times she feels guilty that she did not
save her daughter. "Why am I alive?" she keeps asking
herself when everyone else, especially her daughter who was nearby
her is dead. Suddenly she is furious with her husband for asking
her and the children to come down south. She wants to give up all
worldly things and go become a Bhikkuni. In a little while she changes
her mind and wants to go abroad or get a transfer from her present
she weeps, concerned relatives ask her not to cry, that it is not
good for her. They suggest she go abroad. She has been taken to
many a temple - but she just does not want to hear anymore. She
can't sleep or eat. When she does fall asleep, nightmares jolt her
out of her slumber. Well-meaning relatives have hidden her son's
clothes, but she wants to see them, touch them. She wonders whether
she is mad.
do you deal with her and thousands of others like her? What is the
best approach - to go in immediately after a disaster like the tsunami
and make the survivors talk? Should a stream of people in the form
of donors, counsellors, helpers and journalists keep asking the
tsunami survivors to repeat their ordeal? Will it re-traumatise
are the complex and intangible issues, with no straightforward answers,
that psychiatrists and psychologists have been tackling in a bid
to alleviate the mental suffering of the tsunami survivors. There
is no one model only individual preferences.
other major issue is what will happen to all the different types
of data being gathered by so many diverse organizations. After numerous
visits to the tsunami-affected areas and many long hours of discussions
and arguments, the Directorate of Mental Health Services of the
Health Ministry in consultation with the Psychosocial and Mental
Health Interventions Committee of the Centre for National Operations
(CNO), professional organizations and NGOs has put on the table
a proposed National Plan of Action. The Sunday Times learns that
it is likely to be approved soon.
people experience distressing physical and emotional reactions in
the immediate aftermath of a disaster. These are recognized as normal
reactions to an extremely stressful situation. This does not mean
that people are mentally ill, only traumatized," says Dr. Athula
Sumathipala, Coordinator of the psychosocial desk of the CNO.
is believed, he explains, that the majority of them will be able
to cope with the disaster given that there are many cultural and
community practices and structures that enhance resilience in Sri
the thoughts put down in the proposed Action Plan, he stresses that
the majority of people will not require specific psychological intervention.
The main psychosocial intervention for the majority of people should
To ensure a speedy normalization of life in the tsunami-affected
To protect from possible harm or exploitation while efforts at
normalization are underway
says Dr. Sumathipala, it is expected that some groups of people
may require special psychosocial support or mental health interventions.
vulnerable people falling under this category could be unaccompanied
children and adolescents; pregnant and lactating mothers; single-parent
families with small children; the elderly; people at high risk from
exploitation, abuse, assault or self-harm; people who have lost
a majority of their immediate family members; the disabled; those
who have been previously traumatized; and those who have a history
of psychiatric problems. Recognition and early referral to the relevant
agencies for appropriate interventions, either social, psychological
or medical, would be a preventive measure in these cases.
to the proposed National Plan of Action the supplementation of existing
social and healthcare services and systems, both in the state and
non-state sectors, will benefit people who do need such interventions.
adopting a public mental health approach, the guiding principles
of any such Action Plan should be multi-sectoral and multi-level,
The Sunday Times understands. Experts pointed out that such a plan
should include immediate, mid-term and long-term interventions,
while being age-sensitive, gender-sensitive, and conflict-sensitive.
kind of action plan should also be socially and culturally sensitive
and recognize the importance of the existing social and healthcare
systems in Sri Lanka," another doctor said. Who will coordinate
the proposed National Action Plan?
the strength of the existing health system and its grassroots level
network, The Sunday Times learns that the general consensus has
been for the Health Ministry to handle the proposed National Action
Plan with its Directorate of Mental Health Services being the central
coordinating unit. A Secretariat dubbed the Psychosocial and Mental
Health Committee has been mooted for the project.
Directorate is to liaise with the Centre for National Operations,
other relevant official bodies, medical associations and colleges,
religious groups, the Psychosocial Forum of the Consortium of Humanitarian
Agencies, universities and a wide range of organizations such as
NGOs and also individuals at community level such as teachers.
district-level, experts felt that the Medical Officer for Mental
Health or Consultant Psychiatrist would be better placed to take
on the role of coordinator.
with the streamlining of the psychosocial aspect of the disaster,
through the proposed National Action Plan, organizations and persons,
especially from abroad, offering their services in this field would
have some guidelines to plan and deliver their services.