I look on the map and see that Sri Lanka is a teardrop off the coast of India.

I have not slept through the night since I returned from Sri Lanka five days ago. It is the eyes that haunt me; the eyes of the father whose daughter was ripped out of his arms, the eyes of the grandmother who saw her children and grandchildren swept away. A generation lost in a heartbeat. I see shock on the faces of the survivors, and am reminded yet again of how everything can change in an instant. Whether it is an earthquake, a Tsunami, a tornado, or planes hitting towers, life is so fragile. Everything can be gone in the blink of an eye; we are so little, nature and war are so big. Yet we have this illusion, at least in the West, that we are in control. So I look, and look again, compelled to try to discern how people do it. How do you go on when your village, your home, your family, is destroyed? I see the faces of those who I met in the refugee camps, and it is the eyes that capture me. And it is the eyes of the children that haunt me, and make me unable to sleep through the night.

The number of people believed killed in December's Tsunami disaster rose to 285,993 on Saturday, February 12, 2005. Every day the death toll rises. The number of children orphaned is still unknown. Sri Lanka's death toll now stands at 43,832. (Reuters)

The earthquake hit on Sunday, December 26, 2004 at 7:58:53 AM = local time at epicenter
For us in California, it was on Christmas afternoon,
Saturday, December 25, 2004 at 04:58:53 PM (PST)
Location 3.307° N 95.947° E
Depth 30 km (18.6 miles) set by location program
Region OFF THE WEST COAST OF NORTHERN SUMATRA.
It was a 9.0 earthquake, the fourth biggest since 1900.

(This should be animated to show the Tsunami. If it is not, try passing your mouse over the map.
If it does not animate, the non-animated map below shows the course of the Tsunami.)

I am remembering the Northern California Loma Prieta earthquake in 1989. The Indian
Rim "Boxing Day" 9.0 earthquake makes our 6.9 magnitude pale in comparison, as each Richter logarithmically increases the size on an earthquake, yet the Loma Prieta was strong enough to break the Bay Bridge.   Scientists from Pasadena explain, "It has since been shown to be proportional to the energy released in the earthquake but the energy goes up with magnitude faster than the ground velocity, by a factor of 32. Thus, a magnitude 6 earthquake has 32 times more energy than a magnitude 5 and almost 1,000 times more energy than a magnitude 4 earthquake."

"The massive earthquake off the west coast of Indonesia on December 26, 2004, registered a magnitude of nine on the new "moment" scale (modified Richter scale) that indicates the size of earthquakes. It was the fourth largest earthquake in one hundred years and largest since the 1964 Prince William Sound, Alaska earthquake.

The devastating mega thrust earthquake occurred as a result of the India and Burma plates coming together. It was caused by the release of stresses that developed as the India plate slid beneath the overriding Burma plate. The fault dislocation, or earthquake, consisted of a downward sliding of one plate relative to the overlying plate. The net effect was a slightly more compact Earth. The India plate began its descent into the mantle at the Sunda trench that lies west of the earthquake's epicenter.
For information and images on the Web, visit:
http://www.nasa.gov/vision/earth/lookingatearth/indonesia_quake.html
For the details on the Sumatra, Indonesia Earthquake, visit the USGS Internet site:
http://neic.usgs.gov/neis/bulletin/neic_slav_ts.html
http://www.nasa.gov/home/hqnews/2005/jan/HQ_05011_earthquake.html

Question: How much energy was released by this earthquake?
Answer: Es 20X10^17 Joules, or 475,000 kilotons (475 megatons) of TNT, or the equivalent of 23,000 Hiroshima bombs

.

When I get home, I read:

Sumatra Earthquake Three Times Larger Than Originally Thought

EVANSTON, Ill. --- Northwestern University seismologists have determined that the Dec. 26 Sumatra earthquake that set off a deadly Tsunami throughout the Indian Ocean was three times larger than originally thought, making it the second largest earthquake ever instrumentally recorded and explaining why the Tsunami was so destructive.

By analyzing seismograms from the earthquake, Seth Stein and Emile Okal, both professors of geological sciences in Northwestern's Weinberg College of Arts and Sciences, calculated that the earthquake's magnitude measured 9.3, not 9.0, and thus was three times larger. These results have implications for why Sri Lanka suffered such a great impact and also indicate that the chances of similar large tsumanis occurring in the same area are reduced.

"The rupture zone was much larger than previously thought," said Stein. "The initial calculations that it was a 9.0 earthquake did not take into account what we call slow slip, where the fault, delineated by aftershocks, shifted more slowly. The additional energy released by slow slip along the 1,200-kilometer long fault played a key role in generating the devastating Tsunami.
http://www.sciencedaily.com/releases/2005/02/050211094339.htm

 

Satellite Imagery


This image acquired on 28 December 2004 by the MERIS (Medium Resolution Imaging Spectrometer) on board ESA's Envisat Earth observation satellite shows the northeast coast of Sri Lanka and the southern coasts of India. Sediment (light brown & green colour) left after the Tsunami can be seen along the coast. (Credit: ESA)

(http://www.disasterscharter.org/disasters/CALLID_078_e.html)

Tsunamis

When thrust-faulting earthquakes happen under the ocean, the earthquake can push large blocks of ocean floor up. When the ocean floor moves up, the water that was in that spot has to go somewhere else. That somewhere else is into a large wave called a Tsunami.
http://pasadena.wr.usgs.gov/ABC/pt.html

I keep feeling there is a "disturbance on the field"; that something is very wrong.

NASA Details Earthquake Effects on the Earth
NASA scientists using data from the Indonesian earthquake calculated it affected Earth's rotation, decreased the length of day, slightly changed the planet's shape, and shifted the North Pole by centimeters. The earthquake that created the huge Tsunami also changed the Earth's rotation.
http://www.nasa.gov/home/hqnews/2005/jan/HQ_05011_earthquake.html

 

 

Children in the Bay Area of San Francisco, where I live, are anxious about a Tsunami hitting here. The San Francisco Chronicle has an article about it, so I am able to reassure my son, as well as myself, that we would be in no danger. We live on the Petaluma River, but find out that we would be protected by the deep channel through the Golden Gate Bridge. Deep harbors are more able to absorb the shock of a Tsunami than shallow waters.

