STARTTS:Thefirst10 years

T he 10th anniversarycelebrations of Australia'sfirst refugee service for

torture and trauma survivors area landmark in a journey ofdiscovery and growth. They willprovide a rare opportunity toreflect on past and currentachievements.

Dr Andrew Refshauge, the NSWMinister for Health, will host theanniversary celebrations of theService for the Treatment andRehabilitation of Torture andTrauma Survivors at Auburn townhall on November 20.

In 10 years STARTTS hasprovided counselling, group work,physiotherapy, English classes,camps and excursions to thousandsof clients and currently has morethan 200 people on its waiting list.The majority of clients are from theformer Yugoslavia, South-East Asia,the Middle-East, Latin America andAfrica.

STARTTS anniversary willcelebrate the achievements of theservice and its ability to overcomethe many challenges it has faced. Itwill also celebrate the resilience ofrefugee clients and the contributionsmade by refugees to Australiansociety.

Funding for the service, initially atwo-year pilot project, came fromthe NSW Department of Health in1988 following the recom-mendations of a report made byProfessor Janice Reid, now vice-chancellor of the University ofWesternSydney.

"The horror of torture and theconsequences of its use confrontedus unremittingly as we read themedical literature and reports ofAmnesty International and listenedto the stories of refugees living inSydney who have undergone ordealsbeyond the comprehension of mostAustralians," Professor Reid said inthe report.

!:.

From humble beginnings in athree-bedroom cottage with a staff offour, STARTTShas expanded into aservice employing 50 people in twosprawling office blocks in Fairfieldand Auburn, a reflection of the vastneeds of torture and traumasurvivors in NSW.

"The level of enthusiasm andcommitment was incredible," saysSTARTTSExecutive Director JorgeAroche, recalling the early days ofthe service. "We were operating invery constrained conditions,developing a service from scratch."

One ofthe first challenges for theservice was to gain credibility withthe various refugee communities itintended to serve. Tiep Nguyen,counsellor for the Vietnamesecommunity, believes thatcommunity consultations were asignificant factor in achieving thisgoal.

" One of STARTTScore values is a visionof its clients assurvivors who haveenormous potentialto give. ~~

"The first consultation was heldwith the Indo-Chinese communities.We invited workers from theVietnamese, Lao and Cambodiancommunities and about 80 peopleturned up.

"People were very impressedwith STARTTSinitiative, both thosewho attended, and those who heardabout it later," saysTiep.

The success of the consultation,which aimed to get the support andinput of community leaders, meantthat community consultationsbecame an ongoing part ofSTARTTS' work. Since then,numerous consultations have beenheld with the Indo-Chinese, Middle-

1

by Helen Basili

Eastern and Latin-Americancommunities in Sydney.

Another difficult task STARTTSfaced was to gain the trust of clientsand communities who had beenextremely traumatised and often hada profound distrust of governmentagencies. This was exacerbated bythe fact that these people came fromcountries where counselling, in theWestern sense, was virtuallyunheardof. _ \\

According to Lucy Marin,~STARTTS counsellor for theSpanish-speaking communities, ithas been common practice in LatinAmerica for priests, family orfriends of a distressed person to takeon the role of counsellor. Lucy saysthe Western concept of counsellingwas not fully understood, especiallyin rural areas, although it wasaccepted among the Latin Americancommunities that talking to someoneabout your problems could behelpful.

The reluctance of potentialclients to seek individual therapywas a hurdle that was overcome byimprovisation and creativity."Peopledidn't want to come to us as-: '}'client' but they would be very happ"""to come and tell you all about theirtrauma over a cup of coffee. Werealised we needed to have a lotmorefle).ibility,"says JorgeAroche.

"1"":lsedto see one client in thepark. We had counselling sessionsunder a tree or on the bench."

Many counsellors set up groupsfor clients. This was an ingeniousway of bringing people together in anon-threatening manner so that trustcould be built up with individualswho would later seek counselling.

SaysLucy Marin: "I knew that forLatin Americans, it is quite easy toget into groups. My idea was toencourage the communities to startcoming to group activities beforecoming to seeme as a counsellor on aone-to-onebasis."..

Space was limited, so Lucy set upa Spanish-speaking women's groupin the garage. "It was extremely coldin winter and very hot in summer,"she says.

"It was completely abandoned sowe emptied and cleaned it, painted itand put some shelves there.

"The first activity we did waspottery making which was excellent.Doing that motivated the women towork with their own feelings. Theywere actually creating something inAustralia that belonged to them."

Zalmai Haidary, counsellor forthe Middle-Eastern communities,remembers the difficulties heexperienced trying to encouragecompanies to donate a sewingmachine to the STARTTS Middle-Eastern women's group. He wasunsuccessful.

L _ "STARTTS was new. People.., could not understand the nature of

the service or the issues forrefugees," Zalmai says.

Undeterred, Zalmai organised acommunity fundraising rame sothree second-hand sewing machinescould be purchased for the group. Assponsors could not be found, Zalmaiand several of the women from thegroup donated some of their ownhousehold items forprizes.

In 1989, STARTTS acquired asecond cottage, two doors up fromthe original location. With the extraspace, group-work prospered. Therewere physiotherapy groups, Englishclasses, a Vietnamese women'sgroup and groups for Lao and

~Vietnamese survivors of re-education camps.

At the same time, the number ofpeople seeking individual therapyskyrocketed. Funding enhancementswere received and the number ofcounsellors grew to meet theincreasing demand for the service.STARTTS also began to attract amore diverse clientele representing alarger number of ethnic groups andnationalities.

The process of developingmodels for counselling refugeesurvivors of torture and trauma hasbeen an ongoing one. Ten years ago,this presented a daunting task for thenew service. "The area was veryunexplored. When I first startedlooking for information on treatmentI could only find seven articles," saysJorge Aroche.

STARTTShas been something ofa pioneer in this area. Although theRehabilitation and Research Centrefor Torture Victims in Copenhagenand several other services in Europehad been experimenting with variousmodels there was still much to belearnt.

