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A 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.

They 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.

Life, 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 school.

When 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.

How 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 the survivors?

These 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.

The 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.

"Many 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.

It 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 Lankan communities.

Reflecting 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 be:

To ensure a speedy normalization of life in the tsunami-affected areas
To protect from possible harm or exploitation while efforts at normalization are underway

However, says Dr. Sumathipala, it is expected that some groups of people may require special psychosocial support or mental health interventions.

The 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.

According 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.

While 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.

"This 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?

Considering 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.

The 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.

At 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.

Hopefully, 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.

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