Courtesy of Crisis Center Faculty of Psychology, UGM, Indonesia

In collaboration with

Royal Children Hospital,AIHI/Nossal Institute for Global Health-

UNIMELB, &World Vision Australia - Australia

COPING TO DISASTER

LESSON LEARNED FROM ACEH & BANTUL

Quick facts about Aceh

• The western part of the Indonesia

• 3 hours flight from Jakarta (capital city)

• Rich Islamic culture (one of the first communities in Indonesia to be introduced to Islamic tradition)

• Long history of conflict (between Indonesian Government and Aceh Freedom Movement (GAM)

Quick facts about Earthquake And Tsunami

The earthquake– 9,0 on the Richter Scale (RS)– Tremors at higher than 4,5 RS continue up to 2

months after the major shock– Minor to major property destruction, injuries and

death.– Intense psychological terrors: Fear of a recurring

tsunami and being trapped in collapsing building.

Aceh Jan 2005

Courtesy of Rahmat Hidayat

Quick facts about Earthquakeand Tsunami

The tsunami– Up to 34 meters high – Up to 7 kilometers from the shoreline– Minor destruction to total demolition– Mud and debris, including corpses littering

residential areas– Injuries and permanent disabilities, and

number of death on an unprecendeted scale

Aceh Jan 2005

Courtesy of Rahmat Hidayat

The Ring Modelcourtesy of Rahmat Hidayat

• Assumption: varying degree of destruction, varying level of personal involvement.

• Methods: In-depth interview with survivors.• The ring:

– Ring I: total demolition by the tsunami– Ring II: partial destruction by the tsunami– Ring III: flooded area– Ring IV: earthquake effected area – Ring V: outside the disaster area

RING I: TSUNAMI’S TOTAL DEMOLITION

• Totally demolished by the force of the tsunami.

• Area: 0 – 3 km. from the sea shore.

• Survival rate: 20% or less.

• Survivors losses:

Houses and properties, including capital wealth.

Most of all members of direct family.

RING I: PSYCHOLOGICAL PROBLEM

• Accute stress dissorders: Immediate effects of the traumatic experience.

• Accute feeling of helplessness.

• In-depth interview reveals some positive thinkings:

Having miraculously survived, they got the feeling of God’s mercy.

Unconditional acceptance of the losses.

RING II: TSUNAMI’S DESTRUCTED AREA

• Partial destruction by the force of the tsunami.

• Area: 3 – 5 km from the sea shore.

• Survival rate: 50%.• Survivors’ losses:

Properties and damages on the house.

Some members of direct family.

RING II: PSYCHOLOGICAL PROBLEM

• Survival factor: efforts, including running, swiming, climbing, etc.

• Chances for helping others.• Wathching the drowning or

disappearance of the loved ones.• Psychological problems:

• Accute stress dissorders.• Guilty feeling.• Anxiety regarding the future.

RING III: TSUNAMI TIDE

• No significant physical damage.

• The tide brings along mud and debris, including corpses of the victims.

• Survival rate higher than 80%.

• Most seek for refuges at refugee camps and relatives’ houses.

RING III: PSYCHOLOGICAL PROBLEM

• Stress disorders related to the immediate effects of the traumatic experience.

• Anxieties related to the anticipation of possible disasters in the future.

• Psychological problems related to inactiveness and discomfort of the camp.

RING IV: EARTHQUAKE AREA

• No direct impact of the tsunami disaster.

• Survival rate close to 100%.

• Not seeking for refuge.

• Losses:

• Minor to major damages from the quake.

• Losses of distant families.• Further stressors:

• Earthquake tremors.

• Issues of further tsunamies.

• Issues of diseases.

RING IV: PSYCHOLOGICAL PROBLEM

• Minor to mild stress disorders related to the quake.

• Anxieties related to possible (bigger) disasters in the future.

RING V: DISTANT AREA• No physical effect of both the quake and the

tsunami.• Within and outside NAD.• Relatives of friends in the calamity areas.• Uncertainty regarding the safety of the relatives

or friends.• Emotional bond and economic dependance

(e.g., students) with the relative or friend.• Minor to mild grief.• Affective dissorder, including depression and

suicidal tendencies.