"Counsellors have gone throughquite a deep process of trying outdifferent models and workingthrough what they do and don'taccept", says Robin Bowles, ageneralist counsellor at STARTTS.

"At first I wondered whether wecould use any type of psycho-therapy with people from othercultures or whether it was totallyculture bound". After 10 years ofcounselling refugees, Robin haschanged her mind. "I think thatpsycho-therapy is a gem from theWestthat the whole world can use".

Robin believes that it is possibleto practice successfully from anumber of perspectives. "Theyprobably have a lot more in commonthan we realise," she says.

Jorge Aroche and MarianoCoello, STARTTSClinical ServicesCoordinator, have developed amodel to conceptualise the problemsaffecting refugees. Theimplementation of this approach hasresulted in a set of interventions thatattempt to address the problemthrough a variety of strategiesfocusing on different systems. Theserange from the individual and theirfamily, to the community togovernment services andpolicies.

The expertise of the service intreating survivors of torture andtrauma has grown to the extent thatstaff are often invited to presentpapers at national and internationalconferences.

STARTTS counsellors have alsopublished a number of articles inacademic journals. Tiep Nguyen,one of the services most prolificwriters, has had articles publishes!inthe Australian Journal of SocialWork and the Journal of AdvancedNursing and has also published aresource book on the Vietnamesecommunity in Sydney.

One ofSTARTTS core values is avision of its clients as survivors whohave enormous potential to give."The Fairfield local government areahas developed enormously becauseof the contributions of refugees," ..

2

IIUI8L8,8Jof events

by lan Nlcol

1987Janice Reid and Timothy

Strong published the reportTorture and Trauma: The Health

Care Needs of Refugee Victims inNew South Wales. The reportrecommended that a service beestablished to assist refugeesurvivors of torture and trauma.As a result, the NSW Ministerfor Health announced thatfunding would be allocated forthis purpose.

1988The NSW Minister for

Health appointed a managementcommittee with a brief to set up acounselling service for tortureand trauma survivors.

STARTTS began operatingfrom a three-bedroom cottage inHams Street, Fairfield. Therewere four part-time workers. Itwas the first service of its kind tobe established in Australia.

The clients at that time were,.p:'edominantly from LatinAmerica and South East Asia, aconsequence of the manydictatorships and socialdisruptions in those regions inthe 1970'sand 80's.

1989A camp and recreation

program was established forrefugee children at the RivendellAdolescent Unit of ConcordHospital. The program has beenrunning on a biannual basis eversmce.

Community consultationsheld with representatives of theLatin American and Indo-Chinese communities.

STARTTS received fundingfrom the Department ofImmigration for a grant in aidposition to enhance thecommunity development aspectof the service.

1990Community consultations

become an annual event forSTARTTS. Consultations areheld with a greater number ofcommunities including Lao,Vietnamese, Cambodian, LatinAmerican, Afghan, Tamil andIranian communities.

1991The Eye of the Needle video

and trainers' kit produced bySTARTTS. It was designed toenhance health and welfareprofessionals' understanding ofresettlement issues and improvetheir ability to providecounselling to torture and traumasurvivors. The Eye of the Needlepackage won the Silver MobieNational Award for ExternalCommunications

1992Friends of STARTTS (FOS)

was launched in April by theHonourable Michael Kirby andMrs Kathryn Greiner who alsobecame patrons of FOS. FOS isa non-profit, community-basedorganisation that raises funds toimplement STARTTSinitiatives.

The Eye of the Needlepackage won a MulticulturalMarketing Award presented bythe Ethnic Affairs Commission.

1993Margaret Cunningham,

Executive Director, representedSTARTTSat the UnitedNationsWorld Conference on HumanRights in Vienna.

The NSW Minister forHealth announced a fundingenhancement of $500,000 to begranted to STARTTS. Another$150,000 was allocated for apurpose-built premises. Thiswas the largest fundingenhancement since the inceptionof the service.

A Specialist MigrantPlacement Officer position wasbased at STARTTS to improvethe job prospects of refugeeclients through the provisons ofjob search and referrals, resumepreparation etc.

says Viliam Phraxayavong,STARTTS counsellor for the Laocommunity. "Because of thesuccessful businesses started bymigrants and refugees the Australianeconomy has grown. They add to thecolour of Australia with theirdifferent cultures and traditions".

According to Robin Bowles,refugees bring with them a valuingof democracy and individual rights."I think a lot of them really valueAustralian democratic institutionsand they fight for them. They bringmore of aworldly view to us."

The ability of refugees toovercome adversity is a continualsource of inspiration. Perhaps this isbest expressed by a former client ofSTARTTS Zalmai Haidary whowrote: "I feel that a great burden hasfallen off my shoulders and thatfeeling of depression is gone. Youhave helped me make that positivestep toward the future and given me asense of hope.".

Thefirst issue of

Transitionswas editedand producedby Olga Yoldiand HelenBasili.

3

1994Two staff members

represented STARTTS at theFourth InternationalConference of CentresInstitutions and Individualsconcerned with the care ofVictims of Organised Violence,5-9 December 1994 in thePhilippines.

The CommonwealthProgram of Assistance to Tortureand Trauma Survivors (PASTT)commenced funding the service.This increased STARTTSabilityto resource mainstream servicesto work effectively with refugeesand to extend other aspects of theservIce.

1995In 1995 STARTTSExecutive ...J;

Director, Margaret Cunninghamreturned from a visit of servicesfor torture and trauma survivorsin the Netherlands, Denmark,Norway, Ireland, England,Scotland, Canada, SanFranciscoand Los Angeles. Her trip wasundertaken as part of theChurchill Fellowship.

Training and outreach workwas extended to Newcastle,Wagga, Albury, the CentralCoast and Coffs Harbour to meetSTARTTS regional obligationsto refugees outside the Sydneymetropolitan area.

