STARTTS IN EAST TIMOR

STARTTS assisted in the establishment of a mental health clinic in Dili to help people recover from trauma. Mariano Coello, Jorge Aroche, Julie Savage, Marc Chaussivert and Dr Andrew McNaughtan, shared their experiences working in East Timor with Peter Williamson and Olga Yoldi in a round table discussion.

OY What was it like trying to train health professionals in Timor?

JA STARTTS worked for many years with Timorese refugees in Australia who were waiting for a resolution of the conflict. We had had discussions about what would be happening to people that had been traumatised in East Timor and how we could help them, by training them to develop services in East Timor. Before the Referendum we developed an East Timorese clinic with Professor Derek Silove. We met with Ramos Horta, discussed the future need to assist in the process of healing. He told us that East Timor was the most traumatised country in the world. In 25 years much had happened.

We trained a group of health professionals in how to work with torture and trauma survivors the year before the referendum. A coalition between torture and trauma services and other organisations created the Psychosocial Recovery and Development East Timor Project (PRADET). After that we assisted to establish a direct service in East Timor with Aus Aid funding. The University of New South Wales Psychiatric Research and Trauma Unit became the lead agency. After the referendum there was so much upheaval that it was crazy to train people there so instead we brought people over to Australia. The trainees went back to East Timor. Cristina Tang from STARTTS went there and established connections with a nursing training school. They were able to arrange for some premises in a nursing school but it was burnt down and had to be refurbished.

We had learnt a lot throughout the years working with the East Timorese community and with other communities that had survived trauma in the context of organised violence, so there were a lot of lessons that could be valuable. But we were aware the culture was different. What they had gone through was different so some things could be applied, others couldn’t. Our aim was to transfer our knowledge so that they could apply it to their own context.

JS We went in September to East Timor and the destruction was awesome. I suppose we were teaching concepts of counselling and mental health but there was no infrastructure, nobody had anything. I was very optimistic at the beginning of the training, but we went on a trip to the mountains one day and we saw devastation all around us. Then you began to realise that unless people are in a safe situation the principles we use in STARTTS regarding counselling are not going to be very useful to them. We focussed on community development and things like that. It was very obvious that until people got jobs, until they could get their basic necessities in life, counselling wouldn’t be that useful.

On the other hand people were trying to deal with the backlog of severe mental health illnesses the whole time the Indonesians had been in power. The trainees were concerned about the most extreme mental illnesses because they had been trained in physical health but not in mental health. They wanted to have answers about schizophrenia for instance. Some people with mental illnesses in East Timor had never been able to function in society because they were tied to a room for years. The trainees were thinking, “Can we fix these people up with the skills we have been taught this week? How I am going to do it?”

MC Since September there hasn’t been much happening to rebuild the country. There are still streets with all buildings destroyed. Little has changed. Now there are more people in the streets but there is no reconstruction. The destruction is a continuous reminder of the brutality that was inflicted on the population. If people suffer from trauma or injuries they have scars and those scars are a constant reminder of their trauma. It is difficult treating East Timorese because every time they look around they see devastation which triggers memories and emotions.

You look at Dili and wherever you look there is a scar in the very fabric of society, to such an extent that it was interesting the denial that one of the women working with me was experiencing. She made me realise about the mechanisms people use to deal with their own trauma. She said to me, “what do you think about Dili? Isn’t it a beautiful city?” I didn’t know what to say. Suddenly she was very sad and said. “Well it was beautiful.” She seemed as if she suddenly realised what was Dili like now. Maybe she was idealising, maybe she was looking around trying not to see the destruction around her or denying it.

Every time I went out of Dili I thought I would find something different but everywhere I went it was destroyed. It was demoralising.

JS It was unbelievable the kind of viciousness of that destruction. For the first time in my life I came face to face with war.

I guess that if you have gone through those horrific experiences you don’t know what reality is because your world is upside down and to have someone that you can trust and say things like “I am going mad” is of enormous relief.

