The disaster Tsunami struck on 26tt1 December 2004 and its' devastating effects were concentrated at the northern coastal areas of Penang, an island in Malaysia. The number of deaths currently stands at 68 with 52 in Penang, 12 in Kedah, 3 in Perak and 1 in Selangor. Many families were traumatized by the

experience

See, Assoc. Prof. Dr., Ching Mey

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1lilt International Conference of SAARC Psychiatric FederationHotel Mughal SheratonAgra, India2nd - 4th December 2005,THE TRAINING O~ PUBLIC, HEALTH PERSONNEL AND SCHOOLCOUNSELORS TO HELP TSUNAMI'SURVlVORS:MALAYSIAN EXPERIENCEAssociate Professor Dr. See Ching MeySchool of Educational StudiesUniversity Science MalaysiaMalaysiaThe disaster Tsunami struck on 26tt1 December 2004 and its' devastating effectswere concentrated at the northern coastal areas of Penang, an island inMalaysia. The number of deaths currently stands at 68 with 52 in Penang, 12 inKedah, 3 in Perak and 1 in Selangor. Many families were traumatized by theexperience..It is the first time Malaysia has such a disaster and the immediate response wasto develop a training module for the public, health personnel and schoolcounselors to equip them with intervention skHls so that they can reach out tohelp the survivors- quickly. This paper seeks to share the Penang experience onthe training of the public, health personnel and school counselors to- identify andassist the sUP/ivors to cope with the devastating effects of Tsunami. Theapproach used has helped to reduce the overall impact of the disaster.Note:The author wishes to acknowledge A E Margarita MalayapHlay, leong Min See,Associate Professor las-manl- bte Sh-afiee, Dr. Robert Chen, Dr. lai Feng Hwa,Dr. Lynne Yong, Silviana Bonadai, and Professor Saroja Krishnaswamy for theircontribution in the development of the module and the training.Malaysia was spared the fun impact of the tsunami because it was fortuitouslysheltered by Sumatra itself. Nonetheless, the experience was terrifying for many,especially those living in or visiting the resort island of Penang. Although theearthquake had struck at Sumatra early that morning and terrible events werealready unfolding there and elsewhere, no general warning had sounded andpeople, In a holiday mood, were thronging popular beaches on the western andnorthern coasts of Penang when the first wave landed some 4 hours later.When the sea receded as the waves further out built up height, some curiousobservers actually followed the sea out!The waves when they came were unexpected and disastrous. There are 52recorded direct deaths in Penang, 15 on the mainland and one in Langkawi. All inall, 68 people died from the tsunami in Malaysia2. Coastal villages were severelyinundated and many homes destroyed.Picture: First Wave ApproachingThe Shore In Tanjung Bungah,PenangTragedies of such magnitude are rare in Malaysia. In July 1988, a footbridgecrowded with worshippers going to and from coincidental religious festivalscollapsed at a ferry terminal in Penang and 32 people lost their lives. In2 http://en.wikipedia.orgfwikillmpact_oUhe_2004_lndian_Ocean_eqrthquake.....on_Malaysia2December 1993, one of three blocks of luxury apartments coltapsed. Forty-eightresidents or visitors died. Inquiries were made, blame apportioned, casesbrought to courts and then matter essentiatly rested except for those who aresurvivors or relatives of victims. In Malaysia, since the number of victims wassmall and inconsequential, the management of their mental health followingthese disasters was often left very much to individuals. There is nothingorganized.The tsunami was different. There were many lucky people who escaped withtheir lives though they lost their homes and belongings. However there weremany others, who, through exposure to very horrifying and graphic videos andpictures of the death and destruction and from the sheer magnitude of the scaleof death so nearby, became traumatized. The treatment of post-traumatic stressdisorders (PTSD) became important as it was very soon noticed that PTSD hadspread to a wider swath of the population.This paper describes the various efforts put in place to train quickly healthpersonnel, school counsellors and volunteers to recognize, treat or managePTSD directly arising from the tsunami tragedy. This was needed to arrestemotional and mental decline in the survivors, victims, and others who wereaffected.The Malaysian Association of Scientific Research in Psychiatry (MASRP) -Penang Ass_Q~iatiQD.of Cqun.seJU,llgand Psychology (PACP) Joint Effort inPenangThe Malaysian Association of Scientific Research in Psychiatry and the ~enangAssociation of Counseling and Psychology