Surviving the aftermath of disaster

Some of them came into Auckland Airport's arrival hall in wheelchairs, their limbs wrapped in bandages.

Others arrived with just the clothes they were wearing and an emergency passport, their luggage and personal effects sucked away by the deadly water.

So far, most of those returning from the devastating tsunami have been in their 20s and 30s. But there was an 82-year-old and, at the other end of the scale, a 2-year-old.

All wore haunted expressions. In the tears brimming in the eyes and the pallor of the faces under tropical tans, you read shock, fear and anxiety. The survivors didn't smile as they collapsed into waiting arms.

"All of them have been right in the middle of it, or their friends and family were, or they observed the aftermath," says Kathryn Lawlor, Auckland manager for Victim Support.

"A lot of them are pretty emotional when they get off the flight - they are exhausted and haven't slept for days. Even if they have had some down-time on the plane, the adrenalin is still running."

And may surge for weeks to come. The traumatic reactions experienced after living through a frightening, nearly fatal experience don't necessarily dissipate once survivors come home, she says.

The Government-funded agency, which offers immediate and longer-term personal support for those who have suffered a crisis, was called into the airport two days after the tsunami.

A team of 12 worked rotating shifts 18 hours a day to cover planes arriving from the tsunami zone.

Announcements on incoming planes and messages in the baggage claim area told passengers help was available for practical matters, such as finding a connecting domestic flight or making a phone call.

Information on further Victim Support services was offered, and each person who accepted was to be contacted within 24 hours to see what help they might like. It could range from group debriefings to individual counselling.

Ms Lawlor says she has the names of more than 250 survivors on the books for follow-up.

The immediate reactions to trauma make a long list and may last several days to a couple of weeks. Physically, they may include tension, fatigue, edginess and difficulty sleeping. Emotionally, there may be a range of reactions from shock, fear, grief, anger, survivor guilt and feelings of hopelessness.

Reactions that can hinder day-to-day life include confusion, disorientation, indecisiveness, worry, a truncated attention span, memory loss and self-blame.

"Another thing after a traumatic experience is that you don't retain things," says Victim Support operations manager Bronwyn Williams. "Support workers often have to repeat information continually - people might not even remember that a worker spent three or four hours talking with them. People might have difficulties with logical thought, or have difficulty stringing a sentence together."

Such reactions are normal after great shock, but the way people deal with trauma depends on many variable factors: how early they get help, the strength of personal support networks, a strong religious faith.

"The other thing that makes a difference is their prior exposure to trauma," says Ms Lawlor. "For some that can be very useful, because they've developed coping strategies and personal resilience."

Whatever the starting point, discussing what has happened is crucial in "normalising" the experience and thus reducing the physical stress reactions it provokes, says expert Andrew Moskowitz of Auckland University. He recommends family and friends as the first step rather than counsellors.

"There are a lot of mixed feelings about professionals swamping survivors," says Dr Moskowitz, who is New Zealand chairman of the Australasian Society for Traumatic Stress Studies.

"The consensus is that we want to support the systems already in place - families and communities [around the survivor] - and not pressure them for counselling until maybe a month or a bit longer."

But if things haven't improved after several months he is inclined to start investigating post-traumatic stress disorder, a chronic and disabling condition.

Symptoms include dissociation - feeling completely unreal or outside yourself, as if you are in a dream - terrifying memories, nightmares, substance abuse to help you forget, paralysing anxiety and severe depression.

"I would like to think that if you get really good intervention and support you will avoid getting post-traumatic stress disorder," says Ms Williams.

"We now recognise that it doesn't rear its ugly head until about three months afterwards, and often six months, so we are much more conscientious about following up with people who have experienced serious trauma. We'll be doing that with all victims of the tsunami."

The consensus among trauma workers is that tsunami survivors will never completely banish the event from their minds; they will learn to live with it and may even learn some coping skills as a result of their experience.

Says Ms Williams: "I like to think of it as the ripples in a pool gradually dying down. The stone that was thrown into that pool is always there, and you'll never get rid of that. It just becomes part of your life experience."

* Anyone suffering as a result of the tsunami can contact Victim Support on 0800-VICTIM (0800 842 846).