At Thiruchendue welfare center near Batticaloa, Sri Lanka, Dr. Ashok
Van, M.D. (far right, gray shirt), meets with a family who lost 22 members in
the tsunami as community volunteers listen. Photo courtesy of Ashok Van,
More than six months after the Indian Ocean tsunami took nearly 300,000
lives and left more than 1 million people without homes, many in the affected
areas are still living in fear, according to two psychiatrists who have worked
with disaster relief personnel and tsunami survivors.
Terror inspired by the great walls of water that flooded villages and
cities from India to Thailand on December 26, 2004, keeps fishermen from
venturing out to sea and children from playing on beaches they once loved,
said Jagannathan Srinivasaraghavan, M.D., who prefers to be know as Dr. Van or
Ashok Van, and Ramaswamy Viswanathan, M.D., D.Sc.
The two psychiatrists shared their experiences with Psychiatric
News and in reports to APA leadership, including members of APA's
Committee on the Psychiatric Dimensions of Disaster.
"We were struck by the emotional devastation" of tsunami
survivors, said Viswanathan.
Viswanathan is an associate professor of clinical psychiatry, director of
the psychiatric consultation-liaison service, and medical director of the
Anxiety Disorders Program at the State University of New York Downstate
Medical Center. Van is a professor and chief of the Division of Community and
Public Psychiatry at Southern Illinois University School of Medicine and
medical director of the Choate Mental Health Center in Anna, Ill.
Their journey to the miles of devastated coastline in south India and Sri
Lanka began in April with a two-day conference on disaster relief in Chennai,
India, one of the tsunami-affected areas. They served as APA delegates to the
Asia-Pacific Congress on Disaster Mitigation.
There, Viswanathan presented a seminar on psychobiological responses to
trauma, and Van served as a discussant.
After the conference, Van and Viswanathan visited two coastal villages in
Chennai, in southern India. Through SEWA International, a nongovernmental
organization providing disaster relief to tsunami-affected areas, they
arranged to visit Oodaimanagar, a fishing village, where they met with
fishermen and their families and local merchants.
Though there were no lives lost in Oodaimanagar since villagers were able
to escape, there was considerable property loss, Viswanathan reported."
People lost their livelihoods," he said.
Seaside merchants lost entire inventories, and fishermen lost their boats
and nets, he pointed out, and have been unable to make a living.
The few who were able to salvage their boats "are afraid of going out
to sea," he said, "and if they do, they don't venture far"
because they don't want to be away from their families if another tsunami
Fishermen are not the only ones who live in fear. Children who used to play
on the sandy shores now stay away from the water, he noted, and many families
reported being afraid to sleep should another tsunami catch them
Such hypervigilance and avoidance behaviors may be symptoms of
posttraumatic stress disorder (PTSD), Viswanathan acknowledged.
"Contrary to what we've heard in some circles—that PTSD is not
common following disasters in developing countries—we found plenty of
people spontaneously reporting symptoms characteristic of PTSD," he
said. However, he emphasized that they did not evaluate or diagnose individual
An even greater number of survivors reported symptoms of depression and
other problems, such as substance abuse, he noted.
From Oodaimanagar, the psychiatrists traveled a short distance to Foreshore
Estates, a residential area where 45 people died. There they visited with
Lakshmi Vijayakumar, M.D., a psychiatrist who set up a tent to offer
psychiatric services, including counseling and medication, to tsunami
survivors. Many of these families were "emotionally devastated and don't
want to speak with anyone, so she and her staff are gently trying to reach out
to them in their homes as well," Viswanathan said.
On the heels of the visit to Chennai, Van arranged with SEWA International
to travel to Sri Lanka, where nearly 40,000 people died. Viswanathan could not
accompany him as he had work-related obligations in the United States.
A 10-hour car trip brought Van from the West coast of Sri Lanka across the
mountains to Batticaloa, a city of about a half million on the East coast. He
visited areas such as Navaladi, one of the worst-hit areas of Sri Lanka.
"The whole place was wiped out," he recalled. "I saw one
staircase—just a staircase—leading up to nothing."
He also saw a large banyan tree that on the day of the tsunami held as many
as 40 people who clung to its branches as the water roared past. The water
soon uprooted the tree, which was carried away, and everyone drowned, he was
told by the SEWA representative traveling with him.
He also noted that every house was separated from the next with barbed
wire, which contributed to the demise of many. "Once the waves came,
clothing caught on the wire, and people couldn't rise up." He described
stories told to him by survivors as "heart-wrenching."
During a visit to a temporary shelter, he spoke with an individual who
endured the deaths of 22 family members.
One of the tsunami survivors was a widow employed as a domestic helper for
a family in another country. She learned from a friend that the tsunami had
killed her mother, but the family employing her refused to let her go
"They caught her attempting suicide and beat her" in
retaliation, Van said. "The humane thing to do was to have let that
woman return immediately."
Her 37-year-old brother lost all five of his children.
While in Batticaloa, Van trained 30 community volunteers at several sites
to provide psychosocial support to tsunami survivors and advised them about
where to refer those with signs of suicidality or severe PTSD.
One of those places is Batticaloa General Hospital, which has a 26-bed
psychiatric unit run by Dr. Ganesan, who goes by one name, as is common in Sri
Lanka. He is the only psychiatrist available to serve a population of 1.3
It is the only psychiatric unit on the East coast of Sri Lanka, but stigma
keeps many in need of services away.
Since most Sri Lankans with mental health problems "approach faith
healers and priests as their first line of psychiatric treatment, the number
of patients coming to the unit is manageable," Van said. In addition,
patients are not admitted to the hospital unless there is a family member who
is willing to be admitted and stay with the patient during the
Indeed, family support is crucial in a country where there are fewer than
40 psychiatrists to serve 20 million people, he acknowledged.
"Most survivors relied on the support and understanding of family and
their faith" to cope with their anguish.
Though Van accomplished a great deal during his weeklong stay in Sri
Lanka—he trained another 30 volunteers in Sri Lanka's Ampara district
and visited psychiatric facilities, an orphanage, and a number of temporary
shelters—he said he would have liked to do more. In July he returned to
Sri Lanka to continue his work there.
In an article he wrote in the June newsletter of the Illinois Psychiatric
Society, he asked the unanswerable: "How do you console a mother who
lost several children or a mother whose child is swept away from her
arms?" and "How do we make the world understand that humane
behavior is more than opening up the wallet—it has to come from the
heart to understand the pain of our fellow human beings.... Privately, I shed
tears later." ▪