MC I think in a place like East Timor where it is happening to everyone around, it is much harder to get someone that might listen to you and relate to your experiences, that will tell you that your reaction to trauma is normal. We found that those East Timorese health professionals that we trained had experienced trauma themselves, people that had the role of supporting others. The training at least gave them support, a space where they could tell their story and to some extend and to some level had it acknowledged. That was helpful.

MCh At the time many of them had family and they were uncertain about their exact situation. At the time it wasn’t long after the referendum and they were very distressed. The sense we got from a lot of them was that they were quite traumatised themselves.

PW The kind of counselling you do here with Timorese refugees would it different to the counselling provided in East Timor?

MC Counselling doesn’t exist in East Timor as we understand it here. They use advice, guidance that is normally provided by different people within the communities such as priests, nuns, teachers, nurses, leaders, in other words these were the people we trained. East Timorese refugees in Australia have particular needs related to being in exile and the structure helps them in a particular way. In East Timor you try to work within that framework and adapt as best as you can the methods. If it is counselling, it is the same process provided by the teacher, the nurse, the person that you receive counselling from, but the only difference is that I am not going to tell you what to do. I am going to give you the means, the responsibility to find out by yourself with some assistance. That would be a way of understanding the concept.

Receiving advice in some cases may be perfect in terms of fulfilling their needs, however in other cases it may not be the best way to deal with the problems. That is why we stress what counselling means and I think the East Timorese professionals that we trained incorporated it and took with them the concept.

The problem is that the East Timorese society has been totally dismantled, not only the buildings, but also the infrastructure. There are no services to refer people to. The power relations have changed in society. The new movements within society are challenging the traditional values and beliefs. For example, women now want to play a greater role in society than before and that influences the way the people think, behave.

MCh Women became involved in the struggle, they were given a bigger role during the Indonesian occupation in various social and public institutions because men were involved in the more military form of the struggle. Women were left on their own and took responsibilities that until them had belonged to men.

Apparently there are a lot of tensions. Some men have returned from the guerilla movement to a traditional relationship with their wives and perhaps with sisters and daughters.

JS that tension was present at the women’s conference. Women were disillusioned with male politicians. I heard that many women had a lot to say that was being ignored by the political leadership. There was a fiery discussion. The women were outraged when Xanana came in and delivered his speech. They were accusing him of being a womaniser and not being committed enough to the political cause. They complained about Xanana ignoring women’s possible contribution to the future of East Timor.

MC Recently they have been trying to apply quotas for their parliament and there has been some discussion and opposition to women. Young people are also changing.

AM Society in East Timor is fairly traditional, patriarchal, dominated by the elderly. It is fairly conventional but the students became leaders and put themselves on the line participating in many activities that led to independence, and now they are saying,”Hang on, where is our place at the table?” You have people trying to reassert control and the elderly are saying to them, “Now go back and do what we say”.

MCh The tensions play themselves out in issues such as language. Young people would like Indonesian, but the older generation or the more established leaders want Portuguese. Hardly anyone speaks Portuguese.

MC They don’t want to be controlled by Australia, where English is the language, or Indonesia. Things are published in the four languages. In actual fact language is a much a more profound issue because it is related to identity. We are now talking about what is being said in Dili the capital, the place that has the new ideas. The countryside is as traditional as ever. There is little change there.

The students and professionals that came back have studied in Australia or Indonesia. The only thing that unites the whole country is the religion and the language of liturgy and the language of the struggle is Portuguese. I mean by Portuguese not the Portuguese spoken in Portugal. Portuguese has permeated through Tetum. Many people don’t speak Portuguese they speak Tetum.

I disagree with the issue of being controlled by the elderly. Language is about control also, there are issues there in terms of fears of being colonised.

JA That is why they have chosen Portuguese, it is far away enough.

MCh I just wonder whether there is that kind of romanticising, idealising the previous colony as well.

