The Mercy Corps Blog

Blog Post Posted June 18, 2008, 1:19 am by Maya Alexandri

Fun and Games

Matt Streng conducts a Moving Forward training. Photo: Maya Alexandri for Mercy Corps

On Saturday and Sunday, June 14-15, Mercy Corps conducted a two-day Moving Forward master training. The purpose of this master training is to train people who will in turn teach the methodology to caregivers in local communities who work directly with traumatized children.

Matt, Mercy Corps' Program Officer for Health, Youth and Sports, led this master training at Sichuan University. He said that he initially was unsure of how receptive his students would be to the Moving Forward methodology. "Some people take the attitude, ‘No, I'm not going to do that,' when you ask them to get up and play games. But the group just jumped right in."

During a break on Sunday, I spoke with some of the more than 60 psychologists, elementary-, middle- and high-school teachers, as well as vocational school teachers, who were participating in the master training. As Matt had suggested, their enthusiasm was unbridled.

"What do you think of the training?" I asked.

"The Moving Forward program is very useful," said one psychology teacher. "In China, our educational approach is to require things of the children. But the Moving Forward program asks, from the children's perspective, what do they want? That's best."

Another participant, a vocational school teacher with more than 20 years of teaching experience, said that he was particularly impressed with Matt's teaching style. "The Moving Forward master training is not like a typical Chinese class," he explained. "The training participants are very active, they're not at all passive. That's because Matt pays attention to all the participants and has an open teaching style that encourages active participation. The combination of activities with ideas in the Moving Forward program is also extremely effective."

I asked a group of teachers — elementary- and middle-school, as well as college level — how they would use the Moving Forward methodology to assist youth in the quake zone. "A really good aspect of the Moving Forward program is that it can be used to help all kids, in regular schools and in the devastated areas," replied one of the teachers.

"But it's good for children who have been affected by the earthquake because language cannot always express feelings and ideas," added another teacher. "The Moving Forward activities can help the children express themselves."

I was interested in this teacher's response because psychological counseling is relatively new in China, and mental illness still carries a heavy stigma. Although the Chinese government, from the outset of earthquake recovery efforts, has recognized the need for and supported the provision of mental health services to populations effected by the earthquake, talk therapy lacks an established history and institutional framework in China.

I'd been wondering if quake-affected people might resist talk therapy techniques because such methodologies were unfamiliar. "Do you think Moving Forward is appropriate for Chinese culture?" I asked.

The teachers nodded their heads in agreement. "Chinese children like cooperative games," said one.

"It's also good that the Moving Forward program is appropriate both for boys and girls," added another.

"We've already had success with sports and games activities at the displaced persons' camp," said a teacher who works at a middle school that's located in one such camp. "We thought the kids wouldn't be interested in games because they're too old, but they loved them."

Just then, Matt called an end to the break and began the next session of the training with a game called "Head Hands." The game requires people to stand in a circle, with a person in the center, holding a ball. The center person then throws the ball to each person in the circle in turn, saying "head" or "hands." Depending on the command, the person in the circle either "heads" the ball back to the center person or catches it and tosses it back.

Proving that even adults aren't too old to love sports and games activities, the training participants launched into the game with enthusiastic smiles and gleeful cheers.

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Blog Post Posted June 15, 2008, 7:42 pm by Maya Alexandri

Ages and Stages

A young volunteer asks questions at a recent Comfort for Kids training. Photo: Maya Alexandri for Mercy Corps

Today, Mercy Corps conducted a Comfort for Kids training at Sichuan Southwest Minorities University. This training was organized by the Young Communist League, a government bureau for Chinese youth aged 25 and under, but the attendees at the training were mostly older volunteers with psychological backgrounds.

Griffen Samples, Mercy Corps Senior Technical Advisor, led the group through basic trauma training and provided pointers on the use of the Comfort for Kids workbook supplement, "My Earthquake Experience: 5/12 Wenchuan Earthquake."

One part of the trauma training is called "Ages and Stages," during which Griffen focused the group's attention on the similarities and differences that adults and children exhibit in their normal reactions to traumatic events. First, Griffen asked the group to describe instances of trauma they'd witnessed among adults.