1996 A

The Minister for Health and ;,J;Aboriginal Affairs, the Hon.Andrew Refshauge, openedSTARTTS new premises inCarramar, on the outskirts ofFairfield. The premises werepurpose built for STARTTSandincluded rooms for groupactivities and meetings, officesand counselling rooms., The Families in CulturalTransition kit was launched atthe NSW Parliament House. Itwas a comprehensive andinnovative package whichcontained group activities,games and ideas for groupfacilitators to assist immigrantsor refugees adjust to living inAustralia. It is being widely usedby STARTTSand other services.

........

INTERVIEWwithSTARnSExecutiveDirectorIn the following interview STARTTS Executive Director, JorgeAroche, discusses the first 10years ofthe service and plans for thefuture.

Q. What are the biggestchallenges that STARTTS hasfaced over the last 10years?

It's not easy to tell you what thebiggest challenges have beenbecause STARTTS' history has beena succession of challenges. We have

{. hardlyhada timewhenwecouldsay~ that there was a routine.

From the beginning, justestablishing the service anddemonstrating the need for it was anenormous challenge. Establishingthe contacts, liaising with thecommunities and getting their trustwas the next part of the challenge.

There was the whole issue ofrefocusing the service so that wecould work in a holistic fashion. Thisinvolved expanding from what wasinitially quite a clinically focusedservice towards a more balancedservice as recommended in JaniceReid's report. The report emphasisedthat there needed to be holistic careof torture survivors and service

,r""',roviders needed to look at the~onfluence of problems effecting

torture survivors at different levelsfrom the individual to the family.Essentially, that was quite achallenge because it startedhappening slowly from my point of

~ view.I was hired to work in community

development and also to play aclinical role. Promoting thecommunity development aspect andworking to expand the focus of theservice was quite challenging andsomething that could only be doneslowly. Many people wereinstrumental in promoting thetransition and ensuring its success.Margaret [STARTTS formerExecutive Director] was certainlyone of the main drivers for thistransition.

There were fears at the time thatby adopting an approach thatintegrated community developmentand clinical service provision wemay be leaving the clinical aspect ofthe service behind and so there wassome resistance and ongoingdiscussion on the issue.

One of the ongoing challengesthe services faces are that thepopulation we work with willcontinue to change. Tenyears ago wewere working with Indo-Chinesepeople and Spanish speakers fromLatin America. These groups arevery low now in terms of newarrivals and refugees from theformer Yugoslavia and the MiddleEast make up the largest group. It isvery likely that situation willcontinue to change as events aroundthe world change. There's a need tocontinue to develop relationshipswith those communities as theyarrive sowe can meet their needs.

Q.What has it been like for youworking in an organisation in aconstant state of change?

It suited me to a T.I can't imaginemyself working for very long in anorganisation that was static. Isuppose it could get quite boring.

I think that although we havebeen changing and adapting tocircumstances there has always beena sense of purpose in theorganisation. I think that's the reasonwhy so many staff have stayed on.We had some staff leaving butnowhere near the normal attritionrate in a service of this kind.

The change in staffhas been morethrough new staffjoining the service.I think that's partially explained bythe fact that there has been that senseof purpose and continual change sothey don't need to changejobs to be ~

4

1997STARTTS commenced an

outreach service fromMarrickville Community HealthCentre

The first national conferencefor all Australian services fortorture and trauma services washeld.

1998The STARTTS Early

Intervention and CaseManagement (ElCM) programwas launched by the FederalMinister for Immigration andMulticultural Affairs, the Hon.Phillip Ruddock. An office forEICM staff was opened inAuburn.

STARTTS counsellor RiseBecker and youth worker GaryCachia presented with Awardsfor Excellence from theTranscultural Mental HealthCentre

Implementation of theRefugee ComprehensiveAssessment Tool (R-CAT)commenced. STARTTS andEICM staff use the R-CAT tosystematically collect and recordinformation about clients thatcan be used for treatment andresearch purposes.

STARTTS outreach servicesextended to refugees on theNorthern Beaches and Gosford.

First issue of Transitionspublished. _

doing different things.Certainly from the point of view

of the work it makes it a lot harderbecause there's no time to sit downand relax and develop a routine andwork from nine to five. There'salways been the need to put in theextra hours of work or extrainvolvement to make things possibleand ensure the survival of what wedo.

q

Q. What do you see as themajor achievements of theservice?

There have been a lot. Certainlybeing able to meet those initialchallenges of establishing theservices development andconnection with the communitieshas been an enormous achievement.

A very big challenge waschanging the focus of the serviceagain to include the earlyintervention program and to do thatwithout major problems. We havenot encountered any major strife andI think that's because of the way wewere able to handle that change. Ithink that in establishing the earlyintervention program we have beenable to successfully engage theimportant stakeholders to assist us tointroduce a very significant changeand support it. Getting the proposalthrough the management committee,getting staff to be part of it and thenestablishing the service has been anenormous achievement.

There were other things like TheFamilies in Cultural Transitionprogram that were great. The Eye ofthe Needle was the first trainingprogram for people working withtorture and trauma survivors that hada structure. Now it's due for anupdate but when we did it, it wasreally at the cutting edge and was thefirst train the trainer package in thisfield.

The development of a model thatincorporates a holistic approach andprovides a rationale for it and a wayof implementation has also been abig achievement. In fact, the modelhas now been applied in many otherservices throughout Australia andalso overseas and that I think is asignificant achievement.

Just the sheer amount and depthof the clinical work that has beendone in the service is remarkable.The developments in group work

I..(

and the developments in the way thatwe have been doing systematicconsultations with refugeecommunities for the last ten years.Things like that we take for grantednow but it took a lot to get off theground.

The establishment of theoutreach program and thedevelopment of an outreach modelthat projects our services and ensuresaccess to torture and traumasurvivors throughout NSW issomething that we are still engagedin but it isdefinitely an achievement.

I am sure that I am overlookingmany more achievements becauseone thing with achievements is thatonce you have met the challengesand achieved what you set out to dothen you move on to the next thingand it is easy to take them forgranted.

Like this building, STARTTSthree year old headquarters inCarramar. It was a maj orachievement at the time. Ouraccommodation was absolutelyappalling for the first few years ofthe service.

For information aboutthe next issue of Transitions

please call Helen Basiliat STARTTS on 9794 1900.

