Since a peace accord 18 months ago that ended a brutal civil war in the province of Aceh in Indonesia, nurses and other health professionals have been fanning out to various parts of the province as part of a new community outreach project. Lasting for decades, the civil war in Aceh was only ended by the devastation caused by the 2004 tsunami. The thousands of deaths and the destruction of countless homes led to a peace accord that was signed on August 15, 2005. The consequences of decades of neglect are only now becoming apparent, particularly in a country with an estimated 400,000 nationals with psychiatric needs. The only mental hospital in Aceh has one full-time psychiatrist for 300 patients and administers electro-convulsive therapy without anesthetic. The loss of life from the tsunami has worsened the high level of trauma in Aceh that was caused by the long civil war and the thousands of resulting deaths.
The community outreach program funded by the World Health Organization and the Asian Development Bank has enabled nurses to enter long-isolated districts and set up clinics in communities across Aceh. These nurses have already identified 4,000 people with severe mental disorders including cases where the mentally ill have been kept forcibly restrained by family members (often because there was no other alternative). The traumatic aftermath of the war, including many individuals who have experienced torture and the brutal loss of family members is slowly being revealed. Despite the stigma that is still attached to mental illness in Indonesia, access to psychiatric medication has helped changed the lives of many mentally ill individuals although progress remains slow.
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