A female participant stood and described the experience of a someone she characterized as a "very brave woman." This woman was a new mother. During the earthquake, she'd fled down seventeen flights of stairs, clutching her newborn baby, to escape the danger. Reaching the street, this brave woman had asked the participant who was relating the story, "Where should I go now?"

The participant replied, "Come stay at my apartment building."

Several days later, in the middle of the night, an aftershock shook the participant's building. She heard a crash at her door. Opening it, she found the very brave woman, curled in the fetal position at base of her door jamb.

"What are you doing?" asked the participant.

"How can I live like this?" replied the woman.

"The earthquake," concluded the participant, "transformed this brave woman into a fragile woman."

Explaining that this brave woman's extreme fear during an aftershock was a normal response to trauma, Griffen then asked the group to describe the reactions of children aged 0-3 years old. Another participant rose to relate the changes she'd observed in her own daughter, an 18-month-old.

During the earthquake, the little girl's grandmother had taken her to the basement. The girl became extremely excited, thinking the earthquake was a game. But after the earthquake, the girl continued to behave in a hyperactive manner and had begun biting and scratching other children and strangers.

Griffen emphasized that changes in the child's behavior were indicative of trauma. Biting and scratching, as well as the child's fear of strangers, were all normal responses to trauma, regularly seen in children who have weathered a traumatic event. Pre-verbal children, Griffen clarified, absorb information about the earthquake and the fear it generates in the adults around them — but they aren't yet capable of responding with language, so their behavior bears the expressive freight of their reactions.

Similarly, children commonly behave as if the traumatic event is a game because they may not understand the significance of the event as it's happening. Moreover, playing "earthquake" after the event — constructing buildings from Legos and destroying them in an "earthquake," or shouting "earthquake" and demanding that adults rush from the house — may help children process the experience.

The examples kept coming. One participant described a 10 year-old girl who'd endured the earthquake with equanimity, but subsequently became fearful after watching four days of televised quake coverage. Now she calls her parents when she arrives home from school, demanding to know where they are, and she wants to sleep with them through the night.

Another participant described a 12 year-old boy who, before the earthquake, had enjoyed skateboarding, but after the quake had switched to watching soap operas.

Griffen replied that all these behaviors were recognizable, normal responses to trauma. Children often regress to earlier stages of development after a traumatic event. Independent children may become clingy, needing to know their parents' whereabouts and keep them close.

Similarly, changes in behavior, including a newfound attraction to the story-telling of soap operas, are normal. Escapist melodrama, like soap operas, can serve a soothing role in the wake of a traumatic event.

One 4 year-old boy, who'd been hit with a brick during the earthquake and had been protected from further harm by his grandmother's body, had been hospitalized after his rescue. The boy felt "like a piece of wood," reported the participant, and doctors were worried that he'd been paralyzed. However, brain scans revealed that there was nothing physiologically wrong with the boy. His paralysis appeared to be psychological.

"What should I do to help this paralyzed boy?" asked the participant.

"Comfort for Kids is about recognizing and treating normal responses to trauma," Griffen explained. "These kinds of extreme reactions require the opinion of a psychiatrist or psychologist."

Then she provided him the contact information for a mental health professional who could help.

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Blog Post Posted June 12, 2008, 9:22 pm by Maya Alexandri

Zhao Pengyou - Making Friends

Cai Qikun. Photo: Maya Alexandri for Mercy Corps

After a morning at the Xingfu Jiayuan displacement camp, I visited the Xiangfengqiao displacement camp in the afternoon. There the psychologists are doing double-duty, teaching general education classes to children because Xiangfengqiao camp lacks a school. After class let out, one of the students approached me.

"Can you tell me your phone number?" he asked. I gave him my business card. "I want to tell you my phone number," he said, and I wrote it down.

His name was Cai Qikun. The earthquake had left his house unsafe for occupation, and he and his parents are currently living in the camp.

He is a tall fifteen year-old, who'd previously had a tumor removed from his brain; a large scar circumnavigated his skull. Whether because of this operation, or because of other medical problems, his eyes don't focus properly, but he could see and read, and he spoke preternaturally good English for someone who'd never left Sichuan Province.

