Enhancing Students Participation in Disaster Preparedness (Trauma
Healing Program) for the Victim of Disaster to Minimize a Post Traumatic
Stress Disorder (PTSD) Syndrome
Compiled by:
Sri Hindriyastuti ([email protected])
Mariyati ([email protected])
Nursing School Medical faculty of Diponegoro University
Program Studi Ilmu Keperawatan Universitas Diponegoro (PSIK FK UNDIP)
Jl. Prof Soedharto Tembalang Semarang 50275
Phone: (024) 76486849
Fax: (024) 76480919
Website: www.keperawatan.undip.ac.id
The authors:
A. Correspondence Author:
1. Name : Sri Hindriyastuti
2. Date of Birth : Pati, 13 March 1987
3. E-mail : [email protected] / [email protected]
4. School : Nursing School -University of Diponegoro (PSIK FK UNDIP)
5. Biography :
I am actively involved in local, regional and national organizations. In 2007, I was elected as a coordinator of Social society department of Nursing Students National Organizations (ILMIKI), in 2008; as a president of Student Nursing Council in UNDIP (University of Diponegoro), in 2009; won scholarship from US department of state to study English and Cultural program in America, selected as Indonesia representative in YES 2009 (Youth Engangement Summit) in Malaysia and got 1st winner of National Essay Competition in theme “what can I do as a student to change the world”. Now, I am as project officer of Nonprofit Organization namely YEP (Youthempowering) also as a team of trauma healing for disaster from our Nursing School of UNDIP.
B. 2nd Author
1. Name : Mariyati
2. Date of Birth : 15 May 1988
6. School : Nursing School -University of Diponegoro (PSIK FK UNDIP)
3. Biography :
Mariyati is a student of Nursing School of Diponegoro University. She is active in social activities and research programs. Now, she is as a leader of holistic care program, research programs and entrepreneurship for nursing students. She won a creativity research for students in 2010. Recently, she develop a program namely Ners Travel, this program involve a nurse or nursing students in the event of travel trip in order to enhance the involvement of nursing students in community area. This program provides nursing students to help participants in travel program to conquer unpredicted things happened during the trip.
Enhancing Students Participation in Disaster Preparedness (Trauma Healing Program) for the Victim of Disaster to Minimize a Post Traumatic
Stress Disorder (PTSD) Syndrome
Sri Hindriyastuti, Mariyati
Abstract – Indonesia lies in a strategic location which is consist of 17.583 islands guide Indonesia as a potential place of natural disaster. Tsunami in Aceh (2004), Wasior flood (2010), Eruption of Merapi (2010), Mentawai Tsunami (2010) are some examples of a big natural disaster happened in Indonesia. These disasters remain big trauma in mental health status of the victims including Post Traumatic Stress Disorder (PTSD) syndrome. Considering of this case, the involvement of health students in disaster preparedness especially in trauma healing program is considerably important. Nursing School of Diponegoro University, Indonesia has tried to develop a new strategy in order to increase the capability of students to be involved in disaster preparedness. The project namely trauma healing team which tried to engage students, increase their awareness of social aspects, in additional also help any other medical workers or the volunteers to help the victim of disasters. The program mainly involved students to give some modest therapy but very effective to decrease the level of stress, trauma and post traumatic stress disorder (PTSD) syndrome. In general, we hope that this method will be applied in other universities outside Indonesia as a form of disaster preparedness from education aspect since natural disaster may happen in every part of the world.
Keywords: Students participation, Disaster Preparedness, PTSD syndrome
Enhancing Students Participation in Disaster Preparedness (Trauma Healing Program) for the Victim of Disaster to Minimize a Post Traumatic
Stress Disorder (PTSD) Syndrome
Education: Enhanching access, insuring success
Sri Hindriyastuti, Mariyati
Diponegoro University, Indonesia
e-mail: [email protected] / [email protected]
Abstract – Indonesia is a potential place of natural disaster. Tsunami in Aceh (2004), Wasior flood (2010), Eruption of Merapi (2010), Mentawai Tsunami (2010) are some examples of a big natural disaster happened in Indonesia. These disasters remain big trauma in mental health status of the victims including Post Traumatic Stress Disorder (PTSD) syndrome. Considering of this case, the involvement of health students in disaster preparedness especially in trauma healing program is important. Nursing School of Diponegoro University, Indonesia has tried to develop a new strategy in order to increase the capability of students to be involved in disaster preparedness. The project namely Trauma Healing Program which tried to engage a group of nursing students and some students outside nursing program to increase their awareness of social aspect. This program trains them to help the victim of disaster. The program mainly involved students from various majors be involved in disaster preparedness. This program should be supported by the government and NGO (Non Government Organization). We hope that this method will be applied in other universities as a form of disaster preparedness from education area since natural disaster may happen in every part of the world.
