Carlos Hojaij: Tsunami in Aceh 2004*

        This document was prepared and discussed during an educational symposia entitled “Stress in Disaster” held in the Jakarta Hilton Hotel, February 3, 2005. The symposia was organized by the Indonesian Society for Biological Psychiatry, Psychopharmacology and Sleep Medicines (ISBPPSM), under the direction of 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 living 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 the western coast of Aceh had died or been displaced by the catastrophic event of 26 December 2004. It is estimated that more than a million people have lost one or more family members and thousands have lost their homes, properties, jobs and livelihoods.

The 3 stages of recovery in a disaster:

        1. Early or shock (1-2 weeks)

        2. Reconstruction (2-4 weeks)

        3. Rehabilitation ( 4 weeks and more)

        Psychological reactions like fear, sadness, grief reaction, anger and sleep problems are common in the 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 and continue through the phases of reconstruction and rehabilitation.

Recommendations:

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 the entire populations is addressed and mental health support is programmed and integrated into the overall health plan.

2. It is important to recognize the multidisciplinary team in this national effort. Psychosocial problems concern not only psychiatrists but also other professionals like doctors, nurses, psychologists, teachers and social workers. They should also be involved in 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 NGOs 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 leaders and teachers from local communities could be trained to provide mental health support.

4. Mental healthcare can be provided at three levels:

a) Level 1 by nurses, teachers and religious leaders who have been trained for mental health support

b) Level 2 by doctors and mental health professionals like psychologists, nurses and social workers

c) Level 3 by psychiatrists

5. Training programs for staff at the three levels are important.

6. The trainers must understand and appreciate the cultural issues of Aceh to formulate appropriate educational skills

7. The role of psychopharmacology:

        The mental health problems and stress reactions during the acute phase are best managed without medication following the principles of psychological first aid, i.e., listening, empathy, needs assessment, 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, antipsychotic medication is not necessary but could be given for patients with pre-existing psychotic disorders or those with reactive psychosis.

*Adapted from the 2005 Recommendations for mental Health Response in Aceh, presented by the Indonesian Society for Biological Psychiatry, Psychopharmacology and Sleep Medicines (ISBPPSM), February 3, 2005.

January 7, 2021