I had the chance to volunteer and work with the psychosocial response team in the flood crisis at Kelantan. The experience was both humbling and eye opening. While my job was to provide psychological support, the stories and experiences told to me by various victims of the flood led to a second function; as a witness to the extraordinary effort and spirit displayed by those affected. So this will be an account of my experience there and also the stories that was shared with me.
When I was asked by my head of department whether I was interested in joining the psychosocial response team, I just agreed to it without much thought. I had presumed that since my name is on the “3rd batch” list (the 1st batch had just deployed the previous week) and also with my past experience with MH370, I figured that I would need little preparation. Boy, was I wrong to presume so.
Three days after submitting my name, I was called up to prepare and go over to Kelantan. The Ministry of Health was sending both 2nd and 3rd batch simultaneously. We were given one day training on psychosocial response and we boarded the plane the next morning. Our training focused on psychological first aid.
Based on the “WHO psychological first aid: guide for field workers” (WHO, 2011), psychological first aid (PFA) is a supportive response that is provided for another individual who is suffering and may need support. The same guide listed the following themes for PFA:
- assessing needs and providing non-intrusive practical support
- addressing basic needs or connecting to information
- listening to people without pressuring; providing comfort and calm
- protecting people from further harm
Our training briefly exposed us to listening and communication skills. We were taught what to expect and what can we do while deployed into the field. We were also made aware that it is impossible to “save the world”. This was something that came up again and again during our week long stint in Kelantan.
I was placed in a team that was sent to Manek Urai to do PFA. Our accommodation was located in the Kuala Krai health clinic, some 30 minutes drive from Manek Urai. As we had a few hours to spare during the first day, we headed to a village near Kuala Krai town to see what aid we could provide.
The town was covered in mud everywhere. It felt as if we were driving through an old wild west town. We stopped at the village entrance and got down. I approached the first person I saw, a female teenager that seemed friendly and jovial. After a brief introduction, she quickly started telling me what happened when the flood came. The villagers had ran to the top of the hill where the district officer’s house is located. They were soon marooned off due to speed of the rising water. There, some 300 villagers spent days in that bungalow. Food was scarce but they coped with what they could until help came.
The teenager’s dad came half way through the conversation. He confirmed the story told by his daughter. He initially appeared angry and almost reluctant to talk, but he warmed up after a while. He explained that he had been very angry because ever since the flood subsided, aid had come to town but only reached places where the media covered. His own village was ignored while the next village received aid. This was because there was an impression that the next village needed much more help by virtue of its geographical location. He had to stand by the road and flag down passing convoys just so that his village could be given food and other aid. While he is glad that his family are safe and sound, he do not know what to do for the future. He had lost his house and he still have 10 mouths to feed. He was getting stressed up about it.
Throughout the conversation, I was feeling helpless. Here was a middle-age man telling me all his troubles and miseries and I could not do anything. Part of me was wondering how to get aid to this man, how to ease his burden; but I did not have a solution to any of that. By the end of the conversation, I was beginning to feel depressed and then something he said struck me. With his hand on my arm, he said thank you. I was taken aback. He explained that his problems had been a weight on his chest for some time, and he felt much better after telling me all his problems. He felt that he could face his problems better now with less anger.
This scenario of frustration and anger was seen again and again the next few days with various people from different villages. People were very forthcoming when it came to talking about their problems. They complained that despite having or not having material aids, they felt that a lot was not addressed; and usually, after venting it out, you will be able to see a look of relief on them.
Aside from villagers, we also saw medical personnel. There were two groups of staff that needed PFA: the ones who are victims themselves and the staff who were stuck with the victims in their respective clinics during the flood.
One particular staff’s story stood out in my mind. He was a medical assistant working in Johor who came back just prior to the flood. He came from a family of 5 and stays in the Manek Urai village. His mother described him as the backbone of the family because he is “the most educated” among the family. As he had a special interest in psychology, he had frequently taught his family various stress management techniques. However, he did not expect the severity of the flood this time around. He ended up breaking down in front of his mother and cried. He also appeared stressed out and irritable most of the time. When the topic of stress was broached to him, he admitted to being in a state of shock and denial at the beginning as this is the first time he saw such damage. He was also quite worried about the safety of his family. Now that the flood had resided, he was aware that he still had some residual anger but he finds ways to cope with it, eg taking time off from his family just to be with his own thoughts. The awareness was key to handling his stress.
On the other hand, I had the chance to meet a doctor who was stuck in his clinic together with the victims during the flood. Being the doctor in-charge, he continued to lead his team in handling the victims who used his clinic as a temporary shelter. He worked long hours and took on responsibilities that were beyond his regular scope. When the flood subsided, he continued working at the same clinic with minimal rest, trying to pick up the pieces and restore his clinic. While he initially denied feeling any stress, he started opening up after a while. He was taught some basic stress management skills and advised to seek help if the stress becomes overwhelming.
Part of providing psychological first aid is to look after oneself too. During a crisis, things can get chaotic and disorganised. Long working hours with unpredictable schedules and even poor management can all contribute to stress levels. These were commonly seen amongst the medical staff that was seen by us. Even the volunteers for the psychosocial response team described similar experiences of feeling edgy or numb upon returning from the trip. The management of the stress that arises involve acknowledging the stress, addressing inadequacies felt, and communicating. The latter is no different from the PFA that is provided to the victims but is done amongst the PFA providers instead.
Our training prior to the trip was based on lectures and role plays. While it prepared us on what to expect, the real life experience was different. The training gave us the script, but a huge part of the experience involved impromptu improvisation based on the situation. All that I went through was a new and challenging experience for myself. I would highly recommend reading “WHO psychological first aid: guide for field workers” for anyone who would like to find out more about PFA.
Dr. Eugene Koh (MB BCh BAO, Penang Medical College) is a psychiatric trainee lecturer in a local university.
References
- Psychological First Aid: Guide for Field Workers. 2011.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]