Psychosocial Assistance Without Borders

Wrongly Pathologizing Populations

2009-10-15T21:29:00.000-07:00

Vanessa Pupavac's article "Pathologizing Populations and Colonizing Minds: International Psychosocial Programs in Kosovo" appeared in Alternatives: Global, Local, Political, Vol. 27, 2002.

It is worth a read: http://tr.im/BXxh

Pupavac correctly cautions against superimposing Western notions of how whole populations (e.g. refugees) get traumatized because it interferes with self-government potential (among other things).

Vicarious Trauma -- Video Explanation

2009-06-17T13:11:00.000-07:00

Dear viewers,

Do let me know if this video's language and flow work for you. Also, let me know what else you would like to know in future videos.

Working in Mumbai with Psychosocial Resilience

2008-12-16T18:52:00.001-08:00

We in Greenleaf Integrative Strategies are currently in the process of organizing technical assistance in Mumbai to psychosocial and mental health workers responding to the recent terror attacks. The Government of India’s National Disaster Management Authority has deemed there to be a major shortage in professionally-trained, disaster-prepared practitioners.

Greenleaf's programs include Professional Development and Continuing Education that work best in the late acute or post acute periods of mass disaster. We will play a supportive role to practitioners (therapists, spiritual care providers & health care workers) in order to enhance the sustainability of disaster response.

It is of the utmost importance that practitioners do not prematurely burnout or develop trauma themselves in the process of working in the midst of terrorized people. Supervisors and organizations can learn how to manage practitioners’ stress levels with self-care and other methodologies in order to mitigate vicarious traumatization, secondary traumatic stress and compassion fatigue.

Invisible Wounds of War

2008-05-19T18:52:00.000-07:00

A report released this week by the RAND Corporation, focusing on the rates of PTSD, major depression, and traumatic brain injury in Iraq/Afghanistan war veterans. Researchers also conducted focus groups with military families and spouses about these issues and a model of the economic impact of these conditions.

The authors of the report recommend that effective programs incorporating evidence-based care must be developed to treat veterans experiencing problems such as PTSD and major depression, and suggest that such programs would actually have a negligible or even net positive cost due to their mitigation of the negative economic impact associated with these events.

There is a summary and free download of report results here:
RAND Center for Military Health Policy Research (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: The RAND Corporation.

Crisis in Non-Profit Leadership

2008-05-10T15:25:00.001-07:00

The Meyer Foundation supports capable, community-based organizations that foster the well-being of all people in the Washington DC region.

According to Meyer Foundation's national survey of nearly 6,000 next generation leaders. a skilled, committed, and diverse pool of next generation leaders would like to be nonprofit executive directors in the future, However, the survey also finds that there are significant barriers: work-life balance, insufficient life-long earning potential, lack of mentorship...

500,000 children working with armed groups around the world -- detailed report from Psychology Beyond Borders

2008-05-01T15:21:00.001-07:00

These children serve in a variety of different capacities: as cooks, as quartermasters, as sexual slaves and as combat troops. Their experiences can result in high exposure to profoundly traumatic events, placing them at extreme risk for the development of serious emotional disorders. Psychosocial services targeting former child soldiers are required to help these children transition from their roles as members of armed forces back into a healthy and stable civilian life.

Brief Summary with link to the 100+ page report

Ethnographic Methods for Disaster Mental Health in Low Resource Countries

2008-04-27T21:19:00.001-07:00

Laura Murray and Paul Bolton have worked together to develop a model for how to conduct high-quality research (including a randomized and controlled trial) and service delivery in culturally appropriate ways in low-resource countries. Their approach begins with a relatively quick (three weeks or less) ethnographic and qualitative study to help identify culturally specific definitions of distress and inform the selection of measures and interventions. This article describes this ethnographic phase in detail, and discusses the utility of using it in interventions designed to reduce the impact of disasters.

Here is their article:
Bolton, P., & Tang, A.M. (2004). Using ethnographic methods in the selection of post-disaster mental health interventions. Prehospital and Disaster Medicine, 19(1), 97-101.

Resilience is Universal… and Not Really

2008-04-07T21:13:00.001-07:00

One part of being scientific-minded means being skeptical and contrarian. So I am going to challenge resiliency on a website so dedicated to Resiliency.

