sebelum cahaya

a simple story that i encountered in Stadion Maguwoharjo last 27 november 2010.

Kami turun dari tingkat 3 stadion maguwoharjo ke tingkat 2 menggunakan jalan yang biasa dilalui pembawa kereta. Berpapasan dengan seorang nenek akhir 80-an, berkulit cerah dan berbadan kecil, dengan tipikal kebaya labuh lama, kain batik jawa dan anak tudung yang sering diguna mbah-mbah andai keluar beraktivitas di luar. kami tersenyum padanya. Di tangannya kelihatan baldi separuh penuh berisi air. Dia mengucapkan salam pada kami dengan muka berseri dan senyum penuh:

"Assalamualaikum," kata mbah tadi.

"Waalaikumsalam, mbah, biar kami bantu angkat airnya. Mbah duduknya di lantai berapa?," kataku.

"Oh, ga usah. Gapapa. Terima kasih sekali,"kata mbah.

Dia mengucapkan terima kasih dengan penuh perhargaan, seakan-akan kami sudah memberikan bantuan yang sangat besar , padahal kami tidak melakukan apa-apa pun. Mata kuyu yang dimamah usia itu, bersinar bagai bintang paling terang di ufuk timur.

Mbah di kampung udah biasa kok bawa air kayak gini," kata mbah lagi.

Dia menambah," semoga anak-anak diberkati Allah, pelajarannya bagus, (aku tidak dapat menangkap secara jelas butir bicara seterusnya, tetapi dengan kata-kata setenang dan doa semulus itu, aku jadi terdiam, terpaku di situ).

Mbah itu berada di posisi yang kurang nyaman, dia berstatus pengungsi di stadion itu, tetapi dia dengan ketinggian budi dan kejernihan hatinya mendoakan kami yang pada pandangan manusia biasa,serba ada, sungguh-sungguh membuat aku sebak.

Terus aku memeluk mbah tadi, dan dia menepuk-nepuk belakangku. Terasa seperti memeluk opah sendiri. Dalam hati aku berdoa, supaya Allah memberikan kami kekuatan dan ketabahan sepertinya. Kami bilang padanya supaya berhati-hati setelah dia berkeras tidak mahu kami membantu, dan dia terus-terus mengucapkan terima kasih.

p/s: Apabila kita berpeluang bertemu dengan orang-orang yang lebih kekurangan berbanding kita, tetapi dia lebih bersyukur dengan apa yang dia punya, kita akan tahu betapa kerdilnya diri kita berbanding mereka.

post disaster: are you alright, sir?

Imagine when just yesterday, you were sleeping safe and sound with the comfort of home, and in a matter of few minutes or hours, all of that is gone. You are now living with strangers in a big hall, where you share a place to sleep, food to eat and toilets with everyone else (non-family members). The cause of evacuation can be due to volcanic eruption that burnt down your house, flood that causes damage to your properties, or a freaky earthquake that even hunts you in your dreams (post-traumatic).


Disaster's definition:

"A situation resulting from an environmental phenomenon or armed conflict that produced stress, personal injury, physical damage, and economic disruption of great magnitude." - US disaster relief specialist, Frederick C. Cuny (1944-1995)

"The result of a vast ecological breakdown in the relations between man and his environment, a serious and sudden (or slow, as in drought) disruption on such a scale that the stricken community needs, extraordinary efforts to cope with it, often with outside help or international aid." - World Health Organization (WHO)

How will you respond?

Feeling sad, lost and shaken are the normal responses right after disaster, starts with the critical phase of less than 1 month prior to the disaster. When not handle or manage poorly, the condition worsens to the second phase of post traumatic syndrome disorder. Next, prolonged stressor will produce negative responses to these three aspects; behavioral, physiological, emotional and cognitive. Traumatized individual leads to decrease productivity, become burdens to family, people and community and have higher risk of suicide.

What is the role of public mental health systems in disaster managements?

“People have access to social and mental health services to reduce mental health morbidity, disability, and social problems.” SPHERE Project: Humanitarian charter & minimum standards in disaster response

The minimum standards are based on two key indicators:

(1) Social intervention

- Access to an ongoing and reliable flow of credible information on the disaster and associated relief efforts. ( the survivors of the disaster should be informed clearly about what will happened to them, what they should do before, during and after the events and must always be updated thoroughly by a trusted sources and not listening to random speculations and rumors. Peace of mind is the key.)

- Maintenance of normal cultural and religious events, e.g., funeral ceremonies

- Access to schooling and normal recreational activities for children and adolescents. ( fun school and recreational activities like football had been done in many places where the survivors stay and it work wonders! The children and adolescent spend their time doing beneficial and fun things that can help them forget about the tragedy.)

- Participation of the in the community efforts for adults and adolescents

- Inclusion in the social networks for the isolated persons, e.g., orphaned children.

- Reunification of separated people and families. (every person will be worried about the conditions of their family members. Knowing that our family is safe and can be with them during this crucial time will bring great moral supports.)

- Shelter and community organization for the displaced people

- Involvement of the community in the decisions regarding religious and other community facilities.

(2) Psychological and psychiatric intervention

- Access to psychological first aids at health service facility and in the community for the people experiencing acute mental distress

- Availability of care for urgent psychiatric complaints through the primary health care system

- Continuous treatment for individuals with pre-existing psychiatric disorders. Sudden discontinuation of medications is to be avoided.

- Plans for community-based psychological interventions for the post-disaster phase.

Dealing with post disaster conditions is as crucial as facing the disaster itself. The question that we always have to ask ourselves as we lend a helping hand: what more can I do?

References:

1. Lecture Note: Panel Discussion Global and Mental Health System (Capacity Building) on Disaster and Public Mental Health by Dr. Rahmat Hidayat.

2. Lecture Note: Disaster Management in Mental Health by Dr. Bambang Hastha Yoga

3. WHO websites

4. Additional information from respected doctors during lectures.

a sneak peek of health system

Salam and hi everyone! Sorry for the long hiatus. As an apology, I’ll try to make it up by posting and sharing more frequently. :D


Managing health is not an easy job. It is not something that can be done by one person, in a short period of time or without maintainance. Thus, a good system is needed to realize its goal. It is an overgoing process, handled by commited profesionals in many multidisciplinary levels.

A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health – WHO

It is not about physicians alone, but also includes health infrastructure, funds, health worker staffing, logistics, transport, communications, tracking progress, effective financing. health commodities (such as equipment and medicines) and even providing best services to patients.

There are few things that had been stressed out by WHO in implementing well functioning health system. It includes a balanced between population’s need and expectation with these few ways:

- improving health status of individuals, families and communties

- defending the population against what threatens its health

- protecting people against the financial consequences of ill-health

- providing equitable access to people-centered care

- making it possible for people to participate in decisions affecting their health and health system. (people don’t care how much you know, until they know how much you care! Show your professionalism by guiding their choices, and not instructing them to do this and that without giving any reasoning.)

Who said being a doctor is just about clinical skills?