MC I really don’t think so

JA One of the problems with Indonesian is that it is only spoken in Indonesia so they would have to rely on Indonesian literature, on Indonesian education materials.

MC Or on Australia if they choose English.

JA At least with English there is more diversity of countries while Indonesian is only spoken in Indonesia.

MC Portugal may be far, but remember one thing the unification of Mozambique was done through the Portuguese language, through the Portuguese culture. The same happened in Angola. I believe language plays a very important role. India has many languages, but English has been the language of bureaucracy and the political class while Hindi and many other languages are spoken by the rest of the population. English has become the elite language of those countries that once were colonised. I will agree with the fact that there is a hint of idealisation of the old colonial power. I hope languages can unify.

MCh Language is an additional burden on top of many other burdens.

MCh Language is a worrying trend in terms of keeping their culture. Maybe it is inevitable. People will conform to it and English will be the official language.

PW They will, but it doesn’t mean that they don’t speak Tetum or whatever. It is the norm throughout the world that people speak more than one language.

MC Most of the international agencies providing assistance in East Timor are English speaking. The businesses you see are run by English people. Obviously the whole thing about language is a fantasy, probably it is more of a statement that they like to have Portuguese.

PW How does language intersect with recovering from trauma?

MCh It does, it is an extra stress, an extra burden. Stressful to have to think about that, to have to learn a new language as well as dealing with many other things. There are few educational resources.

OY Nothing much seems to be happening in terms of moving forward. They have to construct a whole political project from scratch. They have to write the constitution, establish the institutions of government, the judiciary, but I can’t see them moving forward in that respect.

PW Not knowing what kind of language to use is a metaphor in a sense of where they are.

MCh Looking at third world countries, when I watch the news about Mozambique and think that’s what I was looking at in the 1970s. The notion of development is the ultimate myth. Many of those countries are not developing at all. I am cynical and pessimistic. I don’t know if East Timor will ever be different.

AM Much money will come to East Timor but it is a matter of using it wisely, not allowing to just foster corruption. That is the risk. The one good thing is that the economic future is reasonably secure and the revenues they should get for the oil and gas are quite significant, enough to run the country if it is used properly. You don’t want the oil ministers starting to buy private jets and embezzling millions of dollars. There has to be effective systems and if that is the case there should be enough money for decent public health and education system.

In terms of what Julie was saying about the violence, it was orchestrated and planned. We went to places that were ghost towns, it was eerie. Many places were burnt. The amazing thing was that people said that after the referendum all these trucks turned up, the military, and the police, the military militia were forcing people into trucks and starting torching everything. Huge convoys heading to West Timor. It was a massive operation. Before the ballot people were terrified, they knew something bad was going to happen. They had this document signed by the militia that said that if people voted for independence we would be distributing 15,000 automatic weapons and would commence their program and that would involve killing all children aged 10.

It was unclear if this was intended to intimidate people or if it was part of a secret plan leaked by someone. The effect was intimidating. I had the same experience before the ballot. A lot of people said we will vote and run to the hills which is what many people did. Here is what the UN said: “Don’t worry we will be here, we will look after you. You can trust us”. The Timorese were wise enough not to and they already had contingency plans. “We will vote, gather our possessions and flee to the mountains”, they said. Two thirds did, the ones that stayed were killed or forced into this incredible organised program.

The army, the airforce, the navy were involved in this coordinated program. Like something out of the Third Reich. They turned up in village after village that were not in the same track. They were even forced to pay fares. Leaving a trail of emptiness across Timor, with everything destroyed or burnt. It was so premeditated.

MC If the international community knew that and this happened, how can East Timorese trust anyone? One of the things East Timorese have mastered throughout all these years is passive resistance. This is positive and negative. It’s good because changes will be imposed upon them and may not wish to go along with them. It is negative because they don’t trust anyone because of the trauma they have experienced.

PW Is this felt in the counselling process?

MC The first time one had to work very hard to gain their trust. You had to prove you were equal to them but had something to give as well.

