1. 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

2. 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)

3. 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.

4. Aceh Jan 2005 Courtesy of Rahmat Hidayat

5. Quick facts about Earthquake and 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

6. Aceh Jan 2005 Courtesy of Rahmat Hidayat

9. The Ring Model courtesy 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

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. RING IV: PSYCHOLOGICAL PROBLEM •Minor to mild stress disorders related to the quake. •Anxieties related to possible (bigger) disasters in the future.

18. 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.

19. CRISIS CENTER FACULTY OF PSYCHOLOGY, UGM INDONESIA IN COLLABORATION WITH ROYAL CHILDREN HOSPITAL, AIHI/NOSSAL INSTITUTE FOR GLOBAL HEALTH-UNIMELB, & WORLD VISION AUSTRALIA - AUSTRALIA MENTAL HEALTH RECOVERY PROGRAM (Jan 2005-June 2008)

20. Program Purpose Develop integrated, sustainable and comprehensive mental health services in Meulaboh and Banda Aceh and build community capacity for improved mental health status

21. 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.

22. MAIN PROGRAM

23. 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.

24. Kec. SamatigaKec. Johan PahlawanKec. Kaway XVI BALEE ZAITUNA Puskesmas Johan Pahlawan (Marty) RSU CND (A.H.Dwijuwon o, Marty, EndangEka) Puskesmas Kaway XVI (Eka) Barak Desa Cot Seumeurun g (A.H.Dwijuw ono) Desa Suak Timah (A.H.Dwijuw ono) PUSTU Desa Keude Tanjong (Eka) PUSTU Desa Padang Sikabu (A.H. Dwijuwono) POS KESEHATAN SATELIT (POSKESLIT) Desa Leuhan (Eka) PUSTU Desa 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

25. 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

26. JUMLAH KLIEN TOTAL FEBRUARI 2007 TOTAL OKT0BER 2007 TOTAL DESEMBER 2007 NoLOKASI PELAYANAN Klien BaruKlien LamaKlien BaruKlien LamaKlien BaruKlien Lama 1Center Balee Zaituna 532582508250 2Rumah Klien (Home-visit) 361267526752 3Desa Suak Timah 23931123112 4Barak Desa Cot SeumeureunG 18532103210 5Tenda Tsu Chi Reusak 204141 6 Klinik WALHI / Yayasan Bumi Sehat Gampong Cot 23142124212 7Puskesmas Samatiga 00301213

27. JUMLAH KLIEN TOTAL FEBRUARI 2007 TOTAL OKT0BER 2007 TOTAL DESEMBER 2007 NoLOKASI PELAYANAN Klien BaruKlien LamaKlien BaruKlien LamaKlien BaruKlien Lama 8Puskesmas Arongan Lambalek 101010 9Puskesmas Bubon Layung 414141 10Puskesmas Johan Pahlawan 5431477816192 11Pustu Blang Beurandang 257328 8 12Pustu Suak Ribee 5027132713 Poskeslit Barak Desa Leuhan 160389 9 14Puskesmas Meureubo 41083519362

28. JUMLAH KLIEN TOTAL FEBRUARI 2007 TOTAL OKT0BER 2007 TOTAL DESEMBER 2007 NoLOKASI PELAYANAN Klien Baru Klien Lama Klien Baru Klien Lama Klien Baru Klien Lama 15Desa Suak Timah 33267307946 16Pustu Padang Sikabu 959797 17Pustu Keude Tanjong 190 0 0 18Rumah Sakit Cut Nyak Dhien 401294114256 JUMLAH 23419817375875444 JUMLAH SESI PELAYANAN / KUNJUNGAN KLIEN 253 1192 1319

29. NONO Tempat Pelayanan 20052006 DesMarAprMeiJunJulAgustSeptOktNovDes 1Center Based/RS034226 240 7 1 2Lam Asan2321700 492 0 0 3Lam Bateung000006 71014 13 3 4Blang Krueng0001068 760 0 7 5Baet-Cadek-Payung0001012 567 5 7 6Lampineung 7Klieng Meuria 8Puskesmas Darussalam000021 222 2 3 9Puskesmas Ulee Kareng000200 321 1 2 10Puskesmas Mibo000005 438 1 0 11Puskesmas Lambada Lhok 2 1 Jumlah2663210383442343124

30. NONO Tempat Pelayanan 2007 Total JanFebMarAprMeiJuniJuliAgustSeptOktNovDes 1Center Based/RS 313538 343604 83 2Lam Asan 02210 334026 62 3Lam Bateung 53 4Blang Krueng 04020 310000 54 5Baet-Cadek-Payung 82610 10316012 92 6Lampineung 22000 001300 8 7Klieng Meuria 00010 000000 1 8Puskesmas Darussalam 42553 1044523 61 9Puskesmas Ulee Kareng 69253 011102 41 10Puskesmas Mibo 36685 107161447 107 11Puskesmas Lambada Lhok 34521 232010 26 Jumlah294431282032233445934 588

31. Total Number of Client 2005-2007=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

32. 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 leader In collaboration with the local government

33. Training of Psychological Support and Mental Health Early Detection •They actively refer a client 533 community leader were trained (during 2 years) •They actively promote mental health •Reducing stigma on mental illness

34. MENTAL HEALTH PROMOTION through MEDIA Poster I ntroducing Stress Buletin Healthy Family and Parenting Family communication

35. Promosi Kesehatan Mental Melalui Media Konsultasi  Local Tabloid Counselling coloumn Leaflet Enhancing Self Confidence Introducing Psychologist Psychologist VS Medical Doctor

36. ADVOCATION ON MENTAL HEALTH POLICY •WORKSHOPs (high level representative, stakeholder) •STUDY TOUR (introducing MH system  Victoria,Sleman District) •BUILDING PERSONAL RELATIONSHIP •INSERTING SERVICE INTO PRIMARY HEALTH CARE

37. 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

38. BANTUL EARTHQUAKE

39. MODUL PSCHOLOGY OF DISASTER •Lesson learned from Aceh and Bantul •International Workshop (UGM-Ruth Wraith (RCHI-Melb)-Witruk(Liepzig Univ Germany))

40. 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