"I want to be the world's second Jay," he said, referring to Jay Chou, a Hong Kong pop star who's massively popular across Asia. Cai Qikun begged me to record him singing a song. I told him that I didn't have a recording device, but that he should just sing.

Without hesitation, he broke into song, and he glowed with happiness when I and the rest of the psychologists in the center applauded him at its end. "I want to be famous," he said. "You must remember me."

Later, when I was admiring the children's many drawings that hung on the wall, another boy struck up a conversation. Thinking he was ten or so, I was surprised to learn that he was fifteen. Vibrant and engaging, he gushed, "I have so few chances to speak to foreigners."

His name was Peng Jie. He was separated from his parents, staying at the camp with other relatives. Although he spoke some English, we spent more than an hour chatting in Chinese.

He was very curious about America. "Do you have robots there?" he asked. I told him that robots are often used in manufacturing.

"That's amazing! America is the most developed country!" Peng Jie exclaimed.

He told me that he could read English-language books, but that they weren't available where he lived. He had neither a cell phone nor access to the Internet. When I asked him if he wanted to visit America, he told me that it wasn't possible: he'd never have enough money. Nonetheless, he wanted to attend college, and he confided that his parents recognized that he was smart and should pursue an education.

He was very impressed that I'd moved to China by myself, without family. I replied that you had to be independent to move to a foreign country by yourself, but that it can be lonely.

"Loneliness is the worst," he commiserated. "My favorite thing is zhao pengyou — making friends," he said, emphasizing the last two words in English.

On the bus home, I considered that both Cai Qikun and Peng Jie were bursting with ambition and capability, intelligence and curiosity. I wondered what the future would hold for them and how the earthquake would change their lives.

I also remembered that, as we'd boarded the bus to leave, the camp's children had playfully blocked the door from closing and tried to pull one of the psychologists off the bus. I could relate. I felt the pull myself, to go back to the camp and do what I could to help.

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Blog Post Posted June 12, 2008, 5:20 pm by Maya Alexandri

Leafless Trees and Spaceships

Photo: Raul Vasquez for Mercy Corps

After the earthquake, the Chinese government established displaced person camps to house the estimated five million people left homeless by the quake. Two of these camps, Xingfu Jiayuan camp and Xiangfengqiao camp, are located in Dujiangyan, a city about an hour outside of Chengdu. In Dujiangyan, the earthquake reduced many older buildings to rubble and caused schools to collapse, killing hundreds of children.

Today, I visited Xinfu Jiayuan and Xiangfengqiao with a team of psychologists from Sichuan Normal University and Southwest Normal University, where Mercy Corps had conducted Comfort for Kids trainings. Both camps have mental health centers, where these psychologists have been evaluating and treating children.

I spent the morning at Xingfu Jiayuan, where people live three-to-a-room in temporary, prefabricated housing. The camp has electricity, running water, flush toilets, public bathrooms and showers, a library, a hair salon and convenience stores. A karaoke stage was set up in a square.

At the camp's school, the curriculum includes a psychology class. The school's psychology teacher coordinates with the psychologists who staff the mental health center, reinforcing the treatment the students receive in one-on-one sessions.

The morning's work began when a psychologist escorted two children, a girl and a boy, from the school to the counseling center — a single room in a row of identical, prefabricated units. The girl wore a matching shirt and pants that looked dusty; the boy had dirt on his ears and mosquito-bitten legs.

The first part of the evaluation involved gathering biometric information from the children to determine the extent to which their stress manifested physically. Each child was asked to sit in front of a laptop, and to attach a clip to his or her ear. The clip measured the child's heart rate variability (HRV). One of the center's psychologists sat next to each child, as the computer played a visual readout of the child's heart rate.

Then the child was asked to watch a short animated cartoon on the computer. The cartoon began with a leafless tree before dawn. Over the course of the cartoon, the sun rose, the tree bloomed and a bird flew into the frame. One of the psychologists explained to me that the cartoon is a variety of "emotional visualizer," special software that produces an image that changes depending on the biometric information received from the sensor on the child's ear.

The animated cartoon ran smoothly with both children in that morning's first evaluation, but later I watched a child stare for five minutes at the leaf-less tree in the pre-dawn. The scene never changed.

"Why isn't the sun rising?" I asked the psychologist.