Introduction
Indonesia consists of 220 million people living in 1.9 million hectares of lands and consists of 17.583
islands, which has 120 active volcanoes and 5.680 rivers (BAKORNAS, 2010). This situation leads
some natural disasters happened in Indonesia. Indonesia and other countries have experienced an
increase number of disaster. Successful efforts to address these and other disaster situations need
sophisticated preplanning measures and a well coordinated implementation effort during the actual
disaster situation. Comprehensive planning requires that everyone have contingency plans to meet any
and all situations that may rise during and after occurrence of actual disaster itself.
Some major disasters such as tsunami, flood, earthquake, volcanic eruption, landslide, mudslide,
snowstorm, fire, explosion, hurricane, tornadoes occurred everywhere. In Indonesia, during this 2010,
there are some big disasters happened such as Wasior flood in Papua, Padang earthquake, Mentawai
Tsunami and Merapi Eruption. These disasters leave a high number of victims whether they die, or
survive in a deep trauma in their live because of physical defect. The trauma may stay through a span
life of the victims and lead to mental health disorder. Physical injury may be able to heal perfectly,
but psychological disorder needs a comprehensive treatment to avoid big effect in the mental health of
the victims.
A limited number of volunteers and health care provider in a refugee camp post disaster event then
become a big issue in Indonesia since Indonesia is very easy of getting disaster. The involvement of
students in disaster preparedness is very important since students are very easy to receive a new
knowledge. Students participation in this case will help themselves to enhance their sensitivity to the
social effect as well as their willingness of helping others.
Content
The American Red Cross (ARC) define disaster as “an occurrence, either natural or manmade, that
causes human suffering and creates human needs that victims cannot alleviate without assistance”
(ARC, 1975), based on this definition. From this statement, disaster similar as one of the producers of
human suffering that may occur. The human suffering consists of two categories, mental health/
psychological aspect and physical health (ARC, 1975). While Meichenbaum (1995) argues that
disasters are traumatic events that are so extreme or severe, powerful, harmful or threatening that they
demand extraordinary coping effort.
This definition leads us to the specific meaning of disaster effects such as physical, social,
psychological consequences that are exhibited to various degrees in different person, community,
environment and cultures depending on past experiences, coping skills, and the scope and nature of
the disaster (Smith and Maurer, 2000). Because most people affected by a disaster pass through
predictable stages of psychological response, some health care professionals can anticipate and
prepare for the needs of the victims (Demi and Miles, 198).
Individual responses to disaster are unique. Some of the common psychological reactions to the
survivor of disaster are depression, sadness, fear, anger, guilt, irritability, anxiety. Feeling of
depression appears when they lost everything they have while sadness and guilt appear when they lost
their family. Their anxiety sometimes appear in some ways such as hyper alertness, palpitations or
whether angry. There are many kind of stress and anxiety levels in the victim of post disaster that may
occur and cause a Post Traumatic Stress Disorder (PTSD) syndrome. Post-traumatic stress disorder
(PTSD) syndrome is identified in the third edition of the Diagnostic and statistical Manual of Mental
Health Disorders (American Psychiatric association, 1994). PTSD was first recognized in veterans of
Vietnam War as a syndrome occurred after a number of traumatic events including war, terrorism,
disasters.
People reaction to the disaster may different from each others. The speed of onset, severity and
duration of symptoms are determined by many personal variables. Despite psychological distress,
many people can function effectively during the impact phase of disaster but will later experience
severe emotional distress (Smith and Maurer, 2000).