joined hands and selected BalikPulau site (see Map) for the preliminary work. On 3rd January 2005, a team ofmedical personnel, psychologists, counsellors and concerned individuals met to3discuss and develop an intervention plan3. It was decided that the interventionhad to begin with the immediate training of health personnel, school counsellorsand volunteers who could identify and assist survivors cope with the devastatingeffects of the tsunami. This primary group would be trained with the module thatwas quickly developed by the core trainers identified. The people trained wouldthen act as trainers themselves to train a second and subsequent echelon withthe module they have been trained with. The grant was provided by theMalaysian Association of ScientifLc Research in Psychiatry.Map OfPenang Island Showing The BadlyAffected Shores3 Faculty staff and research students from the National University of Malaysia, Kuala Lumpur, Facultystaff from University Science Malaysia (the author); health professionals, doctors and nurses from thePrimary Health Clinic in Balik Pulau and the General Hospital Pulau Penang; representatives from theEducation Department of Penang; school counsellors from selected schools; and representatives fromthe Mental Health Association, Penang and Bureau on Learning Difficulties (BOLD), Penang.4As the enormity of the tragedy demanded immediate reaction and from a desireto assist in helping to reduce the psycho-social impact of the trauma experiencedby survivors, all the team members essentiaHy volunteered their trme and effort todevise the primary set of module. The training module comprises classroom andpractical sessions with lectures, discussions, role plays, and supervisedcounseling sessions.The module consisted of:1. Identification and recognition of Post Traumatic Stress.: Lts Signs.and Symptoms2. Differentiating Normal and Abnormal Grief: Causes and Effects3. Critical Incident Stress Debriefing (CISD)4. Critical Incident Stress Management (CISM)5. Intervention skills such as:a. Normalizationb. Validationc. Reframingd. Play and Art Therapy for ChildrenA screening instrument was also developed to identify those who neededimmediate referral to a mental health specialist The instrument originallydeveloped in English was translated into the coltaquiat languages. (Malay andMandarin).The draft module was used in a two-day workshop for the first echeloncomprising doctors, nurses, school counsellors and representatives from Non-Governmental Organizations. Some were assigned to home- visiting to interviewthe survivors using the initial screening instrument developed. The collecteddata was used to devise scenarios for role plays that were based on actualverbatim or interpretation of the responses of the survivors. The training thusbecame relevant as it took into account the varied cultural experiences and social5practices of the local communities at the site. The training module was amendedand it mcorporated these improvements.A broader purpose was also served when the task group organized a publicawareness talk that explained the signs and symptoms of post-traumatic stress,normal and abnormal grief, intervention skills that would be generally helpful, andreferral procedures. This was to empower members of the public who may wantto help- others iii their own- community to come to terms with the- impact of thedIsaster in their lives, and to recruit more volunteers to join in the training. Theultimate goal is to train as many people as possible to recognize those with thePTSD signs and symptoms so that they may be referred for effective professionalpsycho-social or psychiatric treatment as quickly as possiblaAs a- result of this approach, we found that many people were reached andhelped quickly. WJth the increased" nUfffberaf tfained:"arrG Wmtng votun'teefS, there-was more chance of reaching out to those who were traumatized.School children were given special consideration. More than 200 schoolcounselors from primary and secondary schools were identified as importantresource persons to be trained. The Penang Association of Counselling andPsychology, the Penang State Government, and the Penang State EducationDepartment, took on this role and organized a one-day training three monthslater with the module developed.These school counseUors beca11'l'e resource- persons' and also trainers in theirschool to assist the trauma survivors among the staff and students. The trainingwas captured on video compact discs (GO) and made freely avaHable to thosewho wanted to learn but were not able to attend the training.With time and experience, later versions of the role-playing were improvedespecially those sections on the