Things like maintaining themorale of the service and developinga culture that emphasises workingtogether, cohesiveness andmaintaining the commitment ofpeople who join the service. I thinkthose things again, are also oftentaken for granted by us.

So many people from outside askif our burnout rate is very high.

Although we talk a lot aboutburnout, and that's an intrinsic part ofpreventing it, our statistics show thatthe amount of people taking sickleave and the amount of people thatleave the service because they can'tcope with the stress is negligible.

This is an enormous achievementin a service that deals with horror.Considering all the literature onvicarious traumatisation and thedangers of it I think we've done amagnificent job in this area. It's asuccess that's very easy to overlook.

5

Q. What plans do you have forSTARTTS in 1999. In particular,what ideas do you have about theestablishment of a tele-psychiatryservice for regional areas?

Some of the challenges we stillface as a service are to extend accessto torture and trauma survivorsthroughout New South Wales. Oncerefugees arrive in Australia theybecome Australian residents so thereis no way to differentiate betweenthose who are refugees and thosewho are not from census statistics.You can make inferences, forexample, that most people who wereborn in Cambodia and speak Khmerhave come here as refugees, butwhen you talk about the Chinesecommunity, the Vietnamesecommunity or the Spanish speakingcommunity it gets very hard to know

who mayor may not have arrived as~a refugee or from refugee likesituations.

When you have a communitywith a thousand people in one placeand a thousand people in anotherplace, it's very difficult to estimatewhat proportion of refugees may bein a particular place.

Finding ways to extend ourservices to all regions in New SouthWales also presents an enormouschallenge. In rural New South Waleswe are facing very small numbers ofrefugees in different areas. At thesame time these refugees are morelikely to be isolated and have verylimited access to ethno-specific

services and interpreters. We are sti~ ~_looking at different possible avenue~to address this problem.

One response we have made is totrain people in regional centres andrural areas to work with torture andtrauma survivors but that may not beenough in certain cases, particularlywhere language is a problem. This iswhere the idea of using the tele-psychiatry approach came from.

We could make use of the muchbetter, much more accessibletechnology we have now to have atele-video conference and providesupervision to counsellors workingwith refugees in places far awayfrom Sydney and in certaininstances, see clients by using thatmedium. I think that may contributeto making the New South Walescoverage more realistic.

There are a lot of issues we need

to deal with still.Wedon't know howpeople are going to feel having acounselling session looking into ascreen with a camera focused onthem. It may very well be like usingan interpreter where people forgetthe interpreter is there or, in this casethe actual television, and be able toform a good relationship with theperson on the other side of thescreen. We don't know howappropriate and effective this may beand we would need to developprotocols to ensure the medium isused sensitively and effectively.

The medium also has to bereliable to use in a situation like this.The last thing you want is the cameracutting out at a crucial stage of theinterview. So there needs to be a lotmore investigation into the idea.

We would also need to develop

'" protocols regardingthe type ofsupport people need to have at theother end. Like should they havesomeone with them? It's somethingwe are going to explore.

Q. What plans do you have tointroduce a specialist clinic forrefugee children?

In general we are moving to thepoint where we are becoming acentre of expertise with aresponsibility to export thisexpertise to other people and trainthem to work more effectively withtorture and trauma survivors.

That goes side by side with thecontinuation of direct service

~. J'

..

rovision in order to sustain thengoing development of expertise.e need to add to our present

services by expanding our role insupporting, training and providingsupervision and consultation to otherservices so they can work moreeffectively with refugees.The otherarea we need to expand as an expertservice is the different specialtyareas that haven't been sufficientlyaddressed and certainly children isone of those areas. Traditionally,adults comprise the population thatgot the most attention from serviceproviders in the torture and traumaarea.

In the last few years we havebegun to realise that children showsymptoms and experience problemsat school and in other settings thatmay be related to both their owntraumatic experiences and also the

impact of the traumatic experiencesof their parents and their ability to beable to parent.

We have been working withchildren through our youth programand doing an increasing amount ofindividual work with children,learning all the time, but the modelwe work on needs to be furtherdeveloped. The development of achildren's clinic which enables us tofocuses more on the issues affectingchildren and develop a model forworking with children is a veryimportant area and it's somethingthat I'd like to see happen over thenext year or so.

Q. What other areas of workneed to be further developed?

In the next year or two we alsoneed to start focussing more on theaged and look at the impact of theconfluence between the agingprocess and the previous trauma thathas been sustained. This issomething that people are dealingwith in the European communitiesthat came after the war, the peoplewho were effected by the Holocaustand other atrocities in the secondworld war, for example the Jewishcommunity or the Polishcommunity.

Many of these communities havebeen telling us that aged people whohave undergone trauma and areaffected by age related illnesses may

6

begin to be less focused on thepresent and a lotmore focused on thepast. Of course when that happensthey will encounter those traumaticmemories and they will have lessresources to cope with the impact ofthose memories. There are a lot ofissues about prevention andmanagement of the potential impactof the aging process on torture andtrauma survivors.

We need to do a lot of work andresearch in this area and workcollaboratively with people andorganisations with expertise in thisarea. Over the next few years moreand more of our client group whocame 20 or 30 years ago as refugeeswill be entering old age and we needto start developing the tools and theexpertise to be able to assist themand resource their families and agecare services to meet this challenge.

There are many other areas ofspecialisation that we need todevelop, of course, and many otherchallenges to face..

LIVINGTHROUGH...thejourney.

I

TiepNguyenCounsellor / Project Officer (Vietnamese)Date commenced: November 1988

"At the Lunar New Yearfestival inCabramatta in 1993, STARTTS was

granted a plaque in appreciation ofwhat it had done for the Vietnamesecommunity. It was the first time thework of STARTTS had been publiclyrecognised by a community. "

ViliamPhraxayavOngCounsellor / Project Officer (Lao)Date commenced: September 1988

"1noticed most of the counsellorsloved the job. Time did not count

for us. We had a good team andwere very enthusiastic. "

ZalmaiHaidarvCounsellor / Team Leader

Date commenced: February 1989

"Ten years ago people hardlyunderstood about refugee issues.Today there is a commonunderstanding. The communityhas been well educated and

STARTTS and many other servicesfor refugees have played a great role.There are forums and workshops onrefugee issues and discussions inthe ethnic media. "

LueyMarinCounsellor/

Project Officer (Spanish speaking)Date commenced: June 1990

"1can see that for many of myclients who had been extremelytraumatised, although they still

remember the past, they functionin society in a very normal

way and have been very successfulas well."

