Tsunami Team Diary July 27, 2005

7/21 | 7/22 | 7/23 | 7/24 | 7/25 | 7/26 | 7/27 | 7/31 | 8/5 | 8/7

Hurrah! We gave training from our manual, Information Resource: How Disasters Affect People, Children, and Communities: Health, Help, and Assessment. We did a four-hour workshop for Public Concern International (PCI) counselors, social workers, and social coordinators, who came from distant campsites in fishing villages. They had traveled a couple of hours in public transportation to come to the training. We did the workshop at the invitation of PCI Nagapattinam coordinators, Mr. Malim and Mr. John Henry. Since we did not bring our play activities to Nagapattinam, Mr. Mailm generously provided us supplies. He cut saris into quarters, which made better scarves than what we brought from the USA. Mr. Malim and Mr. John took turns in providing simultaneous translations as we presented in English.

Linda opened the workshop by leading the group of seven men and seven women in a community-building scarf dance/activity. Prior discussion regarding whether or not we ought to label the activity a dance determined that we would call it an activity. Miko’s and Gargi’s input indicated that dance may not be an appropriate term for the activity because of male participants. The scarf activity was lead without words, using only hand gestures and music to direct it. Participants engaged easily and with enthusiasm. Thanks go to Kristen for providing soothing backdrop music by Enya, which helped create a relaxed atmosphere.

Gargi provided information from the Diagnostic and Statistical Manual-IV-Text Revised (DSM-IV-TR, American Psychiatric Association, 2001) and from other literature about traumatic events and people’s responses to trauma. From the cross-cultural literature, Gargi discussed disasters and their effects. She discussed cultural presentations of Post-Traumatic Stress Disorder (PTSD) symptoms in India. When Gargi presented methods to assess PTSD, the PCI personnel gave estimates of prevalence rates among the tsunami survivors that they serve. About 5 to 10% have experienced full PTSD effects (similar to the rates in the general population in the U.S.); about 75% have shown some PTSD symptoms; 95% have general life functioning problems, which have also been discussed in the cross-cultural literature on disasters; 45% have presented somatization disorder (significantly higher than the rate in the general population in the U.S.); and 60% have been showing affective disorders. The counselors referred to high alcoholism among the fishermen. Upon being asked by Gargi, the counselors went around explaining what the tsunami meant to them as relief workers.  Gargi will include their meaning-making statements in our forthcoming revised manual. The counselors further added that their clients were fearful particularly because of the recent earthquake around Chennai (which happened two days ago) and also owing to rumors and gossip. They wanted to know how to make the survivors more hopeful. This talk led smoothly to the next phase of our workshop, when we discussed interventions for children (Kristen, Miko, and Linda) and adults (Gargi).

Kristen presented the criteria and assessment of PTSD in children. Using a resiliency model, she gave hope to a camp leader, who wanted to know how to increase hopefulness among his people. The literature we have read confirms that the outreach programming being implemented by PCI really does help survivors return to more normal functioning after a disaster.  Kristen presented helpful counselor responses, as well as activities with children at different age levels.

Linda talked about complicated grief and its relationship to assessment and symptoms of PTSD in large disaster situations. In these situations, crisis interventions are focused on meeting survival needs-food, shelter, sanitation, etc.-and the grieving process is frequently held at bay. Grief related to lost family and friends is made more complex by the loss of lifestyle as it was previously known. Participants shared their grieving and religious community death rituals and Linda made connections between the need for individual as well as community-wide ceremonies. Beaded memory bracelets and individual shrines were suggested as ways for children to honor lost loved ones. Our information resource, which was provided to PCI in both print form and on CD, was referred to for various activities for children to remember and honor those who were lost or killed in the tsunami.

Miko showed play therapy through the use of puppets, this group activity was a total riot. Under Miko’s guidance, PCI folks made puppets out of socks. The socks were given faces; long, colorful hair of wool; and decorated with jewelry, fishing net, or shopping bags (all of small size). When the group interaction started, a father bereft of a daughter adopted an orphan girl (both depicted as talking socks), a drunk refused to turn around to console a child, a community grandmother was affirming and encouraging to all, etc. This activity was fun and, at the same time, powerful. After the intervention, Miko introduced some methods of play therapy that might be useful for child survivors of the tsunami.

Linda closed the workshop with the scarf activity, guiding the participants and their scarves back into the circle. The symbolism of the movement guided the workshop group back to the individual level as each prepared to return to their villages with new information.

At debriefing, the PCI folks gave us very positive feedback. They liked the diagnostic information, and the differentiation made between a traumatic event and a disaster which causes social disorder. They loved the interventions and said that they would practice these with the children in the camps. They found similarity between their experiences and the discussion on grief, loss, and restitution. A couple of counselors suggested that we translate our manual in Tamil. Gargi said that she will get in touch with her undergraduate college in Chennai, which has a major in psychology. She will invite psychology students from there to do the translation. Upon our return to Antioch, we will revise our manual on the basis of the additional information we have acquired about the effects of the tsunami. Subsequent to the revision, we’ll develop a Tamil translation. Two counselors/social workers, Mr. B. Elayaraja and Mr. K. N. Tamil Kumar, said that they will provide tsunami cases (vignettes) for our manual. We are excited about a potential New Hampshire-Tamil Nadu collaboration for our tsunami-based manual on PTSD.

We had a wonderful time at the PCI workshop. We felt welcomed and appreciated. Linda’s heart was soaring, as she was touched by the receptive and generous spirit of our colleagues at PCI.

Kristen is turning into an indefatigable walker, wanting to soak up as much of Tamil Nadu as she can in these quickly passing days. Gargi fears she may fall into a fugue, and we’ll need to go into Chennai’s streets and alleys looking for her. Miko’s stomach condition has been cured with hot curry.

Gargi, Linda, Kristen, and Miko