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THE TSUNAMI

The most powerful earthquake in 40 years erupted under the Indian Ocean near Sumatra on Dec. 26, 2004. It caused giant, deadly waves to crash ashore in nearly a dozen countries, killing tens of thousands. THE TSUNAMI. ABOUT THE EARTHQUAKE.

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THE TSUNAMI

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  1. The most powerful earthquake in 40 years erupted under the Indian Ocean near Sumatra on Dec. 26, 2004. It caused giant, deadly waves to crash ashore in nearly a dozen countries, killing tens of thousands. THE TSUNAMI

  2. ABOUT THE EARTHQUAKE • The 9.0 earthquake occurred along 1,200 km of seabed at a depth of 10 km • it was so powerful, it made the earth wobble on its axis and permanently altered the region • it generated energy equivalent to the simultaneous explosion of 23,000 Hiroshima atomic bombs • it moved small islands off Sumatra's coast by as much as 20 and the north-western tip of Sumatra by 36 metres

  3. ABOUT THE TSUNAMI • The tsunami struck on a Sunday morning when families had gathered for a day at the beach • When the water receded, adults and children alike ran to pick up fish lay flapping in the sand • The first wave was small in comparison to the destructive second wave. In Banda Aceh, survivors described the approaching wave as “…a black wall the height of a coconut tree.” [70-100 ft tall]

  4. 0830 0930 1.0 09002.0 0830 09303.5 0759 10006.0 Tsunami Strike Times Sunday, December 26, 2004

  5. KOH LANTA, THAILAND

  6. PHUKET BEACH, THAILAND

  7. WORLDWIDE SUMMARY

  8. BANDA ACEH, INDONESIA

  9. BANDA ACEH SUMMARY • 127,000 dead. 30,000 missing • 40% municipal employees perished • 90% all public buildings destroyed • 12 of 21 health centers, 5 of 7 hospitals destroyed • 100 schools rendered unusable • Coastal fisheries, rice fields destroyed

  10. BANDA ACEH SUMMARY • 2/3 of all land records lost • Majority of bank records gone • Cement industry ruined • Main commercial strips leveled • Warehouses flattened • 8-12 inches of dense, salt-saturated mud covers the city up to 3 km from the shore

  11. 275 Medical Personnel: Physicians, Nurses, Corpsman, Specialists 90 Medical Personnel: Physicians, Nurses, Social Workers 18 Pub Health Personnel: Physicians, Nurses, Environmental Health, Medical engineer Psychologists Social workers USNS MERCY OPERATION UNIFIED ASSISTANCE ►Floating Tertiary care hospital ►1000 bed capacity, 250 for OUA ►12 Operating Rooms, CT, Pharm, O2 ►Full crew – 1,200+ personnel ►Built a Supertanker in ’74, convt’d ’86 ►894 ft long, disp 70,000 t. ►Last key mission: Persian Gulf War 1990 ►Instances of previous use of flight deck for patient operations: 0

  12. MISSION *Primary mission: Project support ashore. Project Primary Care medical capability ashore: Primary Medical Care - Internal Medicine, Infectious Disease, OB/GYN, Pediatrics, Optometry, Dental, and Mental Health. Project other support functions ashore: Disease Surveillance, Field Testing, Laboratory Services, Immunizations, Insect Control, Preventive Medicine, Veterinary Assistance, Engineer, Supply Distribution and field-based services determined by HN and NGO partners. *Secondary mission: Shipboard Health Services

  13. 29 Jan 05 May Singapore RTHP San Diego MERCY OPERATIONS SEQUENCE As of 17 Mar 05 HADR Assistance Ops Medical / Dental TSC Events Transit Transit USPHS 1ST Rotation 6 Jan 3 Feb 19 Mar 22 Apr U/W from San Diego VIC Banda Aceh, ID Singapore Pearl Harbor Kepualuan Alor, ID LOCATION Dili, TP Madang, PG Majuro, MH 1 Unclassified

