On the surface, Juraida's problem was high blood pressure.
Juraida came to the IMC clinic in the village of Cojaja, where she lives, because she had been having fainting spells. Doctors there diagnosed the blood pressure problem and prescribed medical treatment. But when they found out that Juraida regularly lost consciousness whenever she wept over the loss of her 15-year-old daughter in the December 26 tsunami, they realized her physical problems could also have a deeply emotional and psychological dimension -- and they referred her to a member of one of IMC's newest programs in Indonesia, the psycho-social team.
What counseling psychologist David Stube discovered through a series of counseling sessions was that Juraida's grief was debilitatingly deep -- she had no interest in taking care of her family or home (which had survived the tsunami, but was looted afterwards). She told Stube, a child and family therapist from Missoula, Montana, with more than twenty years experience, that whenever she passed out, she felt her dead daughter's arms around her. Over and over, she heard her daughter's voice, repeating the words she had spoken when the two were running from the tsunami and Juraida urged her daughter to run ahead to save herself: "Why should I live, if you die?"
Patient questioning and listening by Stube and Muhamad, the local medical nurse being trained by Stube in mental health counseling, revealed that Juraida had lost her own father at the age of 12, a grief she had never recovered from, and also that Juraida was sterile and had adopted the girl from neighbors after years of trying to conceive. Finally, Stube learned that the complexity of the bereavement, and the grip that it had on Juraida, was deepened by the fact that not only had December 26th been her daughter's wedding day, but that the girl had only just told her mother that she was two months pregnant. Although not a rare occurrence in Indonesia, a pre-marital pregnancy is a religious taboo -- and Juraida and her husband could tell no one about the double loss they had suffered in the tsunami, of child and grandchild.
It's not an uncommon story in Aceh, where more than half a million people were directly affected by the tsunami -- either through death or displacement. And as the rebuilding and immediate health needs of the population are being addressed, more and more stories are surfacing of emotional trauma manifesting itself in everything from anxiety and severe depression to psychosomatic illnesses and domestic violence.
Those problems become all the more urgent in a society that has no mental health system, and whose traditional systems of mental health care are stretched to the limit. Under the leadership of Lynne Jones, IMC's mental health advisor, IMC has launched an ambitious community mental health program. In collaboration with indigenous healers, IMC's psycho-social team is working to educate the population as to the long-term effects of grief and stress; to treat individuals and families affected by the disaster, as well as those with long-standing psychiatric problems; and to train local health care workers in how to treat such cases.
"The physical rebuilding of Aceh is going to take a minimum of five years," says Stube. "The psychological scars of such an event follow most people to the grave. If these people get stuck in their trauma, they can be stuck for the rest of their lives."
In Juraida's case, Stube has gently helped the woman address the issues that were keeping her "stuck" in her grief -- from the guilt she felt over her daughter's death to the longstanding pain of never having dealt with the loss of her father decades before.
"I've been working to help her experience the grief as something healthy, to understand that grief is based on love, and that more intense grief is for people who love more intensely," he says. "It's about helping her to know that the guilt and rumination in her mind are part of that grief, and that it's a sign of her intense love. It's about reframing things, reframing the grief."
In just four sessions, Juraida has made remarkable progress. When Stube and Muhamad came to her home for her most recent session, the house had been newly painted, and Juraida greeted them with smiles and a warm embrace. In her session, she moved easily between tears and smiles; she has stopped passing out, and her blood pressure has come down to normal. For the first time in her series of meetings with Stube and Muhamad, she served tea and fruit to her guests, a traditional form of hospitality -- and a significant indicator that she was beginning to function normally again in her home.
Most encouraging, perhaps, was the choice Juraida and her husband made about finding a way to honor the grandchild they had lost. When the traditional blessing ceremony is held to place the headstone on the grave of her daughter, Juraida will hold a feast and invite the poorest children in the village to come and be fed.
"I think the prognosis for Juraida is certainly very good," says Stube, who expects to have about six more sessions with her. "I think it's very likely that she will continue to do things like feed the poor in her village, and that she will find that grief is a meaningful sadness based on love.
"When we accept what happens to us, we change pain into tolerable suffering," he says. "This is a heroic feat, a heroic accomplishment to change such intense human suffering into something that brings health not only to ourselves, but health to our families and health to our communities and children."