International Journal of Stress Management, Vol. 4, No. 4, 1997
Letter to the Editor The following letter is based on a presentation at ISMA-5—Editor COUNSELLING AND CRISIS INTERVENTION TRAINING FOR HUMANITARIAN AID WORKERS Dear Editor, Following a fact-finding visit in September, 1995, I presented a Counseling Skills training course as an International Occupational Stress Counsellor and voluntary member of the British Samaritans, to Humanitarian Aid Workers in Serbia. The course was staged over 2 days in mid-November 1995, taking place in the George Soros Foundation premises, Novi Sad, Serbia. The aim of the course was to give a practical application of counselling skills via roleplay, with particular emphasis on crisis, trauma, and posttrauma stress. The program was completed in May 1997. Sixteen students from the Samaritan Centre and the Soros Foundation, psychology students and graduates with eclectic backgrounds, were being trained in crisis intervention skills to support them to help refugees. Due to the economics of Serbia, few of them were able to work in their chosen professions and they needed an opportunity to develop their skills to provide a much needed posttrauma stress training to the population. They needed additional skills to help them deal with the multifarious problems presented by their clients, most of whom had personally experienced the devastating effects of war; some lived with refugees who suffered from Post Traumatic Stress Disorder (PTSD). Everyone knew someone who had been affected by the war. No-one was exempt. The effects of war were limitless—there were no boundaries. Like a river, it flowed everywhere . . . . There were problems, too, that are similar problems to ours in the West. . . loneliness, relationships, ill health, conflict at work, financial, suicide, and the like. The list was no different from ours. But what was different from us was that they also had the additional trauma of the war which exacerbated PTSD, nightmares, panic attacks, problems of separation, bereavement, identity crisis, re-settlement, rape, murder—all of these and more. 309 1072-5245/97/1000-0309$12.50/0 O 1997 Human Sciences Press. Inc.
310
Letter to the Editor
Because of the wide-ranging issues associated with PTSD, the course followed along the following lines: Learning and practicing counseling skills was of paramount importance enabling the delegates to provide additional knowledge and practical application to skills relevant to their work. Throughout the program, these were applied and developed in a way that would reflect the issues related to the war effort. Informal lectures, exercises, one to one roleplay, interactive group work, and overhead projector slides demonstrated the specific skills of body language, open questions, use of language and words, crisis intervention, and crisis telephone counseling. Issues of PTSD and psychological debriefing were left to be addressed in part two of the course when I returned 8 months later. It was difficult to express the intense, emotional feelings of students after the course, which they absorbed completely, and it was obvious from their feedback that this particular type of training, built on what they had previously learned from other professional agencies. A final word from Slavica (the Director of the Novi Sad branch of the Samaritans) was: "Before the course, I thought I knew everything about counselling issues but it turned out not to be so ... I learnt so many practical skills which can't be learned from books ... we need it for our work with refugees . . . the training manual will be translated into Serbo-Croatian for our colleagues who unfortunately could not attend. ... I hope we will be able to continue with this kind of training because it gives so much and we need it badly . . . thank you for coming ... we look forward to your return." Timing and pace, because of the language barrier, slowed down the training to the effect that after the first session, I knew it would be necessary to return again to complete the program. On a personal note, I was truly gratified by the success of the training and the benefits derived by the students. In the planning of the course, I was concerned that it would not be effective because of the cultural differences and the language barrier. I was also uncertain if the practical application of counseling skills would translate in a different culture but, following the training, it was demonstrated that there were no real such differences. I counted myself fortunate to have been given the opportunity to work in Serbia. Due to the language barrier, I was unable to offer any personal counseling help to the refugees themselves. But I was pleased to have had the opportunity to have trained the carers, to have given them some of my experience and expertise in a place not a million miles away from us. My last extract from my diary echoes my warm feelings for some truly special people I met in Serbia . . . '2 a.m. Sitting in a restaurant, listening to traditional Yugoslavia music. The usual smoke filled atmosphere surrounds me. I am sitting with people who have become friends,
Letter to the Editor
311
Tanya, Ivan, Maria. A group of six men including my friend Zoron on accordion, entertain and surround our table. We pay money to the group to play our choice of music—it is part of the Yugoslav culture and tradition. Their music is romantic. It speaks of love, pain, happiness and joy. It is full of life. And so are the people who sit with me. Their music speaks a thousand words. It speaks of pride and love for their country. A country that may be divided by war, but a country whose spirit will not be broken. We are dancing and singing to the music. I do not speak Serbo-Croatian and I am the only English person in the restaurant but we are all united and singing with one voice. Many nationalities but all together for this moment in time. I ask the lead musician to play some English music and, within minutes, the whole restaurant is on its feet, dancing and singing English songs. . . . The atmosphere is electric. There is an energy and vitality that is special. . . .