RobinBowlesCounsellor / Project Officer (Generalist)

Date commenced: November 1988

"You are driven by a passion forhuman rights and the rewards

from doing the work. If someone isgetting better that's wonderful andthatjust drives you to keep going. "

MarianoCoelloClinical Services Coordinator

Date commenced: April 1991

"Working at STARTTS has beenan enriching experience. I have

learned a lot about differentcommunities their customs, their

beliefs and their hopes. I havelearned from the strength of

survivors. It has been satisfYingto assist these people. "

7

.

MINISTERlaunchesnewSTARnSprogram

The Minister for Immigrationand Multicultural Affairs, MrPhillip Ruddock, launched a

new STARTTSprogram to a crowdof more than 500 clients and serviceproviders at Ashfield town hall onJuly 22.

The Early Intervention and CaseManagement program is part of anational initiative, launched by theMinister at the same ceremony,which provides a comprehensiveassessment of the needs of refugee

~ and humanitarian entrants to. Australia.Theaimis to facilitatethe

settlement process for new entrantsby linking them to appropriatehealth, welfare and settlementservices. "Resettlement is atremendously complex task," saidSTARTTSExecutive Director JorgeAroche, who spoke at the launch."This is particularly so where thebackground of the people concernedincludes exposure to highlytraumatic situations involvingpersonal losses, and long term

1

,

NOBEL~EACE PRIZE

WINNERatSTARnSby Reten Basili

NObel Peace Prize winner

Jose Ramos Horta visitedSTARTTS on 12 August to

learn about the organisations' workwith East Timorese survivors oftorture and trauma.

STARTTS Research Assistant,Kristina Tang outlined a study on theEast Timorese community in NSW,ajoint venture between STARTTSandthe Psychiatry Research & TeachingUnit of the University of NSW.MsTang said that preliminary results

consequences for their physical andpsychological health."

A team of highly skilled staff hasbeen employed to implement theprogram. Over the course of several,in-depth interviews, they will collectdetailed information regarding thephysical and psychological health ofnewly arrived refugees and ascertaintheir settlement needs.

"We have learned much over thelast decade or two about what isinvolved in this process ofresettlement. When it works well,people are able to develop a sense ofsafety, and a measure of control overtheir new environment,"

showed that 85% of East Timoreseinterviewed for the study hadexperienced the murder of a familymember or friend, 69% enduredforced separation from their familyand 46% had been tortured. As aresult of these events, manydisplayed varying levels ofpsychological distress.

In addition to collectinginformation from the participants,the researchers also responded totheir mental health, psychosocialand adaptational concerns ensuringparticipants received the servicesmost appropriate to their needs.

"The pioneering work ofSTARTTSis extremelyimportant. . .1hope these programs will eventuallybe brought to East Timor itself," saidRamos-Horta in response to thepresentation. He discussed thedifficulties of engaging the EastTimorese in counselling. "In the East

8

said Jorge Aroche.In his keynote address, Mr

Ruddock stressed the importance offorming EICM partnerships withschools, health services, voluntarygroups and non-government bodies.

"It says something about us as anation if we are prepared to open ourdoors to those people who are beingpersecuted. And it says more if weare able to assist those people whohave the greatest need for oursupport. And that must be thosepeople who have experienced someof the greatest and unimaginablehorrors that one individual canunleash upon another," said MrRuddock.

Mr Ruddock also announced thatSTARTTS would receive $780 000funding in the 1998-99 financialyear.

Paris Aristotle of the VictorianFoundation for Survivors of Torturespoke about the national program,which provides funding to servicesin each state. A speech was alsogiven by Ken Brown, chiefexecutive officer of the SouthWestern Sydney Area HealthService, who commendedSTARTTSfortheir new initiative.

Rathika Sivapatasundram of theNatanalia Dance Company closedthe launch with the performance of atraditional Tamildance..

Timorese vocabulary the word for'counselling' does not exist. Manypeople don't know what apsychiatrist is, particularly amongthe older generation. Those who doknow reject the idea of seeing apsychiatrist because they think itmeans you are crazy. It is difficult toencourage people to seekassistance."he said.

Ramos Horta, who is also thePermanent Representative to theUnited Nations for the EastTimorese Independence Movement,has visited numerous war-torncountries in Latin America, Africaand the Middle East however he said"none have been so thoroughlyaffected by violence as East Timor."

Despite this, Ramos Horta isoptimistic regarding East Timor'sfuture: "I am hoping for areferendum for self-determinationwithin ayear.".

The modern Western idea ofchildhood is a relativelyrecent creation. It is generally

perceived as a period of innocenceand visionary imagination, howeverthis romantic idea of childhood doesnot apply to the overwhelmingmajority of children. Few children indeveloping countries are actuallysafe to grow to the fullestpotential.

For countless numbers of thesechildren there is no peace in theirlives, only terror. Caught in violentconflict, they are enduring almostunimaginable suffering. Childrenare losing life, wholeness, home,family, opportunity and hope. Theirinnocence and openness, which callsus to cherish and protect them leavechildren especially vulnerable.Learned hatred, fears and enmitiesare planting in children the seeds offuture conflict.

In an unspeakable perversion ofinnocence, more and more childrenare being drawn as soldiers intoviolence, they are too young to resistthe consequences of which theycannot imagine. Every yearthousands of children are recruitedaround the world. Their experiencesare brutalising. They are exposed tosevere hardship, harrowingexperiences, serious injury andsometimes death.

In November last year SwedishSave the Children held a pressconference to launch a new reportcalled Children: The InvisibleSoldiers. The report is based onextensive research in 26 countriesand shows that the use of childsoldiers is far more widespread thangenerally realised.

