These guidelines are written for outside helpers who are going into the tsunami-affected areas AND for friends, family members, neighbors and others living in the area who would like to offer help to those who survived, lost someone, or who are affected emotionally by the disaster.

When you go into a community, you might meet two kinds of people. One group has witnessed and survived the tsunami. The other group didn't see it but lost someone or many people they know. In both cases, they have been impacted by the event and need support to recover. The impact comes from having experienced something out of ordinary human experience, AND having lost so many people (someone dear to them, friends or co-workers they know, and the large scale loss of life). The impact is also about having been in the area where this kind of unpredictable event took place. Also, people's view of nature and the world as somewhat predictable changes and they begin to feel more uncertainty about whether this kind of thing can happen again. They feel fear and lose confidence in their ability to protect and take care of themselves.

People from Burma may be impacted even more than Thais or westerners. First, this is not their home, and they have come due to the political and economic situation in their home country. Also, most people cannot return even if they want to because of financial hardship, security risks, safety issues, language barriers, and, at times, physical and/or psychological injuries. Additionally, here in Thailand , they are exploited by their employers. They don't have the power to control the various parts of their lives, including at work, in legal matters, in getting health care, in getting education for themselves and their families. Because they are in the foreign land, they are invisible and they are vulnerable. This invisibility, vulnerability, and insecurity sets up the people of Burma to experience complex trauma (beyond the typical degree of impact for a Thai or foreigner). It will be important to keep this information in mind when you are meeting with people from Bu! rma affected by the tsunami.

When you meet with someone affected, you may notice some or all of the following things that tell you that you may need to start by giving support before moving on to your routine work:

1. Their faces looked distressed; they are not in the present, but instead their minds seem to be somewhere else that is disturbing; their faces have no life; they look exhausted; they don't seem to want to talk.
2. Other people start talking about their experiences and their losses right away and can't seem to stop themselves. They need to tell someone what happened.
3. Some people will be crying and in despair or will be extremely angry or irritable.
   
   

These are all indications of trauma. Here are five different groups of symptoms we may see in the people who are experiencing trauma from the tsunami:

1. re-experiencing symptoms: thinking about the traumatic events and having trouble getting them out of the mind; feeling the same ways one felt during the disaster, such as fearful, helpless, etc.

2. arousal symptoms: jumping or getting startled at the sound of a loud noise or something that is unexpected (like someone coming up from behind and touching unexpectedly); irritable and angry a lot, sleep disturbances, high anxiety quite a bit of the time....

3. avoidance symptoms: feeling numb, not feeling anything, not going near the place where the tsunami happened, avoiding those areas, wanting to leave the area...

4. survivor guilt: in situations where others died and we survived, feeling guilty about having survived, wondering why we survived and others didn't, thinking about what I should have done to save someone or why I couldn't hold on to someone....

5. spiritual crisis: Questioning one's faith; having a crisis of faith OR clinging to one's religious beliefs and system even more to get through.

Here are some simple ways to support people affected by the tsunami. Again, this means you may have to postpone your business with them and start by offering support first. The support should be offered from the power-sharing approach rather than the power-over or expert approach. The power sharing approach means believing that the person has strength and wisdom and is capable of taking responsibility for their own recovery. Of course, the helper has experience, wisdom, and resources to help. This means the helper works together with the affected person or people to support them in regaining strength, confidence, and the ability to return to normal life. On the other hand, the power-over or expert model assumes that people are helpless and need to be told what to do and "taken care of" because they don't have the inner resources to deal with their own problems and challenges.

First and most importantly, offer compassionate listening throughout your meeting.

Compassionate listening means:

1. Use body language that shows friendliness, openness, warmth, safety, and that you are willing to listen to them;
   
2. Listen to what they have to say with respect. Let them talk without a lot of interruptions, especially when you first meet them. Instead of immediately changing the subject to the reason you are there, or giving advise, just repeat back the main points you heard them say (Examples: So you seem to be saying....; What I am hearing you say is.....) and also let them know you are following how they feel (Examples... Sounds like you are feeling...... because........).
   
3. If they are crying usually it is fine to extend physical touch on the arm or should as a gesture of care and connection.
   
4. Be prepared for expressions of strong emotions, including sadness, anger, fear, guilt, and/or confusion.
   
5. By listening well and being a witness for their suffering, this already is helping them release their emotions and to feel that they are cared about and not alone.
   
6. By listening compassionately at first, you will help many of them clear their minds so that you can then get on with your business with them and they will be able to think more clearly.

Some people may be ready to move into business after you have listened to them compassionately. For others you may need to do some or all of the following steps to help them deal with their trauma so that you can then move on to your other work with them. Be sure to use compassionate listening throughout these steps.

