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Last Updated: Monday, 15 August 2005, 13:36 GMT 14:36 UK
Tsunami-hit Aceh's psychological scars
By Alina Paul
International Medical Corps

a child's drawing of the tsunami (photo courtesy of IMC)
Children's drawings can help explain how they are coping
"It wasn't the sea. It was a terrifying monster, like a big snake coming out from the sea to kill us," said Samidan, who lost 115 members of his family during last December's tsunami.

He is not the only person in Indonesia's Aceh province to remember what happened in this way.

The drawings of many Acehnese children tell a similar story.

Dr Andrew Mohanraj, a psychiatrist working with the International Medical Corps (IMC) said: "We need to listen to what people say as this shows how they are coping with what happened."

"The tsunami had a destructive impact on the mental health of so many people. We have a huge job to do, to support those who have been affected," he said.

The World Health Organization (WHO) says that mild or moderate mental disorder - anxiety problems and post traumatic stress disorder - will have doubled in Aceh in the year following the tsunami.

It also estimates that up to half the population will suffer from moderate or severe psychological distress.

To address the significant burden of mental health in the Indonesian province, the WHO is recommending a public health perspective that considers all types of problems, ranging from pre-existing severe mental disorder to widespread psychological distress induced by trauma and loss.

But the scanty mental health infrastructure in Aceh makes this task extremely difficult.

Easing the pain

Most of the children in the village of Gle Jong died in the tsunami.

The few that are left are obviously lonely - like Ela, who now spends time alone or with her mother, because she has hardly any playmates.

The entire community has been affected, but the villagers in Gle Jong now want to focus their thoughts away from what happened last December and towards a tailoring business which international agencies are helping to set up.

Ela (photo courtesy of IMC)
Ela is one of the few children left alive in her village
Dr Joe Asare, an IMC psychiatrist in Lamno on the western coast of Aceh, said that such initiatives were extremely beneficial.

"The women sit in their tents thinking about their lost husbands, children and relatives all day and night, and diversional therapy is most needed for them to cope with their losses," he said.

"Nothing will ever erase the memories of their children, but we hope that programmes like this will help survivors look to the future."

There are also more specific cases of people who need special care to get over their experiences.

A team has been helping 12-year-old Yusuf, whose two sisters and several cousins died in the tsunami.

Since the disaster, Yusuf has had post-traumatic stress disorder. In the months after the tsunami he hardly spoke at all, and suffered from palpitations and sometimes lost consciousness.

Time with a clinical psychologist, as well as small doses of sedative and anti-depressant, have helped control the symptoms, and he is now talking a lot more and has gone back to school near his home in Lamno.

"Lamno was very badly hit in the tsunami," said Dr Asare. "Most of the inhabitants have suffered from a range of psychiatric disorders, predominantly post traumatic stress disorder, depression and delayed grief reaction. A lot of them have not received any help.

"Through regular community education sessions, we are supporting them to diagnose and manage these illnesses so they know what symptoms to look out for and how to seek help."

Healing through sport

Psychosocial support comes in many forms, depending on what communities feel they need.

It could be starting up tailoring businesses as in Gle Jong, counselling and community support services such as those at Lamno or organising sports matches and planning mourning ceremonies.

"Our approach is to ask communities what they want to help them move on, and then work with them to put this in place. That way we are following the Acehnese ethos 'gotong - royong' [working together]," Dr Mohanraj said.

In Lamneheun - a site for communities displaced by the tsunami - a volleyball pitch is being constructed to help children from displaced communities come together and enjoy some semblance of normality.

"Our children are still so traumatised," said the chief of Lamneheun. "They wake up screaming in the middle of the night, clinging onto whoever is near them.

"This new volleyball pitch will mean our children will play with the village children and this will stabilise them. It will bring people together," he said.

But there is a long way to go.

One man recently pointed out a mass grave where the bodies of his family were buried.

"I told them to stay in the house. I thought it would be safe. How could I have known what would happen?" he said.

This utter grief is the biggest challenge. Life may seem to be moving on in Aceh seven months after the tsunami, but you only need to scratch beneath the surface and reality slaps you in the face.

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