A subtle premise of many unscientific resiliency workshops and trainings is that “Everyone is Resilient.” This myth finds itself in crisis against the real finding that some damage strikes very deep.

Childhood Trauma, the Neurobiology of Adaptation & Use-dependent Development of the Brain is a field-changing article in which Bruce Perry, et. al. argues that our brains (particularly young brains) cannot always be resilient. Brains can be malleable -- adapting to trauma in ways that only make sense in the context of horror. This malleability can account for the inexplicable and sometimes unsavory behavior of people who have been secretly affected by trauma.

The non-scientist (layperson) will enjoy reading paragraphs #2, #3 and then review the “Key Points” at the end of the article.

Resilience is Universal… and Not Really, Part II

2008-04-07T21:12:00.000-07:00

Bruce Perry, MD, PhD, the lead author of the Childhood Trauma article referenced earlier, is a child psychiatrist and brain scientist at Baylor College of Medicine. I attended medical school at Baylor, and when Perry taught, his passion for preventing trauma and safeguarding children made a deep impression on us.

While resiliency should be bolstered in all reasonable and rational ways, we must keep another eye towards preventing traumatic stimuli; because bouncing back from every trauma may not be neuro-biologically possible. It is useful to know that traumatic stimuli -- even in the absence of a physical blow or injury -- induce a cascade of neurotoxic insults to brain tissue. Sometimes we can clear the toxin, and sometimes our coping skills are overwhelmed.

Equally important, if we believe that resiliency is possible for everyone, then we secretly judge those who do not demonstrate resiliency as weak or “not trying hard enough.” While resilience is of the utmost importance to pursue, we in the field should never confuse non-recovery from trauma as evidence of failed resilience.

Our duty in trauma work is to temper the discourse of resilience with the reality that some people do not recover. Prevention being the best medicine is why those of us who work in trauma recovery are indebted not only to appropriate law enforcement, but also to the champions of human, civil, and children rights.

Pema Chödrön leads a Support Program for Activists

2008-03-31T22:05:00.001-07:00

Practicing Peace in Times of War with Pema Chödrön is a beautiful offering in line with the philosophy of PAWB. Everything from a lecture in New York City to "a ground-breaking year-long support program for activists working with intense human suffering."

Traumatic Stress and Resiliency Resources drawn from Military Psychiatry

2008-03-29T20:36:00.001-07:00

You can find a wealth of trauma-related resources through the website for the Center for the Study of Traumatic Stress. Dr. Robert J. Ursano is the Director, and he is a crucial contributor to the military and civilian literature for trauma recovery.

As part of the Department of Psychiatry of our federal medical school, the Uniformed Services University of the Health Sciences (USUHS), the Center was established in 1987 as a public private partnership of USUHS and the Henry M. Jackson Foundation for the Advancement of Military Medicine.

One example of the PDF resources that you can find is the Stress Management Guidelines for Leaders.

Greenleaf Integrative Strategies

2008-03-25T12:58:00.000-07:00

Greetings readers. The last time I blogged was one year ago. I was absorbed in other activities -- among them creating a consulting firm called Greenleaf Integrative Strategies (www.greenleaf-is.com). Please learn about Greenleaf when you have time and send me your queries. I have been doing this consulting work without having a name for the work, and Greenleaf is what has emerged.

Trauma-Sensitive Yoga and the Rationale underlying Somatic Therapies for Stress

2008-03-25T12:47:00.000-07:00

I am currently undergoing advanced training in Trauma Sensitive Yoga with a group at the Justice Resource Institute (http://www.traumacenter.org/). So I want to share with you how somatic therapies can critically complement standard verbal, cognitive therapies (“talk therapy”) for addressing traumatic stress.

Even if you don’t identify as being “traumatized,” consider that one important definition of traumatic stress is “stress that overwhelms our coping mechanisms for a period of time.” Most of us can relate to feeling overwhelmed temporarily.

Here is a way to get to know psychiatrist Bessel van der Kolk's thinking behind treating trauma via somatic therapies. The first paper by van der Kolk (http://www.trauma-pages.com/a/vanderk4.php) is a classic in the field of Trauma and sets the stage for the importance of engaging the body, the physical self, in the context of treatment.

The second piece by Dr. van der Kolk (http://www.traumacenter.org/products/pdf_files/NYASF.pdf) is a very recent look at the neurobiology of trauma and also includes the first of its kind yoga study.

