American diplomats and their families assigned to embassies abroad are
vulnerable to crisis situations such as terrorist attacks, hostage taking,
assassinations, and kidnappings.
Embassy consular affairs staff who serve American citizens abroad have also
been the target of attacks in recent years. In the past year alone, the
American consulate in Jeddah, Saudi Arabia, and the consular section of the
American embassy in Tashkent, Uzbekistan, have been bombed, and Americans and
foreign nationals have been injured, according to psychiatrist Samuel
Thielman, M.D., Ph.D., chief of mental health services at the U.S. Department
of State. He is the immediate past chief of crisis response mental health
services at the department, a position created recently to organize and
coordinate psychiatric responses to disasters and crises overseas.
Thielman oversees 14 full-time psychiatrists in the Foreign Service who
rotate to new assignments every two to four years, including Washington, D.C.
Regional Medical Officer-Psychiatrists (RMO-Ps) cover more than 240 embassies
and consulates worldwide, Thielman told Psychiatric News.
The State Department realized in the 1970s that providing on-site mental
health counseling and treatment and establishing community programs were more
effective and less costly alternatives to evacuating personnel who were
suffering from mental health problems after a disaster or other crisis.
The first RMO-P position was established in Vienna, Austria, to serve posts
primarily in Eastern Europe. Other positions were then established in Bangkok,
Thailand; Cairo, Egypt; Monrovia, Liberia; and New Delhi, India, according to
Thielman. These RMO-P "circuit riders" visit several embassies in
their region and conduct crisis intervention, teaching, supportive
psychotherapy, and consultations with school psychologists, counselors, and
Psychiatrist Kenneth Dekleva, M.D., is based at the U.S. Embassy in New
Delhi. When Psychiatric News reached Dekleva by telephone in late
January, he had recently visited embassy staff in Colombo, Sri Lanka, and
southern India to discuss how they were coping in the aftermath of the
December 2004 tsunami. The American embassies in Thailand and Sri Lanka
received the most tsunami-related inquiries about Americans, because of those
countries' popular beach resorts.
"Some employees of the embassy in Colombo were on the beach in
southern Sri Lanka when the tsunami struck and barely escaped. They witnessed
people being swept away and a lot of death and destruction." Dekleva
Consular affairs employees were assigned to help local authorities with
identifying dead bodies, which involved handling human remains. Dekleva talked
to the staff about common psychiatric reactions and how to avoid physical
exhaustion by working in regular shifts, taking breaks, and eating
The consular affairs staff in Colombo responded to hundreds of inquiries
from concerned relatives and friends about American citizens presumed to be
somewhere in the country at the time of the tsunami.
The Bureau of Consular Affairs in Washington, D.C., estimated that it
received 30,000 phone calls within a few weeks of the tsunami, according to a
State Department spokesperson.
By mid-February, the bureau confirmed that 18 American citizens had died as
a result of the tsunami in Thailand and Sri Lanka. Fifteen Americans in the
affected region were presumed dead, given their proximity to the tsunami.
Several Sri Lankan employees of the American embassy lost relatives in the
tsunami. "I was impressed with their dedication to helping American
citizens despite their personal loss and hardship," Dekleva said.
The consular affairs staff also made arrangements for visiting members of
Congress and the Bush administration.
"Embassy and consular staff are highly dedicated and resilient
individuals. It was deeply rewarding for me personally and professionally to
be able to listen to their stories and provide support and consultation. The
next challenge will be the slow and painful process of helping Sri Lanka in
its reconstruction efforts," Dekleva commented.
Many of his Foreign Service colleagues also have experienced the aftermath
of a natural disaster, terrorist event, or crisis during an overseas
Thielman, for example, was assigned to the U.S. Embassy in Nairobi, Kenya,
in 1998 after bombs killed 213 people and injuredd about 4,000. Bombs exploded
nearly simultaneously at the U.S. Embassy in Dar Es Salaam, Tanzania, killing
12 people and injuring about 85, according to the State Department.
After the Nairobi bombing, Thielman collaborated on postdisaster mental
health studies with researchers including psychiatrists Carol North, M.D., and
Betty Pfefferbaum, M.D. The papers resulting from their studies have been
accepted for publication, said Thielman.
"It is critical for our psychiatrists to be well-versed in disaster
responses," said Thielman. North, Pfefferbaum, and disaster psychiatry
specialist and researcher Robert Ursano, M.D., have presented their work to
State Department psychiatrists meeting in conjunction with APA annual meetings
in recent years.
Dekleva praised the APA disaster psychiatry workshops and seminars at
annual meetings that he attended.
Information about Foreign Service Regional Medical
Officer-Psychiatrists is posted online at<www.careers.state.gov/specialist/opportunities/medpsych.html>.
Information about U.S. Department of State tsunami relief efforts is