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

She described a case of what she called tsunami hysteria. “While we were there, a little girl started yelling 'tsunami is coming; tsunami is coming.'

“Sure enough, on that day, there was another minor tremor. There was no tidal wave, but people got scared. The moral of the story is that through the hysteria they were expressing, the children got the whole camp riled up,” said Dr. Sriskandarajah, speaking prior to the 8.7 earthquake that hit the area March 28.

Tsunami survivors are best helped by other survivors, said Vijay Chandra, M.D., a World Health Organization regional mental health adviser.

“The best method of dealing with [the devastation] would be to find people in neighboring villages or communities, people of similar cultural background, who understand the cultural norms to help them,” Dr. Chandra said in a statement.

Additionally, the WHO is improving mental health services in Sri Lanka and has provided a 1-day refresher workshop on psychosocial approaches for 150 school advisers, who will work with teachers in tsunami-affected areas.

The WHO has encouraged aid workers in affected countries to implement the organization's document “Mental Health in Emergencies,” which emphasizes a culturally sensitive approach to care through increased community outreach efforts and by customizing support to meet the special needs of children, women, and the elderly.

The Rotary Clubs have asked Disaster Psychiatry Outreach to train lay counselors to help in affected communities, but Dr. Katz acknowledged that the prospect is overwhelming.

“It's much easier for us to train a bunch of psychiatrists on how to do disaster psychiatry–or train a bunch of physicians on how to identify PTSD [posttraumatic stress disorder],” he said.

Another possibility is to send psychiatrists over there to do direct care, which is how the DPO was originally envisioned: “as a kind of Doctors Without Borders for psychiatry.

” I don't think we've ruled that out for Sri Lanka, but it would require a lot of resources and funding that I'm not sure we'd have in place,” he said.

The organization plans to reach out to Sri Lankan expatriates in the North American psychiatric community a bit further, and Dr. Sriskandarajah also has contacts in the United Kingdom and in Australia.

“We want to send some child psychiatrists,” she said. “But child psychiatrists are in short supply here.”

In late March, the DPO led a team of four physicians to the Kilinochichi and Mullaitivu district on a 2-week mission to work with counselors in the Annai Illam counseling program. They will be trained in general disaster psychiatry, post-disaster child interventions, and cognitive-behavioral therapy for trauma-affected people. These were the same counselors who helped area residents recover psychologically from years of civil war.

And the DPO undertook another trip to Sri Lanka in late April–this time to the southern and western areas.

According to Dr. Katz, the DPO is committed to developing a sustainable program for Sri Lanka and not having its efforts turn into “2 weeks of disaster tourism and then it's over.”

Ultimately, the organization hopes to work with community groups and to train local leaders to be counselors within their communities.

“We can't make them psychiatrists overnight. But we can build up basic knowledge of mental health in these communities so that they can be peer counselors and use what we know is a crucial part of recovery from trauma: good psychosocial support,” Dr. Katz said. We want them to “somehow use their instincts of supporting each other and add a pinch of psychiatric expertise.

“That is what we are hoping to be able to do.”

If you'd like to participate in preparations for and/or direct missions to Sri Lanka, contact the DPO for more information at 212-598-9995 or visitwww.disasterpsych.org