Shantiham /ITC as Prime Subcontractors: Asia Tsunami Response
Psychosocial Support – Children and Adults-Sri Lanka
ITC was deployed to Colombo and Jaffna one month after the 2006 tsunami that devastated areas of Sir Lanka. ITC who had already been working with Shantiham since 2002 (see program descriptions below), funded in part by ECHO, worked with Sri Lankan health care professionals, psychosocial professionals and shamans to design and launch a public health and psychosocial infrastructure customized to local cultural specificity targeting at risk toddlers to 18 year olds and their adult care giving systems exposed to severe trauma secondary to the tsunami.
Sri Lanka: Psychosocial and Mental Health Interventions by Shantiham
Shantiham is a local NGO related to the University of Jaffna that is providing services both for adults and children affected by the longstanding armed conflict in the country. The main activities are:
Psycho-education: Several informative pamphlets and media publications for the public on trauma and related issues were undertaken.
Psychotherapy: From the initial contact an atmosphere of mutual trust and therapeutic alliance is sought to be established. Basic counseling is sufficient and appropriate in a large number of cases. An opportunity to “tell their story” in a non-threatening and accepting atmosphere, express their repressed emotions, and receive the support and the warmth of the therapist is all that was needed. Brief psychotherapy, testimony method of therapy, bereavement counselling, crisis intervention, problem solving, relaxation techniques and other short term therapies are carried out where necessary. Counseling sections attached to the University Psychiatric Unit and the Association for Health and Counselling is carrying out such therapeutic work.
Spiritual beliefs: Spiritual beliefs and strengths have been found to make people more resilient. For once meaning is found most clients appear to recover quickly. Cultural and religious beliefs, for example the doctrines concerning Karma and suffering, central to Hindu system, are important. Attempts are made to co-opt sympathetic traditional resources such as priests, monks and healers as co-therapists or in the traditional nosology, as allies, in the therapeutic endeavour
Group therapy: Group therapy has been found useful. The formation of ex-detainee groups, widow groups, ex-alcoholic (A.A.) groups and other groupings of affected individuals have happened out of need in some cases and were encouraged wherever possible. The ITC CBI group work continues to this day and has been used for youth survivors of the civil war and the tsunami.
Family therapy: Family therapy is an important therapeutic tool. In the Tamil culture where the family bonds are very strong, the family is an essential resource is used in therapy. Communication of individual problems leading to an awareness of each other, one’s role and encouragement towards mutually interdependent functioning is used to build up family unity.
Relaxation techniques: Based on Jacobson’s Progressive Muscular Relaxation and ITC Somatocognitive components of Trauma Informed Care, , culturally acceptable methods of Yoga practice are used for several of the consequences of traumatization, namely states of arousal, anxiety and somatization. Tensed muscles are the cause of much of the somatic pains in traumatized, particularly torture victims. Relaxation counteracts this. Similarly Hyperventilation is a common problem and the basis for many of the psychosomatic complaints. Slow, deep, relaxed breathing can be taught to rectify this tendency.
Cultural techniques: Calling these cultural techniques as relaxation exercises may be a misnomer leading to an underestimation of their value. When methods
are culturally familiar, they tap into past childhood, community and religious roots and thus release a rich source of associations that can be helpful in therapy and the healing process. Further, mindfulness and meditation draw upon hidden resources within the individual and open into dimensions that can create spiritual healing and give meaning to what has happened. Although these techniques do no formal psychotherapy, they may accomplish what psychotherapy attempts to do by releasing cultural and spiritual processes.
At the community level, considerable effort was put into the training of personnel in the aforementioned Yoga techniques, teaching it to the public, and specifically in the treatment of traumatized individuals, and particularly torture victims. It was felt that with sufficient trained personnel and motivation, Yoga could be introduced into the regular school curricula and thereby benefit a large number of students. When Yoga is practiced regularly in the correct way, it helps the child to express pent-up energy and emotions in a healthy way and thus is a promotive, preventive and curative method of health that can be used at a com- munity level.
Pharmacotherapy: In PTSD too, there is positive improvement with anti- depressants, particularly in the intrusive phenomena and nightmares. Low doses of imipramine (25–50 mg) work in the majority of cases.
Expressive therapy: Artistic expression of emotions and trauma can be cathartic for individuals and the community as a whole. Art, drama, storytelling, writing poetry or novels (testimony), singing, dancing, clay modeling, and sculpturing are very useful emotive methods in trauma therapy. A socio-drama goes a long way in creating awareness about trauma among the public and helps traumatized individuals to ventilate their emotions or seek treatment. Local drama groups use drama, including street drama (theru kuthu), to work with affected populations in the community and refugee camps. It has been found a powerful method to increase awareness, promote catharsis and encourage discussion about pressing problems.
Children in particular, who usually are unable to express their thoughts or emotions verbally, benefit from the above mentioned expressive methods and play therapy. In addition, a Class Room based intervention program for children has been developed, studied with a cluster randomized trial design, and is subsequently disseminated. Structured play activity was introduced in many of the refugee camps in the North and East.
Occupational therapy: Individuals can benefit from being taught basic social skills and specific crafts to help them re-find employment and integrate themselves back into society. In addition, occupational training, by structuring time and channeling physical activity into satisfying goals helps the individual regain his or her sense of control and mastery, his or her worthiness and usefulness and thus establish their self-respect and self-esteem. In the long-term, occupational skills are empowering and produce self-sufficiency.
Community approaches: Given the widespread nature of the traumatization due to war, a Community based approach will enable one to reach a larger tar- get population and undertake preventive and promotional public mental health activities as well. Training of grass root community level workers in basic mental health knowledge and skills is the easiest way of reaching a large population. They in turn increase general awareness and disseminate the knowledge as well as do preventive and promotional work. The majority of minor mental health problems can be managed by them and others referred to the appropriate level.
Indigenous coping strategies such as the traditional practices for death— funeral rites, disappearance—that help the local population to survive are encouraged.