When the waters of the 2004 tsunami receded, more than 35,000 Sri Lankans had died and 443,000 were displaced. The country’s economy had suffered a loss of $1 billion. In the east, the catastrophe further exacerbated the daily-life stresses people had been living with for years including pervasive poverty and the raging violent conflict between the government and the LTTE rebels.

PHOTO: Reuters/Yves Herman, courtesy www.alertnet.org After the tsunami many people were displaced, bringing further trauma to a population who already faced daily struggles from poverty and conflict.

Before the tsunami, services in Kalmunai were provided by two medical officers who were general physicians with three months of mental health training. The nearest psychiatrist was located in a neighboring district, serving a population of 1.5 million from all three eastern Sri Lankan districts (Trincomalee, Batticaloa, and Ampara).

In a region with limited health services and virtually no mental health capacity International Medical Corps’ mental health program began filling this gap quickly by providing theoretical and observational trainings for the local medical community. “More people were affected and needed some sort of support for mental health,” says Dr. A. L. M. Nazeer, the Regional Director of Health Services in Kalmunai district on the eastern coast of Sri Lanka. Prior to IMC’s intervention health facilities were overwhelmed with mental health patients and the staff was untrained to handle the case loads they saw after the tsunami. “We only had a clinic once a week coming from neighboring Batticaloa,” says Dr. Nazeer. “We could only support mental health patients on a very small scale.”

Further, like in many countries, Sri Lankan culture does not acknowledge mental health needs. Many of these issues are not openly discussed and patients are stigmatized. International Medical Corps’ programming implemented mental health services in two ways: by training clinicians and constructing spaces for consultations. Both allowed for sustainable knowledge and consistent locations for services and future trainings. They also served to promote access to mental health services in order to break the pervading stereotypes in the area.

The theoretical training brought together some of the basics of patient care as well as a new understanding of mental health issues. These trainings allowed for the doctors to learn how to treat mental health cases with consultations and drugs. Meanwhile, International Medical Corps developed a support network by training midwives and community volunteers, who learned to identify cases and refer them for proper treatment. IMC psychiatrists followed through with on-the-job training.

PHOTO: Hussein Ibrahim The construction of mental health clinics gave the community a place to go, and health workers a place to be trained.

Because of better cooperation between services, the doctors in Kalmunai now schedule days to treat both new and existing patients. And the caseload continues to grow. “We were able to upgrade our knowledge in specific areas,” says Dr. A. L. Farook, a medical officer in Kalmunai. “We can now treat cases under the supervision of the Batticaloa psychiatrist.”

Since the trainings, mental health services in Sri Lanka have dramatically expanded. The World Health Organization and the Sri Lankan Ministry of Health also recognized International Medical Corps as the leading agency in mental health development in the country.

The tsunami was the single most devastating event in Sri Lanka’s history but it also offered an opportunity to improve access to mental health care with the help of organizations like International Medical Corps. Today Sri Lanka has a national mental health policy that aims to expand services and integrate mental health care into primary care facilities. Many of the clinics IMC set up after the tsunami are still operating.

“After the Wave:” For more information on International Medical Corp’s sustainable mental health program in Sri Lanka click here.