  14. Participating Nation Military Operations LST x 2 C-130 x 6 B-707 x 1 UH-1 x4 INDIA C-130 x 1 Ships x 30 Helos x 30 Fixed Wing x 22 C-130 x 2 Ships x 2 Helos x 3 Med Team Eng Team U-tapao Forensic Team Ships x 5 AN-32 x 7 MI-8/17 x 6 Helos x 3 Fixed Wing x 2 Medical Team x 2 1 x DVI Team Fixed wing x 1 MP Team Med Team C-130 x 1 LST to ID LST to SL Field Hosp Eng Team x 2 ALT x 2 HH-60 x 2 Field Hospital Med Team SRI LANKA Khao Lak FFG ARS 2 x helos Ships x 7 Field Hospital Field Hospital Eng Team Ship x 1 Enroute Colombo Ship x 1 C-130 x 2 Helos x 2 Med Team Eng Team Aceh Helos x 1 C-160 x 2 Hospital Ship Helos x 2 C-130 x 1 Water System Medan Ship x 1 Helo x 1 C-130 x 1 Ships x 2 LPD/AOR CH-47 x 3 HH-60 x 2 Med Team Meulaboh C-130 x 1 Ships x 2 DART Team ROWPU x 4 Med Team Eng Team K.L. LPA – CJTF 629 Helos x 2 Ships x 12 Helos x 13 Fixed Wing x 5 Male Helos x 4 Ships x 28 Helos x 2 Fixed Wing x 15 C-130 x 2 Ships x 2 Eng Team C-130 x 5 CH-47 x 4 Super Puma x 4 French Ships X 2 Helos x 8 Med Team Swiss Helos x 3 ETA: TBD C-130 x 2 Med Team Ships x 4 Helos x 3 Fixed wing x 3 Medical Team x 4 INDONESIA Eng Team Hospital Ship AUS BRN DEU IDA KOR NOR SGP RNZAF B-757 in region LKA NZL THA AUT CAN FRA IND USA CHE JPN MYS PAK BGD GBR Darwin 2 x C-130 UNCLASSIFIED

  15. Civilian Relief Operations CHINA • SRI LANKA • 84 NGOs Operating • ICRC: household items, • shelter, water, medical • care • IFRC: household items, • shelter, food, water, • medical care • Oxfam: water, sanitation • IOM: water • Care Int’l: general relief • items • Mercy Corps: cash-for- • work, household items, • food, water INDONESIA 68 NGOs Operating • THAILAND • 35 NGOs Operating • Thai Red Cross: food • distribution • World Vision Int’l: building • materials, water/sanitation • facilities • Banda Aceh • Indonesian Red Cross: cooking/ • hygiene items; water/sanitation • World Vision Int’l: food aid • Medecins Sans Frontieres • Mercy Corps: cash-for-work, • food, relief supplies • IOM: shuttling IDPs • Care Int’l: food INDIA • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level THAILAND PHILIPPINES U-Tapao • Meulaboh • Indonesian Red Cross • Medecins Sans Frontieres • Mercy Corps: cash-for- • work, food Phuket Kuala Lumpur MALDIVES Colombo Male SRI LANKA Butterworth B-Aceh MALAYSIA • ANDAMAN / NICOBAR • ICRC • Catholic Relief Services: • home rebuilding • Medan • Medecins Sans Frontieres • IOM: shuttling IDPs Meulaboh Medan SINGAPORE • MALDIVES • 17 NGOs Operating • Save the Children Sumatra Diego Garcia INDONESIA MALAYSIA (Near KL) - Malaysian Red Crescent Jakarta SINGAPORE - ICRC Regional Hub 26 CLERK Unclassified Darwin AUSTRALIA

  16. OUA MISSION(from 40,000 ft. level) • Part humanitarian relief • Part international diplomacy • Part global public relations • Part experiment in military-civilian joint operations

  17. CONSTRAINTS TO MENTAL HEALTH MISSION • Constraints of timing • on-site arrival (6 weeks post-incident) defines nature of med/surg and mental health activities • Constraints of access • to potential aid recipients, planning partners and ready communication • Constraints of time (in theater) • limiting access to target populations and organizations • limiting scope and scale of aid projects • limiting ability to leverage targets of opportunity

  18. OPERATIONS PLAN

  19. FOCUS ON BEHAVIORAL HEALTH BANDA ACEH, INDONESIA

  20. Mental Health InfrastructureAceh Province, Indonesia • Before the disaster • Psychiatry rare ~1/2 dozen in province • One psychiatric hospital. No institutionalized system of community care for the seriously mentally ill. • No psychology • No social work • Unable to determine the nature and extent of role of Islamic leaders in psychosocial care

  21. Mental Health InfrastructureAceh Province, Indonesia • Before the disaster • One psychiatric hospital, 4 locked units • 2 short-stay units (male, female) • 2 long-stay units (male, female) • ~200 patient hospitalized • After the Tsunami • One flooded, marginally cleaned, still US 1950’s vintage psychiatric hospital • 60+ patients remain, the others died in the wards or escaped as the waters rose

  22. BANDA ACEH, INDONESIA

  23. Factors promoting emergence of psychosocial symptoms • The acute response phase of the disaster has passed • In addition to the enormous loss of life, there is widespread social disruption and economic and institutional destruction • Rebuilding is on a slow track because of endemic mismanagement and tepid political support for the province

