Thursday, May 13, 2010

Working the Trauma Zones


       I had been working with the International Center for Psychosocial Trauma in war zones training teachers and doctors in techniques to help traumatized children. With that background it seemed logical at the time to also volunteer with the Red Cross and I had taken their training on mental health debriefings after disasters. When the Typhoon hit Guam I was asked to go there and apply my mental health skills. It gave me an opportunity to see recovery work from the bottom of the pecking order and I feel it might be of interest to some to see what it was like working a trauma zone. Keep in mind there will be similarities whether we are working after an earthquake, a hurricane, or a tsunami. The defects in the system are of general interest. I arrived on January 8 and my journal start on the 10th.

In the area the Chamorros lived in few buildings were
left standing after the Guam typhoon.

       January 10, 1998. It is amazing how quickly things have gotten back into operation here on Guam. Several factors account for this: 1st they are used to severe storms, this being the 3rd typhoon within the year and while it stripped all the leaves off the trees and palms and blew down the little shacks the native people the Chamorros live in. Most of the other buildings are still standing because over the years they have been built of cement blocks that withstand the winds. The island also had a 8.1 earthquake the other day and they hardly paid attention to it.
       2nd tourism is the main industry here so nothing must interfere with it going on. Many large expense hotels here mainly service the over one million Japanese who come here on vacation. They often buy their tickets months in advance and if they miss their tour—there goes their vacation. To prevent loss of customers all of the hotels have backup generators—so while the town may have their traffic lights out the hotels glow brightly.
       I had been warned I would be living in a tent and sleeping on a cot, instead I am living in a condominium in an apartment with three bedrooms. As people leave they will be moving us down to the Hilton or the Palace. It is costing the Red Cross a small fortune to keep us here.
        I am already hearing complains from the Red Cross staff about how the operation is being handled. Because of the political situation here some of the tasks such as emergency shelters and mass feedings are being done by other groups. Service centers that people can come to for help do not exist and instead the Red Cross had put together teams of three people who go from door to door to find out what people need. They then give them chits to go to Wal-Mart and get what they need. Store shelves are being stripped of goods and ships cannot get stuff in fast enough because the harbor is only big enough for two ships to unload at one time.
        A lot of people are going home right now—some early, but they continue to bring in mental health specialists in large numbers. I don’t see how they can possibly use. They man I’m replacing is ready leave because he isn’t being useful. He suspects some political reason for so many mental health workers.

       This is not a hardship assignment, but some people are treating it as such. We are allowed $35 a day for food, but if you eat in a hotel restaurant breakfast can be $22. We are still drinking bottled water. On the other hand we are sleeping in 1st class beds in air conditioned rooms.
        Japanese tourists are very obvious here. On a walk I passed four bus loads whose focus of attention were two well kept parks. I suspect they were memorials for Japanese who were killed in WWII.
        The volunteers and staff here are excitement junkies—they often have many worked many crisis. For one woman I debriefed this was her 42nd disaster. She feels these trips are good for her mental health. Some I’ve talked with seem to be constantly on the move from one disaster area to another. Many of these people seem to be leaders, which causes some conflicts because they all want their way. Many appear to have career military backgrounds.

        The locals, the native Chamorros, seem to be very stoic. They have been through this so often they just start looking for some more tin and sticks so they can rebuild. K is a mental health worker I debriefed today. He described what he has been doing. First he distracts the children and others who might interfere with what Family Service workers are doing, which is to find out what people need and give them D.O.s (Dispersing Orders). Second he debriefs them afterwards by just having them talk. Third, he fills out forms and does other things for the Family Service worker to speed up the process.
        I hear that since homes are completely destroyed they cannot find the people who need help. This is a weakness of the new system—you can’t help people if you can’t find them.
         The tensest place at central office is the hot line room. It needs a full time debriefer, but Carl has that position. He’s been in the Red Cross for 28 years, which gives him a good background for answering questions and backing up the hot line operators.