identification of signs and symptoms associated6with the trauma and how they are manifested. We found that the trained schoolcounselors became quite adept at suggesting intervention or referral accordingly.We introduced play and art therapy as a means of helping the children withtrauma as this is an excellent technique for them to express their feelings and forus to interpret them. Play therapy is a helping interaction between a trained adultand a child that seeks to re-live the child's emotional distress through thesymbolic communication of play4. Enzer (1988) agrees, noting that the therapistnot only helps bring about relief of clinical symptoms (important as this may be toparents and chHd}, but also works toward removal of impediments to the child'scontinuing deve!opment, so that the prospects for the child's future growth areenhanced.Woltmann (1955/1964} quotes Erikson as saying that "the child uses play tomake up for defeats, sufferings, and frustrations, especially resulting from ...limited use of language". Winnicott (1971) reminds us that "the child does notusually possess that command of language that can convey the infinite subtletiesthat are to be found in play".We extended this technique to the children affected by the tsunami and foundthat it was very useful in helping our trained health personnel, school counsellorsand volunteers to interpret the experiences and to suggest intervention routes.4 "The assumption is that children will express and work through their emotional conflicts... withinthe metaphor of play" (Reid, 1986, p.261)7Other Efforts1. The National Committee of Mental Health Response Towards DisasterThe National Committee of Mental Health Response Towards Disaster was setup by the Department of Psychiatry and Mental Health, Hospital Kuala Lumpur inthe aftermath of the tsunami to provide counseling services to survivors, and tothe aid workers who participated in the tsunami disaster. They have begunpreparing a trauma training module for professionals which is meant as a manualfor future tragedies.2. Training By Crisis Relief Squad Of MCA (CRSM)The Crisis Relief Squad of MCA (CRSM} was set up under the MalaysianChinese Association (MCA) to provide humanitarian services to the survivors ofdisaster. Its purpose inctudes the enhancement of their image in social service.Initially a Crisis Management Tratnih'g CaFftjJ was'firstheld for the CRSM aboutfour months after the disaster. At this camp, about 100 representatives (from thevarious states in Malaysia) were identified to become members of CRSM andthey were trained on the following topics:a. Signs and Symptoms of Post-Traumatic Stressb. Team Work Collaboration To Handle Crisisc. Role of Police In Crisis Managementd. Planning A Community Project Proposale. International Linkage To Incident Command System83. Training By The United Nations Children's Fund (UNICEF) M.alaysiaThe United Nations Children's Fund (UNICEF) Malaysia has also began to builda local mental health support network by training residents (teachers, medicalworkers and community leaders) to form Local Mental Health Team (LMHTs)5.Through the training, teams are equipped to:a, Identify children and adults who are experiencing psycho-social problemsor mental disorder related to the tsunami.b. Conduct initial assessment interviews to identify the severity and nature ofthe mental problem.c. Provide counselling sessions.What follows is largely extracted from their website.To facilitate the work of the Local Mental Heath Team (LMHT), UNICEFconducted many community awareness activities. Its purpose is to establishtrustful working relationships with local residents, and to this end UNICEF isidentifying community contacts, lobbying for support and active participation, andmobilizing people in the community, including women and youths.The Langkawi Community Education Workshop- was held from 19..2-1 May 2005-,about five months after the disaster. It was attended by 30 local residents. Theworkshop included a brief training session for parents and teachers onrecognizing psycho-social disorder in- their chHdren-. Until the end of December2005, tt aimed at providing- 12 briefing- and semirrars for parents and teachers tohelp them understand psycho-social disorders.UNICEF continues to conduct post-trauma mental health training throughoutMalaysia among organizations that are sending relief workers to Kedah and5 www.uniceforg/mediaifiles/UNfCEFResponse17JanuaryOS.pdf9•Acheh in order to safe.guard the mental health of the workers. In the longer term,UNiCEF wili also build the capacity of emergency aid and relief organizations tostrengthen their mental heaith infrastructures and systems. rhis training