In this edition of the journal we explore some aspects of exporting trauma programs to countries and cultures foreign to the provider. Even though agencies like the Red Cross have been providing material and moral aid to countries and communities savaged by war and disaster for at least a century, psychological trauma programs are relatively new. These programs have not been subject to rigorous scrutiny and evaluation as have other treatment and therapies (eg CISM, psychotherapy, CBT, EMDR). Research on the effects of major traumatic events has established that psychological effects are very real and enduring, but the appropriateness and effectiveness of intervention are far from resolved. So it is hardly surprising, given the dilemmas and unresolved issues in immediate and long-term interventions after traumatic events, that complex transcultural interventions should also raise similar dilemmas and questions.
The discourse surrounding trauma intervention is still primarily informed by the existing paradigms on disaster mental health in the more affluent developed nations from which the aid emanates. In addition, the paradigms influencing the nature of the delivery also infuse the method applied in the limited research that has been undertaken. From both a practice and research point of view there is a case for seeking a new set of paradigms. An alternative discourse to the western dominated disaster mental health paradigms that have informed the trauma field in the past 20 years is slowly emerging. This is best illustrated in a recent publication (Bracken & Petty, 1998) of papers delivered at a 1996 symposium on trauma aid programs sponsored by Save the Children Fund (UK). The contributors offer alternative ways of constructing trauma experience and implementing trauma programs in war-ravaged communities. The key to this alternative is careful listening to the voice of victims in negotiating appropriate intervention rather than imposing exported foreign packages. Some commentators, such as Summerfield, argue that such programs can actually do harm in communities and countries. This alternative critical discourse emerging from specialists in the field can provide a stimulus to pursue a more critical examination of the social and political contexts in which trauma aid is delivered.
The critique in this discourse urges practitioners and researchers to continue to be sensitive to the complexity of entering into a foreign country and culture at a most vulnerable time. These communities are not only fractured, but traumatic events accentuate existing tensions and dynamics within communities. Trauma aid workers will, as these papers demonstrate, ignore these tensions and dynamics at their peril. The complexity of such situations raises issues not just of professional propriety, but also more fundamental considerations of justice to peoples already ravaged by events outside of their control. The ramifications are quite serious and wide reaching - not only for the training, preparation and accreditation of skilled trauma aid workers, but also for the design and funding of appropriate psychological intervention programs. A further consideration is whether trauma intervention also includes addressing fundamental structural and systemic inequalities and injustices.
In this edition we present three papers which illustrate how the complexity of the cultural and social contexts can affect the implementation of foreign trauma programs. Two papers examine the pervasive effect religious ideas and practices can have on the delivery of programs after natural disasters in Pacific Island countries. Matt Gillard and Douglas Paton report on the complex interaction between religious organizations and ethnic groups in Fiji. Tony Taylor describes how religion can determine the attribution of causality in a natural disaster in the Cook Islands. Each of these contributions, even though in exploratory stages, provides an insight into one dimension of the interface between foreign psychological aid and local situations. George Doherty, the State Coordinator of Wyoming Red Cross, illustrates the complexity of working within the cultural frameworks of recipient countries and describes ways in which appropriate cross-cultural disaster mental health services can be delivered.
Bracken, P. & Petty, C. (1998) Rethinking the Trauma of War. New York, Free Association Press.
Massey University, New Zealand
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