I received an e-mail from the Association for Play Therapy calling for a team of volunteers "to participate in a US delegation to Sri Lanka to provide play activities (but not psychotherapy) to children in orphanages and community centers."

I quickly faxed and mailed off my application, hoping to be selected. I was so honored when when Dr. Janine Shelby, the Association for Play Therapy Foundation President, and a brilliant clinician, called to invite me to join the project.  I learned later that only 14 play therapists from across the country have been selected to go. We will be working with OperationUSA, an NGO that was the co-recipient of the 1997 Nobel Peace Prize for its work banning land mines. Their mission is based upon Mahatma Gandhi's belief that "You must be the change you wish to see in the world".

After the initial elation, panic sets in. What am I going to do there? I don't speak the language, nor know the culture. I madly research techniques for working with children after a disaster, and find very little. There is a need for Dr. Shelby's project, which will be to bring specific cognitive-behavioral protocols, in the form of games, to the field.

I find that the Save the Children guidelines are:

1.Apply a long-term perspective that incorporates psychosocial well being of children.
2.Adopt a community-based approach that encourages self-help and builds on local culture, realities and perceptions of child development.
3.Promote normal family and everyday life so as to reinforce a child’s natural resilience.
4.Focus on primary care and prevention of further harm in the healing of children’s psychological wounds.
5.Provide support as well as training for personnel who care for children.
6.Ensure clarity on ethical issues in order to protect children.
7.Advocate children’s rights.

I have ten days notice in which to prepare. I have to tell my patients, and work through their feelings about me going so soon after the holiday break. One mother sums it up, "Well, while I am glad for all those children that you will help, I am not happy for my daughter who you will be leaving!" Shots - I rush to the doctor to get Hepatitis A and B vaccines, Typhoid, tetanus and diphtheria shots, and malarial prophylactic pills. After the shots, I cannot raise my arms for days. I have to pack; we are told to wear long sleeved shirts (with high cut necklines) and pants. I go to Target and buy loose fitting cotton outfits in the pajama department. I will not be a fashion plate this trip, that's for sure. I spent hundreds of dollars on over-the-counter stuff: mosquito repellant, sunscreen, tea tree oil, antacids, anti-diarrhea pills, Advil, Tylenol, anti-itch cream and pills, wipes, toilet paper, hand sanitizer, etc. I feel like a walking pharmacy.

My sister, Elizabeth Howell, tells me that one her colleagues and dearest friends at Calvin College, where they both teach, is from Sri Lanka. His name is Kumar Sinniah; he is an Associate Professor in the Department of Chemistry & Biochemistry. He is wonderful, e-mailing me information, and offering to hook me up with his five sisters in Sri Lanka. I get helpful e-mails from his sisters Sharmini, who is working with the Christian Blind Mission,  and Melanie. My one regret was that I was unable to call with them or meet them when I was in Sri Lanka. When I had a few minutes, finally, on our last day in Colombo, my laptop, with their phone numbers, went on a little jaunt through Colombo on its own. Fortunately, it returned intact and in time for the plane.

To further prepare, especially emotionally, I go to the Center for Disease Control, the National Center for Post Traumatic Stress Disorder, and the  National Center for Child Traumatic Stress. (The following articles are in the public domain. Feel free to skip them if you just want to read about my journey.)

Disaster Rescue and Response Workers

A National Center for PTSD Fact Sheet

The terrorist attacks on New York and Washington are, together, the greatest man-made disaster in America since the Civil War. Lessons learned from natural and human-caused disasters can help us understand the unique stressors faced by rescue workers such as police and firefighters, National Guard members, emergency medical technicians, and volunteers. Past experience may also help us recognize how these stressors may affect response workers. Rescue workers face the danger of death or physical injury, the potential loss of their coworkers and friends, and devastating effects on their communities. In addition to physical danger, rescue workers are at risk for behavioral and emotional readjustment problems.

What psychological problems can result from disaster experiences?

The psychological problems that may result from disaster experiences include:

• Emotional reactions: temporary (i.e., for several days or a couple of weeks) feelings of shock, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, or emotional numbness (difficulty feeling love and intimacy or difficulty taking interest and pleasure in day-to-day activities)
• Cognitive reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, self-blame
• Physical reactions: tension, fatigue, edginess, difficulty sleeping, bodily aches or pain, startling easily, racing heartbeat, nausea, change in appetite, change in sex drive
• Interpersonal reactions in relationships at school, work, in friendships, in marriage, or as a parent: distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-controlling

What severe stress symptoms can result from disasters?

Most disaster rescue workers only experience mild, normal stress reactions, and disaster experiences may even promote personal growth and strengthen relationships. However, as many as one out of every three rescue workers experience some or all of the following severe stress symptoms, which may lead to lasting Posttraumatic Stress Disorder (PTSD), anxiety disorders, or depression:

• Dissociation (feeling completely unreal or outside yourself, like in a dream; having "blank" periods of time you cannot remember)
• Intrusive reexperiencing (terrifying memories, nightmares, or flashbacks)
• Extreme attempts to avoid disturbing memories (such as through substance use)
• Extreme emotional numbing (completely unable to feel emotion, as if empty)
• Hyper-arousal (panic attacks, rage, extreme irritability, intense agitation)
• Severe anxiety (paralyzing worry, extreme helplessness, compulsions or obsessions)
• Severe depression (complete loss of hope, self-worth, motivation, or purpose in life)

Who is at greatest risk for severe stress symptoms?

