STARTTS: The first 10 years

by Helen Basili

The 10^th anniversary celebrations of Australia's first refugee service for torture and trauma survivors are a landmark in a journey of discovery and growth. They will provide a rare opportunity to reflect on past and current achievements.

Dr Andrew Refshauge, the NSW Minister for Health, will host the anniversary celebrations of the Service for the Treatment and Rehabilitation of Torture and Trauma Survivors at Auburn town hall on November 20.

In 10 years STARTTS has provided counselling, group work, physiotherapy, English classes, camps and excursions to thousands of clients and currently has more than 200 people on its waiting list. The majority of clients are from the former Yugoslavia, South-East Asia, the Middle-East, Latin America and Africa.

STARTTS anniversary will celebrate the achievements of the service and its ability to overcome the many challenges it has faced. It will also celebrate the resilience of refugee clients and the contributions made by refugees to Australian society.

Funding for the service, initially a two-year pilot project, came from the NSW Department of Health in 1988 following the recommendations of a report made by Professor Janice Reid, now vice- chancellor of the University of Western Sydney.

"The horror of torture and the consequences of its use confronted us unremittingly as we read the medical literature and reports of Amnesty International and listened to the stories of refugees living in Sydney who have undergone ordeals beyond the comprehension of most Australians," Professor Reid said in the report.

From humble beginnings in a three-bedroom cottage with a staff of four, STARTTS has expanded into a service employing 50 people in two sprawling office blocks in Fairfield and Auburn, a reflection of the vast needs of torture and trauma survivors in NSW.

"The level of enthusiasm and commitment was incredible," says STARTTS Executive Director Jorge Aroche, recalling the early days of the service. "We were operating in very constrained conditions, developing a service from scratch."

One of the first challenges for the service was to gain credibility with the various refugee communities it intended to serve. Tiep Nguyen, counsellor for the Vietnamese community, believes that community consultations were a significant factor in achieving this goal.

"The first consultation was held with the Indo-Chinese communities. We invited workers from the Vietnamese, Lao and Cambodian communities and about 80 people turned up.

"People were very impressed with STARTTS initiative, both those who attended, and those who heard about it later," says Tiep.

The success of the consultation, which aimed to get the support and input of community leaders, meant that community consultations became an ongoing part of STARTTS' work. Since then, numerous consultations have been held with the Indo-Chinese, Middle-Eastern and Latin-American communities in Sydney.

Another difficult task STARTTS faced was to gain the trust of clients and communities who had been extremely traumatised and often had a profound distrust of government agencies. This was exacerbated by the fact that these people came from countries where counselling, in the Western sense, was virtually unheard of.

According to Lucy Marin, STARTTS counsellor for the Spanish-speaking communities, it has been common practice in Latin America for priests, family or friends of a distressed person to take on the role of counsellor. Lucy says the Western concept of counselling was not fully understood, especially in rural areas, although it was accepted among the Latin American communities that talking to someone about your problems could be helpful.

The reluctance of potential clients to seek individual therapy was a hurdle that was overcome by improvisation and creativity. "People didn't want to come to us as a 'client' but they would be very happy to come and tell you all about their trauma over a cup of coffee. We realised we needed to have a lot more flexibility," says Jorge Aroche.

"I used to see one client in the park. We had counselling sessions under a tree or on the bench." Many counsellors set up groups for clients. This was an ingenious way of bringing people together in a non-threatening manner so that trust could be built up with individuals who would later seek counselling. Says Lucy Marin: "I knew that for Latin Americans, it is quite easy to get into groups. My idea was to encourage the communities to start coming to group activities before coming to see me as a counsellor on a one-to-one basis." W

Space was limited, so Lucy set up a Spanish-speaking women's group in the garage. "It was extremely cold in winter and very hot in summer," she says.

"It was completely abandoned so we emptied and cleaned it, painted it and put some shelves there.

"The first activity we did was pottery making which was excellent. Doing that motivated the women to work with their own feelings. They were actually creating something in Australia that belonged to them."

Zalmai Haidary, counsellor for the Middle-Eastern communities, remembers the difficulties he experienced trying to encourage companies to donate a sewing machine to the STARTTS Middle- Eastern women's group. He was unsuccessful.

"STARTTS was new. People could not understand the nature of the service or the issues for refugees," Zalmai says.

Undeterred, Zalmai organised a community fundraising raffle so three second-hand sewing machines could be purchased for the group. As sponsors could not be found, Zalmai and several of the women from the group donated some of their own household items for prizes.

In 1989, STARTTS acquired a second cottage, two doors up from the original location. With the extra space, group-work prospered. There were physiotherapy groups, English classes, a Vietnamese women's group and groups for Lao and Vietnamese survivors of re- education camps.

At the same time, the number of people seeking individual therapy skyrocketed. Funding enhancements were received and the number of counsellors grew to meet the increasing demand for the service. STARTTS also began to attract a more diverse clientele representing a larger number of ethnic groups and nationalities.

The process of developing models for counselling refugee survivors of torture and trauma has been an ongoing one. Ten years ago, this presented a daunting task for the new service. "The area was very unexplored. When 1 first started looking for information on treatment 1 could only find seven articles," says Jorge Aroche.

STARTTS has been something of a pioneer in this area. Although the Rehabilitation and Research Centre for Torture Victims in Copenhagen and several other services in Europe had been experimenting with various models there was still much to be learnt.

"Counsellors have gone through quite a deep process of trying out different models and working through what they do and don't accept", says Robin Bowles, a generalist counsellor at STARTTS.

"At first 1 wondered whether we could use any type of psycho- therapy with people from other cultures or whether it was totally culture bound". After 1 0 years o

counselling refugees, Robin has changed her mind. "I think that psycho-therapy is a gem from the West that the whole world can use".

Robin believes that it is possible to practice successfully from a number of perspectives. "They probably have a lot more in common than we realise," she says.

Jorge Aroche and Mariano Coello, STARTTS Clinical Services Coordinator, have developed a model to conceptualise the problems affecting refugees. The implementation of this approach has resulted in a set of interventions that attempt to address the problem through a variety of strategies focusing on different systems. These range from the individual and their family, to the community to government services and policies.

The expertise of the service in treating survivors of torture and trauma has grown to the extent that staff are often invited to present papers at national and international conferences.

STARTTS counsellors have also published a number of articles in academic journals. Tiep Nguyen, one of the services most prolific writers, has had articles published in the Australian Journal of Social Work and the Journal of Advanced Nursing and has also published a resource book on the Vietnamese community in Sydney.

One of STARTTS core values is a vision of its clients as survivors who have enormous potential to give. "The Fairfield local government area has developed enormously because of the contributions of refugees," says Viliam Phraxayavong, STARTTS counsellor for the Lao community. "Because of the successful businesses started by migrants and refugees the Australian ,economy has grown. They add to the -colour of Australia with their Different cultures and traditions".

According to Robin Bowles, the refugees bring with them a valuing of democracy and individual rights.

"I think a lot of them really value Australian Democratic Institutions and they fight for them. They bring more of a worldly view to us."

The ability of refugees to overcome adversity is a continual source of inspiration. Perhaps this is best expressed by a former client of STARTTS Zalmai Haidary who wrote: "I feel that a great burden has fallen off my shoulders and that feeling of depression is gone. You have helped me make that positive step toward the future and given me a sense of hope."