The report found that anestimated 250,000 children under18,some as young as 7, are presentlyserving around the world ingovernment armed forces or armedopposition groups.

Children took part actively in 33armed conflicts in 1995-96; most

by Olga Yoldi

al warchild soldiers join armed oppositiongroups and paramilitary groups.

Moreover several governments'armed forces have sent childrenunder 18 into combat, child soldiersoften carry out extremely dangeroustasks such as mine detecting andspymg.

The report actually documentsnumerous cases of how children areexploited and abused, such as thestory of this Burmese boy:"Sometimes when I fell asleep whenI was on sentry duty, I was beaten bymy corporal. He beat me like a dog,like I was an animal, not a humanbeing. There were 2 or 3 suicidesduring that time, of boys who hadbeen hospitalised and finally shotthemselves".

...

In countries in West and CentralAfrica, children as young as 8 to 10years of age are forcibly recruited,coerced or induced to becomecombatants. Although exact figuresare unavailable, the estimatednumber of 20,000 to 50,000 childcombatants often cited is consideredan underestimate.

9

Approximately 90% of all childsoldiers are boys. Survival, selfesteem, revenge of death of familymembers, peer groups pressure andcoercion by adults and familymembers are some of the factorscompelling children to participate inthe wars inWest and Central Africa.

The demobilisation of childsoldiers has been constrained for avariety of reasons, including the lackof political will on the part ofmilitary leaders, the absence of

sanctions against recruitment, weak Jpnational demobilisation structuresand the social disintegration offamilies and communities.

The report makes recom-mendations on how to reduce thevolume of child recruitment, forexample, international and nationallegislation on recruitment, improveddocumentation of children,including the routine provision ofbirth certificates and monitoring ofrecruitment practices by reliefagencies operating in conflict areas.However, it would be rather difficultto monitor and enforce thesemeasures on governments generallybecause the mechanisms are not inplace to do so.

The United Nations Genera~Assembly in 1993 unanimouslycalled on the Secretary General toappoint an expert to conduct a studyon the impact of armed conflict onchildren. Fifteen representativesfrom a wide variety of Africancountries participated in the regionalconsultations and formulated anumber of recommendations. Theyhighlighted the fact that theprevention of war requiresaddressing and eliminating the rootcauses of conflict, until this happenschildren will always be at risk.

The recommendations addressedissues such as the reduction of armsand more accountability on the partof governments, using mechanismsfor conflict prevention andeducation.

I

CHILDRENaI.Jla[

f

They also declared the targetingof children and their recruitment assoldiers of war as crimes againsthumanity.

So far the recommendations haveremainedjust awritten document.

Unfortunately very little has beenachieved to protect children in war.The violations on their childhood areintolerable but failure to respond is abetrayal and silence complicity..

11

Rwanda is called the nationof traumatised children.Children have been

exposed to atrocities to a degreenever been seen before. Threehundred thousand children havebeen killed, often in brutal ways.

In some of the largest massgraves up to 45 % of the victimswere children.

Over 95000children, 40000 inRwanda lost their parents or wereseparated from them.

42% lost both parents.56% witnessed a familymember being killed.75% witnessed other peoplebeing killed.47% saw children killingother children.64% witnessed massacres.20% witnessed rape andsexual assault.

Many children are able to namemore than 20 persons close to themwho are dead.

In August 1994 UNICEF'schild psychologists visited the sitesof massacres and talked to thechildren in the area, producing thefirst assessments of the traumaticeffects of war on children.

The Trauma RecoveryProgram (TRP) within theChildren in Especially DifficultCircumstances Section wasestablished to address theimmediate and long termpsychosocial needs of war affectedchildren and their families.

As part of the programUNICEF trained 12 traumaadvisers in trauma alleviationmethods. These advisers passed

on their knowledge to teachers,social workers, health careproviders and religious leaders. Sofar TRP trained a total of 1843social workers in basic issues oftrauma identification, andbroadcast over 1500 trauma firstaid messages to various socialagents throughout Rwanda.

The TRP has conducted andanalysed data from a pilot surveycompleted in December 1994 onlevels oftrauma among children incentres and family settings.

Among the findings was thefact that 62% ofthose interviewedfelt they had no future and did notexpect to live long. A set ofGuidelines for PsychologicalTrauma Healing was produced bythe Minister of SocialRehabilitation in collaborationwith UNICEF and seven nongovernment organisations. TheGovernment of Rwandaacknowledged the importance ofpsychosocial intervention withtraumatised children as one of itspriorities.

Consequently a national ChildRecovery Centre was opened inApril 1995 in Kigali to become afocal point for training,documentation and research, withan outpatient clinic for severelytraumatised children and families.

The effects of such experienceson children, and its subsequentdocumentation, was of vitalimportance to services providers,not only in this country but aroundthe globe. Hopefully it willcontribute to provide more insighton effective healing treatmentsand understanding of childsurvivors..

The next issue of Transitions will publish lettersfrom our readers. If youwould like to respond to any of the articles in this issue or comment on anyarea related to refugee survivors of torture or trauma please send yourletters to Helen Basi/i at STARTTS, PO Box 203, FairJield, NSW 2165.

10

MENTALHEALTHSERVICESin Cambodia

STARTTS counsellor, Meng Eang Thai fled from Cambodia with his father in 1979 due to the massive socialdisruptions occurring there at the time.

Almost 20 years later, Meng has revisited Cambodia accompanied by STARTTS sessional psychiatrist, ProfessorDerrick SUove. Together they visited a new mental health clinic in Siem Reap Hospital as independent observersfor aHarvard University trainingprogram.

In thefollowing interview, Meng discusses his recent experience in Cambodia.

I

~

Q. What were your firstimpressions of Cambodia whenyou returned?

I've been influenced by the ideaof democracy in the Western worldso I was concerned that going back toCambodia and seeing the lack ofdemocracy and oppression couldaggravate my feelings. Also, theconnection with my past wassomething I had to be aware of. Iwondered about my ability to adjustto the society.