Rescue workers who directly experience or witness any of the following during or after the disaster are at greatest risk for severe stress symptoms and lasting readjustment problems:

• Life threatening danger or physical harm (especially to children)
• Exposure to gruesome death, bodily injury, or dead or maimed bodies
• Extreme environmental or human violence or destruction
• Loss of home, valued possessions, neighborhood, or community
• Loss of communication with or support from close relations
• Intense emotional demands (such as searching for possibly dying survivors or interacting with bereaved family members)
• Extreme fatigue, weather exposure, hunger, or sleep deprivation
• Extended exposure to danger, loss, emotional/physical strain
• Exposure to toxic contamination (such as gas or fumes, chemicals, radioactivity)

Studies also show that some individuals are at a higher than typical risk for severe stress symptoms and lasting PTSD if they have a history of:

• Exposure to other traumas (such as severe accidents, abuse, assault, combat, rescue work)
• Chronic medical illness or psychological disorders
• Chronic poverty, homelessness, unemployment, or discrimination
• Recent or subsequent major life stressors or emotional strain (such as single parenting)

Disaster stress may revive memories of prior trauma and may intensify preexisting social, economic, spiritual, psychological, or medical problems.

How can you manage stress during a disaster operation?

Here are some ways to manage stress during a disaster operation:

Develop a "buddy" system with a coworker.

Encourage and support your coworkers.

Take care of yourself physically by exercising regularly and eating small quantities of food frequently.

Take a break when you feel your stamina, coordination, or tolerance for irritation diminishing.

Stay in touch with family and friends.

Defuse briefly whenever you experience troubling incidents and after each work shift.

How can you manage stress after the disaster?

After the disaster:

• Attend a debriefing if one is offered, or try to get one organized 2 to 5 days after leaving the scene.
• Talk about feelings as they arise, and be a good listener to your coworkers.
• Don't take anger too personally - it's often an expression of frustration, guilt, or worry.
• Give your coworkers recognition and appreciation for a job well done.
• Eat well and try to get adequate sleep in the days following the event.
• Maintain as normal a routine as possible, but take several days to "decompress" gradually.

How can you manage stress after returning home?

After returning home:

• Catch up on your rest (this may take several days).
• Slow down - get back to a normal pace in your daily life.
• Understand that it's perfectly normal to want to talk about the disaster and equally normal not to want to talk about it; but remember that those who haven't been through it might not be interested in hearing all about it -they might find it frightening or simply be satisfied that you returned safely.
• Expect disappointment, frustration, and conflict -sometimes coming home doesn't live up to what you imagined it would be -but keep recalling what's really important in your life and relationships so that small stressors don't lead to major conflicts.
• Don't be surprised if you experience mood swings; they will diminish with time.
• Don't overwhelm children with your experiences; be sure to talk about what happened in their lives while you were gone.
• If talking doesn't feel natural, other forms of expression or stress relief such as journal writing, hobbies, and exercise are recommended.

Taking each day one at a time is essential in disaster's wake. Each day provides a new opportunity to FILL-UP:

* Focus Inwardly on what's most important to you and your family today;

* Look and Listen to learn what you and your significant others are experiencing, so you'll remember what is important and let go of what's not;

* Understand Personally what these experiences mean to you, so that you will feel able to go on with your life and even grow personally.

______________________________________________________________________________

Psychological Impact of the Tsunami Across the Indian Rim

National Child Traumatic Stress Network
www.NCTSNet.org

The massively destructive Tsunami that struck across the Indian Rim caused extensive loss of life and injury as well as devastation to property and community resources. The combination of life-threatening personal experiences, loss of loved ones and property, massive disruption of routines and expectations of daily life, pervasive post-disaster adversities, and enormous economic impact on families and entire nations pose an extreme psychological challenge to the recovery of children and families in the affected areas. This brief information sheet provides an overview of expected psychological and physical responses among survivors. The key concepts include:

o Reactions to Danger
o Posttraumatic Stress Reactions
o Grief Reactions o Traumatic Grief o Depression
o Physical Symptoms o Trauma and Loss Reminders
o Post-disaster Adversity/Disruption

Appreciating the psychological implications of such an overwhelming event on the lives of the survivors plays a crucial role in considering specific efforts that will be of greatest help to the affected communities. The following issues may be helpful to consider in efforts to respond to disaster victims:

Reactions to Danger

It is important to recognize the difference between a sense of danger and reactions to traumatic events. Danger refers to the sense that events or activities have the potential to cause harm. In the wake of the recent disaster, people and communities have greater appreciation for the enormous danger of a Tsunami and the need for an effective early warning system. There are likely to be widespread fears of recurrence that are increased by misinformation and rumors. Danger always increases the need and desire to be close to others, making separation from family members and friends more difficult.

Posttraumatic Stress Reactions

These reactions are common, understandable, and expectable, but are nevertheless serious and can lead to many difficulties in daily life. There are three types of posttraumatic stress reactions. Intrusive Reactions are ways the traumatic experience comes back to mind.

These include:

o recurrent upsetting thoughts or images that occur while awake or dreaming
o strong emotional or physical reactions to reminders of the Tsunami
o feelings and behavior as if something as terrible as the Tsunami is happening again

Avoidance and Withdrawal Reactions include:
o avoiding talking, thinking, or having feelings about the Tsunami
o avoiding places and people connected to the event
o feeling emotionally numb, detached or estranged from others o losing interest in usually pleasurable activities

Physical Arousal Reactions are physical changes that make the body react as if danger is still present.

These include:
o constantly being “on the lookout” for danger
o being startled easily or being jumpy or nervous
o feeling ongoing irritability or having outbursts of anger
o having difficulty falling or staying asleep or having restless, easily disturbed sleep
o having difficulty concentrating or paying attention

Children may show some of these reactions through their play or drawing. They may have bad dreams that are not specific to the Tsunami. In addition to increased irritability, children may also have physical complaints (headaches, stomachaches, vague aches and pains). Sometimes these are difficult to distinguish from true medical concerns.

