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A Report of the Trauma Counseling Service Provided at the IAF Training Station, Tambaram -December, 30-31, 2004

DEPARTMENT OF CLINICAL PSYCHOLOGY,
SRI RAMACHANDRA MEDICAL COLLEGE AND RESEARCH INSTITUTE
PORUR, CHENNAI, TAMIL NADU, INDIA 600 116

NOTE: The following article is presented here with the written permission of Prof. Dr. L.S.S. Manickam, who holds the copyright. Requests to reproduce this article in whole or in part or for other uses involving copyright should be addressed to Professor Manickam. © 2005 Prof. Dr. L.S.S. Manickam

BACKGROUND INFORMATION

The Indian Air Force (IAF) service personnel and their families air lifted from Car Nicobar following the natural disaster were stationed at the Air Force station, Tambaram, Chennai. There were about three hundred families and one thousand people who were rescued from the airbase and brought to the mainland. All of them were in a state of shock. Some of them had physical injuries and ailments. The emotional state of the people required immediate attention.

Realizing the need the Senior Medical Officer Group Capt. S.N. Aithal contacted Dr. L. S. S. Manickam, Professor and Head, Department of Clinical Psychology, Sri Ramachandra Medical College and Research Institute (SRMC& RI, Deemed University) Porur, Chennai. After the initial discussion over telephone, the permission to take up the disaster counselling services to those at the Relief Centre was sought from the Dean of Faculties, SRMC& RI. It was decided that a team of clinical psychologists from the Department of Clinical Psychology would go to the relief camp to provide psychological help.

PREPARATION WITHIN THE DEPARTMENT

In the month of December, the Department had conducted 2 teaching programmes on Post Traumatic Stress Disorder and its management. One of the programmes focused on lessons learnt from our exposure to the trauma related counselling conducted at the disaster site of Kumbakonam fire accident in September 2004 in Tamilnadu.

On 27th morning, the staff and the students discussed about the tragedy that happened and got prepared for relief work. A 2 hours session on trauma related counselling was conducted in the afternoon. It was also decided that a training module on short term counselling be developed and be presented by one of the second year students in consultation with the Professor and Head of the Department.

DATES OF INTERVENTION

On 28th December 2004, a team of 5 headed by Dr. L. S. S. Manickam, Professor and Head, Department of Clinical Psychology, SRMC& RI, (Deemed University) Porur, Chennai, went to the Air Force Training station. As requested by SMO, a larger team of 7 was deputed on 29th December.

DAY I

On the first day, psychological intervention was carried out with 72 persons, which included 45 women, 26 children and 1 male. The process of intervention was explained to CNC A.M. Bhojwani and his wife when they visited the camp to review the relief operations.

DAY II

On the second day, psychological help was provided to 77 persons. This included 32 women, 41 children and 4 men. The number also included 8 people who were seen on the previous day.

The need for intervention with the children was briefed to PMO Ajith Kumar during his visit, while the group session for children was in progress.

PROCESS OF INTERVENTION

Day I

Psychological help on a one-to-one basis (individual sessions lasting about 30 to 40 minutes) was provided to those who were highly traumatized. These people were identified by the SMO and the health care team at the camp. However it was learnt that there were a number of people who were emotionally under shock and in order to help more people, group sessions were considered to be more useful. Generally, children were excluded from being given delivery support, since they got engaged by themselves in play or other activities. But based on our previous experience in psychological intervention in disaster situations, we planned the sessions for children. Simultaneous group sessions for adults and children were conducted.

INDIVIDUAL SESSIONS

On the first day, initially individual sessions were carried out with women. Most of these women lost one or both of their children, who had slipped out of their arms due to the high tidal waves. Women who lost their children had severe feelings of guilt, as they felt responsible for their own child or children's death. One couple lost their sons who were 2-1/2 years and 8 months old respectively. The mother was highly guilt stricken, as she felt guilty of having taken the wrong direction in saving the family.

Many parents reported to have recurrent memories of their lost children when they saw any other child. All parents who lost their children were not able to sleep or eat but physically survived by the social support network available at the Air Force community.

Bedside counselling was given to those victims who were injured and to those who were not ready to come out of their bed due to severe shock caused by the disaster.

In the individual sessions, the person was facilitated to narrate his/her experience and feelings regarding the Tsunami. They were allowed to ventilate their feelings and the counsellor was an active listener. Those who were having guilt feelings were explained about their lack of control over the event. The individuals were made to realize that they had tried their best to save their children. Efforts were made to instill hope in them about future and encouraged adaptive coping skills.

During group sessions, some of the individuals who needed individual attention were identified and were counselled individually. These mainly comprised of women whose family members and husbands were yet to come back, or those with one family member missing.

