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Past Research Enables Mental Health Services to Fill Gap for Tsunami Survivors

Shortly after the recent tsunami in South Asia, the World Health Organization warned that many of the survivors would suffer from long-term mental health problems. In Indonesia alone an estimated 160,000 people died, leaving millions to mourn and manage the aftermath. Fortunately for those living in the nation’s devastated Aceh province, a cadre of Indonesian mental health specialists are prepared to help provide trauma treatment and long-term mental services due, in part, to a decade of collaboration with HMS professors Byron and Mary-Jo Good and training in the HMS Department of Social Medicine.

Ten years of collaboration between Indonesian health professionals and Mary-Jo and Byron Good has strengthened the mental health services that tsunami survivors will receive. (Photo by Rachel Meyer)

“Providing emergency medicine is not the only answer,” Byron said of the tsunami victims. “Families have been ripped apart and communities destroyed. We need a long-term medical and social response to see results.”

Growing Collaboration
Ten years ago, Byron Good, chair of the HMS Department of Social Medicine and professor of medical anthropology, and his wife, Mary-Jo Good, professor of social medicine, began collaborating with health care professionals in Indonesia toward the goal of using social medicine to address the country’s health problems. They have returned every year since then to teach, conduct research, present workshops, and lead conferences. In turn, Indonesian physicians, psychiatrists, and psychologists have visited the Medical School as fellows in the department’s training programs.

This exchange, supported by the Freeman Foundation, the Fogarty International Center of the NIH, and the American Indonesian Exchange Foundation, is aimed at providing leading Indonesian physicians and medical educators with an understanding of the critical role of the social and cultural dimensions of clinical medicine and health policy. The Goods were instrumental in training researchers and clinicians in the treatment of trauma victims, for example. Indonesian psychiatrists began looking at social strife associated with trauma, drawing on this connection while providing mental health services. Now they are mobilizing these skills to provide care for the tsunami survivors.

“I want to see the development of mental health care that addresses both acute trauma and problems of depression, anxiety, and learning difficulties that are certain to be continuing challenges for this population.”

Initially drawn to Indonesia by Mary-Jo’s consultations with child survival projects in the country, the Goods joined the faculty at the University of Gadjah Mada in Yogyakarta in 1996 as senior Fulbright lecturers. At the time, Indonesia had been under the repressive rule of President Suharto for almost three decades, and there was widespread opposition to his government. In addition, tensions were rising between different ethnic and religious groups.

In 1997, the country suffered a monetary crisis, and the next year, Suharto was forced to resign following riots against Chinese businesses and communities and student protests against his regime. Widespread ethnic and religious violence in the late 1990s displaced about a million people.

To address concerns about trauma due to this unrest, the Goods organized a workshop in 1999, drawing together Indonesian psychiatrists to discuss civil and political violence and the resulting mental health issues.

“The workshop was done with the support of the Indonesian Psychiatric Association and Dr. Rusdie Maslim, one of the top administrators in the Health Ministry,” said Mary-Jo Good. Maslim later drafted Indonesia’s next five-year mental health plan, devoting a whole section to how mental health services should be provided to the victims of ethnic and religious conflict. A network of psychiatrists and psychologists who began data-gathering in the conflict areas also grew out of the workshop. This network is now proving invaluable in trauma treatment and in developing long-term programs of care for tsunami survivors.

Photos by Rahmat Hidayat The top photo shows one of the bulletin boards in Aceh with names and photos of people who are missing. The word dicari means "searching for." The other two images show the destruction caused by the tsunami.

The Goods recognized the further need for advanced training of Indonesian mental health specialists in current approaches to trauma treatment. Last year, supported by the nonprofit Foundation for Psychocultural Research and the Center for Bioethics at the University of Gadjah Mada, they organized a workshop that brought together Indonesian psychiatrists, pediatricians, psychologists, Ministry of Health officials, and NGO members, many of whom had worked with victims of interethnic conflict and violence. Little did this group think that six months later, their skills would be needed for addressing a devastating natural disaster.

Community Care
When the Goods arrived in Indonesia last month to work with colleagues on collaborative research projects, they saw that citizens had become active in providing relief to the tsunami survivors. Universities had taken on different tasks of emergency relief. The University of Gadjah Mada had set up a weekly rotation of 26 health workers to go to the devastated town of Meulaboh and provide emergency medical care. The Goods collected $2,000 from staff, students, fellows, and friends of the Department of Social Medicine and donated half of it to support the health workers going to Meulaboh. They donated the rest to the Center for Disaster and Violence Studies of the Department of Psychiatry at the University of Indonesia in Jakarta. This department is headed by Dr. Irmansyah, a former Fogarty fellow in the Department of Social Medicine, who led a mental health team to Aceh in early January to evaluate the mental health needs of tsunami survivors. The donation supports the center and the trauma network’s efforts to develop a long-range plan for mental health services in Aceh. The Goods continue to support these efforts to make mental health services an integral part of the health care system of the rebuilt province.

“The problems of trauma will be long-term,” said Byron Good, “but rather than a narrow focus on trauma, many mental health professionals and I want to see the development of mental health care that addresses both acute trauma and problems of depression, anxiety, and learning difficulties that are certain to be continuing challenges for this population.”

—Sena Desai Gopal

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