Grief Reactions

Those who survived the Tsunami have suffered many types of losses – including loss of loved ones, home, possessions, and community. Loss may lead to:

o feelings of sadness and anger
o guilt or regret over the loss
o missing or longing for the deceased
o dreams of seeing the person again

These grief reactions are normal, vary from person to person, and can last for many years after the loss. There is no single “correct” course of grieving. Personal, family, religious and cultural factors affect the course of grief. Although grief reactions may be painful to experience, especially at first, they are healthy reactions and reflect the ongoing significance of the loss. Over time, grief reactions tend to include more pleasant thoughts and activities, such as positive reminiscing or finding positive ways to memorialize or remember a loved one. One of the many untoward results of the Tsunami is that some family members’ bodies have not been found. This, unfortunately, has prevented the normal use of religious, and cultural burial and mourning rituals, and has put the experience of grief on hold. Whereas trauma is more restricted to personal experience of the Tsunami, loss and grief extend well beyond the impacted areas, indeed across the world.

Traumatic Grief

People who have suffered the traumatic loss of a loved one often find grieving more difficult. Their minds stay on the circumstances of the death, including preoccupations with how the loss could have been prevented, what the last moments were like, and issues of accountability. These reactions include:
o intrusive, disturbing images of the manner of death that interfere with positive remembering and reminiscing
o delay in the onset of healthy grief reactions
o retreat from close relationships with family and friends, and avoidance of usual activities because they are reminders of the traumatic loss

Traumatic grief changes the course of mourning, putting individuals on a different time course than is usually expected by other family members, religious rituals, and cultural norms that offer support and comfort.

Depression

Over time, the risk of depression after the Tsunami is an additional major concern. Depression is associated with prolonged grief and strongly related to the accumulation of post-Tsunami adversities. Symptoms include:
o persistent depressed or irritable mood
o loss of appetite
o sleep disturbance, often early morning awakening
o greatly diminished interest or pleasure in life activities
o fatigue or loss of energy
o feelings of worthlessness or guilt
o feelings of hopelessness, and sometimes thoughts about suicide

Demoralization is a common response to acutely unfulfilled expectations about improvement in post-disaster adversities, and resignation to adverse changes in life circumstances.

Physical Symptoms Survivors of the Tsunami may experience physical symptoms, even in the absence of any underlying physical injury or illness. These symptoms include:
o headaches, dizziness
o stomachaches, muscle aches
o rapid heart beating
o tightness in the chest
o loss of appetite
o bowel problems

In particular, near-drowning experiences can lead to panic reactions, especially in response to reminders. Panic often is expressed by cardiac, respiratory, and other physical symptoms. More general anxiety reactions are also to be expected. Physical symptoms often accompany posttraumatic grief and depressive reactions. More generally, they may signal elevated levels of life stress.

Trauma and Loss Reminders

Posttraumatic stress reactions are often evoked by trauma reminders. Many people continue to encounter places, people, sights, sounds, smells, and inner feelings that remind them of the Tsunami experience. The ocean has become a powerful reminder. Additionally, the tide simply going out or even the wave in a bathtub while bathing a child can act as a disturbing reminder. Because the Tsunami was accompanied by a loud roar and the crashing of waves, loud noises can be strong reminders. Reminders can happen unexpectedly, and it can take quite a while to calm down afterward. Adults and children are often not aware that they are responding to a reminder, and the reason for their change in mood or behavior may go unrecognized. The day of the week, the time of day, and the anniversary date are common reminders. Television and radio news coverage can easily serve as unwelcome reminders. It is particularly difficult when family members have been together during a traumatic experience, because afterward they can serve as trauma reminders to each other, leading to unrecognized disturbances in family relationships.

Grief reactions are often evoked by loss reminders. Those who have lost loved ones continue to encounter situations and circumstances that remind them of the absence of their loved one. These reminders can bring on feelings of sadness, emptiness in the survivor's life, and missing or longing for the loved one's presence.

There are several types of loss reminders: Empty situations occur when one would be used to being with a loved one and they are no longer there, for example at the dinner table, during activities usually done together, and on special occasions, like birthdays and holidays. Children, adolescents, and adults also are reminded by the everyday changes in their lives, especially hardships that result from the loss. Examples include temporary or changed caretakers, decreases in family income, depression and grief reactions in other family members, disruptions in family functioning, increased family responsibilities, lost opportunities (for example, sports, education, and other activities), and the loss of a sense of protection and security.

Post-disaster Adversities/Disruption

Successfully addressing the multitude of post-disaster adversities not only saves lives, protects health, and restores community function, but constitutes an important mental health intervention. Contending with adversities such as lack of shelter, food and other resources, and disruption of daily routines can significantly deplete coping and emotional resources and, in turn, interfere with recovery from posttraumatic stress, traumatic grief, and depressive reactions. Post-disaster medical treatment and ongoing physical rehabilitation can be another source of post-disaster stress. New or additional traumatic experiences and losses after the initial experience are known to exacerbate distress and interfere with recovery. Likewise, distress associated with prior traumatic experiences or losses can be renewed by the experience of the Tsunami.

Children’s recovery is put in jeopardy without proper caretaking, reunification with family members, and restoration of normal daily routines – for example, schooling. Some adversities require large-scale responses, while others can be addressed, in part, by personal and family problem solving.

What Are the Consequences of These Reactions?

Post-disaster reactions can be extremely distressing and may significantly interfere with daily activities. For adults, posttraumatic stress, grief, and depressive reactions can impair effective decision-making, so vital in adapting to the recovery environment. They also compromise parenting. For children and adolescents, intrusive images and reactivity to reminders can seriously interfere with learning and school performance. Worries and fears may make it difficult for young children to return to school or to venture any distance from parents or caregivers.