wilt builda larger pool of human resources from which to draw to provide pOst~disastermental heaith care when the next disaster strikes in Malaysia or elsewhere theregion.4. Critieaf fneident Stress Management Training At HELPHigher Education Learning Program (HELP) University College is a privateUniversity. It's Centre forPSycnology organized a two-day Criticat incident StressManagement (CISM) training at its campus in March 20056 .CISM in this context is defined as a form of crises intervention and can becharacterized as psycho-social first aid. CISM interventions cover all phases of acrisis from preliminary through acute to post-erisis and can be appfied to bothgroups and individuals. During the training, the participants had hands-onexperience with activities on Defusing and Oebriefings. Participants were set upin teams where they had the opportunity to practice skilis by delivering supportinterventions.The training is the first muiti-disciplinary certified CfSM training in Malaysiainvolving 80 participants from over 30 bodies comprising Non~GovernmentaiOrganizations, Educational tnstitutions and Private Hospitals.6 http://ww.w.help.edu.my/new5/pressJQom/20050314_cism.php10ConclusionThe Malaysian Government and many Non-Governmental Organizations (NGOs)have played a significant role in helping the tsunami survivors. They haveactively supported the humanitarian efforts in affected areas soon after thetsunami struck by providing humanitarian aid, medical relief and mental healthsupport. The Malaysian Government and NGQs, within a short time, havedeveloped training programs and Qfganized public awareness activities to public,mental health personnel and school counsellors so that they can help thetsunami survivors t"O better understand what has happen and to cope with it. Thishas been something that had been talked about before on those rare occasionswhen tragedies have struck in Malaysia. However the sheer scale of the tsunamidisaster has galvanized public opinion and concern; and highlighted the lack ofpr:epareoprOOS tcprcvmepcst-traumat1c-c-ounseHng for future disasters.Although the training ofpublic, health parsennat and_ scflQ9J -qQIJns-e{Io:rs were adhoc to meet the immediate need of the recent disaster, cohesive organizationmust continue_ For a star:l those organizations wroch had afIeady respQnded~such as the Penang AssQciation of Counseling and Psychology (PACP),National Committee of Mental Health Response to Disaster, Crisis Relief Squadof MeA CCRSM}, Malaysian Chinese Association (MCA) and United NationsChiTdren's Fund (UNICEF) should puff their resources together and proceed (a)to plan strategie-s" oftraining so that there is no duplicate of training, and (b) toreview the module and techniques of counse.l1ing post-traumatic stress disorder.It must be mentioned that, although no mention has been made here of CriticalIncident Debriefing (Cll)) for those involved in aid and rescue. Nonetheless, etnis an essential cottatera1 to the wllole issue of mental wetlness in rescuers a~rescued.11AcknowledgementThe author wishes to acknowledge the Penang Association of Counseling andPsychology and Malaysian Association of Scientific Research in Psychiatry forthe sponsorship. The author also wishes to acknowledge the team who workedtogether to build the module, train the trainers, counselors and health personnelin Balik Pulau, Penang. They are A. E. Margarita Malayapiliay, Leong Min See,Associate Professor Zasmani bte Shafiee, Dr. Robert Chen, Dr. Lai Fong Hwa,Dr. Lynne Yong, Silviana Bonadei, and Professor Saroja Krishnaswamy.12REFERENCEBook:Enzer, N. B. (1988). Overview of play therapy. Paper presented at the annualmeeting of the American Academy of Child and Adolescent Psychiatric, Seattle,WA.Reid, S. E. (1986). Therapeutic use of card games with learning-disabledchildren. In C.E. Schaefer & S. E. Reid (Eds.), Game play (pp.257-276). NewYork: Wiley.Winnicott, O. W (1-971). Playing and reality. New York: Basic Books.Woltmann, A. G. (1964). Varieties of play techniques. In M.R. Haworth (Ed.),Child psychotherapy (pp. 20-32). New York: Basic Books. (Original workpubHshed 1955)Website:Impact of the 2004 Indian Ocean Earthquake on Mala-y-siahttp://en.wikipedia.orgtwiktllmpact of the 2004 Indian Ocean earthquake onMalaysiaHELP University College: Critical Incident Stres-s- Management Training, At Helphttp://V\-l\WI.hsfp.edu.my/news/press Joom/20050314 dsm.phpUNICEF Response To The Indian Ocean Emergencywwvv.unicef.org/mediaifih;L~UNICEFResponset71.?nuary05.pdf13

The Training Of  Public, Health Personnel And School Counselors To Help Tsunami  Survlvors: Malaysian Experience.

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