11/19/2010 Day 4, Jaipur
At 9 a.m. this morning, the delegation of mental health counselors traveling with People to People, visited DISHA, an NGO established in 1995 to address the needs of children with mental, physical and neurological challenges. After watching a Powerpoint presentation given by the teachers at DISHA, we toured the facility, and then had a question and answer session. People to People mental health delegates introduced themselves and talked about their professional backgrounds and interests in learning from the model provided by DISHA for helping children with mental, physical, and neurological challenges. We were also privileged to meet the founder of DISHA, Mrs. Gauri.
In a day school setting, DISHA works with children from the ages of 3 years to older adolescent years with a teacher to student ratio of 8:1. Children with special needs are educated, and taught social and vocational skills in a barrier-free environment, with the hope of eventually integrating these children into mainstream society. Vocational training for teachers is available on site, and specially trained teachers work together in teams to create individualized programs of learning that best address the special needs of each child. Counseling and education for families is part of the program, and teachers meet with parents at least monthly, or more often as needed.
DISHA began with only 18 children in 1995, quickly saw an increase in the number of students needing special education, expanded its facilities and staff accordingly, and has grown to treating 137 children last year. Specialized teachers and trainers work with children suffering from autism, epilepsy, learning disabilities, and other mental and physical handicaps, providing an environment that does not limit their capacity for learning, but strives towards being as close as possible to the mainstream environment, to minimize the challenges of social integration in the future. Physiotherapy, speech therapy, sensory integration, play therapy, art, music, sports, computer classes, and vocational training are included in the DISHA program.
DISHA also provides training programs for teachers and parents in other schools, as a community outreach effort. Teachers are DISHA explained that 3.7% of the world's disabled children live in India, and approximately 14% of India's children are disabled. In consideration of the dire need for serving the interests of children with special needs, DISHA has created a model that deserves our attention, respect, and gratitude, and DISHA has won prestigious awards from the government of India and other NGO's.
Following our tour and exchange of information, Dr. West-Olatunji presented gifts from our delegation and a certificate from People to People to the DISHA staff. Our visit was enlightening, informative, and enriching on both sides, and our mental health delegates felt inspired by hope that the DISHA model will be replicated elsewhere in India, and in the USA.
Our next stop was Jaipur Psychiatric Centre, which is part of the SMS, Jaipur Medical College. Dr. West-Olatunji and the other delegates were welcomed and presented with floral garlands by Dr. Solanki, the Director and Head of Psychiatry, and his colleagues. He discussed the current situation with disaster and trauma response, and consequent mental health issues in India.
Dr. West-Olatunji gave a presentation to the panel of doctors from Jaipur on her experiences and expertise in addressing mental health issues in disaster and trauma response, and it was greatly appreciated by both the Jaipur doctors, and the People to People mental health delegation. One of the important points Dr. West-Olatunji made was that multicultural competency among disaster mental health counselors is essential. She stated that this is because individuals who have been traumatized must be understood in the context of their worldview and in the context of their available local resources. Further, she noted that mental health professionals are subject to compassion fatigue that can develop as a result of constant empathic contact with traumatized victims.
Compassion fatigue presents itself with the development of PTSD-like symptoms, cognitive shifts, adopting a victimized worldview, and showing emotional distress. Preventative measures include continually assessing mental health care workers for burnout, signs of counter-transference, and changes in emotional energy or affect. Dr. West-Olatunji stated that workplace support, decreased work hours, and counseling to normalize disaster management experiences further assists in preventing compassion fatigue in mental health care workers at disaster sites.
The panel of doctors from Jaipur Psychiatric Centre were attuned and interested to hear about Dr. West-Olatunji’s experiences after Hurricane Katrina and in Asia. They agreed with her statements that spirituality and connection with community are important resources for strength and resilience in treating disaster trauma. They seemed keenly interested in the treatment methods she described that involved engaging trauma victims in group activities that yield a positive outcome for the community. One example posited by Dr. West-Olatunji was the creation of a book of poems written by disaster victims, sales of which benefited the community at large.
Dr. Lalit Batra from SMS gave a presentation detailing the many natural and human-made disasters suffered in India over the last decade, and stated that we can reduce the impact of disaster upon its victims, though we cannot prevent the disaster itself from happening. He noted that 3000-4000 people per year, on average, die from such disasters in India, and that at some level, nobody is immune to the mental health effects of trauma. Dr. Batra pointed out that relief agencies are involved with addressing immediate concerns for food, shelter, and physical health issues, and are, therefore, not focused on the psychological trauma and mental illnesses that often accompany natural and man-made disasters causing major losses of lives. He detailed the signs and symptoms of psychological trauma that are often seen, such as numbness, confusion, and disbelief in the initial stages, and diagnosable symptoms of psychological disorders occurring within a few months after a disaster experience. Dr. Batra further noted that most psychological trauma can be successfully treated with counseling, and may not require pharmacological intervention methods. Another point he made was that the meaning of loss is different for each person, and that the integration of mental health services with other relief services is the essential challenge facing us today.
Dr. Paramjeet Singh stated that the future challenges of disaster management involve determining when and how much is to be given in services to those who have lost everything, and that he believes this should be the focus of disaster management response. He further stated that India is gradually working on mental health response to disaster, but that it is not the most immediate problem demanding attention when a disaster occurs.
The panel of Indian psychiatrists agreed whole-heartedly with Dr. West-Olatunji that knowledge of cultural, social, and historical context is imperative for mental health professionals to effectively practice disaster mental health counseling, and that spirituality is a great source of strength for the traumatized. As the meeting concluded, Dr. West-Olatunji presented a certificate from People to People to Dr. Solanki, with our thanks for accepting our visit and sharing knowledge with us. Dr. Solanki presented a beautiful, floral bouquet in expression of their respect and appreciation for our visit.
Both visits today underscored the purpose of People to People, and the personal transformation and magic that happens when people of different countries and cultures reach out, share knowledge, communicate, and show respect for one another.
Cirecie West-Olatunji, Associate Professor, Mental Health Track Coordinator Counselor Education at the University of Florida and ACA Governing Council Representatitve, is leading a People to People Disaster Mental Health Delegation to India. She will be sending us regular updates during her trip.