Training at Janvikas, January 4

2007-03-02T21:48:00.000-08:00

In January 2007, PAWB rolled out its most comprehensive training for JANVIKAS, a large and influential development NGO in India, to address the cumulative stress of their managers & supervisors. For this we developed metrics to conduct research at two months post and one year post. We had laughter yoga as a fun, yet educational, interlude.

Training at Janvikas, January 5

2007-03-02T21:45:00.000-08:00

Nisha Gautam, a school counselor, helps to train the leadership of Janvikas (a strategic and well respected NGO in India that trains leaders from other NGOs) in the monitoring and intervention of staff work exhaustion.

Training Doctors of the World

2006-10-25T16:59:00.000-07:00

Doctors of the World is a non-profit that organizes and teaches physicians to evaluate torture survivors. On September 26, 2006 in Washington, D.C., PAWB gave a well-received presentation on the impact of vicarious traumatization and how to minimize this occupational hazard. Here you see the physician organizer, a NYC-based staffer, another physician presenter, PAWB director Siddharth Shah, and a young supporter.

Integrative practitioners in NYC help to support PAWB

2006-07-14T14:09:00.000-07:00

On June 23rd in New York City, The Center for Health & Healing at Beth Israel Hospital hosted an informational session for PAWB along with music and refreshments. Organizer Asma Sadiq, M.D. joined the Center’s medical director Roberta Lee, M.D. to help PAWB with expansion and advocacy. Psychotherapist Amy Begel, M.F.T. donated her time and talents along with her jazz ensemble to make the evening grand. Interdisciplinary practitioner support such as this advances PAWB's mission of bringing innovative, state-of-the art treatments to trauma recovery.

Month in India

2006-05-24T05:25:00.000-07:00

In May 2006, PAWB has had contact with the following organizations in India that have shared their experience with humanitarian worker stress: Apne Aap, Students for Free Tibet, and Jagori’s Rural Expansion program.

Also in May, PAWB's Dr. Siddharth Shah continues his consultation to fellows and staff of Indicorps. Over the past 16 months, he has assisted fieldworkers with psychosocial challenges; and he advises the Ahmedabad-based staff on bolstering their work environment for emotional resiliency.

Well-wishers keep pouring in with ideas

2006-05-24T05:23:00.000-07:00

In April 2006, PAWB has seen a 200% increase in contact with well-wishers, students and young professionals wishing to volunteer and looking for employment. PAWB is actively seeking small grants so that it can fund public health or psychology students to do brief studies to help PAWB hone in its work to appropriate clients.

Ahmedabad training with Aman Biradari

2006-03-24T21:43:00.000-08:00

Aman Biradari (www.amanbiradari.org) works heroically in an environment of great psychosocial demands. After assessing needs with Aman Biradari founder Harsh Mander, Siddharth Shah gave a one-day training to nearly 20 of its field workers.
The photos show the training didactic followed by role plays designed to reinforce the skills of psychosocial support.

Here are some comments from the PAWB trainees:
“I will certainly use this in my work”
“Now we can protect ourselves”
“We need more time for training because of our work with hate, which is very tension-producing”
“This gave me more enthusiasm for going on with my work”

Sri Lanka all-day seminar

2006-02-05T10:06:00.000-08:00

On Jan 28th, PAWB's Siddharth Shah teamed up with Banyan Education's David Harshada Wagner to provide training to youth volunteers who are working in a tsunami affected village called Seenigama.

The Sinhala translator (seen here in a white shirt) proved to be an excellent match because he was a retired social worker who had worked his whole life with at-risk youth. PAWB's mission is to reduce the risk of secondary trauma unduly affecting humanitarian workers.

Website & Second Islamabad training

2006-01-06T22:10:00.000-08:00

For those of you who don't have it in your favorites, PAWB's website is
http://pawb.cfsites.org/

This is a photo of Siddharth Shah doing the second Islamabad training (Dec 26th). That day we had more teachers and special education specialists who wanted to understand psychological difficulties among children. The earthquake and its aftermath have caused serious concerns, but at the same time we had a very empowering training session that elicited a can-do attitude.

Some people travelled from Kashmir (where we trained Dec 22) to get a second round of PAWB training. It was not a total repeat for them because we adapt our training material depending on the needs of the trainee composition.

