Introduction: The Indian Ocean tsunami in 2004 received massive media coverage as it affected many countries, among others Indonesia, Thailand, Sri Lanka and India. In all 229,866 lives were lost and many changed forever as people try to cope with their grief and struggles of re-building their lives. It has been reported that 70-80 % of all natural disasters occur in Asia, and are estimated to increase in the future. It is thus important to have good cultural adaptive interventions at hand when such calamities occur to address the needs of the affected people, in particular school children who are a vulnerable group in mass disasters. To have a crises intervention plan is especially vital in developing countries, where mental health is not on the daily agenda.
Research questions: What are the post-tsunami mental health effects in school children and the prevalence of post-traumatic stress disorder? What may be the role of the teacher in psychosocial intervention? Significant attention is given in this thesis to the cultural understanding of the tsunami how the trauma related symptoms were perceived by the affected pupils, and possible cultural sensitive interventions.
Method: The method of literature review was used to answer the stated research questions. It is my aim to present and discuss research and theory, establishing an overview of what researchers have published, and through this present literature relevant to this topic. I have mainly used electronic databases to find related literature. The key words used in the search were combinations of: tsunami, trauma, PTSD, children, mental health, psychosocial support, disaster aid and culture. Many key word combinations received a high number of hits, therefore a selection of relevant studies was chosen, and thus this literature presentation is not exhaustive. Four research studies were used as main literature, in addition to four articles and two editorials as supportive literature. The main criteria for choosing an article, besides its relevance, was that it is published in an acknowledged journal that is peer-reviewed.
Presentation: Children are vulnerable in the aftermath of disasters, and many consequently experience psychological distress. Thienkrua and colleagues (2006) found that 13 % of children living in camps, 11 % of children from affected villages, and 6 % of children from unaffected villages reported PTSD symptoms in Thailand. In a collaborative study, van Griensven and colleagues (2006) reported that 12 % displaced and 7 % of non-displaced adults in Phang Nga, and 3 % of non-displaced adults in Krabi and Phuket reported PTSD symptoms. Bhushan and Kumar (2007) conducted an assessment of distress and post-traumatic stress in Indian children, with results showing a high level of post-traumatic stress. Neuner and colleagues (2006) assessed children’s prevalence of PTSD in Sri Lanka, where prevalence rates of tsunami-related PTSD ranged between 14 % and 39 % and an additional 5 to 8 % had PTSD unrelated to the tsunami. It is evident, based on these researches, that there is an essential need of intervention after a mass disaster. Teachers may be important resources for psychosocial support. The main roles of teachers is to provide pupils with opportunities to express thoughts and feelings, share accurate information, engage children in the community and referral of children with severe distress. It is reported that therapeutic effect of their psychosocial support can be achieved through utilizing cognitive-behavioral strategies adapted to the cultural context in the school-setting.
Conclusion: Many children and adults were negatively affected by the tsunami, experiencing prolonged distress and some PTSD. This distress has been reported to affect children’s learning abilities and parents’ ability to care for their children. All children have the right to evidence-based treatment, which is however limited in developing countries. Research states that there is potential in applying cognitive-behavioral strategies, especially since they can easily be adapted to various cultural contexts and may have with their psycho-educational elements a natural role in school-based intervention. Acknowledging the value of keeping an open dialog with community and religious leaders, and including local professionals and teachers, may be the key to successful psychosocial support and intervention after disasters. More research is urgently needed to assess the efficiency of the above stated interventions.