Enhancing Students Participation in Disaster Preparedness (Trauma

Healing Program) for the Victim of Disaster to Minimize a Post Traumatic

Stress Disorder (PTSD) Syndrome

Compiled by:
Sri Hindriyastuti (hindriyas_tuti@yahoo.com)
Mariyati (ns.mariyati@yahoo.com)

Nursing School Medical faculty of Diponegoro University

Program Studi Ilmu Keperawatan Universitas Diponegoro (PSIK FK UNDIP)
Jl. Prof Soedharto Tembalang Semarang 50275
Phone: (024) 76486849
Fax: (024) 76480919
Website: www.keperawatan.undip.ac.id

The authors:
A. Correspondence Author:
1. Name

: Sri Hindriyastuti

2. Date of Birth

: Pati, 13 March 1987

3. E-mail

: hindriyas_tuti@yahoo.com / indri@youthempowering.org

4. School
UNDIP)

: Nursing School -University of Diponegoro (PSIK FK

5. Biography

I am actively involved in local, regional and national organizations. In 2007, I was

elected as a coordinator of Social society department of Nursing Students National
Organizations (ILMIKI), in 2008; as a president of Student Nursing Council in
UNDIP (University of Diponegoro), in 2009; won scholarship from US
department of state to study English and Cultural program in America, selected as
Indonesia representative in YES 2009 (Youth Engangement Summit) in Malaysia
and got 1st winner of National Essay Competition in theme what can I do as a
student to change the world. Now, I am as project officer of Nonprofit
Organization namely YEP (Youthempowering) also as a team of trauma healing
for disaster from our Nursing School of UNDIP.
B. 2nd Author
1. Name

: Mariyati

2. Date of Birth

: 15 May 1988

6. School
UNDIP)

: Nursing School -University of Diponegoro (PSIK FK

3. Biography

Mariyati is a student of Nursing School of Diponegoro University. She is active in

social activities and research programs. Now, she is as a leader of holistic care
program, research programs and entrepreneurship for nursing students. She won a
creativity research for students in 2010. Recently, she develop a program namely
Ners Travel, this program involve a nurse or nursing students in the event of travel
trip in order to enhance the involvement of nursing students in community area.
This program provides nursing students to help participants in travel program to
conquer unpredicted things happened during the trip.

Enhancing Students Participation in Disaster Preparedness (Trauma

Healing Program) for the Victim of Disaster to Minimize a Post Traumatic
Stress Disorder (PTSD) Syndrome

Sri Hindriyastuti, Mariyati

Abstract Indonesia lies in a strategic location which is consist of 17.583 islands guide Indonesia as a potential
place of natural disaster. Tsunami in Aceh (2004), Wasior flood (2010), Eruption of Merapi (2010), Mentawai
Tsunami (2010) are some examples of a big natural disaster happened in Indonesia. These disasters remain big
trauma in mental health status of the victims including Post Traumatic Stress Disorder (PTSD) syndrome.
Considering of this case, the involvement of health students in disaster preparedness especially in trauma
healing program is considerably important. Nursing School of Diponegoro University, Indonesia has tried to
develop a new strategy in order to increase the capability of students to be involved in disaster preparedness.
The project namely trauma healing team which tried to engage students, increase their awareness of social
aspects, in additional also help any other medical workers or the volunteers to help the victim of disasters. The
program mainly involved students to give some modest therapy but very effective to decrease the level of stress,
trauma and post traumatic stress disorder (PTSD) syndrome. In general, we hope that this method will be
applied in other universities outside Indonesia as a form of disaster preparedness from education aspect since
natural disaster may happen in every part of the world.

Keywords: Students participation, Disaster Preparedness, PTSD syndrome

Enhancing Students Participation in Disaster Preparedness (Trauma

Healing Program) for the Victim of Disaster to Minimize a Post Traumatic
Stress Disorder (PTSD) Syndrome
Education: Enhanching access, insuring success