January 11, 1998
        I’m getting used to doing very little. My main task at the moment is to debrief Red Cross workers as they make preparations to return to the states. I did two debriefings and one emergency treatment today. The emergency was an older volunteer who had gotten a poor evaluation that sent his blood pressure up to 220 over 110. He had been working the hot line so he was already under a lot of pressure. I’m afraid my trance relaxation techniques didn’t work. His blood pressure was still high when we got done.
       I’m friendly with the transportation head, so Carl and I now have a car. Carl is off tomorrow so he will use it and I get it all day Thursday, which is my day off. The transportation chief let me ride with one of his drivers so I saw both the office in the north of the island and the one is the south. My driver was a career navy man who was one of the personnel assigned to pick up bodies and body parts after the 801 Korean Airline crash here. He had had and had needed a good psychological debriefing after that experience.
       The trees that were totally stripped of leaves are, after three weeks already showing a lot of green. Some of the trees that had been blown down have been pushed up and soil put back around them. Burt who cam in with me has decided to go home—they have no real function for him.
       Bruce, who is my boss, had been told about me before I came. I think he expects a lot out of me and is doing me a favor by keeping me at headquarters. I have asked to be put out in the field, but if I can make it more interesting here I might stay. I just need to get used to the low level of activity. Despite the excess of mental health workers new ones are still coming in. It’s still a mystery as to why.
       Eighteen percent of the staff is out sick. A stomach bug is going around. I had lunch with a lady who is just getting over it. She says its three day of awful pain and misery. As far as they figure it was brought in on a military flight.

January 12, 1998
        I finally had a busy day. The older volunteer who had the bad evaluation who hadn’t responded to my stress management techniques was back and we had a long session helping him write a logical concise reaction to the poor supervision he got. The poor supervision that seems to be both unfeeling and inconsistent is the biggest cause of unhappiness among volunteers. Supervisors seem to forget these are volunteers whose only reward is self-satisfaction in a job well done.
       I was replacing Carl as the mental health worker in the hotline room. I didn’t get a chance to do any helping as the lines were constantly busy with no breaks for anybody—10 lines, 10 people. About 9:30 I handled a call from a father whose child had died. He wanted clothes for the family to wear to the funeral. I took the problem to my supervisor who was very unhappy with the inadequate way I had handled the situation. Her reaction made me feel really shitty.
        Shortly thereafter Lori asked me to dive in and take the hotline. I got a brief course from one of the other workers and took a call while another hotline worker stood by and guided me through it. After that I handled about 30 calls.
        We can’t do much for many of them. We no longer give chits for clothes or food. All the beds on the island have been given out and all beds coming in on a ship on the sixteenth are already assigned.
        Some of the stories I’ve heard are really sad. People have been overlooked. For example, a woman in a wheelchair with six children who have no shores (needed for school) living under a tarp in a back area where outreach workers hadn’t found her.
        I talked with some outreach mental health workers tonight. They are really enjoying their work. They’re older psychologists like me. They say it’s hot, the mosquitoes are thick, places are hard to find, but the work is very satisfying.

January 13, 1998
        I’m feeling low—a combination of boredom and being at the bottom of the pecking order. It’s hard to relearn humility after all these years. I covered the hotline this morning, and at times felt like hanging up: (a) when I couldn’t understand the accent of the caller, (b) when there was much need and I couldn’t do anything because there are no resources. Out of 28 calls I handled I could only do something for eight. The callers were unfailingly polite which add to the problem. I had to take an Advil to get through the morning. People have been led to believe the Red Cross could do more than it’s doing.
        After the hot line I went to lunch with the head of logistics and transportation. He selected me as the person to vent to. He feels the reason we are not doing more is because the bean counters have taken over and one of them from the National Office is heading up this project. She believes in keeping emergency services to a minimum; unlike FEMA who seem to be providing a lot of help. After lunch he met with staff and prepared a report that he showed me that pointed out how badly much of this project had been handled.
        We also have a problem with the woman who is in charge of mental health. She speaks to us only through Bruce, her second in command and appears unfriendly in general. Bruce appears to be loath to approach her with ideas or suggestions.

