Tsunami trauma still rising
2005-06-20 10:25
Banda Aceh - Like many teenagers, Joni wears a baseball cap, plays football and loves computers, but behind his awkward smile lurk painful memories that, six months after the tsunami, have the power to reduce him to a trembling wreck.
"He is so scared. Every time there is another earthquake he gets a panic attack, sometimes fainting," says Indrayanto, who supervises Joni at a children's centre in the disaster-hit Indonesian city of Banda Aceh.
Among those who survived the tsunami which left tens of thousands dead on shores around the Indian Ocean, from the fishing villages of Sri Lanka to the resorts of Thailand, Joni is not alone.
Experts say almost all who lived through the events of December 26, even if they did not lose their homes or loved ones, are still suffering from some form of trauma. Many need counselling and some need medical intervention.
"Everyone is affected mentally because even if their houses are intact and their family is alive, they are living in the middle of a major disaster," says Lely Djuhari of the United Nations Children's Fund (Unicef), which helps look after Joni.
Mental scars after trauma
Psychologists say although tsunami survivors are now putting their lives back together, the scope of the mental scars are only now becoming apparent, revealing a daunting job for an already overburdened support system.
"After six months the short-term denial and disbelief has worn off and people are finding the reality of their situation," says Susan Prosser, a mental health consultant working with the World Health Organisation (WHO) in Aceh.
"People have nothing left, there is huge devastation and damage and the quality of life has totally deteriorated," she said. "They now have to adjust to this, they are coming to terms with it and it is difficult."
Albert Maramis, a senior psychiatrist with WHO, said while many are able to cope with the trauma, some suffer from psycho-social problems which may develop into severe distress requiring quick intervention.
Treatment is not always readily available. In Aceh, the region's already inadequate psychiatric hospital lost 26 of its staff in the tsunami, while other Indian Ocean countries report chronic shortages of trained professionals.
"We don't have enough experts to deal with the trauma," said Benjaporn Panyawong, a doctor and director for health care rehabilitation in Thailand. It is a problem shared with Sri Lanka and India.
"We had an extensive network of counsellors in the first two months, but after that we ran out of money for work," said Ray Illangakoon of Sri Lanka Cricket Aid, which organised trauma counselling for survivors.
Dealing with post-traumatic stress disorder
In most regions women, children and the elderly are seen as among the most vulnerable to problems. Counsellors with basic training are now able to spot the key symptoms among those with post-traumatic stress disorder.
"Initially it was difficult to identify trauma in survivors. But after a couple of months, as people came to terms with their life, trauma slowly manifested itself," said B Damodaran, a psychologist working with Indian non-governmental group, the Art of Living Foundation.
"They fear the sea and are scared of repeated rumours that tsunamis will strike again. Many old men and women who have lost family members are shattered and some refuse to speak and just stare through you.
"Children get nightmares and refuse to eat. Women often cry without reason," Damodaran said. "Some tremble without reason."
These include Joni, 17, who lost both his parents and a sister when the waves swept through his village in Aceh.
"Sometimes I cry and it's hard to sleep at night," he said.
Joni is being helped by a programme in which he looks after younger children, taking responsibilities as a youth leader, say his counsellors at a children's centre on the outskirts of Banda Aceh run by the Jakarta-based Muhammadiyah group.
He says the treatment helps, although the bad memories still haunt him.
"When I'm doing the activities I do not worry about the disaster. When I'm alone I of course remember someone I lost and about what happened."
Children suffer from stress after tsunami
Other children, says Unicef's Djuhari, suffer stress because of how their traumatised parents react to them in the wake of the tsunami. Some have fallen prey to violence or other forms of child abuse.
Although many people with post-traumatic stress disorder will be picked up by counsellors using simple check lists, these will often miss equally troubling conditions such as depression or debilitating grief, according to WHO's Maramis.
In Aceh a mental health roadshow, organised by the WHO in conjunction with the Indonesian government, is being launched in an effort to help people realise their problems and point them towards help.
Other regions are using puppet shows or radio dramas to spread the word.
But, says Maramis, trauma and grief are for many a healthy process in coming to terms with what has happened.
Yusriah, 50, a widowed former school teacher living under canvas on the devastated shoreline just outside Banda Aceh, is one example of the many survivors who have shown a remarkable resilience to harrowing experiences.
"I am full of sadness. Every day I wake up, I remember what has happened and I remember my loss," she said.
"But I am no longer afraid of the sea. This is my homeland. I do not want to leave this place and if it is my destiny to leave this world in another tsunami, then that is what I want."