Steps:

1. Find a place to talk that is free of distractions and where the person or People can feel that they can talk privately
2. What happened? Begin by asking them to talk about the facts of what happened to them before, during, and after the actual tsunami event.
3. What were you thinking? Ask the person/people to talk about what was going through their minds/what they were thinking before, during, and after the tsunami events.
4. Emotional responses? Ask the person what were the most difficult parts of the tsunami experience. Be prepared for crying, anger, and other feelings to come out.
5. Trauma responses? Ask the person/people what unusual things they are now experiencing following the tsunami events (nightmares, difficulty sleeping, thinking about the tsunami events, thinking about those that were lost....numbing out, not feeling anything...)
6. Normalize and educate... Discuss with the person/people that the events that happened were unusual and not part of our ordinary human experiences. Let them know that their symptoms are normal responses to these extraordinary circumstances and that it can take time to work through them and return to normal functioning. Explain the five kinds of responses outlined above that are commonly seen in people after they have been through this kind of disaster (re-experiencing, arousal, avoidance, survivor guilt, spiritual crisis). Be sure to use simple language to explain these.
7. Explore where they find strength to get through this period. Then offer other information about what is helpful in the healing and recovery process: talking with friends, helpers, and others about the experience (releasing difficult feelings and thoughts), eating regularly, getting into a routine every day, doing some meaningful activities, doing some spiritual practices (meditation, chanting, rituals, etc.). Ask the person to talk about what they would like to do and give support for their doing it. Help them problem solve if needed.
8. Plan: What will they do from here?

A note about mental health treatment for tsunami survivors and other affected persons: The symptoms that people typically show after this kind of disaster are part of a short-term stress response. Usually they don't need to see a mental health professional or to have medication. If they receive good support and can resume normal life, the symptoms will go away gradually over time. However, some people have very severe symptoms or symptoms that don't go away. In these cases, they will require evaluation and treatment by a mental health professional. The symptoms may be very extreme and/or continue for many weeks.

If you see the following symptoms, help the person get a mental health evaluation:

The person shows very extreme emotions consistently, for many days, without change, such as...

- cries all the time

- cannot sleep for many days/nights

- does not eat for many days

- shows no sign of life or awareness

- stares off into space most of the time, for many days at a time

- disconnects from friends and family for many days at a time

- cannot get the tsunami events or dead friends/relatives/bodies out of their minds for many days

- angry and agitated much of the time for many days

- says "I want to kill myself" or "I want to die" regularly and seriously

Here are some you should not do because not only will it not be helpful, it would make their suffering worse!!

1. Do not tell them "Forget about it. You will get over it."
2. Don't tell them not to feel how they are feeling. For example, don't say: "You shouldn't feel sad. You are not the only one who had this happen. Its no big deal."...or..."You should not be angry...."..."Its not good to cry... you will keep the dead person from going on to the next life..."
3. Do not tell them "Its your kamma that this happened; Oh, I am sorry... you happened to be one of the the unlucky ones."
4. When you meet with someone, if they show the symptoms discussed above, don't ignore it. Go ahead and offer support, then do your business.
5. If you help them discuss a plan for their future, don't promise help that you cannot deliver (Examples: taking them somewhere; financing their trip home; looking for the dead relative,etc.). Remember, they already are living in uncertainty so not following through on a promise can do damage or interfere with their healing process.
6. Do not pressure them with your own ideas and solutions. Support them in making their own decisions.
7. Do not argue with them, especially when you have a different opinion or disagree with what they are saying.
   

Helper self-care

Please note: It is better to go to the affected area in teams because of the intensity of the work and because of the exposure to difficult experiences. This allows for someone to take a time out when necessary and there will still be others to carry on the work. Also, often, in this culture, when helpers go into a community, many people will come over at the same time to see what is going on and to talk. Having several team members available allows the team to respond to the varying needs of community members. For example, one or two helpers can work with a larger group and another team member can go and talk with someone who is sitting alone. It is critical for the team to debrief at the end of each day about how they have been affected by the work that day. Team members provide important emotional support throughout the day and during the daily debriefings. In addition to the emotional support, daily debriefings also offer the team an opportunity to reflect on lessons learned that day so that the team can improve their skills and counseling approach in preparation for the next visit and so that they can be as effective as possible.

In working with people who have survived traumatic situations, especially in cases of large scale disaster, helpers are vulnerable to being emotionally impacted by hearing story and after story and by seeing the physical devastation in the affected area. At some point, the helper could develop secondary trauma or vicarious trauma, meaning that the helper begins to have some of the same symptoms as the affected individuals they are helping. For example, the helper may not be able to calm down and may stay in "crisis mode", becoming very reactive in problem solving. Or, the helper may start to question whether what they are doing is helpful at all, or that they can never do enough. The helper may have a spiritual crisis of his or her own, or have difficulty sleeping, eating, or focusing.

In order to prevent secondary trauma, it is very important for the helper to do regular, daily self care. This can include:

Take breaks throughout the day, meaning stop working and stop thinking and

talking about work;

Take a walk

Do chanting or meditation

Read something not related to work

Do physical exercise

Listen to relaxing music

Do gardening

Play with children

Cook good food

**Be sure that helpers debrief at the end of each day (after finishing the work)

with co-workers.

Prepared by:

Ouyporn Khuankaew :International Women's Partnership for Peace and Justice
Chiang Mai , Thailand
email : mailto:

AND

Kathryn Norsworthy :

Rollins College , Ahimsa International:
Projects for Peace, Justice, and Mindful Living
Winter Park , Florida USA

email :