Trauma Care Expanding As Need Grows
Tue, 05/17/2011
Israel Correspondent
In Sderot, where roughly 10,000 rockets from Gaza have landed during the past 10 years, bus stop bomb shelters are common .
In Sderot, where roughly 10,000 rockets from Gaza have landed during the past 10 years, bus stop bomb shelters are common .

Sderot, Israel — Last autumn, Ronith Gil, a kindergarten teacher in Kibbutz Zakim, near the Gaza border, attended five workshops offered by the Israel Trauma Coalition (ITC) on how to help children cope
with fear and trauma. On Dec. 21, soon after the fifth class, Gil was forced to put her new training to use when a Kassam rocket landed just 15 feet from her kindergarten.

“I was on my way to school when it hit,” Gil recalled. “Despite the loud boom, I was in total denial until I saw a rocket sticking out of the ground.”

Although a father dropping off his child at the kindergarten managed to seal the building’s reinforced safe room a split-second before the rocket landed, blunting some of the incredible noise, the already war-weary children were still deeply traumatized, Gil said.

“The training taught me what to do,” Gil explained at her tranquil house in Moshav Gea, near Ashkelon, during her day off. “I took out a lot of crayons and encouraged the children to draw. We did gymnastics to let off some energy, and I encouraged them to talk about the experience using puppets.”

The preparedness workshop Gil attended is one of the many recently developed programs launched by Israeli psycho-trauma experts, who have studied and treated large numbers of traumatized individuals during the past two decades. A new round of violence — the attack on the central bus station in Jerusalem in late March, the first such attack in four years, the murder of five members of the Fogel family in the West Bank town of Itamar, and the rocket attack on a school bus in the Negev, which resulted in the death of one student — only points up the continued need for such treatment, which has evolved over the years.

The 1991 Persian Gulf war “was a turning point,” in trauma care, said Tali Levanon, director of the Israel Trauma Coalition (ITC), which has 50 member organizations.

“In 1991, when Saddam Hussein was sending missiles into central Israeli cities, we understood that the ‘front’ had moved to the civilian population,” Levanon said. “Before that, Israel’s wars were usually on the borders, fought by soldiers.”

That shift led to the creation of several trauma-related organizations, but it wasn’t until 2001 — when the second intifada was raging and ITC was founded by UJA-Federation of New York — that the groups began to strategize and share best practices in a coordinated way.

Levanon explained that in its early years, ITC emphasized direct psychological care to trauma victims. While this remains a central goal, the model of how to help these victims has been greatly expanded.

For one thing, people all over Israel, and not just in border communities, are now undergoing training to identify and treat trauma victims on the spot.

“Today, a threat is a general threat. If you live in Nahariya,” a northern town near the Lebanese border, “you may not be able to go to relatives in Tel Aviv,” since it, too, could be in missile range, Levanon said. “You’ll need to rely on the resources of your local community. We’re trying to make them as self-reliant and resilient as possible.”

An increasing number of local teachers, social workers, first responders, HMO health officials and others are taking the kinds of preparedness courses that enabled Ronith Gil to confidently enter her classroom after a rocket attack.

And in an effort to help children in the south of Israel deal with the stress brought on by rocket attacks, some unique, technology-based methods are being tested.

A program, begun last fall by the World ORT network of schools, gives hospitalized children, some as young as 5, digital cameras to help them express themselves through art and work out their feelings as they try to heal from both physical and mental wounds. Part of a wider ORT program to provide science training and high-tech equipment to the Israeli classroom, the art therapy project is being piloted at Barzilai Hospital’s Mental Health Center in Ashkelon, about 10 miles north of the Gaza border.

“Most of the children have difficulty in learning, staying focused and concentrating,” ORT’s head computer teacher Naor Epstein said in a release. “But the cameras open a way for them to actually show what they think of the world and what they feel in a way they couldn’t before. They open up and start to show an interest and to talk about things they never talked about before.”

With the continued attacks, the problem of caring for the trauma caregivers is also coming into clearer focus. Although local personnel have always experienced trauma — because they, too, live in a war or terror zone and experience second-hand trauma from the victims they treat — their need for ongoing counseling wasn’t widely recognized.

Ornit Rozenblatt, who manages the psychological services department at ITC’s resiliency centers in Sderot and the Sha’ar HaNegev regional council, estimates that 30 percent of her region’s 30 psychotherapists “are in need of help themselves.” Therapists “may be more resilient because they have learned coping tools, but they’re not immune,” she believes.

Rozenblatt said that almost everyone who has been exposed to long-term rocket fire from Gaza has been deeply traumatized, and that the traditional therapies used to combat Post Traumatic Stress Disorder (PTSD) aren’t necessarily effective.

“There is nothing ‘post’ about the trauma people here experience. Ten thousand rockets have landed and it continues to this day,” Rozenblatt noted. The demand for therapy has skyrocketed, but due to a lack of funding, there aren’t enough therapists to provide it.

The list of trauma-related symptoms is unending.

“You have 15 seconds to seek shelter after a Red Alert,” the therapist said, referring to the public announcement in response to a rocket launch. “People become anxious every time they hear an announcement at the supermarket.”

And children on their way to school in the south have been targets. Last month, a 16-year-old boy injured in a rocket attack on a school bus traveling outside of Kibbutz Sa’ad near the Gaza border died of severe head trauma.

Younger children have become “incredibly clingy” and many — including those aged 6 to 12 — wet their beds, Rozenblatt said.

When their family isn’t crowded into a safe room, “children are afraid to sleep alone and we’ve seen teenagers sleeping in the same bed with their parents. There’s also a huge problem with concentration. There’s definitely a correlation between the inability to concentrate and how often a community, such as a kibbutz, is attacked,” Rozenblatt said.

Children and even adults may be afraid to spend time in the bathroom, since it’s not reinforced, “so people become constipated,” Rozenblatt said. “People don’t realize that many of their physical problems are in fact related to stress. Their bodies can never relax.”

When Ronith Gil, the kindergarten teacher, boarded a plane to visit her siblings in New York not long after the rocket attack, she experienced debilitating pain on the left side of her body.

“The crew thought I was having a heart attack and almost landed the plane,” Gil said, her eyes suddenly flooding with tears. “I told them no, it’s not that. It’s too many Kassams.”

Gil, who exudes the kind of motherly warmth and confidence so typical of veteran preschool teachers, is currently in therapy to deal with her fears.

“On the outside I’m very strong,” Gil said, trying to muster a smile. “On the inside I know I’m not strong enough.”