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Mental, Emotional Health Providers Assist Indonesian Quake Victims

The first wave of relief to earthquake areas in Central Java has focused on food and medicine. Now a second wave of volunteers is tending to a need they say is just as important - mental and emotional health. Chad Bouchard reports from the Indonesian city of Yogjakarta, in the region hardest hit by the May 27 quake.

Under the shade of a gray tarp in a sprawling landscape of earthquake debris, dozens of children waddle and flap their arms. They sing a traditional song about ducks and geese. The children are survivors of the earthquake that shook their school, their homes, and the town of Birin into rubble more than a week ago. Thirty-seven of Birin's 400 residents died in the quake.

The play group is part of a Red Cross program to address psychological wounds, which aid workers say are often ignored. Many of the children lost relatives or friends in the quake, and carry physical wounds of their own. Living outdoors in makeshift camps, the children are not sleeping at night, and cling to their parents during the day. Some have stopped speaking altogether.

An 11-year-old boy at the edge of the temporary classroom smiles to himself during a ball-tossing game. His broken leg is wrapped in a splint and bandage - it was crushed by a falling cabinet.

His mother, Suarni, says it makes her happy to see him laughing among the other children.

She says when the children have something to do, everyone is happy, because the adults can be free for a few hours to tend to camp, prepare meals, and clean up the remains of their village. She says he looks like he does not feel the pain in his leg anymore.

Later that morning, the children draw with crayons and paper. Many draw scenes of a volcano spitting rivers of lava. They are afraid the rumbling Mount Merapi volcano, about 19 kilometers from here, will cause another earthquake.

Red Cross volunteer Amin Khoja says drawing helps the children express their fears. Later it will become a teaching tool.

"Slowly by slowly, we'll turn it to some information about the disaster, how an earthquake happens and what they can do - how they can save themselves," said Khoja.

Thousands of homeless adults are suffering from emotional trauma, too.

Intermittent aftershocks have been a constant reminder of those fears. People run into the streets at the slightest tremor, and most still do not sleep indoors for fear of a second quake.

Severely traumatized survivors have been taken to the psychiatric ward at Sardjito Hospital in Yogyakarta.

Semi's doctor, Indrianti, asks her how she is feeling. Semi says she wants to go home, because she does not know how her family is. Semi has not been sleeping, and reports that she is constantly angry. Tears trickle down her face as she talks.

Pandu Setiawan is the country's director of mental health. He says dozens of psychiatrists and psychologists have been dispatched to hospitals to look for signs of serious stress.

A group of international and Indonesian aid agencies is still assessing the need for care, but Setiawan says based on experience from the 2004 tsunami, survivors will likely need services for up to five years after the disaster. He says the organizations are working together to prevent a repeat of the problems seen in Aceh, which was hit hardest by the deadly tsunami. He says there, agencies often failed to share information.

"And they do their own program, without coordination and without collaboration, and we didn't know what they do, and where they do, and how long they will do," said Setiawan. "Most of the NGOs [non-governmental organizations] left Aceh without any report what they have done."

Psychology professor Makmuri Muchlas says survivors in Aceh and Yogyakarta will recover from disaster in different ways. He says after decades of separatist fighting before the tsunami, uncontrolled anger was a common response to stress in Aceh.

In Yogyakarta, Muchlas says, the culture is defined by its obedience to the local sultan. He says that results in a more patient, but internalized response to stress. The stress causes physical symptoms such as headaches, fevers, and diarrhea.

"It's being suffered by these people inside," he said. "That's why for helping these people, we also help the physical symptoms first, and after that, we try to be a facilitator for empowering their mental health."

Muchlas says therapists will integrate local traditions to encourage healing. In Aceh, trauma teams relied on the traditional Muslim mourning rituals common to the area. Muchlas says in Yogyakarta, therapists will take advantage of an ancient local custom, called rondayah, where villagers stay up all night by a fire and tell stories. He says a trained counselor can lead a rondayah to help survivors digest their anxiety, guilt, and grief.

The World Health Organization says up to half of the affected population in Banda Aceh experienced significant psychological distress, with five to 10 percent developing long-term disorders. The Red Cross alone has treated 60,000 survivors for mental and emotional trauma in Aceh.

Two men who lost their homes in Bantul committed suicide Friday. The District Health Office says there are unconfirmed reports of many more suicide attempts.

Back in Birin, Wongsoaje picks through the rubble of his home, looking for jewelry and other valuables. He says he is not sleeping at night, because there is so much work to do.

The Indonesian government says it will take at least a year to rebuild the area. It may take much longer for survivors to put the earthquake behind them.