Sri Hindriyastuti, Mariyati

Diponegoro University, Indonesia

e-mail: hindriyas_tuti@yahoo.com / indri@youthempowering.org
Abstract Indonesia is a potential place of natural disaster. Tsunami in Aceh (2004), Wasior flood (2010),
Eruption of Merapi (2010), Mentawai Tsunami (2010) are some examples of a big natural disaster happened in
Indonesia. These disasters remain big trauma in mental health status of the victims including Post Traumatic
Stress Disorder (PTSD) syndrome. Considering of this case, the involvement of health students in disaster
preparedness especially in trauma healing program is important. Nursing School of Diponegoro University,
Indonesia has tried to develop a new strategy in order to increase the capability of students to be involved in
disaster preparedness. The project namely Trauma Healing Program which tried to engage a group of nursing
students and some students outside nursing program to increase their awareness of social aspect. This program
trains them to help the victim of disaster. The program mainly involved students from various majors be
involved in disaster preparedness. This program should be supported by the government and NGO (Non
Government Organization). We hope that this method will be applied in other universities as a form of disaster
preparedness from education area since natural disaster may happen in every part of the world.

Introduction
Indonesia consists of 220 million people living in 1.9 million hectares of lands and consists of 17.583
islands, which has 120 active volcanoes and 5.680 rivers (BAKORNAS, 2010). This situation
leads some natural disasters happened in Indonesia. Indonesia and other countries have
experienced an increase number of disaster. Successful efforts to address these and other
disaster situations need sophisticated preplanning measures and a well coordinated
implementation effort during the actual disaster situation. Comprehensive planning requires
that everyone have contingency plans to meet any and all situations that may rise during and
after occurrence of actual disaster itself.
Some major disasters such as tsunami, flood, earthquake, volcanic eruption, landslide, mudslide,
snowstorm, fire, explosion, hurricane, tornadoes occurred everywhere. In Indonesia, during
this 2010, there are some big disasters happened such as Wasior flood in Papua, Padang

earthquake, Mentawai Tsunami and Merapi Eruption. These disasters leave a high number of
victims whether they die, or

survive in a deep trauma in their live because of physical defect. The trauma may stay through a span
life of the victims and lead to mental health disorder. Physical injury may be able to heal
perfectly, but psychological disorder needs a comprehensive treatment to avoid big effect in
the mental health of the victims.
A limited number of volunteers and health care provider in a refugee camp post disaster event then
become a big issue in Indonesia since Indonesia is very easy of getting disaster. The
involvement of students in disaster preparedness is very important since students are very
easy to receive a new knowledge. Students participation in this case will help themselves to
enhance their sensitivity to the social effect as well as their willingness of helping others.

Content
The American Red Cross (ARC) define disaster as an occurrence, either natural or manmade, that
causes human suffering and creates human needs that victims cannot alleviate without
assistance (ARC, 1975), based on this definition. From this statement, disaster similar as one
of the producers of human suffering that may occur. The human suffering consists of two
categories, mental health/ psychological aspect and physical health (ARC, 1975). While
Meichenbaum (1995) argues that disasters are traumatic events that are so extreme or severe,
powerful, harmful or threatening that they demand extraordinary coping effort.
This definition leads us to the specific meaning of disaster effects such as physical, social,
psychological consequences that are exhibited to various degrees in different person,
community, environment and cultures depending on past experiences, coping skills, and the
scope and nature of the disaster (Smith and Maurer, 2000). Because most people affected by a
disaster pass through predictable stages of psychological response, some health care
professionals can anticipate and prepare for the needs of the victims (Demi and Miles, 198).

Individual responses to disaster are unique. Some of the common psychological reactions to the
survivor of disaster are depression, sadness, fear, anger, guilt, irritability, anxiety. Feeling of
depression appears when they lost everything they have while sadness and guilt appear when
they lost their family. Their anxiety sometimes appear in some ways such as hyper alertness,
palpitations or whether angry. There are many kind of stress and anxiety levels in the victim
of post disaster that may occur and cause a Post Traumatic Stress Disorder (PTSD) syndrome.
Post-traumatic stress disorder (PTSD) syndrome is identified in the third edition of the
Diagnostic and statistical Manual of Mental Health Disorders (American Psychiatric
association, 1994). PTSD was first recognized in veterans of Vietnam War as a syndrome
occurred after a number of traumatic events including war, terrorism, disasters.
People reaction to the disaster may different from each others. The speed of onset, severity and
duration of symptoms are determined by many personal variables. Despite psychological
distress, many people can function effectively during the impact phase of disaster but will
later experience severe emotional distress (Smith and Maurer, 2000).
Individual reaction can be defined into the diagram:

Warning

Nature of
Disaster

Previous
Experience

Severity of
Disaster
Physical
Proximity

Role Overload
INDIVIDUAL REACTION

Support
systems

Role Conflict

Concurrent
losses

Coping skills

Psychological
Proximity

Fig. 1. Variables influencing disaster reaction. (redrawn from Demi, A.S., and Miles, M.S.
(1983).Understanding Psychologic Reaction to Disaster. Journal of Emergency Nursing, 9(1),
(2)

Three criteria define the syndrome; the trauma must be universally recognized, the individual must reexperience the trauma through flashbacks, dreams or triggering events and the individual
must demonstrate physic impairment. Furthermore, victims of PTSD experience two or more
of the following symptoms: hyper alertness or exaggerated startle response, sleep disturbance,
survival guilt, decreased concentration, impaired memory and avoidance behavior (Smith and
Maurer, 2000). If survivors do not recognize and deal effectively with these feelings they may
suffer numbness and exhaustion in a long period of time. Volunteers and health workers
should be sensitive with this kind of syndrome after some time after the actual event has
occurred since this kind of trauma will appear in a life span of the survivor which possible of
leading to the mental health disorder.
Understand the risk of trauma to the disaster victims, the preparation for disaster is very important.
The need for disaster response is greater today than sometimes ago. It is because disaster
happens unpredicted in every part of the world. The increase of human populations, effect of
pollutions as well also contributes a lot for the happening of disaster. The more disaster
happens, the more trauma influence the lifes victims. Smith and Maurer (2000) emphasize
that most victims will have some psychological reaction to the disaster situation. To overcome
this condition, some therapies activities may effective to be implemented. As a part of disaster
preparedness, these therapies including playing therapy, cooking therapy, relaxing, explore
the feeling, focus group discussion.

The assessment of mental health status may vary. A standard assessment used by some health
institutions to know the level of stress is by using standardize format available.
Tab.I : Format of Disaster Stress Reaction Assessment
Disaster Stress Reaction Assessment
1. Has client experienced a disastrous event?
2. Was this event generally outside the range of human experience?
3. Would this event evoke symptoms in almost everyone exposed to it,
even those who have been emotionally healthy previously

Yes:
Yes:

No:
No:

Yes:

No:

if answer to first three questions is ye, client may be experiencing a disaster stress reaction.
Continue assessment.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

_____a. Re-experiencing disaster through recurrent intrusive recollections or dreams.

_____b. Re-experiencing disaster in response to environment triggers
_____c. Feeling of unreality , numbness, or lack of responsiveness to events
_____d. Decreased interest in previously significant people
_____e. Decreased interest in previously meaningful activities
_____f. Hyper alertness
_____g. Increased startle response
_____h. Guilt about surviving disaster or about behavior during disaster
_____i. Difficulty concentrating and/ or remembering
_____j. Avoiding activities or places that stimulate recollection of disaster
_____k. Worsening of symptoms with exposure to events that symbolize or resemble disaster
experience.
Three or more of these symptoms indicate high likelihood of clients having a disaster stress
reaction.
Other symptoms not diagnostic of disaster stress reaction, but that may accompany the
reaction, are the following:
____ increased irritability
____Unpredictable explosion of aggressive behavior
____ Impulsive behavior (if a change from previous pattern)
____Overwhelming sadness

From Demi, A.S., &Miles, M.S. (1983). Understanding psychologic reaction to disaster. Journal of
Emergency Nursing 9, 13-16.

Case Study
The many disasters that have occurred during the 2000s and 2010s in Indonesia have brought a big
effect for mental and physical condition of the victims. These disasters have required for
emergency preparedness to the attention of Indonesian public. Unfortunately, some disaster
preparedness in Indonesia just focused on the physical disaster management while mental
health management was still being ignored.
The limitations of health worker in disaster area cause an ineffective handling of trauma. In our
nursing school of Diponegoro University for example, we make a group of trauma healing.
This group consist of some students who is interested in disaster preparedness especially for
healing process of trauma. This group consists of students from nursing major coming from
different grade. This team regularly held a trauma healing training such as how to give a
modest therapy that effective to be implemented to the victim of disasters.
Recently, this trauma healing team also did open recruitment for students outside nursing program.
This is because we are realize that everyone can become a volunteers for trauma healing
process of the victims since our programs are simples and easy to adapt by others major.
Some training we include in our project cover the individual and group therapy.
The existence of this trauma healing team is very important. As a students, the team of trauma healing
have involved in some disaster program beside that the team also have given some disaster
preparedness training for other majors. In November 2009, a 7.6 magnitude earthquake
struck off the city of Padang on Indonesia's Sumatra islands, killing at least 75 people and
trapping thousands under rubble. In this case for example, the team of trauma healing from
students of nursing school have involved actively in giving some therapies to the victims in
order to minimize a Post Traumatic Stress Disorder (PTSD). This therapy includes individual
therapy such sharing experience or group therapy such as cooking therapy, playing therapy,
focus group discussion.