        Being very bored this afternoon Carl and I took off for a while without telling Bruce. A volunteer came in for debriefing while Bruce was in a meeting and when he couldn’t find us he had to take time to handle it. I got a chewing out—something I’m not used to. The worse part is I look forward to doing debriefings and was sorry to miss it.
        It also bothers me that people I outrank in my other life can admonish me. That’s where I have to practice humility.
        If something doesn’t change I may ask to be sent home early. My training is being wasted here.

January 14, 1998
        I spent the day on the hot line handling 39 cases of which I could do something for 18. We keep getting orders that let us do less and less. For example:
        1. Shoes—there is a requirement that children must wear shoes with solid fronts—no tongs or sandals. We can write an order for them but not for clothes unless they have nothing but the clothes on their back. 2. Beds—it seems that everyone who calls has ruined beds and moldy bedding. All beds in Guam have been vouched for, including the ones coming in on the 16th. That means a lot people are sleeping on the floor. We are putting people on lists. The last three days we have added 338 families to the list. You can hear in their voices that many are upset with the wait. FEMA is replacing kitchen stuff and furniture. They seem to be doing a better job than the Red Cross. 3. Some people live in out of the way places that outreach people can’t find. For them there should be a service center, but the present decisions is to go with the outreach policy. 4. Some of my callers said they weren’t home when the team called since they work or are living elsewhere. I can only write orders telling the team how to contact them. We ran out of tents this afternoon. We were told more would be shipped in soon.
        The Chamorros come across as very warm and friendly. They often ask my name and use it. That certainly adds to the guilt when you can’t do something for them.
        Carl dealt with two suicidal clients today—the first one hung up and he hasn’t been able to track her down. The second he settled down. We got off work 45 minutes late as a result. I did one debriefing—an easy one—a girl from New York who was recruiting local people to take part in recovery when we leave. She liked her supervisor and enjoyed the work. She sees no problem going back to New York, except it is now a disaster area because of an ice storm.

January 15, 1998
         I got a good run in the morning and packed for my move to one of the downtown hotels. I hate giving up my kitchen here in the condo. The new hotel is plush, but then Guam has a lot of plush hotels. The one million Japanese tourists can afford them. While the Red Cross gets a cut rate on the rooms it is still costing them a lot to bring me in and keep me here. I know I’m not worth what they’re paying even without my getting paid.
        This was my day off and I spent the day driving around the island. I spent two hours at the WWII museum that shows a film on the history of the war in the area. The Japanese beheaded a number of locals and let many starve. Strange that the Japanese are now the main source of income to the island. It doesn’t take long to drive around the island even with frequent stops and getting lost. Few signs are left of the typhoon since a lot of growth of green leaves hides a lot of the damage.
         My new hotel is down among the hotel row which runs along the beach. All of the hotels are large and new looking. With the door to my balcony open I can hear the roar of the surf up here on the eighth floor.

January 16, 1998
          I spent the morning on the hot line able to do very little for anyone. It seems that the Red Cross often does much more than we’re doing here—but politics are influencing this project. The mayors of 19 villages are not co-operating and other agencies are taking over certain functions. FEMA is the agency that is really co-operating with us.
          Ali took me up north and I’ll be working the rest of my tour there. They have asked me stay on for an extended tour, but since I’m booked to go back to Bosnia when I get home I can’t stay on. (My work in Bosnia is covered in the book, My Trauma Work in Bosnia: Teachers as Therapist, available through
        I spent a little time with Lisa at the front door where the screener is a local volunteer who is very unpleasant to those seeking help. I had reports on her when I was on the hot line. I took a hot line call from a Japanese woman who was considering suicide. She has a 91 year old mother who is in the country illegally and she fears to seek any help because she has committed a crime. The main thing was to defuse the situation and get her to call a mental health number so she can get some aide to release from having to be with her mother constantly.
        One of my cases was women who had an infected foot which was treated at the hospital. She now wanted to return to the housing center for those who had lost their homes, but they wouldn’t take her back: the rules had changed. Her husband had brought a translator who was very angry and chewed on me for a while. I finally got help from a nurse who could make arrangements to place them in a medical housing unit.
         After work we went to a party given by the mayor of Yigo—we were a group of FEMA, Red Cross and locals who got together for a barbeque. The mayor had been a policeman for 14 years but wanted to do more for his community.