CRISIS CENTER FACULTY OF PSYCHOLOGY, UGM INDONESIAIN COLLABORATION WITH ROYAL CHILDREN HOSPITAL,AIHI/NOSSAL INSTITUTE FOR GLOBAL HEALTH-UNIMELB, &WORLD VISION AUSTRALIA - AUSTRALIA

MENTAL HEALTH RECOVERY PROGRAM

(Jan 2005-June 2008)

Program Purpose

Develop integrated, sustainable and comprehensive mental health services in Meulaboh and Banda Aceh and build

community capacity for improved mental health status

LOGFRAME• Activity 1. Integration of the program with the provincial

mental health service, national policies and other relevant mental health programs, policies, services and

institutions.• Activity 2. Establishment of mental health community

centers in Banda Aceh and Meulaboh.• Activity 3. Increase local capacity in basic management

and mental health service administration.• Activity 4. Increase capacity of local mental health

clinical service delivery• Activity 5. To raise awareness of mental health, mental

ill health and mental health services in the community.

MAIN PROGRAM

Outreach Counseling

• Daily counseling service delivered by the two field center of Crisis Center, namely Balai Zaetuna (BZ) in Meulaboh and Rumoh Seurunee (RS) in Banda Aceh

• Outreach counseling delivered by the two center in some baracks, primary health care (puskesmas) and other satelite centers.

Kec. Samatiga Kec. Johan Pahlawan Kec. Kaway XVI

BALEE ZAITUNA

PuskesmasJohan

Pahlawan(Marty)

RSU CND(A.H.Dwijuwon

o, Marty, EndangEka)

PuskesmasKaway XVI

(Eka)

Barak Desa Cot

Seumeurung

(A.H.Dwijuwono)

Desa Suak Timah

(A.H.Dwijuwono)

PUSTU Desa Keude Tanjong

(Eka)

PUSTU Desa Padang Sikabu(A.H. Dwijuwono)

POS KESEHATAN SATELIT

(POSKESLIT)Desa Leuhan

(Eka)

PUSTUDesa Blang Beurandang

(A.H.Dwijuwono)

PUSTU Suak Ribee

(Marty)

Kec. Meurebo

Puskesmas Meurebo(Endang)

Klinik Bumi SEHAT

Gampong Cot

(Endang)

SERVICE AREA of BALEE ZAITUNA

RUMOH SEURUNEE

Kec. Banda Raya(Banda Aceh)

Kec. Baitussalam(Aceh Besar)

Kec. Syiah Kuala(Banda Aceh)

Kec. Ulee Kareng(Banda Aceh)

Kec. Kuta Alam(Banda Aceh)

Puskesmas Ulee Kareng(Tuti)

Puskesmas Mibo(Bintang)

Center/Rumoh Seurunee

(Bintang, Tuti, Farah)

Puskesmas Kopelma Darussalam (Tuti)

Puskesmas Lambada Lhok

(Bintang)

Barak Lampineung

(Bintang)

Barak Blang Krueng

(Bintang, Tuti)

Barak Cadek Baet

(Bintang, Tuti)

Desa Lam Asan

(Bintang)

Barak Klieng Meuria(Tuti)

SERVICE AREA of RUMOH SEURUNEE

JUMLAH KLIEN

   TOTAL

FEBRUARI 2007TOTAL

OKT0BER 2007TOTAL

DESEMBER 2007

No LOKASI PELAYANAN Klien Baru Klien Lama Klien Baru Klien Lama Klien Baru Klien Lama

1 Center Balee Zaituna 53 25 82 50 82 50

2 Rumah Klien (Home-visit) 36 12 67 52 67 52

3 Desa Suak Timah 23 9 31 12 31 12

4 Barak Desa Cot SeumeureunG 18 5 32 10 32 10

5 Tenda Tsu Chi Reusak 2 0 4 1 4 1

6Klinik WALHI / Yayasan Bumi

Sehat Gampong Cot 23 1 42 12 42 12

7 Puskesmas Samatiga 0 0 3 0 12 13

JUMLAH KLIEN

   TOTAL

FEBRUARI 2007TOTAL

OKT0BER 2007TOTAL

DESEMBER 2007

No LOKASI PELAYANAN Klien Baru Klien Lama Klien Baru Klien Lama Klien Baru Klien Lama

