Tsunami . . . . https://dryuliskandar.wordpress.com/2011/03/15/tsunami/

Tsunami in Aceh 2004
Recommendation 2005 for mental Health Response in Aceh.
From Indonesian Society for Biological Psychiatry, Psychopharmacology and Sleep Medicines (ISBPPSM).

This document was prepared and discussed during an educational symposia : Stress in Disaster in Jakarta Hilton Hotel, February 3nd ( Organized by Indonesian Society for Biological Psychiatry, Psychopharmacology and Sleep Medicines (ISBPPSM)) , 2005 by Dr. Yul Iskandar (President Biological Psychiatry Indonesia), Prof Kua Ee Heok ( Former President Singapore Psychiatric Association ), Prof. Saroja Krisnaswamy (President Biological Psychiatry Malaysia)., Prof Pichet Udomratn ( President Biological Psychiatry Thailand), Prof.J.K Trivedi (President Indian Psychiatric Association)., Dr Christopher Cheok (Singapore) and Prof. Carlos R.Hojaij (President World Federation Society of Biological Psychiatry)
Rapporteur : Mr Agus Purwono.

Before the Tsunami Disaster, Aceh had a population of about 4 million with 230.000 in the capital city of Banda Aceh and 450.000 along the affected western coast of Aceh. Almost all people living in Banda Aceh and western coast of Aceh had died or been displaced by catastrophic event of 26 December 2004. It is estimated than a million population have lost one or more family members, and thousand have lost their homes, properties, job and their livelihoods.

The 3 stages of recovery in disaster :
1. Early or shock (1-2 weeks)
2. Reconstruction (2-4 weeks)
3. Rehabilitation ( 4weeks and more)

Psychological reaction like fear, sadness, grief reaction, anger and sleep problems are common in initial phase. Serious mental disorders like adjustment disorder , acute stress disorder, major depression, generalized anxiety disorder and post traumatic stress disorder may occur later.
Humanitarian work must start in the first days and weeks, continue through the phases of Reconstruction and Rehabilitation .

1. The Immediate medical interventions following any disaster must focus on search and rescue efforts . A Mental health orientation requires that the well – being of entire population is addressed and mental health support and programmed are integrated into the overall health plan.
2. It is important to recognize the multidisciplinary team in this national effort. Psychosocial problems concern not only psychiatrist but also other professionals like doctors, nurses, psychologist, teachers and social workers. They should also be involved in the mental health care and public education. Religious leaders can also play an important role.
3. There are many agencies currently providing mental health support in Aceh. The following agencies and NGO are already involved PMI, IPSI, MSF Belgium, Save the Children, Mercy Corps, International Medical Committee, Care International, IFRC, WHO, UNFA and UNICEF. It is important to work hand in hand with the local communities. Doctors, nurses, religious leader and teachers from local communities could be trained to provide mental health support.
4. Mental healthcare can be provided at 3 levels:
Level 1 by nurse, teachers, religious leaders who have been trained for mental health support
Level 2 by doctors and mental health professionals like psychologist, nurses and social worker
Level 3 by psychiatrist.
5. Training programmes for staff at the three levels are important.
The trainers must understand and appreciate the cultural issues of Aceh to formulate appropriate educational skills
6. The role of Psychopharmacology.
The mental health problems and stress reaction during the acute phase are best managed witout medication following the principles of psychological firs aid., i.e listening, emphaty, needs assessment and mobilization and social support. Medications should be used judiciously with disaster survivors. If indicated, anti-anxiety, antidepressant and sleep medication can be effective interventions. In general, antipsychotics medication is not necessary but could be given for patients with pre-existing psychotic disorders or those with reactive psychosis.

Background paper :
Dr. Yul Iskandar (Indonesia)
Prof.Kua EE Heok (Singapore)
Prof. Ayub Sani Ibrahim (Indonesia)
Dr. Nurlaela N,Q.,M.Pd (Indonesia)
Dr. Christopher Cheok (Singapore)
Prof. Saroja Krinaswamy (Malaysia)
Prof.Pichet Udomratn (Thailand)
Prof. J.K. Trivedi (India)
Prof. Carlos R.Hojjaij (Australia, President WFSBP)


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