Individual reaction can be defined into the diagram:
Physical Proximity
Severity of Disaster
INDIVIDUAL REACTION Support systems
Psychological Proximity
Coping skillsConcurrent losses
Role Conflict
Role Overload
Previous Experience
WarningNature of Disaster
Fig. 1. Variables influencing disaster reaction. (redrawn from Demi, A.S., and Miles, M.S. (1983).Understanding Psychologic Reaction to Disaster. Journal of Emergency Nursing, 9(1),(2)
Three criteria define the syndrome; the trauma must be universally recognized, the individual must re-
experience the trauma through flashbacks, dreams or triggering events and the individual must
demonstrate physic impairment. Furthermore, victims of PTSD experience two or more of the
following symptoms: hyper alertness or exaggerated startle response, sleep disturbance, survival guilt,
decreased concentration, impaired memory and avoidance behavior (Smith and Maurer, 2000). If
survivors do not recognize and deal effectively with these feelings they may suffer numbness and
exhaustion in a long period of time. Volunteers and health workers should be sensitive with this kind
of syndrome after some time after the actual event has occurred since this kind of trauma will appear
in a life span of the survivor which possible of leading to the mental health disorder.
Understand the risk of trauma to the disaster victims, the preparation for disaster is very important.
The need for disaster response is greater today than sometimes ago. It is because disaster happens
unpredicted in every part of the world. The increase of human populations, effect of pollutions as well
also contributes a lot for the happening of disaster. The more disaster happens, the more trauma
influence the life’s victims. Smith and Maurer (2000) emphasize that most victims will have some
psychological reaction to the disaster situation. To overcome this condition, some therapies activities
may effective to be implemented. As a part of disaster preparedness, these therapies including playing
therapy, cooking therapy, relaxing, explore the feeling, focus group discussion.
The assessment of mental health status may vary. A standard assessment used by some health
institutions to know the level of stress is by using standardize format available.
Tab.I : Format of Disaster Stress Reaction Assessment
Disaster Stress Reaction Assessment
1. Has client experienced a disastrous event? Yes: No:2. Was this event generally outside the range of human experience? Yes: No:3. Would this event evoke symptoms in almost everyone exposed to it,
even those who have been emotionally healthy previously Yes: No:
if answer to first three questions is ye, client may be experiencing a disaster stress reaction. Continue assessment.
4. _____a. Re-experiencing disaster through recurrent intrusive recollections or dreams.5. _____b. Re-experiencing disaster in response to environment triggers6. _____c. Feeling of unreality , numbness, or lack of responsiveness to events7. _____d. Decreased interest in previously significant people8. _____e. Decreased interest in previously meaningful activities9. _____f. Hyper alertness10. _____g. Increased startle response11. _____h. Guilt about surviving disaster or about behavior during disaster12. _____i. Difficulty concentrating and/ or remembering13. _____j. Avoiding activities or places that stimulate recollection of disaster14. _____k. Worsening of symptoms with exposure to events that symbolize or resemble disaster
experience.
Three or more of these symptoms indicate high likelihood of client’s having a disaster stress reaction.
Other symptoms not diagnostic of disaster stress reaction, but that may accompany the reaction, are the following:____ increased irritability____Unpredictable explosion of aggressive behavior____ Impulsive behavior (if a change from previous pattern)____Overwhelming sadness
From Demi, A.S., &Miles, M.S. (1983). Understanding psychologic reaction to disaster. Journal of Emergency Nursing 9, 13-16.
Case Study
The many disasters that have occurred during the 2000s and 2010s in Indonesia have brought a big
effect for mental and physical condition of the victims. These disasters have required for emergency
preparedness to the attention of Indonesian public. Unfortunately, some disaster preparedness in
Indonesia just focused on the physical disaster management while mental health management was still
being ignored.
The limitations of health worker in disaster area cause an ineffective handling of trauma. In our
nursing school of Diponegoro University for example, we make a group of trauma healing. This group
consist of some students who is interested in disaster preparedness especially for healing process of
trauma. This group consists of students from nursing major coming from different grade. This team
regularly held a trauma healing training such as how to give a modest therapy that effective to be
implemented to the victim of disasters.
Recently, this trauma healing team also did open recruitment for students outside nursing program.
This is because we are realize that everyone can become a volunteers for trauma healing process of
the victims since our programs are simples and easy to adapt by others major. Some training we
include in our project cover the individual and group therapy.