Avoidance of reminders can lead adolescents to place restrictions on important activities, relationships, interests and plans for the future. Irritability can interfere with getting along with family members and friends. Trauma-related sleep disturbance is often overlooked, but can be especially persistent and affect daytime functioning. Adolescents and adults may respond to a sense of emotional numbness or estrangement by using alcohol or drugs. They may engage in reckless behavior. Adolescents may become inconsistent in their behavior, as they respond to reminders with withdrawal and avoidance or overly aggressive behavior. Over time, there may be increases in marital discord and domestic violence.

Depressive reactions can become quite serious, leading to a major decline in school or occupational performance and learning, social isolation, loss of interest in normal activities, self-medication with alcohol or drugs, acting-out behavior to try to mask the depression, and, most seriously, attempts at suicide.

Traumatic grief can lead to the inability to mourn, reminisce and remember, fear a similar fate or the sudden loss of other loved ones, and to difficulties in establishing or maintaining new relationships. Adolescents may respond to traumatic losses by trying to become too self-sufficient and independent from parents and other adults, or by becoming more dependent and taking less initiative.

Coping after Disaster

In addition to meeting peoples basic needs for food, water, shelter, clothing and medicine, there are several ways to enhance people’s coping. Physical: Stress can be reduced with proper nutrition, exercise and sleep. People may need to be reminded that they should take care of themselves physically to be of help to families and communities. Emotional: People need to be reminded that their emotional reactions are normal and expected, and will decrease over time. However, if their reactions are too extreme or do not diminish over time, there are professionals who can be of help. Social: Communication with, and support from, family members, friends, religious institutions and the community are very helpful in coping after a disaster. People should be encouraged to communicate with others, and to seek and use this support where available.

Daily Routines: For children especially, it is important to restore normal routines, including mealtimes, bedtime) as much as possible. Children feel more safe and secure with structure and routine. Meeting basic survival needs, restoring a sense of safety and security, and providing opportunities for normal development within the social, family and community context are important steps to the recovery of children and adolescents.

source: http://www.nctsnet.org/nccts/asset.do?id=603
This project was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.

My preparation to go to Sri Lanka was aided by a visit to Leland "Skip" and Aew Whitney, Mill Valley residents who arrived in Colombo just after the Tsunami. Synchronistically, Skip is on the board of OperationUSA; I read about his family's journey in the local paper and then called him. He and his wife graciously invited me to their home to tell me about what had happened to them.

Mill Valley man helps in Tsunami zone
Jason Walsh, IJ reporter
Wednesday, January 19, 2005
- As a fund-raising board member of the international relief foundation OperationUSA, Skip Whitney is used to helping disaster victims from a distance.
But when fate placed the Mill Valley real estate developer at the center of the Sri Lankan Tsunami devastation, Whitney found himself offering relief in ways he never would have imagined. Whitney, his wife, Aew, and their two daughters were vacationing in Southeast Asia during the holidays and were due to fly from Bangkok to Colombo, Sri Lanka on Christmas Day. But, because of a miscalculated departure time, the Whitneys missed their flight - as well as the earth-shattering waves that rocked the island the next day. "I have no doubt in my mind that if we had arrived on schedule, we would be dead," Whitney said. Having heard only vague rumors of a tidal wave and unaware of the full extent of the catastrophe, the Whitneys caught the next flight to Colombo, arriving hours after the Tsunami swept away the lives and homes of thousands of Sri Lankans. (The full story is at http://opusa.org/press/marin_ind.htm)

As I prepare to go to Sri Lanka, I also solicit donations from friends and the local schools. It is so hard to ask for money that instead I ask for crayons, paper, scissors, stickers, and children's band-aids. People are wonderful. Especially moving are the letters and drawings done by children here to give to children in Sri Lanka. People I did not know were coming up to me, offering me crayons, blessings, good wishes, and respect.  It is the admiration that throws me, as I feel this is something I have to do; a call I must answer.

Friday, January 28, 2005

Today is my flight, and at 4:00 a.m., I am still awake. The alarm is set for 5:00 a.m. to begin the journey. Yet here I am, packing and racing around, fueled by adrenaline, anxiety and pressure to get everything into one small bag. I am shocked by my lack of preparation; why am I just now starting to pack? It was hard, I had only known for a week and one half that I was going to Sri Lanka, and only found out yesterday I will be in the group going to Batticaloa, affectionately known as “Batti”. I hear many jokes from my son Colety that “Mom is going Batty!”, which feels very true at the moment. We are allowed two bags, up to 70 lbs each, so my husband Roy and son Colety packed the big suitcase with things for the children: stickers, paper, letters and drawings from children here, zillions of children’s band-aids, scissors, paper punches and balloons. 69 pounds, all donated. Colety handed me a roll of money; between bake sales and spare change jars, the Novato Charter School had collected $200 for the children of Sri Lanka.

7:09 am
Now the journey really begins. I missed the Airporter bus, so Roy had to race me to the Larkspur terminal to catch another bus. Kate Chaos! I do get a little tired of my frenzy at times, wishing for some of Roy's composure and serenity. Finally, I am on the Airporter bus, heading to SFO. From there, I catch a plane to LA, switch airlines and terminals, meet with the group, and then we fly to Colombo, via Tokyo and Singapore.

Our team met in boarding area of Singapore Airlines, we range in age from 26 (our leader, David) to the geriatric one among us; me, age 50. We bring a wide range of experience to the project. We will find out more of what we will be doing in Singapore; there will be training. The interventions are specific, and directive. We cannot bring anything aquatic, including in the stickers. I would like to know more about this; it seems a paradox to be directive, but avoid talking about the thing that caused the trauma. Kind of the "you-know-who" Lord Voldemort thing in Harry Potter.