GROUP SESSIONS

On day one, as the number of traumatized people was more and counsellors were less, we decided to conduct group sessions. These groups consisting of 12 - 15 individuals had sessions, which lasted for about an hour and 15 minutes each. They were allowed to express their experiences and emotions. Many of them had their families intact but were anxious to see their husbands who were still in Car Nicobar. Some of the people ventilated their feelings by crying out. People reported to have recurrent images, thoughts, and feelings of tremors, fear, nightmares and disturbed sleep. Those who were seriously affected were not able to eat; most of them were worried about their future.

CHILDREN AT THE RELIEF CAMP

While at the relief station, the children were playing around, it was felt that the children in general were not affected by the disaster. Only a small number of children were found to be clinging to their parents or being aloof.

While conducting the group session for adult women, one child came to the group along with her mother. But the child was found not to be emotionally comfortable, while the adults were narrating their traumatic experiences. So the six-year child was taken out of the adult group.

SESSIONS WITH THE CHILDREN

Sessions with the children were initiated by getting one child to draw a picture of what she liked using crayon on a white sheet of paper. This sparked an interest in the other children and a group evolved. As and when the children joined the group each one was asked to depict in drawing what they had witnessed at the time of disaster. Without much prompting the children drew pictures of their homes, the wreckage caused by the disaster, people trying to save their lives and struggling to get help.

In a brief interactive session later, most of them revealed that they had difficulty in sleeping well and got dreams about earthquakes and floods. They were reassured that they were in a safe place and we would meet them again the next day.

On the second day, a drawing session was organized targeting the same group that was met the previous day, where the children were allowed to draw anything of their choice. While most of them came up with general scenery of Car Nicobar, 3 children came up with images of the flood.

Group relaxation training followed the drawing session. First the procedure to relax was demonstrated to them and then they were given group relaxation in the lying posture. The whole procedure lasted for about 30 minutes.

Some of the children who were present the first day either moved out of the camp, or got dislocated when another member of their family joined them by the evening on the day of our intervention.

TRAINING OF LAY COUNSELLORS

The team of 5 clinical psychologists was inadequate to provide services for the survivors from Car Nicobar. As a group of officers' wives volunteered to help in any way possible, it was decided to train them to render psychological services to the maximum number possible.

Two groups were trained, consisting of 6 and 4 women respectively. The training consisted of an orientation about the emotional reactions of people experiencing loss and crisis. Intervention strategies were also discussed. The focus was mainly on providing active listening, allowing the individuals to ventilate their pent up emotions and feelings related to the trauma. The dos and don'ts of effective listening were also discussed.

While the participants were informed about the effects of trauma counselling on the caregivers themselves, a few opted out of the group, as they were not emotionally prepared for it.

The lay counsellors were initiated into counselling as observers of group sessions and later they started counselling groups of women under supervision. Later they conducted group sessions and individual's sessions on their own.

On the second day, the lay counsellors engaged in individual sessions, especially for those who could not or were not willing to leave their bed.

OUTCOME

  1. The people acknowledged the benefit of the individual counselling.
  2. Training lay people in counselling helped to continue the relief work even in the absence of the intervention team.
  3. The group sessions facilitated people, who were hesitant to talk about their traumatic experience in individual sessions, to open up.

OBSERVATIONS

  1. Majority of people reported to have recurrent images, thoughts, and feelings of tremors, fear, nightmares and disturbed sleep.
  2. Reaction to the loss of the loved ones was expressed through non-verbal behaviour and required training to attend to those.
  3. People who had lost their loved ones expressed the need for understanding their emotional state than expressing pity or questioning them about the loss.
  4. Parents were repressing their feelings in front of their children.
  5. There is a need to provide psychological help to the family members.
  6. Men seemed as if they had adjusted to the reality.
  7. The acceptance of the event/loss was difficult among women than men, especially mother's who lost their infants had great problems due to milk production, which reminded them again and again of their missing/dead child.
  8. Anger towards God was seen in adults as well as children who had different kinds of loss.

RECOMMENDATIONS

  1. Persons who have lost a loved one or still waiting for their husbands to return, may be offered supportive counselling which will help them to be prepared for any kind of news about their missing family members and to accept it relatively better.
  2. A follow-up of those individuals who are presently experiencing intense emotional turmoil would be ideal. This can help in their long-term adjustment and restoration of normalcy.
  3. With regard to future interventions, proper screening and preparation of volunteers for training in lay counselling is recommended. This can avoid loss of personnel after the training has been imparted.
  4. It appears necessary to facilitate formation of support networks among the survivors themselves, so that social support can continue even after the relief measures/ services are withdrawn.

Members of the Team

 

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