"Because he's anxious," she replied.

After the cartoon, the children were asked to draw pictures of trees, people and houses. One child drew a spaceship. After they completed their pictures, the psychologists asked the children to explain what they'd drawn. Throughout the activities, the psychologists sat at close proximity to the children, often laying an encouraging hand on the child's back.

When the evaluation ended, the psychologists gave the children their choice of books to take with them as a gift.

So far — a month after the earthquake — the psychologists have completed evaluations for most of the camp's hundreds of children.

"How many of the children have problems that are revealed by the evaluation?" I asked one of the team's psychologists.

"All the children display some symptoms of post-traumatic stress," he said.

The psychologists are awaiting official publication of the workbook, "My Earthquake Experience: 5/12 Wenchuan Earthquake," a supplement to the Comfort for Kids methodology in which the psychologists had been trained.

"The book is very good," one of the psychologists affirmed, thumbing through a photocopy of the book that she'd been given during the Mercy Corps training. "We just need the official copy to give these children." The book has just gone to press, and will be available for distribution in the next several days.

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Blog Post Posted June 10, 2008, 11:02 pm by Maya Alexandri

Supporting Caregivers

Mercy Corps' Griffen Samples teaching a Comfort for Kids workshop. Photo: Maya Alexandri for Mercy Corps

Today Griffen Samples, Mercy Corps' Senior Technical Advisor, conducted a Comfort for Kids training at Sichuan Normal University. Comfort for Kids is one of Mercy Corps' youth psychosocial methodologies. It has an impressive track record, having been used to alleviate childhood trauma in the aftermath of 9/11, in the wake of Hurricane Katrina and following the 2007 earthquake in Peru.

The Comfort for Kids methodology combines a trauma training workshop with an interactive workbook that helps children tell their story of the disaster in a safe context moderated by an adult caregiver. The workshop introduces the framework of the "Pillars of Security," which are the people, places, routines and rituals that anchor our everyday lives.

After a disaster, the task for caregivers is to re-establish these four pillars of security for children, so they can feel safe enough to resume their day-to-day lives. The workshop also assists caregivers in identifying normal, age-specific trauma responses that children may exhibit.

As a supplement to the trauma training workshop, Comfort for Kids also includes a workbook, adapted to be context-specific and culturally relevant for each disaster in which the methodology is used. "My Earthquake Experience: 5/12 Wenchuan Earthquake," a Chinese-language workbook for use by children in Sichuan, has been produced in record time thanks to extensive collaboration between Mercy Corps, the Children's Psychological Health Center, the China American Psychoanalytic Alliance and dedicated volunteers.

Today's training was attended by more than forty psychologists and psychology graduate students, many of them who have been counseling children in Dujiangyan, one of hardest-hit areas. In Dujiangyan, the earthquake reduced much of the city to rubble, and hundreds of students died when schools collapsed. Consequently, the trainees had been confronting tough questions and difficult behaviors from traumatized children.

One theme that surfaced repeatedly during the training was the question of how to discuss death with children. During a break, Professor Zhang Rili — a renowed psychologist on the Sichuan Normal University faculty — spoke forthrightly with Griffen about the issue.

Whether to tell children that their parents have died, Professor Zhang speculated, might depend on the age of the child. Griffen agreed that answers to children's questions must be age appropriate but, from her perspective, age-appropriateness must be balanced against the imperative to tell the truth. Being evasive or untruthful can undermine trust between the child and the caregiver. Moreover, Griffen emphasized that not knowing what has happened can be worse than the truth.

Professor Zhang agreed, but she clarified that she'd encountered two distinct situations with children. First, some children ask, "Where are my parents?" In that situation, Professor Zhang agreed that telling the children that their parents had died was likely appropriate. But some children don't ask. "Do you volunteer the information?" the professor wondered.

Griffen responded that children often ask for information when they're ready to receive it. But she also highlighted the importance of preparing children by asking them questions. "Do you know where your parents are? Do you want to know? Should we try together to find out where they are?"

Accepting Griffen's suggestion to prepare a child for difficult information with gentle questions, Professor Zhang further shared that — after hearing that their parents are dead — some children had then asked her if they would die.