We had received an e-mail from the Association for Play Therapy; our team is:

Janine Shelby, Ph.D., B.C.E.T.S., RPT-S is a licensed psychologist and a clinical faculty member in the department of Psychiatry at UCLA. When she returns from Sri Lanka, she will assume the position of Chief Psychologist in the Child Crisis Center, Department of Pediatrics, Harbor-UCLA Medical Center. She is a frequent consultant for OperationUSA and other NGOs, a consultant for the National Center for Child Traumatic Stress, and a long-term American Red Cross volunteer. She appears on the National Red Cross mental health training video. Dr. Shelby has lectured in and provided relief to survivors in more than a dozen countries including those in the former Yugoslavia, Russia, Western Europe, Asia, and Latin America. Her articles and book chapters focus on posttraumatic interventions for traumatized children. She is the President of the Foundation for the APT and in that capacity, worked with OperationUSA, the Foundation Board, APT staff to design the project in which we are participating.

Our leader, David Bond MSW, has been collaborating with the National Center for Child Traumatic Stress for the last nine months on Psychological First Aid, an early response intervention protocol to be used in the immediate aftermath of terrorist attacks and natural disaster. He works full time as a psychotherapist at St. Francis Medical Center in Lynwood, CA. David is a member of APT and has completed the requirements for the RPT credential, for which he will apply upon obtaining his LCSW in March '05. He is currently co-authoring a chapter on mental health practitioners' involvement in post-disaster relief work.

Kate Amatruda, MA, LMFT, Novato, CA: UC Berkeley Adjunct Faculty, Certified Sandplay Therapist-Teacher, relief work during Loma Prieta Earthquake, 9/11 work in schools, ARC Disaster Mental Health Member, CAMFT Trauma Response Network Responder, Author of "Trauma, Terror and Treatment: PTSD in Children and Adults".

Sharolyn Wallace Bowman, Ph.D. (Social Work), Tulsa, OK: Professor at Tulsa Community College, 18 experience in the childhood grief field, past experiences working in Russian orphanages doing related work, RPT-S (Registered Play Therapist-Supervisor), Officer for OK Branch of the APT

Valerie Hearst, LGSW, Brunswick, OH: Provided work to orphanage in Mexico and Standing Rock Reservation, lived and studied in Mexico, social justice trip to Puerto Rico and Dominican Republic, backpacked in Thailand, Mexico, Guatemala, and Belize

Maria Parreno, Psy.D., Psychologist, Mission Viejo, CA: Experience with relief work after Hurricane Iniki, volunteer work in orphanages in Mexico, studied in Israel during war, background growing up in Philippines with missionary parents

Prabha Sankaranarayan, MS (Child Development), Pittsburgh, PA: Therapist and Mediator, Snyder & Sankar Associates, 20 years experience working with children, lived in India for 20 years, speaks Tamil (one of the Sri Lankan languages), NOVA training, currently writing PA plan for victims of a terrorist attack

Jodi Smith, LCSW, Claremont, CA: social worker at Children’s Hospital LA in ER and long-term wards for crisis and trauma victims, Red Cross Volunteer, provided recreational activities for orphans in Mexico

Joseph Wehrman, Ph.D. (Counselor Education), Aberdeen, SD: Many years experience working in early childhood, former member of US Army where he provided on-site medical care to remote villages in Honduras, lived and worked in Iraq providing medical care to civilians and soldiers, worked 5 years in early childhood development, former Hall Director for international students.

clockwise: Kate, Joe, Prabha, Jodi, Sharolyn, David, Valerie, Janine and Maria

The flights are endless. We left LA at 1:00 pm, went to Tokyo for a refueling. In Tokyo, even though the layover was less than an hour, everyone had to get off the plane, exit, go through security again, wait in a long line, and get back on the plane. The security guards, the ones who run your things through the x-ray machines, are all young women, wearing red hats, red skirts and vests, with white blouses. They wear high heels, as does every Japanese woman we see who works in the airport. All the people I encounter on the plane, in the airports, even at the security screening areas are so touched that I am going to Sri Lanka, that they thank me. I accept their gratitude, knowing it is soul food that will sustain me during the hard times.

The LA to Tokyo flight was 11h 40m long. Tokyo to Singapore is 7h 30m long. Singapore to Colombo 3h 35m. 22 hours and 45 minutes in airplanes! Are we there yet?

Back on the plane, seven+ more hours in the air until Singapore. I am getting a bit squirrelly. It would be nice to go outside, breathe fresh air. In Singapore, we stagger out of the airport, having been stamped through immigration (I was so happy to get a stamp in my new passport) and through the “nothing to declare” line in customs. We get off the plane, into the night, and realize we have no way of getting to the hotel. David arranges for a van, and we get to the hotel at 3:00 a.m., but which day I have no idea.

Sunday
Hotel, shower, sleep. In the morning, David tells us “The Protocol”, a series of exercises designed by Janine Shelby and her team to help children master trauma. They are cognitive behavioral, with specific objectives and techniques. Each game has the objective, such as to:

*Normalize reactions ("Yes, you are having a 'normal' reaction to an 'abnormal' situation; whatever you are experiencing; sleep difficulties, crying, anger, etc. is OK and normal."   In my work in the States, this is the  stage when I usually reassure a person that they are NOT crazy, but in Sri Lanka I don't know the cultural context for craziness.)
*Assess current coping mechanisms (and reinforce healthy ones),
*Assess and modify misattributions and cognitive distortions (such as if the child feels that he or she did something to cause the Tsunami)
*Decrease hyperarousal and panic symptoms (We hear that at one camp, people feared that another Tsunami was coming. Some children were hurt in the stampede.)
*Increase self-soothing (breathe! breathe!)
*Identify and change intrusive re-experiencing, such as flashbacks
*Decrease isolation and withdrawal and reinforce the ability to seek helpful social support (ask for a hug, find someone to talk to, tell a grown-up)
*Decrease regressive behaviors by focusing on strengths and resources
*Identify loss reminders (water images, perhaps the aquatic stickers?) and trauma triggers (such as loud noises, big waves, whatever you were doing at the time at the disaster)
*Finally, to leave the child with a sense of hope.
(Adapted from "Enhancing Coping Among Young Tsunami Survivors: Culturally Approved Interventions 1/24/05 © Shelby, Bond, Hall & Hsu, 2004)

I am worried that our attempts to help will come to nothing; that we are offering a band-aid for a gaping wound. A disaster that has killed so many cannot be quickly overcome, particularly after so much war trauma. The Tsunami is a holocaust that will affect Sri Lanka, the Indian Rim nations, and the world for generations. And no technique will work if the hierarchy of needs is not met; if the child is still in danger, hungry, or without shelter. The first step in trauma work is to establish that the danger is over, that the child is safe now.

