Relief workers in Indonesia's Aceh province say food, clean water, and immediate medical care are beginning to reach almost all the victims of last month's earthquake and tsunami. But they say they are just beginning to assess the psychological trauma affecting the half million victims of the disaster.
It is late morning at Zaineol Abidin hospital, Banda Aceh's main medical facility. The collapsed wall at its entrance and the muddy courtyard inside are grim reminders of last month's deadly tsunami, which killed scores of patients and many doctors and nurses here.
On the veranda of the main entrance, a half-dozen doctors, volunteers from Indonesia and abroad, attend to the hundreds of patients who come in every day, referring the most severe cases to teams inside. One of them is psychiatrist Ira Savitri Tanjung from Jakarta, who sits at the far end of the veranda with a bag of medicine at her side.
Dr. Tanjung is trying to comfort a young mother who speaks slowly, staring deep into space.
Dr. Tanjung says the woman was already having family problems but after the tsunami took both her parents, she began to suffer from depression. The doctor says this is but one symptom of what is called post-traumatic stress disorder, which afflicts many people in Aceh now.
"The problem's symptoms are anxiety, jitters and depression because they lost everything. And sometimes they worry, [they] hear water," she said.
The doctor says she talks to the patients and tries to help them cope with their shock. Some cases require medication. She says she sees about 100 people a day and one by one tries to help them regain their spirit.
In the camps of survivors who lost their homes as well as family members, the feelings of shock are even more intense. An American doctor working in a tent community on the hard-hit western coast, Sanjay Thomas, says most of its residents are suffering from post-traumatic stress.
"I think about three-quarters of the camp here are suffering from that kind of disorder," he said. "We have a social worker here to try and develop a plan for the next three to six months so that they can have a counseling program and people can just vent about their experiences."
A delegate from the International Federation of Red Cross and Red Crescent Societies, Langdon Grenhelgh, says the best way to deal with trauma of this nature is to use local therapists.
"You deal with local representatives from these communities who can understand what these folks have gone through, understand what the coping mechanisms are within these communities and how best to strengthen these coping mechanisms," he said.
A health officer with the Red Cross, Caroline Dunn, has just completed a medical assessment in the region. She says the symptoms her volunteers are seeing include sleeplessness, crying and an inability to talk about the events.
Her group is helping the Indonesian Red Cross set up clinics to train medical workers on how to spot and treat people with problems.
"All the people accessing this clinic are given information on how to recognize certain symptoms that people might be acutely stressed or traumatized and what they can do to help them," she said. "This will be followed up by a longer-term program in the next few months to make sure that people get some support where possible."
She says the clinics will be community based, and will be run by volunteers with the Indonesian Red Cross. Nevertheless, she says her group plans to be in Aceh for the long term, until the communities regain some sense of normality.