Please let us know what else we should include on this Blog platform. We want it to be relevant and helpful.

Role of Systematic Relaxation Techniques in Relief Work

2005-12-25T10:43:00.000-08:00

What you see here is a series of pics in which trainees are learning relaxation techniques for themselves as well as their beneficiaries (clients): deep abdominal breathing, Muraqba “Noor” Meditation, and alternate nostril breathing.

Trainees in the heavily affected areas of Muzzafarabad and Mansehra spoke glowingly about the emphasis PAWB lays on self-care. Here are their words:

“In our work we really forget our self…”

“This was a very very good learning environment”

“…doctors we needs more workshops…”

And excerpted from a letter written by a field coordinator after the training: “During relief work due to continuous work I was so much tyred mentally and physically but after today training I am feeling now very well and become so much easier through breathing and murakabah exercises.”

Dedication of the Trainees

2005-12-25T10:38:00.000-08:00

December 25th meant a day of rest for the PAWB team. Arvinder (seen standing here) flew back to her family in Delhi, Khalida spent time with her family in Pindi, and I bummed around watching movies and documenting our last few days of training in Northern Pakistan.

In addition to rest for us, I pray that all the trainees we have met are finding more time for their own rest.

The dedication of the trainees is mind-boggling to me. They do and say things that are unheard of. For our Muzaffarabad training on Dec 22nd, one group of young relief workers from Bagh started their day at 2:30am. They walked in the bitter cold in order to meet up with other colleagues at 3:30. They caught transport at 4am and finally arrived at the training camp site at 7:30am. In light of such dedication, I felt that I could at least put in a little work on my 'day of rest.'

Advocating for our Children -- Idara-e-Taleem-o-Aagahi

2005-12-25T10:26:00.000-08:00

Children attend open-air schools in the Northern Areas as many of their schools have been left looking like the one on the right.

Idara-e-Taleem-o-Aagahi is a well-established and highly respected organization that prioritizes the education of Pakistan's children. For the PAWB trainings, ITA has been able to marshal the support of the Gov't of Pakistan, UNICEF, and several key NGOs. PAWB has been blessed by ITA's hosting of our Pakistan trainings in a way that can only be called extraordinary and prescient. They anticipated all of our personal needs and exceeded all of our expectations.

TESTIMONIALS from the first training day

2005-12-21T12:48:00.000-08:00

Arvinder is our deeply committed trainer and therapist from New Delhi. She is wearing the cream colored dupatta here.

“Sessions were very useful. I like the first session with Arvinder -- particularly useful based on trauma conditions. The workshops conducted today, and method used in that, I will try my best to implement. I will train other people so that they could use with others as well.”

“I found training on alternative healing very helpful. The discussions we had, and the exercises we learnt were very simple but beneficial”.

[One of the effects of compassion fatigue is that relief workers lose touch with their own selves.] “Being in emergency work, I forgot myself as a human, it made me realized to make my efforts more productive, not only in field work, but also to myself”

“Such workshops should be conducted on a large scale, so other could learn more useful techniques and implement them”

“As a special education teacher, I can use these skills in my school, and especially for myself, because self-care is also a very important factor”

“What I have learnt today will help me to provide psychosocial support to survivors of earth quake, and provide training”

“Training should be extended up to three or four days, and cover more topics”

First Day of training -- getting started with yoga

2005-12-21T12:44:00.000-08:00

Dec 20, 2005
Islamabad
Today at 8am Siddharth began by teaching a hatha yoga class in Islamabad. Two people came on time. We got started with Suryanamaskar, about 5 of them; and then we sat in meditation. After a body scan revealing whether we should work on upper body opening (upper back, shoulders, neck) or lower body (lower back, hips, thighs), we got into a routine designed to bring focal relief and teach body awareness. This caught the imagination of the group that had since gathered. We were up to about 10 people, more than our small room could accommodate. People basically took turns using the same space to stretch out. As is often said among desis, “you have to adjust.”

Ms. Khalida Sheikh -- One of our trainers

2005-12-21T12:38:00.000-08:00

Khalida Sheikh is a talented psychotherapist from the UK who works with a diverse population of Muslims in Bradford as part of the National Health Service. Specializing in transcultural mental health training, she manages a team of therapists.

