Tsunami: Health Organizations Respond

With the immediate survival needs of tsunami survivors being addressed, international and national organizations and agencies are now tackling mental health concerns. The World Psychiatric Association (WPA) has created a Tsunami Committee, is taking steps to provide technical assistance to the affected areas and has established a disaster fund.

"The Tsunami disaster is an example of... a global call for kindness," Ahmed Okasha, M.D., Ph.D., WPA president, wrote in a message to member societies.

It has united the otherwise divided world into a desperate wish to help. ... Billions are living on the brink of disaster with minimum coping capacity, where the disaster recurs again and again in their dreams as well as during their waking hours.

To develop strategies to assist the affected regions and put those plans into action, the WPA has initiated a three-tiered Tsunami Committee comprised of a steering group, taskforce from the region and advisory board. The first meeting of the steering group was scheduled for Feb. 9, 2005, in Cairo, Egypt.

Okasha said the WPA's job will be training the trainers to deal with posttraumatic stress disorder and the mental health sequelae of the disaster. Okasha, who is director of the World Health Organization (WHO) Collaborating Center for Training and Research at the Institute of Psychiatry, Ain Shams University in Egypt, has also been in contact with key WHO officials. In a letter to members, Okasha said that Benedetto Saraceno, M.D., director of WHO's department of mental health and substance abuse, informed him that Saraceno and Shekhar Saxena, M.D., coordinator in WHO's department of mental health and substance abuse, will be available for the emergency situation in the region for the next two months. Saraceno will be based in Indonesia and Saxena in Sri Lanka, with other WHO representatives in different afflicted areas. Saraceno, Okasha explained, will be communicating with the WPA, so that the organization knows the needs of the afflicted regions before its Feb. 9 meeting.

The newly established WPA Disaster Fund, Okasha said, "Is a WPA initiative to be able to immediately intervene to help victims of both man made and natural disasters by providing the needed logistics for training and management of sufferers from PTSD and other stress-related mental disorders, not only for victims of the Tsunami disaster but for any further ones to come. It welcomes the contributions not only of WPA member societies, but also pharmaceutical companies and philanthropic organizations worldwide." Contributions can be sent to:

J.P. Morgan Chase Bank
Routing # 021 000 21
Account number 426-5000545-65.

Many member societies also have begun their own initiatives, according to Okasha. For example, J.K. Trivedi, M.D., president of the Indian Psychiatric Society, informed Okasha that the society has formed a Task Force for Tsunami Disaster Relief and already has received some funds from WHO Delhi for an action plan that involves providing training, counseling and referrals.

Michelle Riba, M.D., M.S., president of the American Psychiatric Association, in a statement said APA has offered to work in partnership with the leadership of WPA and WHO, and in concert with national and regional psychiatric organizations and government agencies throughout Southeast Asia and Africa. The APA also promised to help assure accessibility to necessary psychiatric care to individuals in the United States who are affected by the loss of family members and others in the affected regions. Coordination efforts are being handled by the APA's Committee on Psychiatric Dimensions of Disasters, under the chairmanship of Anthony Ng, M.D.

The American Red Cross, as part of its initial $134 million commitment to address immediate needs, has allocated $2 million for psychosocial support. That support will include providing psychosocial first aid and a "train-the-trainer" model to increase the capacity of affected Red Cross Societies and local agencies to provide psychosocial services. Already, American Red Cross workers in India were deployed to the Maldives and other affected areas.

According to a story in The Age, Indonesia is launching its biggest mental health drive in an attempt to help traumatized tsunami survivors, many of who have never heard of psychological counseling. There are 650,000 refugees who are in very unstable emotional conditions, according to Yulizar Darwis, head of the mental health division of Indonesia's Health Ministry. The ministry has launched a 1.3 billion-rupiah ($US142,326), WHO-funded program that will establish treatment guidelines and send counselors to affected areas. In cooperation with groups such as the Indonesia Psychiatric Association, the program will draw on the experiences of Indonesian counselors who have responded to earlier social crises.

Aid workers in Banda Aceh, Indonesia, report rising numbers of survivors showing symptoms ranging from sleeplessness to depression, rage and despair. According to a WHO Tsunami & Health Situation Report for the region, the only mental hospital in Banda Aceh is severely flooded, and the supply of medicines is inadequate. All 300 of the hospital's patients were released at the time of the tsunami, and only 100 have since returned.

According to the WHO report, "Part of the Acehenese population suffers from a double mental health burden: years of civil war and now the psychological trauma of the tsunami."

In Thailand, the Ministry of Public Health revealed that 5,000 survivors have sought help from psychiatrists working in the tsunami-hit region. The majority of the cases involve symptoms of stress, insomnia, fear, guilt and confusion; some survivors refuse to go anywhere near the sea. The Department of Mental Health has pledged to establish a psychiatric help center in the Phang-nga resort and keep it in operation for at least two years.

In the Andaman and Nicobar Islands, off the coast of India, a six-member team from India's National Institute of Mental Health and Neuro Sciences has made an eight-day survey of some 10 relief camps, according to a Reuters' news report. The team noticed symptoms of depression and anxiety among survivors as well as fear of loud sounds--a reminder of the tsunami.

"We fear if these people do not get long-term treatment, there may be a psychological epidemic which may reduce the quality of life," said G.S. Uday Kumar, head of the team and assistant professor in the institute's department of psychiatric social work. "A number of the children are not socializing anymore and jump at loud sounds like a plane taking off."

Kumar said there is a desperate need for more mental health professionals; the island chain has only one psychiatrist for a population of more than 350,000. According to Reuters, the Indian government plans to send a team of 10 psychiatrists and psychologists.