When I first got there it touchedmy heart to be back in my homelandfor the first time in 20 years. But itbrought back some traumatisingfeelings in terms of leaving duringthe reign of the Khmer Rouge andmy time there as a student.

Apart from that, I felt happy tosee that people have the freedom tomove around. Certainly, I haven'thad much connection with localsocial and political issues but peoplegave the appearance of being able tomove freely. I noticed there weresoldiers present in the streetsalthough they weren't behaving in athreatening way

.Q. How has Cambodiachanged in the 20 years since youleft?

Compared to the period before1970, before the war had started, itwas like two different worlds.Cambodia was so peaceful then andthe cities were so organised. Butcompared to when we left, whichwas a very traumatic period, andnow, I think there has been someimprovement in terms of standardsof living.

The people have freedom tomove around and start businessesand many of the schools have re-opened. The arts have been revived.

There is a new wave of talent withpainting, writing and all those things,which are a valuable asset to theculture. The temples have opened upagam.

It has come to the point wherethey can regenerate and rebuild thedamage done in the time of theKhmer Rouge. I have to stress veryclearly though, that I have notexplored the social structure orsocial policy in depth.

About 80% of schools have re-opened but they are in a deterioratedcondition. It is still not much,because if you look at the educationsystem, the students only go toschool for half a day and half a dayisn't enough to studyproperly.Also

TEMPLE ENGRAVINGAT ANGKOR WAT

Photo by Meng Eang Thai

11

the teachers don't get paid properly.Not only the teachers, allprofessional people in the publicservice. It leads to the point wherethe people don't see those

professionals as having a value for '\society. They only see things that \JiIincrease the economy as important.The economy is the dominant forcein society.

In the long run there is a need foreducation and to rebuild a strongsocial structure.

Q.What was your purpose forgoing to Cambodia?

The purpose was for me to findout about the changes in the countrybut also to observe the newtechniques of introducing primarymental health care to the community.My desire was to see how they dealwith mental health issues becausethere is a huge need in Cambodia formental health care and mental health

servIces. / 1.On this occasionwe went to do a~

independent evaluation of theHarvard University trainingprogram for mental health workers.

Harvard University in the UnitedStates has sponsored a program totrain Cambodian G.Ps andcounsellors to become the primaryhealth care givers who can diagnoseand treat the mental health problemsof Cambodian people.

The training centre was located inSiem Reap, in the northern part of thecountry and the second group ofG.Ps and counsellors were justcompleting their training.

I was impressed with how theprogram fits in with the culture. It's acrucial part of the program andtreatment that a cultural componentis included. They try as far aspossible to integrate the beliefs of the

locals in the program.I stayed in Siem Reap for nine

days. Every day we were involved intraining at the clinic at Siem Reaphospital. We learnt about the work ofthe clinic and the work of the traineeswhen they get out in the field towork. We met with a Buddhist monkwho is involved with the treatmentprogram and we met with thepatients themselves. We met withother organisations like the UNDP[United Nations DevelopmentProgram] who are also involved.

Q.What did you learn aboutthe service for torture and traumasurvivors in Siem Reap?

I found that primary mentalhealth care interventions are the bestway to develop the treatment fortorture and trauma survivors.Providing the basic knowledge and

{' techniques to the G.Ps and, counsellors appears to give them alot of encouragement andconfidence to develop appropriateideas to adapt to their environmentfor further down the track.Following the training, they canassess their own needs and evaluatethe first stage of their learningexperience. I see it as very positiveinitiative.

I have been arguing with peopleto acknowledge that Cambodianshave had the concept of counsellingfor a long, long time but most of theWestern practitioners havedisagreed. In Cambodia, the traineescame to me and said 'we do havecounselling in our culture'. I feel

r~~"'-l ery good to know that I have some

people who agree with me. We haveto acknowledge that although theCambodian idea of counselling isdifferent from the Western tradition,it still exists. It's a matter ofintegrating the two into one form.

Q. Who funds the service atSiem Reap?

The service is funded by US Aidthrough Harvard University. Part ofthe grant comes from Japan as well.

Q.How effective is the serviceat Siem Reap?

It is very effective indeed. Therehas been a high success rate in termsof patient recovery. Some patientswent from a state of psychosis to thefunctional stage where they could goback to work and get along with theirlives. They did this with minimalmedication.

Q. What sort of programs dothey have for clients?

They use medication andcounselling but also they look at thepractical needs of clients. InCambodia, when one member of thefamily falls ill the whole family iseffected and the income ofthe familyis reduced. In that sense, they workwith a welfare program to supplyfood to the family ofthe sick person.

The UNDP is also involved andprovides some career training andeducation after they recover.Attempts are made to place them injobs or help them establish their ownbusiness.

Where necessary, a monk isinvolved to provide spiritualsupport. They really take a holisticapproach.

Q. How many clients do theyhave?

Each counsellor has about 30clients and there were eightcounsellors. The clients are from allover Cambodia. Sometimes thecounsellors go to the eastern parts ofthe country and do outreach.

The program has become wellknown to the local community. Theydo community development worksuch as providing education to thevillages about mental health andtreatment but they also try toencourage the traditional approachto treatment as well.

All the counsellors and doctors atthe service are Cambodian. Theywere trained by a group fromHarvard University. In that group oftrainers there were two Cambodianpeople who now live in the US. The

training program included guestspeakers who spoke about topics likecounselling intervention,medication and diagnosis. Theyhave a year of training altogether.

The clinic has provided treatmentto patients from remote regions ofthe country near the Vietnameseborder. The patients come and stayfor short periods of treatment fromfour to eight weeks.

Q.What were the most pressingneeds ofthe Cambodian service?

What we found out from thedoctors and the counsellors was thatthey need further advanced trainingin terms of professionaldevelopment.

The counsellors also need moretraining on stress managementotherwise they won't be able to cope.

The medication they have overthere is not the sort of medicationthat tends to be used in developedcountries.

It is not enough. They need morevarieties of medication to make thetreatment more effective.