(All Pictures courtesy by: team Trauma Healing Nursing School of Diponegoro University)

Pic 1: Explore feeling (individual therapy) by Team of Trauma Healing

of Nursing Program Diponegoro University

Pic.2 Motivation Therapy (group therapy)

Pic. 3. Home Visit (Family Therapy)

Pic. 4. Cooking therapy (Group therapy)

In this program, nursing School of Diponegoro University has made cooperation with PKPU or Post
Keadilan Peduli Umat (The National Humanitarian Foundation). The cooperation with this
NGO (Non Government Organization) is considerably important in order to make students
well organized in doing their activities for the victims. The support from NGO or Government
for the involvement of students in disaster preparedness will built good cooperation across
volunteers for the victim of disaster in maintaining the healing process of trauma.
Recently, in November 2010, an eruption of Merapi Volcano in Jogjakarta attract the team of trauma
healing of nursing program of Diponegoro University to get involved in the trauma healing
process to the victims. Different from Padang earthquake, in this case, the team not only
consists of nursing students, but we also offer an open recruitment which is aimed to get
students from other major to be involved in our project. We got a good response from some
other majors in our University, then they join our team of trauma healing and then we
involved together in disaster area, specify in refugee camp to give support and some therapies
for the victims.

Pic 5. Team of Trauma Healing of Nursing School Medical Faculty of UNDIP for Merapi Eruption,
Jogjakarta. 2010

Pic 6. Laughing Therapy (group therapy)

After doing assessment by interviewing participants and spread out 112 questionnaires, we can
analyze that the victims of Merapi eruption still have a feeling of anxious about their next
future. 73% of them suffer from lower anxiety, 17% of them middle anxiety and 10% of them
got higher anxiety. Most of them confused about their home, their future life, their family. In
refugee camp, we gave intervention such as health education, playing therapy for children,
laughing therapy, explore feeling (sharing experience), educate children, focus group
discussion. Some of the victims said that the programs should be follow up in their new
community. They hope that there will be community mental health program in their new place
of life they will get after the disaster.

Conclusion

Disaster occurs in every part of the world. In Indonesia, there are many big disasters happened during
the last decade. Every disaster leaves physical and psychological effect for the victims. the
lack of volunteers or health worker may requires solutions. This is because the preparation for
disasters and effective response when a disaster occurs can help minimize the long-term
effects of these events such as mental health disorder that begin from the occurring of Post
Traumatic Stress Disorder (PTSD) syndrome. Educational institution, can actively involved
taking a part actively in disaster preparedness. Establish a team of trauma healing will very
effective to help the victims from trauma. But, the involvement of health students in
minimizing PTSD syndrome or mental health disorder will not fully effective if there is no
support from other institutions or social organizations. That is the reason why the government
and other institutions should support the disaster preparedness program.

References
American Psychiatric Association. 1994. Diagnostic and statistical manual f mental health disorders
(3rd ed.). Washington, DC: Author.
American Red Cross (ARC). 1975. Disaster relief programs. 2235. Washington, DC. Author.
BAKORNAS. (2010). Management disaster in indonesia, retrieved December 14 2010.
http://www.aprsaf.org/data/malaysia_tecshop_data/malaysia_presen_day1/pm/4_Indone
sia.pdf
Demi, A.S., and Miles, M.S. 1983.Understanding Psychologic Reaction to Disaster. Journal of
Emergency Nursing, 9(1),(2).
Meichenbaum, D. 1995. Disasters, stress and cognition. In. S.E. Hobfol & M. W. de Vries (Eds.),
Extreme stress and communities: impact and intervention (pp. 33-45). Boston: Kluwer
academic.

Smith and Maurer. 2000. Community health nursing; theory and practice. W.B Saunders Company.
Philadelphia.