Why do we go to play, and teach play techniques, in a cataclysm? As we get closer to Sri Lanka, my mind struggles to hold the number who died. September 11 was about 3000, the Tsunami was around 150,000 when I left.  By the time I returned home the death toll was 285,000; the count rises each day. I think we go to play with children because play is the first language, before children can verbalize, they play. Play allows for the expression and healing of trauma. And we go because we, as humans, want to do something for other humans who are suffering.

After working all day in Singapore, we have a few hours off. Prabha, Valerie and I jump into a cab and go to Chinatown. We walk through crowded streets; Chinese New year is almost here, so it is very festive. Great shopping; I keep thinking I could make a killing on EBay if I had enough time and money, connections, and could carry everything. This must be how people make money; they buy things very cheaply, sell high. What an alien concept for a therapist! Not this lifetime! We check out of the hotel and then leave for the airport to head to Colombo, the biggest city in Sri Lanka. We had arrived at the hotel at 2:00 a.m., and we leaving at 8:00 p.m. the same day...how many hours is that? 18 hours, most of it spent in training.

We get to Colombo, where there is a strong military presence. The Army is everywhere, running checkpoints and randomly pulling over cars. We are pulled over and the soldiers shine a flashlight into the car, mostly focusing on Valerie. She is scared, keeps asking, “Should I open the door?” Everyone yells out, “No! No!” Later we find out we were stopped because some of the women in our group have short hair.  The women fighters of the Liberation Tigers of Tamil Eelam (LTTE), or Tamil Tigers, are the only women in this country to have short hair.  We get to the hotel very late, it is 3:00 a.m. I am still awake, wondering what is to come.

Monday
The next day is Monday, and we have another meeting, this time with Nimmi Gowrinathan, an OperationUSA worker, a tall, brilliant and gorgeous Tamil woman who grew up in Los Angeles, and is getting a Ph.D. in Political Science from UCLA. She embodies her quote, "Leadership is the capacity to translate vision into reality." Nimmi orients us to the political and social structure of the country. We learn about the years of warfare, the riots, the discrimination that the Tamil have felt at the hands of the Singhalese. (For more on this conflict, please go to: Sri Lanka: Ethnic Conflict & Civil War.)

There is now a cease-fire in the war. We learn that three days after we left Batticaloa that Kousalyan, the head of the Liberation Tigers' political division for the Batticaloa-Amparai district, was killed in an ambush on the highway to Batticaloa Monday night February 7 around 7:45. Three people who were traveling with him were killed and four were injured. [source: TamilNet, February 07, 2005 16:08 GMT]

I wonder how this will affect the survivors of the Tsunami...how can they begin to feel safe if the war comes again? I cannot help but feel we left just in time, and, after viewing the devastation wrought by nature, I would like to bring the leaders of every country to view it, to tell them to stop all wars.  To help rebuild the planet. To stop senseless killing.  To use resources to end human suffering, not to increase it. (Of course, I do keep all these sentiments to myself. One of the requirements of disaster response is to be non-political, non-denominational and nondiscriminatory. We offer aid by need, not religion, ethnicity, political affiliation, etc.)  

We have two teams, one headed to the South, the area that is primarily Buddhist and Singhalese. My team's destination is Batticaloa, ground zero of the Tsunami, and the place where there have been the least services provided. The East is primarily Tamil, with the major religions being Hindu and Muslim. There also seem to be pockets of Christianity throughout the country, and the Eastern team will be staying at an orphanage started by Christian Missionaries.

We learn about the social customs; that women tie their hair up or back at all times, that dress is modest, with most of the body covered. Women and girls wear earrings, and we hear tales that if a woman has a hole in her ear, without an earring in it, that the Sri Lankan women will come up and try to put an earring in the piercing. Irreverently we joke that is a way to get more earrings. The henna paintings on hands, toe rings and lovely sandals make sense if a woman's body is mostly covered; for where else can she show her beauty?

We then briefly meet Janine Shelby, the play therapist who has masterminded this project. She is very busy in Colombo, doing many trainings. David asks her some clarification questions and then she ends by giving us some lovely words of encouragement for our mission. We race upstairs to pack up the toys, and we are off to Batti, while the southern team heads toward Galle.

To Batticaloa is a long drive, at least 8 hours through the center of the island. The roads are winding, the countryside incredibly beautiful. We see elephants and monkeys, and go by some huge statutes of the Buddha, towering over the town and countryside.

We are regretting the ‘typical Sri Lankan breakfast’ of very spicy curry we had this morning, as it is raising havoc with our Western tummies. For bathrooms, we stop at “rest houses”, which have little cafés with bathroom facilities. Almost all have ‘English toilets’, but not all. The alternative is a hole in the ground over which one squats. You stand on little wooden steps, pull your pants down and to the front, and squat down low, trying not to splash yourself. There is a bucket of water nearby that you fill and dump in quickly, hoping to flush. We carry our own toilet paper, as few rest houses have any.