JA These are symptoms of people who have survived oppression. Trust is not something you can give at face value and then hope for the best.

MC at the same time East Timorese are warm and generous. But there is a difference between forced respect and the respect you gained through your work.

JS There was confidence in the new East Timor. The participants did criticise and evaluate what we were doing. They said when the Indonesians were here we had to do what we were told, but now we are in free East Timor and we want you to know that.

MCh One thing that makes me optimistic is the level of enthusiasm those people had.

MC While we were in East Timor we were living in this nursing school which had resident students. Our living quarters were basic but fine. Next door students didn’t have a washing machine or a fridge, which we had. They had to do the washing and the cooking outside with fire, even if it rained and there was mud They would wake up at 5am singing. They were such happy souls. They got dressed in immaculate white aprons and went together to study. They were always smiling, ready to talk to you and sometimes they would play the guitar. They were so self disciplined.

OY There seems to be a leadership vacuum at the moment. Xanana does not seem to be convinced that he wants to run the country.

MC How many countries do you know where the first leader has lasted more than 3 months? He is wise. He wants to be the second leader. Xanana doesn’t seem to inspire confidence to outsiders. He changes his mind.

AM I think he wants to be the leader on his own terms without all the political fighting. There are a lot of factions, groups, a lot of maneuvering. I think Xanana partly gets sick of it. He also finds it to be politically expedient to say “OK I don’t want to be President”, then the others say, “You must come back”. “OK, but on my own terms”. He has more bargaining power. “If you want me to lead you, you must do this and this”. It gives him more control.

Elections will be held two years after the referendum. A lot preparatory work is happening now. Work has been done but cannot be formalised until they have a proper elected government. For every department of the UNTAIR there is an equivalent Timorese department working beside it.

AM I worked very briefly in Timor as a doctor but I noticed people seemed to have a very concrete expression of their feelings. Before and after the referendum they suffered from pain everywhere. That was called the Dili syndrome, a non -specific ache starting in the head going down to the shoulders, arms, down the legs. “I can’t sleep, concentrate”. But what was happening is that these people were manifesting at a concrete level psychic pain that had been somatised. People who worked in Cambodia after Pol Pot said that this was a common manifestation.

We are more used to the idea of saying “I am feeling depressed, angry”, and you can recognise this is emotional, but in fact emotional and physical symptoms are like two sides of the same coin. What I noticed in East Timor was that firstly there may be a cultural reluctance or maybe it is because you have a whole society traumatised and people don’t have the ability to identify their feelings. They turned up wanting pills. In Timor you have this culture where people are frightened to be labeled mad.

JS If you have been for 25 years unable to talk about anything the level of dislocation must be enormous.

MC It is my experience that people are quite reluctant to express feelings. It is a combination of political repression, cultural issues. They don’t want to appear weak or mad because madness is manifested in spiritual terms, as people being possessed by spirits and becoming strange creatures, which isolates them from society. Men seem more reluctant, women are more expressive. Body language plays an important role particularly in the clinical sense. Until they trust you, you cannot get anything out of them. You can see sadness, fear, but you have to guess because there is no clear expression.

AM The Timorese have a warrior culture, a tribal culture. They have their own machismo, we need to add to that the 25 year fight against a brutal foreign force. All that combined produces machismo. My theory is that this has to do with domestic violence. If you disassociate yourself from your own emotions they come in unpredictable ways.

PW Could we then talk about a traumatised nation, or just traumatised individuals?

MC You can talk about traumatised individuals in the sense that it doesn’t matter if the person has been affected individually but someone has been affected in the family or in the neighbourhood. It is what I said before, even walking in the streets I felt the impact of being in a place that had been dismantled, brutalised.

PW What is the prognosis for a community or a nation that had this kind of experience?

MC Not everything needs to be seen in a negative way. People and communities go through trauma and in the process they can become stronger. Trauma has strengthened their values, their understanding of life and their survival skills. It is very much our concern because we work in the helping profession.