January 17, 1998
        I worked with Richard Garcia today. He had been a marine and then with customs. At one point he trained dogs to sniff out drugs and other dogs to sniff out bombs. He was great to work with because he has done so many different things and had about 20 different training programs. He prefers to remain in the field because it’s more exciting. He’s retired and 64, but looks much younger.
         We didn’t see many cases today, but I had the opportunity to talk with people, and use some of my counseling skills. They saw me as just being a friendly concerned old person. One woman who had just lost her husband to cancer looked ancient. I was surprised to learn that she was younger than I was.
         I was introduced to Stephanie Daw who I will be working with tomorrow. She is 19 and has pierced ears and navel and wants to get more piercings. She was also looking forward to getting a tattoo when she gets home. Because of her poor sense of direction I will go with her, between us we just might be able to find our way around.

The second week in Guam I worked with as a team member giving out basics to those who had lost everything

        The back country has a surplus of dogs of indeterminate breed. Brown, skinny, sharp faces and lots of bark. Many belong to no one and have formed packs. The workers are generally frightened of them, but so far only one has been bitten.
        Houses are hard to find, not only because many of them no longer exist, but because the numbering system is not consecutive. In some blocks they are random. Despite our being here for four weeks a number of places destroyed are only now being discovered. Because of government policy people living on government land can only build out of boards with tin roofs when what they need to do in this climate is build with cement blocks. Even the houses of cement, had windows blown out and the insides soaked, but they are still standing.
         As I watched Garcia work I felt I would rather be doing his job. It’s so much more active in the sense of giving people tangibles.

January 18, 1998
        Bob my ride debriefed with me over breakfast. He is unhappy with the way things were run, but I become redundant that seems to be something I hearing at all levels.
        Stephanie and I went out and at the first place I felt I finally began doing some real counseling. While she filled out forms I got a real chance to talk to people. They really seem to appreciate the attention. Despite being laid back on the surface they are often very tense about what has happened to them.
        The next place we hit had three related families close together. Finding them was a real problem. They were back in the jungle on a dirt road. We finally had to have a neighbor lead us back to them. Two of their houses had been totally destroyed and one badly damaged with the roof off and the windows out.
         These people did have telephones and relatively new cars, but the houses had been shacks. The mother had seven children with two of the daughters living in the immediate area. She had thirteen grandchildren. Her husband had died; drown in an undertow just before the typhoon. One grandchild had been born with only one lung and needed special attention.
        The children seemed especially bright. The about to be two year old talked in complete sentences. The fourth couple in the area had had their house totaled and had had no visit from Red Cross. They were already setting up to rebuild. They had eight to ten cousins who were helping them to rebuild. They main problem was they couldn’t build a brick house because of the rules about building on government land. There was movement to let Chamorros buy land where they could build. There was resistance from others who wouldn’t be allowed to buy.
         It would certainly save FEMA and Red Cross millions of dollars if the locals were allowed to use brick.
        When we got back to the center to get more paper forms they held Stephanie and put her to work on the front desk and I was assigned to screening people coming in the door. The woman in charge continues to insult the visitors and on one can make her stop despite its not being approved of. Visitors are getting a mixed message. They are told to call the hot line that tells them to go to the center that tells them to call the hot line.