  24. Factors promoting emergence of psychosocial symptoms • Acute response phase has passed • Great loss of life + widespread social, economic and institutional disruption • Rebuilding slowed - mismanagement and tepid political support for the province • Unavoidable, omnipresent traumatic reminders (everything has been touched by earthquake / tsunami)

  25. Factors promoting emergence of psychosocial symptoms • The large number of missing delays the important process of grieving for many • Population has access the emotions of pain and loss and the Culture has language to express it • Emergence of religious justification of events • Unavoidable, omnipresent traumatic reminders (everything has been touched by the earthquake and tsunami)

  26. NEWSThe Tsunami’s Psychological Aftermath 12 August 2005 “…the tsunami triggered an...unprecedented attention to the mental health of the survivors, many of whom saw their children or other family members carried away by the waves.” • The WHO suggested that: • 50% of the 5 million affected people would experience psychological distress that would fade without intervention over the course of a year or more. • Roughly 5% to 10% would develop more persistent problems, such as depression, posttraumatic stress disorder (PTSD), or other anxiety disorders that would be unlikely to resolve themselves without intervention. • And perhaps 1% to 2% would be left with incapacitating mental problems such as major depression or psychosis.

  27. Mental Health ObservationsBanda Aceh, Indonesia • Respectful reluctance to speak of events use of avoidance, redirection, rather than denial • Willingness and interest in speaking of events when topic arises unavoidably • An ability to express and share sadness • Father, son and former insurance agent

  28. Mental Health ObservationsBanda Aceh, Indonesia • Expressed optimism about the future and simply stated resignation about the tragedy • An understanding that events, feelings and function in the world are linked • the father and a foundation • psychosis and miscommunication

  29. Faith and Psychosocial Resilience in Banda Aceh • Islam teaches that human beings have no control over matters of life and death. The day of death for every individual is decided upon his birth. • Daily prayer ritual provides continuation of pre-disaster routine and reminder of God’s presence and will. • Islamic charities very active in humanitarian relief post-disaster

  30. Faith and Psychosocial Resilience in Banda Aceh • No well publicized modification of burial ritual for dead • No well publicized recommendations on mourning for the missing • No widespread dissemination of religious findings related to personal or collective culpability for the disaster

  31. NEWSThe Tsunami’s Psychological Aftermath 12 August 2005 “At the same time, many people who have worked with tsunami survivors are struck by their resilience. Asian culture, with its emphasis on group welfare over individual self-reliance, seems to have been a powerful, positive influence.” Sadly, a long-standing familiarity with upheaval and tragedy may also have bolstered the coping mechanisms of many tsunami survivors. People here have a tough life to begin with,…The expectations in life are very different from those in the West. Many people…view the tsunami more as the latest obstacle life has thrown at them than as a cataclysmic blow.”

  32. What Interventions Make Sense? • Institutional • Support existing institutions • Rebuild destroyed ones • Individual • Provide individual or group services • Population • Adapt well-heeled population interventions to current cultural context

  33. Considerations for population psychosocial intervention in Aceh • Restore homes, community, institutions and economic infrastructure • Provide psychosocial education through community leaders, networks and structures (“erte”)

  34. Considerations for population psychosocial intervention in Aceh • Primary care/mental health professional development • reconstitute preexisting established professional structure • consider primary and maternal child care cross-training • Use health care professionals and paraprofessionals to disseminate pyscho-educational information

  35. Considerations for population psychosocial intervention in Aceh • Make substantial outreach to faith leaders to encourage: • a declaration of pardon to relieve followers who were not able to perform death rituals • a statement clarifying position on the personal/population blame for the disaster • advice to those whose loved ones are still missing • the provision of faith-appropriate psycho-educational information

  36. THE HOME STRETCH

  37. “They knew to run…” The Sydney Morning Herald By Lindsay Murdoch, Correspondent in SimeulueDecember 30, 2004 They knew to run on Simeulue, a palm-fringed island closest to the epicentre of Sunday's devastating earthquake. "Our ancestors have a saying - if there is an earthquake run for your life," Darmili, the mayor of the island, said yesterday. "Thousands of our people were killed by a tsunami in 1907 and we have many earthquakes here." Only five of 70,000 villagers on Simeulue were killed, all of them in the earthquake that struck at 7.55am last Sunday. Nobody perished in the five-metre-high walls of water that followed.

  38. A NARROW ESCAPE

  39. LAMNO LAMNO Isolated from points North, South and East

  40. A WALK THROUGH LAMNO

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