They also need to have a follow-up team to work with doctors andmonitor the person during treatment.

We would like to see this type ofprogram included in the curriculumof the School of Medicine inCambodia in the future.

This would allow the new G.Psthat graduate from the School ofMedicine to have an understandingof the mental health program andtreatment. It could also assist theG.Ps to identify mental healthproblems at an early stage beforethey become too severe..

TEMPLE ENGRAVING AT ANGKOR WAT.

12

Photo by Meng Eang Thai

VIETNAMESEfullofgenerosityandgoodwill

r:

Drugs and violence alwaysseem to be the focus of themainstream media when

portraying the Vietnamesecommunity. But what about thepositive aspects of a communitythat has been thriving in Australiafor more than 20 years?

The Vietnamese chapter of theScout Association of Australiaraised $22,000 in an SBS radiothonheld in September to generate fundsfor the expansion of Scout groupsthroughout NSW.

Requests for contributions to theScout Association were broadcastthroughout the day on theVietnamese language program onSBS causing the switchboard to beinundated with calls. Scout leaderswere overwhelmed by the success ofthe venture.

"I'm more than happy with theresult. I only expected to raise$7000. The support from thecommunity is very big. Parentswould like to prepare their childrento have a good life in the future,make friends and maintain theirculture. The Scout Movementprovides an opportunity for theirchildren to serve the community andbecome good citizens," said ThuatVan Nguyen, Vice-President of theInternational Vietnamese ScoutMovement.

The radiothon money will beused to recruit more children to theScout Movement, set up new groupsand train more adults to becomeScout leaders. A dance group, bandand more sporting activities will alsobe established.

Currently there are twoVietnamese Scout Groups inSydney, Bach Viet and Van Lang,which have a total of 150 members.The members meet regularly andengage in activities such as camping,swimming, picnics, sport andlearning survival skills. Accordingto Mr Nguyen, the emphasis is on"activities for children to help them

by Relen Basili

develop their full potential."Mr Nguyen's involvement in the

Scout Association stems from hisdesire to minimise the problemsfaced by young Vietnamese inAustralia.

"I think we should do somethingto help the younger generation. Wewould like to have integration intoAustralian society. We know that ittakes aperiod of time for the youngergeneration to become good citizens.Our community has some problemswith teenagers. By involving them ingood activities there are lessproblems," Mr Nguyen said.

Ms Ngoc Han, the coordinator ofthe SBS Vietnamese radio programholds a similar point of view:

"If children don't have a goodplace to learn or play it's easier forthem to go to gangs," sheremarked.

The radiothon is one of a spate offundraising events launched by theSydney Vietnamese community thisyear. When Ms Nhu Hoa,Chairperson of the Vietnamese-Australian Buddhist Women'sAssociation, saw media footage ofthe Papua New Guinea tsunamisurvivors she was deeply moved. "Ittouched our hearts", Ms Hoa said.

13

She presented the issue to thenext meeting of the Association and,after two weeks of advertising, held afundraising luncheon to assist boththe Papua New Guinea tsunamisurvivors and famine victims in theSudan. The $17000 they raised inAugust was divided equally betweenthe two causes.

In June, a thirteen-seater buswas donated to Cabramatta Police byaVietnamesecommunity group.

Dr Tien Nguyen, a Cabramatta-

based G.P who assisted with raising \jthe $24000 required for the bus, said"When you do something for othersyou get gratification that you havecontributed to some unselfishcause."

A previous SBS radiothon held inMay urged listeners of all languageprograms to donate money for theRefugee Council of Australia andAUSTCARE, another refugeeagency. The Vietnamese were thelargest contributors accounting for$318000, almost half of the$713000raised.

The Director of SBS radio inSydney and Melbourne, Mr QuangLuu believes Vietnamese

Australiansare prolific fundraisers \'

due .to their past traumatiWexpenences:

"Most Vietnamese Australianscame here as refugees...They have personal experience ofliving in poverty and in politicallydifficult situations and can relatequite strongly and readily to otherpeople in need."

Mr Luu sees no correlationbetween a person's financial statusand their contributions to charity:

"Generosity doesn't depend onwealth, it depends on good will.".

Design & Layout:Olga Yoldi,Helen Basi/i and Hien Le

Printed byBLUEPRINT(02)97937655

FreebirdFree bird.Free bird.What good luck,you have.What good chance,That it is your rightto fly freely,with no document,

~ with no passport,to pass throughall continents,beach of Australia to Ivory Coast.As you like,day and night,having nice songsung in delight.To take recreationin the Falklands,to be joyfulin England.

o free.l>ird,

~iet rne.l11ett~i~nsome q1Jtestl~ns.Who haS'e'atS

~;to pay atten~ion'?-R Wh~has eyes

for affection'?My free bird,don't say to me,'Are you mad'?'I know that1am cryingfOt"nothing.. .

only to show youmy feelings.~

/

By Admasu GirmaEthiopia

Fr~m: Flutter,N& C Solomon fetiSJTilting Cages: An Anthology of Refugee Writings

14 ISSN 1441 6247

By a Kurdish client.Dedicated to the supporters of STARTTS.

Listen to me people who are supporting those with no oneYou are like a bunch of flowers and the thorn in the eye of evil

Listen to me who is like a voiceless fluteI am talking of tyranny and injustice

I am like a migrant bird with no speechBroken wings, tired and no nest.

Who am I?

I am a refugee far from my homelandLike a bird away from the forest who no longer sings

Who am I?

I am a prisoner of distanceIf I laugh it is because I force myself

Underneath I want to cryI might look happy but I am neglected

Who am I?

I am a Kurd who has been intimate with painI am like a wave in a river that never settles downIn my homeland I was full of happiness and life

Yes, yes, I am like a tired river.

;

-'1-'My only belongings are on my shoulder

And like a river, my path has no certainty.Yes, yes, I will reach to the river

I will survive the long night and put the darkness behind me .I will not give in to disappointment

because I am a Kurd and I was born to be tough

Who ever has a friendship with STARTTSWon't have to climb the mountains alone.

Translated from Persian by Zalmai Haidary