January 19, 1998
         Another good day. I was with Joe a retired professor who worked slow, was conversational and tried to give people as much as was reasonable under our rules. We found several destroyed homes that had not been covered yet and several that were just damaged. I continue to be impressed with how bright many of the children are—they all seem to like school and were happy to see it start again.
        The Chamorros are prejudiced against the Truckies, which is what they class Micronesians as. They say they are lazy and ruin things like apartments and that they are all willing to live on welfare.
         Many of original islanders after 40 seem to have illnesses—diabetes, hypertension, obesity, etc. I wonder what the relationship is with being introduced to modern civilization after having evolved for a different life style.
         In the evening I went to a get together with the 14 mental health workers still here. I met Peter a funeral director from Cedar Rapids, Iowa who is a specialist in mass death disasters like plane crashes.

January 20, 1998
         I really like the Chamorros, they are open and friendly and accept their typhoons and there destruction stoically. Their building fall down and they put them back up. The cousins get together and despite the rules against concrete blocks I see them using them for their bathrooms and showers. The only thing standing in some places are the shower stalls and toilet walls.
          Many of the families are large by our standards, but many include nieces, aunts and their children. Formal marriage is not real popular among the Chamorros and a woman may have children with 2-3 and even four last names.
         One reason so many live in common law is that they are Catholic and divorce is almost impossible to get and if you do get it remarriage is not possible so common law is the answer.
          The women seem to have much of the power and when a man is home he will not give us information. He says his wife (woman) might not agree with what he says and be unhappy with him. So we have to arrange to come back. I notice the mothers also keep their children in line.
           Alcoholism is a major problem on the island. The native peoples seem to have a low tolerance for alcohol and addict quickly. Many of them also smoke.
           Nice tattoos are common in both men and women. Women’s tattoos are small and discrete but men have many and they are usually very well done.
           We have to be careful discussing cases where we might be overheard. While you might feel you’ve given no clues to who you are talking about the locals have so many relatives and are so interconnected they know who you are referring to.
           “Keep Christ in Your Heart” is a big sign at the center and religious mottos are common. Many people mention Jesus when you talk to them and they seem to be true believers in power of God to protect them despite what has happened to them.
          One way of making a house is to use a shipping container like those used to send stuff on ships. One we saw had been rolled 35 yards by the wind and stopped by a large tree. We did hear of a couple who survived such an event, but he had tied him and his wife to the wall and used the mattresses for protection.
          There are lots of Red Cross junkies here. One coordinator in mental health who was trained at the same time I was a year and half ago has already been on nine missions. My partner today is on his 15th and he teaches family service to Red Cross volunteers in Iowa.
          As usual the lobby of the hotel was crowded with Japanese tourists who are coming back in force. This will give the economy a needed shot in the arm. Locals have been working fewer hours because of the temporary fall off in tourism.
           I have stopped worrying about using my skills and if I don’t expect to do much I get along just fine. For a while today I felt more like a secretary and that was alright also. We were given some coloring books about typhoons and colors to share with the children as part of the mental health treatment.

January 21
          Well here I am ticket in hand ready to go home. The morning went well; Joe and I hit four places, but got stuck in the afternoon. When he finally got some new cases it was too late for me to go out with him. Lisa Ladue did my debriefing. I feel it has had no negative impact on me. The responses have been calm and stoic and it doesn’t depress me. It's not like my work in India and Bosnia. Bob seemed loath to give me my evaluations. I think he thought I would be upset with some of the comments that basically said I didn’t know much about Red Cross operations. Actually that’s right and I couldn’t expect them to say anything else.
           As I cleared the station I was aware I had made quite a number of friends. Fran Walker drove me back to the Palace and we decided to pick up our tickets tonight. Afterwards we went to a Japanese Restaurant at the hotel. It was excellent. I’m now sorry I haven’t taken more advantage of some of the good restaurants in the area.
           Time has collapsed on me and it hardly seems I’ve been here two weeks. After the first few days I thought it was going to be endless.

           After this experience I decided to not take anymore opportunities with the Red Cross and focused my attention on working training teachers and doctors working in trauma zones with children. Within a week of leaving Guan I was in Bosnia.

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