Psychiatrists Responding to Tsunami Tragedy : Disaster Psychiatry Outreach hopes to train local leaders in Sri Lanka to work as counselors.

Members of Disaster Psychiatry Outreach who traveled to Sri Lanka after the late December tsunami say their initial efforts to assist survivors are just the beginning.

“What we did was the easy part,” Craig Katz, M.D., cofounder and president of the New York-based DPO, told CLINICAL PSYCHIATRY NEWS. “What we saw and what we're going to do [about it] are the harder parts.”

Dr. Katz, who in January was accompanied by Nalaini Sriskandarajah, M.D., a DPO board member and child psychiatrist, said their objective was to develop a needs and assessment plan, and to determine how they could help.

The psychiatrists, who were hosted by local clubs, worked with the Rotary Council of Sri Lanka.

The devastation left by the tsunami that struck countries bordering the Indian Ocean on the morning of Dec. 26, 2004, is almost incomprehensible. Conservative estimates put the loss of life at 265,000-310,000, but a definitive count may be impossible.

The tsunami caused death and destruction in more than 11 countries, including Sri Lanka–where more than 31,000 people were killed, 12,000 of whom were children.

Nearly 1 million people in Sri Lanka were left homeless. The World Health Organization estimates that 90% of those displaced by the tsunami had also been displaced in the past because of more than 20 years of fighting between government forces and Tamil Tiger rebels.

Other countries affected were Indonesia, India, Thailand, Somalia, and South Africa. Centered off the western coast of north Sumatra, the undersea earthquake triggered waves up to 100 feet and will go down in history as the second largest ever recorded, at 9.3 on the seismograph.

While based in the city of Colombo, Dr. Katz and Dr. Sriskandarajah traveled through the affected southern districts of the country for several days. Then they visited northeast Sri Lanka, a region occupied by Tamil Tiger rebels. The regions are distinctly different.

“The reasons those distinctions are important is because [northern residents] are just emerging from years of war,” said Dr. Katz of the department of psychiatry at Mount Sinai School of Medicine, New York.

“They've had a truce there for about 2 years, and they were just climbing out of that and finally rebuilding economically and socially–and then [the tsunami] hit.”

While in the welfare camps, Dr. Katz said he remembers seeing a house that had been destroyed. Part of a wall was still standing and in it were bullet holes–apparently because the house was shot at during the war.

“It was a complete symbol of one bad thing happening on top of another,” Dr. Katz said. “That was rather powerful, and it was just a piece of concrete.”

In this part of the country, a group of about 18 counselors has been active since 1996. Their work during the conflict better prepared them to deal with this event, he said. They're not health professionals, but they've acquired a lot of training and experience over the years.

“We're hoping to work with them and give them some more specialized training … in child work and a little bit of [cognitive-behavioral therapy] to help them,” Dr. Katz said.

Whenever they could, he and Dr. Sriskandarajah visited “child-centered spaces,” which are designed to give children a place to play together.

Those spaces proved to be particularly important given the range of problems –including sleeplessness, nightmares, and flashbacks–that officials observed among the children at the newly established base hospitals in each district.

“In the daytime, they were happy and playing, because they were given structured activities,” Dr. Sriskandarajah said in an interview with this newspaper. “But they were waking up in the middle of the night or having nightmares, or refusing to go to sleep.”

The children sometimes have weekly visits from a psychiatrist who supervises the camp coordinators, which are the Sri Lankan equivalent of what we would call house officers, Dr. Katz said.

But resources are limited, and an on-site mental health staff is nonexistent.

Many children have been unable to sleep because they fear that the tsunami might return, one counselor told Dr. Sriskandarajah.

The counselors responded by lighting a fire outside. They told the children that if the fire went out, it would mean that the tsunami was returning–and the children could run.

“It seems to have helped the children a little bit,” said Dr. Sriskandarajah, who was born in Sri Lanka, is in private practice in Poughkeepsie, N.Y., and serves as chairwoman of the DPO's child and adolescent committee.

“These were [the] kinds of things that people were doing.”