"What's the appropriate age to tell children that they're mortal?" the professor asked. Griffen reflected that kids know people die.

"Death is not in our control," she said. "What's in our control is making a safe space for children, so that they can build a ‘new normal' existence after the earthquake."

Both Professor Zhang and Griffen agreed that, with respect to discussing death with children, the question was one of timing. Referring to the Comfort for Kids guidelines, Griffen offered that "My Earthquake Experience" recommends that children be asked if they know their parents' whereabouts about a month after the disaster.

As the participants' survey responses to the training made clear, the attendees valued the Comfort for Kids methodology in meeting the challenge of answering these tough questions of timing and child readiness to confront and accept death in the aftermath of the earthquake. They identified the "My Earthquake Experience" workbook as the most useful aspect of the training.

The participants could hardly have failed to notice that, on pages 14 and 16 of the workbook, is a series of questions both straightforward and heartbreaking: "My Earthquake Experience" asks children to check a box if their mother or father died in the earthquake.

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Blog Post Posted June 8, 2008, 8:24 am by Maya Alexandri

A Different Game of Cat and Mouse

Children play chen qiu rong, or "Chinese jump rope." Photo: Mercy Corps

Mercy Corps' Moving Forward program uses sports and games activities to facilitate psychosocial recovery for disaster-affected youth. Conceptualized by Nike and developed by Mercy Corps in conjunction with CARE, Moving Forward has been used in two previous crises: helping children recover from trauma stemming from the 2007 Peru earthquake and from social unrest in Kenya surrounding its 2007 presidential election.

Although sports and games are universal, Moving Forward is adapted prior to each implementation to ensure that it's culturally relevant and accessible to the local population. Matt Streng, Mercy Corps' Program Officer for Health, Youth and Sports, has been working for the past week in Chengdu to adapt Moving Forward and ready it for use in the Sichuan earthquake zone.

Matt has gone to Sichuan University's primary school to determine what kinds of games are popular with the local children. In the school's "chatting room," he met six children — three each of girls and boys, ages 6-8 — along with the school counselor and the students' teacher.

The students described, and then demonstrated, a variety of local games. One game involved keeping a toy reminiscent of a hacky sack in the air with one's feet.

Another game, called chen qiu rong or "Chinese jump rope," required the use of a large elastic band. Two children loop the band around the backs of their ankles and stand facing each other, three or more feet apart, with the elastic band stretched between them. To get an idea of this, just imagine putting both your index fingers on the inside of a rubber band and stretching it taut.

A third child then jumps between the elastic bands in an elaborately choreographed pattern of moves. The elastic band can be raised, to the knees, waist, or even shoulders of the supporting players, to heighten the difficulty or change the challenges of the game.

The last game was a variation on tag, with a cat and mouse theme. A group of children, identified as mice, stand on one leg, supporting one another. They hop forward as a group, four times. Then a sole child, the cat, hops forward three times. The cat then pushes the mice, and the mice have to resist. If all of the mice remain upright on one foot, the game continues. But if one of the mice places a second foot on the ground, then that mouse becomes the cat for the next round of play.

Matt thought the cat and mouse game could readily be adapted for Moving Forward. "The mice are all standing on one leg, supporting each other, trying to resist a challenge posed by the cat — you can go anywhere with that," he said.

Here's how it could work: after the children play the game for several rounds, the caregiver could call a break and ask the children how they feel. They know that they have to resist the cat, but also know that they can rely on the other mice for support. What if they had to resist the cat on their own? And what's the significance of the fact that all the mice stand on one leg? Can the children think of other examples from their own lives about how they might be "standing on one leg" in some way, but that they have support from their family or community to compensate?

Matt incorporates local games, like the cat and mouse version of tag, into the Moving Forward activity guide that he's been preparing for use in an upcoming training of Moving Forward master trainers (that is, people who will train the caregivers who work with children). By design, the caregivers themselves will continue this process of adaptation.

The Moving Forward program met the approval of at least one youngster at Sichuan University's primary school. After hearing Matt give a brief overview, this girl piped up, "That's a good idea. I prefer playing games and sports to talking to the counselor in the chatting room."

"Besides," she added, "after you play sports, you're tired, and it's easier to share your feelings."

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