The existence of this trauma healing team is very important. As a students, the team of trauma healing
have involved in some disaster program beside that the team also have given some disaster
preparedness training for other majors. In November 2009, a 7.6 magnitude earthquake struck off the
city of Padang on Indonesia's Sumatra islands, killing at least 75 people and trapping thousands under
rubble. In this case for example, the team of trauma healing from students of nursing school have
involved actively in giving some therapies to the victims in order to minimize a Post Traumatic Stress
Disorder (PTSD). This therapy includes individual therapy such sharing experience or group therapy
such as cooking therapy, playing therapy, focus group discussion.
(All Pictures courtesy by: team Trauma Healing Nursing School of Diponegoro University)
Pic 1: Explore feeling (individual therapy) by Team of Trauma Healing of Nursing Program Diponegoro University
Pic.2 Motivation Therapy (group therapy)
Pic. 3. Home Visit (Family Therapy)
Pic. 4. Cooking therapy (Group therapy)
In this program, nursing School of Diponegoro University has made cooperation with PKPU or Post
Keadilan Peduli Umat (The National Humanitarian Foundation). The cooperation with this NGO
(Non Government Organization) is considerably important in order to make students well organized
in doing their activities for the victims. The support from NGO or Government for the involvement of
students in disaster preparedness will built good cooperation across volunteers for the victim of
disaster in maintaining the healing process of trauma.
Recently, in November 2010, an eruption of Merapi Volcano in Jogjakarta attract the team of trauma
healing of nursing program of Diponegoro University to get involved in the trauma healing process to
the victims. Different from Padang earthquake, in this case, the team not only consists of nursing
students, but we also offer an open recruitment which is aimed to get students from other major to be
involved in our project. We got a good response from some other majors in our University, then they
join our team of trauma healing and then we involved together in disaster area, specify in refugee
camp to give support and some therapies for the victims.
Pic 5. Team of Trauma Healing of Nursing School Medical Faculty of UNDIP for Merapi Eruption, Jogjakarta. 2010
Pic 6. Laughing Therapy (group therapy)
After doing assessment by interviewing participants and spread out 112 questionnaires, we can
analyze that the victims of Merapi eruption still have a feeling of anxious about their next future. 73%
of them suffer from lower anxiety, 17% of them middle anxiety and 10% of them got higher anxiety.
Most of them confused about their home, their future life, their family. In refugee camp, we gave
intervention such as health education, playing therapy for children, laughing therapy, explore feeling
(sharing experience), educate children, focus group discussion. Some of the victims said that the
programs should be follow up in their new community. They hope that there will be community
mental health program in their new place of life they will get after the disaster.
Conclusion
Disaster occurs in every part of the world. In Indonesia, there are many big disasters happened during
the last decade. Every disaster leaves physical and psychological effect for the victims. the lack of
volunteers or health worker may requires solutions. This is because the preparation for disasters and
effective response when a disaster occurs can help minimize the long-term effects of these events such
as mental health disorder that begin from the occurring of Post Traumatic Stress Disorder (PTSD)
syndrome. Educational institution, can actively involved taking a part actively in disaster
preparedness. Establish a team of trauma healing will very effective to help the victims from trauma.
But, the involvement of health students in minimizing PTSD syndrome or mental health disorder will
not fully effective if there is no support from other institutions or social organizations. That is the
reason why the government and other institutions should support the disaster preparedness program.
References
American Psychiatric Association. 1994. Diagnostic and statistical manual f mental health disorders
(3rd ed.). Washington, DC: Author.
American Red Cross (ARC). 1975. Disaster relief programs. 2235. Washington, DC. Author.
BAKORNAS. (2010). Management disaster in indonesia, retrieved December 14 2010.
http://www.aprsaf.org/data/malaysia_tecshop_data/malaysia_presen_day1/pm/4_Indonesia.pdf
Demi, A.S., and Miles, M.S. 1983.Understanding Psychologic Reaction to Disaster. Journal of
Emergency Nursing, 9(1),(2).
Meichenbaum, D. 1995. Disasters, stress and cognition. In. S.E. Hobfol & M. W. de Vries (Eds.),
Extreme stress and communities: impact and intervention (pp. 33-45). Boston: Kluwer academic.
Smith and Maurer. 2000. Community health nursing; theory and practice. W.B Saunders Company.
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