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Article Excerpt
Abstract
After the 2004 Asian tsunami, a group of concerned scientists, physicians, and community service providers united to form a Local Distress Relief Network (LDRN) to provide information, referral, and care to affected members of the large Sri Lankan Tamil community in Toronto. The LDRN organized a workshop that brought together community-based organizations and international and local experts in mental health and disaster response to review existing knowledge on disaster response and to share community knowledge and experience. This article summarizes the development of the network, the workshop proceedings and joint recommendations for community-based, culturally appropriate mental distress relief.
Resume
Apres le tsunami survenu en Asie en 2004, un groupe concerne de scientifiques, medecins, et fournisseurs de services communautaires se sont unis pour former un reseau local de soulagement de la detresse (Local Distress Relief Network--LDRN) dans le but de fournir des renseignements, de referer, et de prodiguer des soins aux membres affectes de l'importante communaute tamoule sri lankais a Toronto. Le LDRN a organise un atelier de travail qui a rassemble des organisations communautaires ainsi que des experts internationaux et locaux dans le donmine de la sante mentale et d'intervention en cas de desastres pour passer en revue les connaissances existantes en matiere de reponses aux desastres et partager le savoir et l'experience de la communaute. Cet article resume le developpement du reseau, les deliberations de l'atelier de travail et les recommandations communes pour le soulagement de la detresse mentale adapte a la communaute et culturellement approprie.
Introduction
In response to the devastating effects of the December 26, 2004, tsunami in Asia, a group of concerned scientists, physicians, and community service providers came together in Toronto to form a Local Distress Relief Network (LDRN). The goal of the Network was to provide a locally targeted, responsive system of information, referral, and care to assist affected members of the Sri Lankan Tamil community in Toronto (population 200,000) (1)--the largest Tamil diaspora in the world--which was deeply and directly affected by the disaster. This was not the first time the Tamil community had suffered. The Tamil population in Canada originated as refugees fleeing war and persecution in Sri Lanka, and thus had endured previous dislocation, psychosocial trauma, and resettlement stress. (2) Even before the tsunami inundated the homeland, appropriate mental and other health services had not been available to meet Tamil community mental health needs. In a multicultural society such as Canada's, where numerous diaspora communities bind us all to world events, a vision for culturally appropriate and effective mental health services during and after emergencies was (and remains) critical.
The ongoing controversy in mental health over trauma counseling and appropriate responses to disaster, whether focused on mental health treatment or social interventions, has produced principles for training (3) and public health responses, (4) which commonly and clearly express the importance of community-based interventions to aid recovery for affected populations. However, a "community" may be conceptualized as transnational, or defined by a "type of consciousness," thus having psychosocial as well as political and economic ties. (5) Not only are survivors of natural disasters or conflict in resource-poor countries directly affected and at risk of mental distress, but also affected are members of those societies living in the diaspora in refugee resettlement countries, particularly families of those injured or killed. (6)
To date, little attention has been devoted to understanding the mental health effects of far-flung diasasters or to devising an appropriate public and mental health response to support affected diaspora populations whose psychological ties to the homeland may be strong. Psychiatric epidemiology and studies of the effects of disasters have noted heightened vulnerability for women, children, (7) and ethnic minorities with prior exposure to community violence and disparities in the availability and accessibility of mental health care. (8) They have concluded that community-based interventions are most effective. Experts have also confirmed that psychosocial support interventions following disasters are best provided by understanding cultural context and how cultural factors can shape social responses and healing strategies. (9)
Our own participant observation in the LDRN initiative, begun as a way of addressing the psychosocial needs of the Sri Lankan Tamil community in Toronto after the tsunami, confirms that culturally appropriate and community-based distress relief can be successful when such initiatives support communities and unite the strengths of many actors. This article briefly describes the development the LDRN, and then describes the content of a joint workshop that was organized to exchange knowledge about distress relief models and practices that can promote recovery in both local and transnational contexts.
Background
Canada is one of the leading refugee resettlement countries in the world today, and Sri Lanka one of the world's leading refugee producing countries. Toronto is North America's most diverse city, with nearly half of its population born outside of Canada. Yet, despite a well-deserved reputation for multiculturalism and universal health care policies, Canada has not yet done enough to ensure that mental health care is accessible to its diverse newcomer populations. Needs for culturally appropriate mental health promotion, prevention, and care outstrip the available mental health services even in normal times. This is one reason that Toronto Tamil individuals and community organizations had approached Dr. Morton Beiser in the Culture, Community and Health Studies Program at the University of Toronto in 1999 to propose conducting a mental health survey in the Toronto Tamil community. The Community in Distress study was proposed, funded by the Canadian Institutes for Health Research, and carried out from 2000 to 2004 in partnership with several Tamil community groups. (10)
Social conditions in Canada, as well as pre-migration experiences, influence refugee community mental health. Some challenges facing the Talnil community are similar to those in other immigrant and refugee groups, and include experiences of displacement and exposure to traumatic events; limited comfort, especially among women, with using English; underemployment and discrimination in Canada; difficulties for seniors in terms of loss of freedom and social status; and lower than average household incomes during the early years in Canada. Nonetheless, Toronto Tamils form an increasingly well-educated community with a great deal of social capital. Most feel that they have good social relations and support among family and friends. Though nearly half of those interviewed in the study were forced to seek asylum in Canada, 65 per cent are now Canadian citizens. (11) There is also a marked increase in prosperity after ten to fifteen years in Canada. This trajectory suggests that the Toronto Tamil community rises to challenges, as also is proven by the community's response to the tsunami.
The Local Distress Relief Network originated in the commitment of the Tamil study's research team to community collaboration and socially relevant research. When the tsunami struck, the team sought ways to translate this commitment into support for the Tamil disapora community of Toronto. While much of the public attention was focused on disaster relief efforts overseas, it was clear that there were also unmet needs for distress relief locally, for affected community members with worries or grief for loved ones back home, returnees from the region, and emergency disaster workers. The goal of the network became linking people and resources to facilitate knowledge exchange.
LDRN activities included information and networking meetings; preparation of a culturally competent flyer in...
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