Almost didn't make the plane

2005-12-21T12:33:00.000-08:00

Dec 19, 2005
New Delhi
Arvinder & Siddharth have tickets to Pakistan today, but one of them doesn’t have a visa. Even though PAWB considers Arvinder irreplaceable, even though our partner organization in Pakistan (ITA) has spent countless work hours on justifying her expertise to the Pakistani High Commission, the fact is that Arvinder was born in India! Siddharth, on the other hand, went to the consulate in New York City one day, dropped off an application and his passport at 12 noon, and picked up a fresh stamped visa at 4:30pm the same day.

We are sitting across from a man in the High Commission who really wants to see Arvinder go to Pakistan. Not only because PAWB has work to do that he admires, but also because Arvinder’s mother was born around where PAWB is going to travel. So this man is not being obstructive. In fact, no one we meet actually says “We have a problem with your Indian citizen PAWB member…” But there is a problem nevertheless. While Siddharth got an experience of wiling away half a day at the High Commission, Arvinder has come here 2 times, waiting in outside lines with no promise that her case will get any attention that day. Meanwhile, she loses time with her clients. Meanwhile, Arvinder has had to turn down consultancy offers because she wants to do PAWB work. Still, limbo characterized her life for a good 3 weeks.

Part of the stress of doing relief work is the need to be ready for deployment. And part of being ready for deployment is readiness NOT to be deployed. Arvinder had a very long introduction to this basic meditation (or should we say frustration?) that all relief workers learn early.

“You know we have hundreds of faxes per day. We have to manage that.” Finally, finally, that faxed letter was located at the High Commission. And things were done in a shockingly short stroke of the pen. It almost seemed bizarre that after hours and hours of effort on the part of ITA and Arvinder, this visa was essentially someone saying “I knew all along that you should be allowed to come, but having you wait until the VERY last second is our way of letting you know who is really in control here.” That wasn’t the attitude of the official who helped us. He wanted to then give a visa to Arvinder’s mother right there, on the spot, no questions asked…

We made it to the airport with only 30 minutes to spare. One wrong move, one hour more of a delay in finding that fax, and Arvinder would have been lost as a fieldworker in this first PAWB project.

From groundwork to fieldwork

2005-12-16T09:29:00.000-08:00

My flight to New Delhi is today, and Inshallah, I will be joining the others in the first clinical team in Islamabad, Pakistan on Monday. The last two months of launching PAWB and preparations to work in South Asia have been blessings to me. Blessings because not only has PAWB consolidated dozens of relationships that I knew I had, but also through the challenges of the PAWB launch, I have learned just how resilient, flexible, and potent those relationships are. Thich Nhat Hanh speaks of Interbeing, and I feel it profoundly.*

If you can, please visit the PAWB blog every 4-5 days and see what our clinical team is doing. The website (http://pawb.cfsites.org/) may get updates, but the blog will be the key way to get current news. Your comments, ideas, referrals are welcome.

I want to thank everyone who came to the Fundraiser Luncheon on December 10, 2005. There were many others who wanted to come, and I felt them in spirit. It was a simple affair: expertly prepared food that had everyone asking for recipes, PAWB supporters networking with each other, and a wave of support that flowed into anything and everyone that is involved with the PAWB mission.

My gratitude goes out for all your contributions – whether it be running errands, editing text, giving funds, or extending the psycho-spiritual.
Siddharth

*For those who demand strict adherence to definitions, Interbeing is an English approximation of pratitya samutpada, dependent co-arising. It does not require that we be aware of it – it simply is what is. But it is a blessing to abide in it, and that is what transpires in these moments of great synchronicity and cooperative action.

Mission of PAWB

2005-12-14T13:53:00.000-08:00

1. Psychosocial First Aid Capacity-Building for people working with trauma/disaster survivors
2. Managing Humanitarian & Relief Workers Stress/Burnout/Compassion Fatigue
3. Ethnomedical Competence -- Integrating capacities of local healers with Western psychotherapy/psychiatry

Launch of Psychological Assistance Without Borders

2005-12-12T15:42:00.000-08:00

PAWB came together Oct 2005 when several people showed support for its mission of capacity-building for relief workers and humanitarian volunteers. Serving victims of the 2005 earthquake in South Asia was the first rallying point.