8 Puskesmas Arongan Lambalek 1 0 1 0 1 0

9 Puskesmas Bubon Layung 4 1 4 1 4 1

10 Puskesmas Johan Pahlawan 54 3 147 78 161 92

11 Pustu Blang Beurandang 25 7 32 8 32 8

12 Pustu Suak Ribee 5 0 27 13 27 13

13 Poskeslit Barak Desa Leuhan 16 0 38 9 38 9

14 Puskesmas Meureubo 41 0 83 51 93 62

JUMLAH KLIEN

    TOTAL FEBRUARI 2007

TOTAL OKT0BER 2007

TOTAL DESEMBER 2007

No LOKASI PELAYANAN Klien Baru

Klien Lama

Klien Baru

Klien Lama

Klien Baru

Klien Lama

15 Desa Suak Timah 33 2 67 30 79 46

16 Pustu Padang Sikabu 9 5 9 7 9 7

17 Pustu Keude Tanjong 19 0 19 0 19 0

18 Rumah Sakit Cut Nyak Dhien 4 0 129 41 142 56

  JUMLAH 234 19 817 375 875 444

  JUMLAH SESI PELAYANAN /

KUNJUNGAN KLIEN   253  1192 

 1319 

NO

Tempat Pelayanan

2005 2006

Des Mar Apr Mei Jun Jul Agust Sept Okt Nov Des

1 Center Based/RS 0 3 4 2 2 6 2 4 0 7 1

2 Lam Asan 2 3 2 17 0 0 4 9 2 0 0

3 Lam Bateung 0 0 0 0 0 6 7 10 14 13 3

4 Blang Krueng 0 0 0 10 6 8 7 6 0 0 7

5 Baet-Cadek-Payung 0 0 0 1 0 12 5 6 7 5 7

6 Lampineung                      

7 Klieng Meuria                      

8 Puskesmas Darussalam 0 0 0 0 2 1 2 2 2 2 3

9 Puskesmas Ulee Kareng 0 0 0 2 0 0 3 2 1 1 2

10 Puskesmas Mibo 0 0 0 0 0 5 4 3 8 1 0

11Puskesmas Lambada Lhok                   2

1

  Jumlah 2 6 6 32 10 38 34 42 34 31 24

NO

Tempat Pelayanan

2007

Total

Jan Feb Mar Apr Mei Juni Juli Agust Sept Okt Nov Des

1 Center Based/RS 3 13 5 3 8 3 4 3 6 0 4   83

2 Lam Asan 0 2 2 1 0 3 3 4 0 2 6   62

3 Lam Bateung                         53

4 Blang Krueng 0 4 0 2 0 3 1 0 0 0 0   54

5 Baet-Cadek-Payung 8 2 6 1 0 1 0 3 16 0 12   92

6 Lampineung 2 2 0 0 0 0 0 1 3 0 0   8

7 Klieng Meuria 0 0 0 1 0 0 0 0 0 0 0   1

8 Puskesmas Darussalam 4 2 5 5 3 10 4 4 5 2 3   61

9 Puskesmas Ulee Kareng 6 9 2 5 3 0 1 1 1 0 2   41

10 Puskesmas Mibo 3 6 6 8 5 10 7 16 14 4 7   107

11 Puskesmas Lambada Lhok 3 4 5 2 1 2 3 2 0 1 0   26

  Jumlah 29 44 31 28 20 32 23 34 45 9 34   588

Total Number of Client2005-2007=1907 person

7 fulltime psychologist

During the first year, totally outreach counseling (the people of Aceh did not see the psychologist voluntarily)

In the second year, inline with Mental Health Promotion done by the two centers, the people of Aceh gradually come to the psychologist voluntarily

Training of Psychological Support and Mental Health Early Detection

Recruiting & educating community leader to be mental health caders: teachers, primary health care teams and religius leaderIn collaboration with the local government

Training of Psychological Support and Mental Health Early Detection

533 community leader were

trained (during 2 years)

•They actively refer a client

•They actively promote mental health•Reducing stigma on mental illness

MENTAL HEALTH PROMOTION through MEDIA

PosterIntroducing Stress

BuletinHealthy Family and Parenting

Family communication

Promosi Kesehatan Mental Melalui Media

Konsultasi Local Tabloid Counselling coloumn

LeafletEnhancing Self

ConfidenceIntroducing Psychologist

Psychologist VS Medical Doctor

ADVOCATION ON MENTAL HEALTH POLICY

•WORKSHOPs (high level representative, stakeholder)•STUDY TOUR (introducing MH systemVictoria,Sleman District)

•BUILDING PERSONAL RELATIONSHIP•INSERTING SERVICE INTO PRIMARY HEALTH CARE

ACHIEVEMENT

1• Support from local government

and local parliament • take over the system and service

after 3,5 years, by local government’s funding

2 •Increasing awareness on Mental Health •Society voluntarily seeking help from MH professional

3 •Pioneering comprehensive MH system•Psychiatrist, CMHN, GP working together within referral system

BANTUL EARTHQUAKE

MODUL PSCHOLOGY OF DISASTER

• Lesson learned from Aceh and Bantul• International Workshop (UGM-Ruth Wraith

(RCHI-Melb)-Witruk(Liepzig Univ Germany))

Content of The Modul• Psychology as a content (micro skill)

- assessment

- disaster preparedness

- disaster management

- intervention• Psychology as a package (macro skill)

Psychologist among non psychological science