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19 January 2005, New Delhi/Geneva: The World Health
Organization (WHO) is warning that almost all of the people affected by the
tsunami that hit South East Asia on 26 December will be suffering from some
form of psychosocial trauma. Health workers report that virtually everyone in
many of the affected communities is suffering from some degree of
psychological trauma. WHO mental health experts fear that psychological
trauma among the tsunami victims is more widespread than initially believed.
"The mental anguish of those who narrowly escaped the
tsunami or lost close relatives is made far worse because many of them have
lost their homes, their jobs and their possessions. These people urgently
need support," said Dr Samlee Plianbangchang, WHO Regional Director for South East Asia.
"Many can cope and will gradually come to terms with what has
happened. But many others will either
sit motionless or cry for hours on end.
If support is not urgently provided, the long-term effect on these
populations could be terrible."
The situation is further complicated by an acute shortage
of health workers trained in mental health care and counseling. In Banda
Aceh, Indonesia,
for example, more than 150 people worked at the mental health hospital before
the disaster struck. Today, only one
psychiatrist, three trained counselors and six nurses remain.
WHO recommends that psychosocial support should be
provided by community-based workers who understand the needs of disaster
victims and have been trained in psychosocial support. According to Dr Vijay Chandra, WHO Regional
Mental Health Advisor, “We must ensure that this is not trivialized by permitting any
untrained person to do counseling, but is done by health workers who have
been trained under WHO guidelines.”
WHO has already begun to coordinate the appropriate
training of community workers. Focus of the training is on role plays,
empathizing with victims, providing support and encouragement to affected
individuals to talk through their problems.
Given the acute need, WHO is rapidly increasing its support
to countries to implement WHO Guidelines for Mental Health in Emergencies. The
guidelines outline an increased involvement of community outreach, taking
into account the needs of special groups such as children, women, elderly
people and the severely injured, while offering a culturally-appropriate
approach to any offered support.
The primary need is not medication, nor the labeling of
individuals with a medical diagnosis which suggests the need for psychiatric
interventions, said Dr Chandra. "It would be inappropriate to fly in
numerous psychiatrists to provide support," he said. "Health workers from the affected
communities will be much more aware of what the victims are now going
through. As such, they are in a
position to provide much more empathic support than any external professional
could."
Dr Chandra said that for the loss of a loved one under
normal circumstances, there are social support systems built into community
life, such as prayers, rituals, a role for each family member and neighbors
sitting with the family members in support.
"However," he continued, "in the unique circumstances
of the present disaster, we must address the needs of people who have not
only lost loved ones, homes, means of earning, but their entire neighborhood
and with it their lives' context which essentially defines every
individual. The best method of dealing
with this would be to find people in neighbouring
villages or communities, people of similar cultural background, who
understand the cultural norms to help them."
WHO has already sent four mental health experts to Sri
Lanka and Indonesia, to work with local mental health professionals and
ministries of health, and provide the technical guidance to ensure
psychosocial training focuses on: timely and appropriate interventions; honouring the dignity of survivors; identifying
potentially high-risk populations; helping survivors reunite with friends or
family; activities to re-normalize life as much as possible; and the
importance of self-help information materials.
In one province in Thailand alone, local authorities
are rotating 80 mental health workers on a weekly basis to support
particularly-affected communities.
"Some of these people are literally suffering a second
tsunami," said Aphaluck Bhatiasevi of WHO in Thailand. "Today, we saw a son who was extremely
distressed at the guilt he feels for not having been able to save his father
from the force of the tsunami. Such
people urgently need a support system to help them cope with this traumatic
experience. If such support is not
provided, it could very likely end in yet another tragedy for some of the
families, and we simply cannot allow this to happen."
Providing support to countries to implement the WHO
Guidelines for Mental Health in Emergencies is a key component of the
organization's long-term strategy to rehabilitate the damaged or destroyed
public health infrastructure. To
implement the strategy, WHO urgently requires US$67 million for activities
through the next six months.
For further information, please contact:
Mrs Harsaran Pandey, WHO Regional Office for South-East
Asia, New Delhi, Tel. +91 98 110 21001, email: pandeyh@whosea.org
For full information on WHO's response to the tsunami in South East Asia, please visit www.who.int and www.whosea.org
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