The Age Thursday 28 June 2001

Helping the Timorese heal wounds of the mind

By PAULA DORAN

For half of his 30 years Domingos lived chained to a wooden bench behind his village home in the hills of East Timor. His family was so afraid of his unexplained aggression that they bound his wrists and feet with chains.

Domingos' behavior changed when he was 15. At first his family thought his unrequited love for a schoolteacher sparked his rage. He began wandering daily and he would burn things for no reason. His speech was often jumbled. His family said he claimed to speak with spirits and with Jesus.

Because of his condition, Domingos was abused by fellow villagers, who frequently pelted him with stones. Afraid that his son would come to harm, his father brought out the chains.

Once, in a wave of guilt, his father unchained him. Domingos ran but was caught by Indonesian troops who beat him badly and then put him in a hessian bag and dumped him in a river. He was found and returned home barely alive.

When Australian psychologist and doctor Kim Baker first visited his village in December last year, Domingos lay on his bench, thin and dirty. He spoke single words and made no eye contact.

He has since been diagnosed and treated for schizophrenia.

"Two months later he has shown enough improvement for his mother to remove the wrist chains," Dr Baker says. "One week later the family removed all of the chains. Sadly, his father wasn't alive to witness the removal of the chains. He died 17 months before." Domingos is now an integrated member of his community.

Dr Baker works with PRADET (Pyschosocial Recovery and Development in East Timor), a group funded by AusAID that provides what is believed to be the first mental health service in East Timor's history. Domingos is one of 255 cases PRADET has treated since the service began in April last year.

Led by a small Australian team - director Kristina Tang, clinical supervisor Susan Kendall and Dr Baker - PRADET has trained 12 local staff as mental health nurses and continues their training on the job.

Given the extent of neglect in the past, it is not surprising that no figures are available on the extent of mental illness in East Timor.

But the limited research that has been done, also not surprisingly, suggests a high level of post-traumatic stress disorder.

A survey of East Timor's 13 districts, conducted in June-July last year by the International Rehabilitation Council for Torture Victims, found that 96.6per cent of the 1033 people surveyed had suffered trauma during Indonesia's occupation.

Seventy-six per cent had experienced a combat situation; 64per cent had suffered a lack of shelter; 60per cent had endured ill health without access to medical care; more than half had been close to death. A third of those surveyed reported symptoms of post-traumatic stress disorder.

In their first week of operations, PRADET treated 17 patients; they now have more than 250. Most patients suffer psychosis (45per cent) and severe depression (40per cent). Many suffer post-traumatic stress disorder.

"Half of these people are under 30 years old. Many have had the illness for decades. It's not uncommon for the patient to have gone 10 to 15 years without treatment," Dr Baker explains.

With little other option in the past, it was common for the mentally ill to be chained up or locked away in barricaded rooms or prison. Some of these practices continue today, and mentally ill people are still in East Timor's prisons.

"During Indonesian times they were simply diagnosed 'bulak' - crazy. The Indonesians treated the mentally ill very basically. They were given a handful of pills and told to `go away'. At best these pills were a sedative, at worst, they did nothing," Dr Baker says.

"There was no follow up, the people would relapse. "Some of the mentally ill were sent to Bali to a psychiatric hospital. Most didn't come back. Some patients were treated with the anti-psychotic chlorpromazine injection and I believe some people died from that.

"I heard that in some instances, if someone was very `crazy', if they were very dangerous and tying them up didn't work, then the village chief would meet with the family and together they would face the decision of whether that person should live," she explains.

"That was a decision made with great difficulty for the good of the community, to contain the danger.

"Many times the condition of the person tied up would deteriorate so they couldn't eat ... they eventually passed away." IGNORANCE about mental health issues, and prejudice against sufferers, are the first obstacles the team must tackle. An incident Dr Baker witnessed during a recent visit to the small Becora Clinic, which adjoins a school on the outskirts of Dili, demonstrates the scale of the task. In the middle of the schoolyard was a patient, a 25-year-old stabbing victim who had developed post-traumatic stress disorder and depression after the attack. Surrounding him were swarms of children, who chased, taunted and stoned him.

"I ran outside to defend him, but every time I shooed away some of the kids, more would surround us. They kept on screaming and pelting stones at this poor man," Dr Baker says. "He'd ran out of medicine, and off his own bat he was coming down to the clinic to get more."

Public education, starting in schools, is next on PRADET'S agenda.

After personally experiencing the trauma of the war in the former Yugoslavia, Croatian psychologist Suzanah Paklar, representing the International Catholic Migration Commission, has been training East Timorese women in trauma, tolerance and communication skills.

"People here lived so long under threat," Ms Paklar says "They learnt how not to think, to make your mind blank. You function, but your mind is not functioning ... they switch off because it helps not to feel.

"We need to share the message that recovery will take time, steps, processes and activities to heal these people."

Ms Paklar says her training sessions left her with hope that women would lead the recovery in East Timor.

"The idea is to focus on women and increase the knowledge of trauma, to empower the women in the local community.

"A lot of (East Timorese) military come home after years in the mountains, away from their families, with a very important job of defending their country. When they return they are still on a little bit of a high ... they're welcomed, then slowly, normality hits and they don't know how to fit in.

"These men need to learn how to deal with everyday life that is now too simple."

She says it was important for aid organisations to treat more than the bricks and mortar deficiencies in East Timor. "People aid the visible, the tangible problems, the destruction, the burnt houses ... which is all very fair but the longer you wait to treat mental health, the more complex the condition."

She cites the rise in domestic violence as an example.

"There is no group that would not be affected by the experience of their country. You have a situation that you live under for a long period of time, in conditions defined as very traumatic, then the trauma is all that you know. It's not like a train crash, it's your life."

Domingos' name has been changed for reasons of privacy.

Paula Doran is an Australian journalist doing volunteer work for an East Timor radio station.

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