We are almost there when our driver, Ravi, pulls over. The van has a flat tire. Out comes most of the luggage (and we are not traveling light; with clothing and supplies for the entire 10 day trip, as well as toys and art materials). We pile ourselves and our luggage out of the car, and wait while Ravi tries to find the jack to raise the car. He finds most of it, missing however the crucial piece that is the crossbar, with the socket end to remove the nuts that hold the tire on. Fortunately, we have stopped in a well-lit place by the university, and Ravi is able to borrow the cross piece of the jack. We stand around swatting at mosquitoes until Nimmi’s father, Roger, suggests that we put mosquito repellant. We find later that the mosquitoes are very resilient in Sri Lanka, finding the tiniest area of skin not covered with DEET. Poor Valerie awakens one morning with swollen eyelids; it had not occurred to her to put the repellant on her eyelids. “DEET UP” becomes a clarion call of the group, morning and evening.

We drive further, and are ‘almost there’ when the lights go out on the van. This is very dangerous, as the road is narrow and the people drive like maniacs. (It doesn't help my sense of mastery that Sri Lanka has right hand drive; I keep being surprised by trucks and busses roaring toward us on the right.) I feel as if I am in one of my son’s video games, in which driving on a road means taking your life into your hands. We find out later that traffic fatalities are the leading cause of death in Sri Lanka, followed by snakebites. We scrounge around in our luggage and find flashlights, and Nimmi hold a flashlight through the windshield as Ravi drives. We are grateful for Ravi’s driving skills, as in the morning we see that he has successfully navigated between the sea on one side and the sewer trench on the other. There are cows and goats to be avoided as well; somehow, Ravi got us safely to the orphanage. Later we draft Ravi into our team to work with the children; he knows how to play cricket!

We finally find our destination, St, John’s, an “American Ceylon” mission that is an orphanage and school for children whose families have died in the war. The children run out to greet Nimmi, who has visited before.   Jeff Greenwald   wrote in his Field Journals: A Journey Through the EastJanuary 19, 2005:
"At the St. John’s Tsunami Relief and Rehabilitation Center in Batticaloa, an Episcopal Reverend known as “Father J” (short for Jeyanesan) is spearheading a multi-level effort that includes orphanages, feeding centers, vocational training, and emergency relief supplies. (The popular Reverend was already immersed in refugee work, providing for families displaced by the civil war, when the Tsunami struck. Trained at the Hebrew University in Jerusalem, Father J’s commitment to spiritual integration is immediately obvious; St. John’s is the first church I’ve seen with a Jewish mezuzah on its doorway.)"

We stumble upstairs to a large airy room and have dinner. This dinner, to be repeated every night we are here, consists of cold rice noodles, a sauce of coconut milk with a yellow spice in it, a curry with chucks of meat and bone, cut up and steamed carrots and green beans. We see there are no utensils, so we follow Nimmi and Prabha’s lead as we eat with our hands. One never touches food with the left hand, ever, as that hand is used for cleaning oneself. Joe, who is left handed, has to sit on his left hand in order not to use it. I find that I cannot bring myself to eat any fish here, fearing, as the villagers do, that the fish might have eaten the dead. There are charts in the papers to show what fish feed on, to reassure us that the fish are safe to eat, but I can't make myself do it.

The room upstairs is large and airy, and we think it will be a good place to sleep. We find out, however, that only the men will sleep there. The women go down to beds in the girl’s dormitory, bunk beds. The girls flock to us, touching, talking in Tamil. They are very curious about us, and call us “Auntie’, which is a sign of respect given to an older woman. They quickly find something to tease us about; for Valerie it is her long nose (which to my Western aesthetic seems on the short side), for me it is my lack of earrings, as I have removed my earrings due to sore piercings. They tug at their earrings and then reach for my sore and inflamed ear lobes. I am determined to find earrings that are not as heavy as the ones I was wearing, and put antibiotic ointment on my earlobes before bed.

Getting ready for bed is a challenge. The girls are very modest, and so I take my clothes with me to the shower. What shower? Bathing take place in a large red bucket, with a smaller pitcher. You use the pitcher to pour water over you, then soap down, and rinse again with water from the pitcher. There is no hot water, and by the end of our stay there, I am in agreement with the ‘what do you need hot water for in the tropics anyway?’ school of thought. Right now, it is a shock, and I just cannot deal with it.

After the plane trips, the long ride from Colombo, dinner eaten with my hands, I confess to a moment of Western princessness; I want a real shower and a room of my own! Not. Instead of braving the shower, the big red bucket, I use wipes to clean myself, and try to change into sleeping clothes without getting them wet, as there is water everywhere in the floor. I do a little dance of rolling up my pants leg, getting my feet in and out of my flip-flops, getting my legs through the pants, without getting them wet. I am not quite successful, so spend the first night with pants wet around the ankle. At least it is water from the bath, and not the toilet!

All ready for bed, and I cannot sleep. I wander out and run into Selvie, the lovely 30-year-old woman who is in charge of all the girls at the orphanage. Selvie speaks some English, and we find ourselves sitting on a bench, talking. She is “amah” or mother to 175 girls! I compliment her, and say that I an amah to only three children , and I cannot imagine how she does it. The girls call her “Selvie-amah”. I tell her that I will be a grandmother in July, so my name becomes ‘Amahmah”, or grandmother. Soon all the children call me “Amahmah”. Selvie and I talk a bit, but every minute a girl comes up to her for something; she is mother, nurse, soother, everything to 175 girls. She also supervises the wardens, or young women who serve as house mothers. They get to go home each night if they have one, while Selvie-amah lives at the orphanage with the girls.

Things have become complicated lately, as the Tamil Tigers, as a gesture of good will, released their child soldiers to Unicef. Unicef turned the children over to the orphanages, the place where they would be safest. Selvie has to integrate adolescent girls who were soldiers into the community of proper Christian-schooled girls. The child soldiers are the ones with short hair, and they stick together. The culture of the army and the culture of the orphanage are quite different, and I wonder how long, if ever, it will take for the soldiers to blend in with the cloistered girls. Finally, I am sleepy enough to try to go