During this trip I was hoping to capture a special moment and now know that I truly have done so. The War's Over ... but What Was It All About. . .? I returned to Serbia in May 1996 to stage the second part of the program. Tanya and Ivan, my Samaritan friends, collected me from Belgrade airport. We had said goodbye in November and now I was warmly welcomed back. It was so good to see them again and it was like coming back to see old friends. The airport was as quiet as it had been last year, with no through traffic ... no English voices to be heard . . . tourism, which had been a major industry, still a far-away dream. We drove to Novi Sad where Spring was bringing the town back to life. Anarchy was over but there was still a strong feeling of uncertainty with a strong physical police presence on the roads: cars were stopped and drivers asked for papers, being searched for armaments or whatever . . . and the radar traps were back in use. The populace were generally pleased that order was being brought back to society! Following the lift of sanctions, petrol stations were open again and had petrol to sell: and there were queues at the garages. The black marketeer selling petrol by the curbside had become an unemployment statistic. The roads were busy and people were moving around: mobility had brought life back to the town and cities. The bus service had started to operate to Sarajevo but Tanya said that one only went there out of necessity. She also told me that the road from Belgrade to Zagreb (capital of Croatia) had opened that day for official visitors only but it was hoped that it would soon be opened to everyone. Telephone lines were improving but efficient lines of communication still had a long way to go. Ivan said that infrastructure took time to be rebuilt, but re-building the trust of a nation was not so easy and would take many years to evolve. We drove along the road and saw the crops being harvested and stopped to
312
Letter to the Editor
talk to two war veterans who had both had legs amputated. They were unemployed and had no money. They had performed their job, were no longer needed and there was no Government aid to help them. They didn't want to beg but they couldn't find work, so they stood on the curbside washing motorists' windscreens. Ivan said they were the main casualties of war . . . people wanted to forget that a war had been fought and they represented a painful reminder. Slavica took me to their new center, where I met up with the volunteers with whom I had previously trained in November. The aim now was to develop and build on to the skills previously learned, with the focus of the practical application of counselling skills via roleplay. During the program, the objectives were straightforward: they needed additional skills to help them deal with the multifarious problems presented by their clients: problems of loneliness, isolation, drug and alcohol abuse, environment issues, sexual problems, bullying, unemployment, abuse ... all in addition to living within a country experiencing the after-effects of war.
They told me that there were clients experiencing PTSD who had difficulty coping with everyday life after having been engaged in actual fighting. They could not sleep at night and their dreams recurred as nightmares. They had become withdrawn, depressed, and were unable to communicate with other members of their family, and were even suicidal. Wives living with their husbands, or mothers living with their sons, who had returned from war were now living with people whose personalities had changed: the man who once was open, warm and friendly was now a recluse and insular. . . . wives had waited for months for their husbands to return and now lived with a shell of a person. . . . children waited to see their fathers and didn't recognize the man they now saw. The person was there in body but not in spirit. People such as these needed support in these difficult times to enable them to cope with their hopeless situations. I was also told that soldiers experiencing psychological problems, either turned to drink or ended up in psychiatric hospitals. Post-trauma Stress was not being highlighted as an issue. Mira, one of my students, said that if people felt proud about going to war and felt good about fighting for their country, then maybe they would not experience PTSD. But of course she knew that this was not so: it was not "macho" to suffer the psychological effects of war—"it goes with the job!"—and psychological problems resulted. Refugees lived in camps outside of town. At the height of the war, psychological support was offered to them but at that time, their environmental needs were foremost and had to be dealt with first, so psychological support was put on hold. The Samaritans were not receiving as many callers from the refugees as they had anticipated and thought that maybe it was still too soon for them to be able to address their minds to their psychological problems.
Letter to the Editor
313
Sonia, a Pharmacist, told me that her son left the country when he was 18 to avoid being called up. She said it was not her war and she didn't want him to be fighting her friends. She had sent him away and it had been the hardest decision she had ever made in her life. She had not seen him for 5 years and said "there are no winners in the war, just casualties." Goran, a urologist, told me that he did not feel fulfilled. He worked tenaciously every day but had lost his inner drive and self-motivation and generally felt helpless, obtaining little satisfaction from his work. He was searching for the old values, lost during the time of war, when life was more meaningful. I also spoke to Vlada, an unemployed psychologist, who couldnt find work in his own field. He told me that, culturally, professional people thought that a job would come to them. They were not used to being pro-active in their approach and it was not a concept to which they were accustomed. Communism had left its mark behind . . . people still expected to be looked after and given work. Even though he knew intellectually that his society had changed, he found it hard to change his inbred attitudes. The old culture and expectations were still there. People were tired. They had lost their motivation and energy. There was an anger and disillusionment all around. The war was over but they were no better off ... so what was it all about? Life was still uncertain and they had no new direction. Isolation was felt all around and the futility of war was expressed everywhere. They said that they had spent the last 5 years fighting a war going nowhere and now could only look forward to planning a future . . . hopefully going somewhere! Carole Spiers, MIHE MISMA International Occupational Stress Counselor Gordon House, 83-85, Gordon Avenue, Stanmore, Middlesex HA7 3QR, U.K.
