Posttraumatic Stress Disorder: Two Unlikely Case Studies

We often think of Posttraumatic Stress Disorder as an ailment affecting soldiers returning from combat. But how is it being diagnosed and treated in other parts of the world? Zaki Djemal ’14, a former Israeli soldier, has worked in both Japan and South Sudan with IsraAID, an organization that, among other things, helps in the treatment of PTSD.

Though Japanese are suffering from PTSD after the March 11, 2011 tsunami and the South Sudanese are suffering from PTSD after 38 years of a bloody civil war, Djemal noted some surprising similarities and contradictions in the development and treatment of PTSD programs in both countries.

The March 11 earthquake and tsunami that struck Japan killed an estimated 15,870 people and came to be the most expensive natural disaster in world history, costing an estimated $235 billion in damages.

IsraAID entered Japan two days after the tsunami with a medical team to help with the relief effort. The team faced initial resistance from Japanese doctors, but after many negotiations, the community centers allowed IsraAID to conduct some programs with kids who lost homes and family members in the tsunami.

“We took a large piece of white paper and divided it into four categories,” Djemal explained. “The categories were ‘tsunami,’ ‘hope,’ ‘home,’ and ‘happiness,’ and the kids were asked to draw pictures of what came to mind.” They etched out the word “tsunami” with dark markers. Under “home,” they drew their homes being swept away. Under “hope,” they drew the zecora cherry tree. Under “happiness,” they drew their homes as they were. It had been two weeks since the tsunami, but it was the very first time the kids were addressing what had happened.

After this initial discovery that the trauma hadn’t been addressed, IsraAID started working in eight different municipalities all over Japan, training government officials, teachers, and aid workers in PTSD treatment.

So how can it be that this small organization from Israel is able to help a country that has the third largest economy in the world?

Djemal explains, “Once you cross that visible line between outside and insider, the teachers wanted to learn how to do it. Also, the same social norms and protocol of the country don’t apply to us outsiders. So we had a comparative advantage in that sense.”

IsraAID plans on staying in Japan to continue training officials and teachers in PTSD treatment until the end of 2013.

This past summer, Djemal travelled to South Sudan with IsraAID. South Sudan became a country on July 9, 2011. The country has one of the highest infant mortality rates in the world and more than a quarter of the 8 million South Sudanese don’t have enough food to survive.

IsraAID entered South Sudan two weeks after its independence, and four months later it launched its first program focused on helping South Sudanese tackle posttraumatic stress disorder caused by the civil war, working specifically with cases of gender-based violence. GBV is prevalent not only because of the civil war, but also because polygamy, wife-beating, and forced marriages are still common cultural practices that undermine the rights of women and girls in the country. Lack of awareness about GBV, coupled with a lack of resources and trained personnel, limit the numbers of women and girls that can be properly and effectively treated for PTSD.

The organization sent a team of trained mental health practitioners and social workers to the new country to begin training for organizations and the government on how to cope with PTSD and GBV.

The organization has a five-pronged approach to tackling PTSD in South Sudan: capacity building, community centers, advocacy, female empowerment, and livelihood activities. IsraAID is now training the country’s first social workers.

So how does PTSD treatment compare in both countries? “Japan was a lot more resistant to PTSD treatment initially—PTSD was more of a taboo. In South Sudan, everyone is more receptive,” Djemal notes. “We are comparing one of the most developed countries in the world to one of the least: South Sudan has no basic infrastructure. Yet in Japan, it was harder for us to make a case for PTSD treatment because the Japanese had more ‘established’ systems and less initial reason or want for outside help.”

Djemal stresses that a big part of treatment of PTSD is early detection. “Because it is something so prevalent in Israel, it is something we are in tuned to,” he explains.  “PTSD is experienced not just from soldiers but also a civilian setting. Dealing with civilian PTSD has developed into a skill-set in Israel…it is our responsibility to share our findings and programs with others.”

Meredith C. Baker ’13, a Crimson editorial writer, is a social studies concentrator in Eliot House. Her column appears on alternate Tuesdays.