Trauma is not an absolute. It affects people in different ways at different times. Sometimes the aftermath of trauma is something that hits you much later, whenever you stop and get out of the survival mood. Others are very strong and determined through these experiences as happened with the Holocaust.

JA Mentally ill people are more vulnerable particularly when the traditional methods of looking after people are broken down, when there is no health system or when they have been exposed to violence.

MC Many people we had assisted that had mental illnesses had deteriorated after traumatic experiences. In fact after the Referendum many people were suddenly ill.

Some people had been mentally ill but were controlled by the circumstances, by the social structures and the support from their communities. But when there is a breakdown and trauma in the community mentally ill people become more vulnerable. The same occurs with people who have a propensity for mental illness. War, turmoil introduces additional stresses which might trigger symptoms.

Behind the whole Post-traumatic Stress Disorder is the notion that anybody put in a situation that is traumatic enough will develop some problems as a result and certainly in East Timor there has been more than enough trauma going around to affect a significant proportion of the population at different levels.

MC The circumstance and the environment have not been conducive to recovery. Some people have had massive losses including loss of relatives and loss of status, which is important. You might recover faster if you happen to recover the status you lost.

JA When you have this massive trauma people learn to live and develop adaptative mechanisms to survive in a situation of repression where you cannot take things for granted, where trust becomes precious. In a way a lot of people would have experienced trauma, not necessarily symptomatic but it is still having an effect.

MC There are issues around impunity, people who have committed atrocities have not been punished.

JA If you look at Cambodia, Bosnia, Kosovo, these are places that are struggling to overcome the effects of that repressive violence and that is in itself an issue that needs to be taken into account. After conflicts of that magnitude societies don’t just go back to functioning as usual, as if the conflict never happened. It takes a long time. At the same time these societies have to develop their economic infrastructure, build up the social capital again.

MC It is similar to what happened in Chile with Pinochet. The comparison I might make may sound ridiculous because one death is too many. We are talking about 3,000 people who disappeared or were killed in Chile. There were 100,000 to 300,000 in the case of East Timor. Every single family has been affected and if people cannot forget in Chile, can you image what a demoralising effect it must have in the whole fabric of society?

AM You are suggesting that there should be some sort of justice?

MC Of course. If you go out in the street and someone mugs you, wouldn’t you expect that this person is punished and that he or she is going to be caught by the police? It is a violation. Can you imagine if you have lost your son or your wife or the whole family and your property? Justice is very important for the process of healing. It is important particularly for the adolescence. If there is no justice what are you showing those young people is that you can kill, that you can brutalise other people.

AM It would lead to a profound cynicism if you have these terrible crimes being committed but you know nothing will happen.

MC The legal system in many countries now provides for the victims to confront the perpetrators to understand the impact their action has on the victims’ lives. For the victim it is a positive move because someone acknowledges that the perpetrator’s crime isn’t just a single and isolated act but that it does have an impact on the victim. Impunity on the other hand creates a desire for revenge.

MC I met an investigator in East Timor who was rather angry at the lack of political will to unearth the human rights violations. This guy had been in Bosnia and other war areas. He said that the investigative teams of the mass graves had become very blasé. They were doing their work in a rushed way. As a result nobody could identify anything from the videos. Now it is impossible for the families to recognise any family members. He said that he had been in many countries at war, but one of the things that struck him here was the sort of tactics that they were using. In other places at least they knew who the enemy was but in East Timor the Indonesian police would say things like “Come here we will protect you” and then they would kill everyone with a smile on their faces.
Someone told us there is a lack of will to uncover what really happened.

AM Yes, the human rights investigation is underfunded ineffectual, badly organised and underesourced. There is no political will, the investigations are slow. Why is that? Is it because of incompetence? The UN isn’t cooperating because they signed an agreement that allowed for Indonesia to control security so they are in a sense culpable. There will probably never be any justice.