CALLS FOR HELP
HAD THE TSUNAMIS that devastated south Asia arrived a decade ago, Dr Kitty Wu's plans for the New Year would have been a write-off. Rather than seeing-in a much-needed break at home with her family, she would have been stationed in her office, charged with a daunting task: co-ordinating a counselling service for victims traumatised by the disaster.
'It would have been a difficult time,' says Wu, a clinical psychologist at the Hong Kong Psychological Society.
Thanks to the progress Hong Kong has made towards offering post-trauma assistance, however, Wu no longer needs to face the overwhelming work alone. Counselling hotlines and debriefings for the distraught are commonplace today.
A Social Welfare Department hotline was in place just days after disaster struck, and the Hospital Authority's senior clinical psychologist, Rosalie Kwong, is already in Thailand as part of the medical team.
In the 1990s, post-trauma assistance was still a relatively overlooked service. The focus then was mainly on attending to those with physical injuries. Wu recalls the first time she and her colleagues were thrust into action: the tragic crush in Lan Kwai Fong which left 21 people dead and scores injured - and shocked - 12 years ago today.
'That was very gruelling, because all we could do was to operate a hotline, with each of us manning it for a few hours after work,' she says of a service that was hastily established just a few days after the tragedy. 'There was only one line, so if someone rang in, others seeking help wouldn't get through - it was the time before mobile phones.'
Debriefings were held but were sparsely attended. So instead of waiting for the needy to come forward, Wu and her colleagues went to them.
'We spent several days just combing the shops in Lan Kwai Fong, talking to people about the potential stress the event would have had on them and methods to cope with it - after all, they were the ones who were exposed to it all,' Wu says. 'Nobody actually came to us for help - so we had to ring every newspaper on our own initiative and provide information to them. It was a time of pro-actively introducing society to the meaning of post-traumatic stress.'
In the light of such general indifference to mental health issues - even after one of Hong Kong's most significant tragedies of recent years - the Hong Kong Psychological Society's Division of Clinical Psychology established the Critical Incident Team, a group designed to formulate contingency plans for psychological intervention in the face of civil disasters.
At its launch, the team stood virtually alone in its work, but public awareness grew over the long-term psychological effects on the survivors of the Lan Kwai Fong tragedy. The team also performed post-disaster counselling after two blazes in 1996 (the Pat Sin Leng hill fire and the Garley Building in Yau Ma Tei). The government - with the help of the team - also started its own services in the Social Welfare Department and in hospitals, rendering the Critical Incident Team's services obsolete. Wu and her team no longer need to organise hotlines, which she insists is a good sign that mental health is officially acknowledged as a legitimate issue.
Public acceptance towards the pursuit of post-trauma guidance also helped clinical psychologists, Wu says.
'Now people understand that seeing psychologists doesn't mean you're mad or you're weak.
'That is now seen as positive coping. Then again, there is still stigmatisation towards people seeking psychiatric help - and it certainly affects how many people will contact us.'
Such prejudice was anchored partly by the fact that Hong Kong has been hardly disrupted regularly by natural or human disasters. Massive social upheavals - such as the fear Sars generated in 2003 - have certainly wrought much mental stress on the population, just as the Lan Kwai Fong crush had on witnesses of the event.
'Over the years, the public has gradually understood the fact that when they run into civil disasters they should be ready to seek help,' says Yuen Shing-chi, senior clinical psychologist at the Social Welfare Department. 'Hong Kong might not be regularly struck by natural disasters like earthquakes, but still there are smaller tragedies which affected tens or hundreds of people at a time.'
Assistance from Yuen and his colleagues have been in much demand over the past few years. Recent instances include the traffic accident on Tuen Mun Highway two years ago, which left 21 people dead and hundreds of staff and students - who counted colleagues and classmates among those who perished - in severe distress. Psychiatrists also helped the victims of the tourist bus crash in Jioufen, Taiwan in which five Hong Kong tourists were killed.
One of the most traumatic events Yuen was involved in was when a China Airlines aircraft flipped and burst into flames at Chek Lap Kok airport in 1999, killing three passengers and leaving more than 200 injured. 'There were lots of people who came to us with near-death experiences - debriefing that time was essential in alleviating their trauma,' he says.
The department's hotline now caters for anyone who feels adversely affected by the tsunamis - whether from direct experience or from witnessing it through the mass media. Yuen says people who suffered from traumatic stress should call in: symptoms range from dramatic mood swings, recurrent lapses in concentration and decision-making capabilities and withdrawal from family, friends and usual daily routines (see table).
'We need to talk to these people to let them know that these are perfectly normal reactions, and that if they persist, where they could seek further help from,' he says.
Counselling for such victims - which is taking place in disaster areas in Thailand - include debriefings, which aim to alleviate the anxiety among victims and also the survivors' guilt that might persist among those who passed through the events unscathed. Allowing victims to communicate their experiences also prevents instances in which they avoid facing their own insecurities - a situation which would lead to even tragic consequences later on.
Post-traumatic stress is not limited to those people who have been directly affected by events, Wu says. The morbid media images natural disasters generate - such as photographs of apocalyptic devastation in Indonesia's Aceh province - the area worst hit by the tsunamis - could evoke just as much reaction as being there for real. 'If the pictures are very grotesque, the impact is going to be huge because they are rare to most viewers,' she says.
There are also people whom clinical psychologists call 'secondary victims': family and friends who strain themselves in finding and caring for their loved ones.
Wu, meanwhile, is concerned with people she says are 'tertiary victims': emergency workers and media workers who are forced to face the catastrophic consequences of such natural disasters.
Her views are corroborated with reports of journalists close to nervous exhaustion as they work long stretches among distraught victims and their relatives or in the corpse-laden fields of Khao Lak and Banda Aceh, or volunteers working to their limits in stricken areas.
'When you listen to all the stories and have first-hand experience of the injuries suffered by victims, it can become extremely stressful,' she says. 'Supporting plans should be in place for relief workers. Supporting plans should be in place for the staff on the frontline.'
A counselling hotline manned by the Social Welfare Department's clinical psychologists is at 9184 3775, from 9am to 10pm. Caritas Hong Kong also operates an answerphone hotline offering counselling in English, Thai or Bahasa Indonesia at 2810 0092, from 10am to 5pm.