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Brief Introduction

There were 15 participants invited of whom 14 were able to attend at least partof the conference. Claudia Samayoa was not able to attend at the last minute since she was asked to go to Honduras to make contact with human rights workers who were being attacked in connection with the coup d'etat in Honduras. Our conference took place during this time of traumatic upheaval in Honduras, which was felt by all of us in one way or another.  Felix Maradiaga was only able to attend the first day due to last minute family and work constraints. Estela Heredia and Mary Bolt were not able to be there the last day due to a prior commitment to attend a celebration in honor of the death of a long-time woman activist friend.

We were a group that represented psychologists, researchers, body-workers, activists and providers of workshops on trauma recovery.  Some of us fitted into more than one category.  The majority of us spoke both Spanish and English but there were those who spoke only one language so all was translated into both languages.

Our point of departure was that we wanted to keep in mind the entire picture from the global causes of political trauma down to the nitty-gritty of exercises that helped in trauma recovery. We spoke of it in terms of taking care of the bodies downstream while we also worked to end the killing upstream that was the source of the bodies.

We were led by the 4 Key Questions that had originated this conference. (Key Questions)

(1) What have been the successes and limitations of the present recovery programs? What does the present body of experiences and research tell us about those who continue to live in traumatic experiences while they deal with past trauma at the same time? 

(2) What are the elements of a recovery program that responds to the needs of the majority of people in a traumatized society?  How can more recovery for more people occur within the restrictions of realistic resources? 

(3) What are the relationships between emotional and spiritual healing and social/political changes?  Can programs be developed that both help people to recover emotionally and encourage people to change the elements of the society that are retraumatizing them?

(4) How do we begin to reach others with these ideas?  What are our next steps after this conference?                                  

1)  We shared experiences on both a personal and work level. On the first day we got to know each other through sharing these experiences. On the second day in the morning we had a conference call with staff from Just Peace International in Pakistan. In the afternoon we formed work groups and came up with 4 documents: A Context for Trauma Recovery, Suggested Elements for Trauma Recovery Programs, Ideas for Evaluation of Trauma Recovery Programs, Self Care and Integration . On the final day we reflected on how to integrate what we had learned into our lives and work and took on specific tasks to move forward.

There were certain themes that kept reoccurring throughout the three days:
* how to balance and integrate self-care with the pressures of our work and our lives
* how to keep focused on our specific aspects of trauma healing and work to change the larger societal forces that keep producing more trauma
* how to know what are the most effective methods of trauma recovery given the differences in situations, cultures and individual needs
* the role of community and the context in which a person sees themselves and the work that needs to be done locally and globally

Teleconference Call with Ali Gohar of Just Peace International
(JPI) is attending to the needs of those Afghanis and Pakistanis that have fled the Swat Valley and moved south, those who are fleeing the Taliban and the drone bombing by the West and those refugees who have been displaced for over 30 years. The refugees are gathered together in UN camps of about 30,000 people, living in tents. Outside aid organizations need to first seek the permission of the Elders of the community before they can offer any aid. Sometimes it is difficult for them to assess the needs because of restricted access to the people. 

(1) The impact of trauma on women and men is similar in some ways but women are impacted more since they live restricted in women's compounds and the disruption affects their daily lives of house maintenance more. Women need the permission of the Elders before they are allowed to seek treatment.

(2) There are always the immediate needs that need to be addressed (food, clothing, shelter, water, medicines, etc.) and then the healing of the trauma. The UN camps (where most of the refugees JPI works with are located) attend mostly to the immediate needs and not so much to the long-range trauma needs.

(3) Because of the makeup of the Afghani and Pakistani Muslim communities there is a built-in community organization through the elders which is easier to replicate in camps and when communities are displaced.  This is an aid to the Muslim communities. Also a strong tenet of the Afghani/Pakistani communities is the concept of helping guests no matter what the situation.  This is also a help to displaced persons.

(4) There have been four components in the trauma work that JPI has done: build awareness of symptoms, doctor visits, psychotherapy and vocational training.  They are not using any specific trauma recovery model. People are dealing with the usual symptoms of stomachaches, sleeplessness, etc. Many have lost property, wealth, status and family and friends. In addition, they are not used to the terrible heat and this is causing added problems in the camps.

(5) There will be a meeting in the coming weeks between the providers of aid, donors and Afghani community members.  Any information we can provide them about the necessary components of a trauma recovery program will be very important and he wants to stay connected with this conference group.

Document 1. Context for Trauma Recovery (Estela's Report)

A Participative Model
I. Analysis of the local and global context

• Cultural concept of damage and trauma: The intervention should be from the point of view of the local level, not disconnected from local level and context. So first there must be an analysis of the context (local place, culture, social-cultural reality about trauma and damage).
• How do we feel its effects? These are the questions to the participants in the group—what does trauma and damage mean to the participants? How does it affect them? How do they describe it?
• Up until now what did the participants do to respond to trauma. We need to help them see what coping strategies they were using and to give a dimension of value to what they have done already.  This strengthens the individual and the group and it shows them that they have the capacity to recuperate and be active in their own lives; move from passive to active.

II. Training  - experiential methodology

1. How does the problem affect the participants – mind, body, social, spiritual
2.  How they have solved their problems up until now, individual and collective problems. They have their story up until now, and it is about remembering their positive experiences and their story, what they have been able to resolve. It takes them from the place of a passive victim to actors in their own lives and by that means raises their self-esteem. Should remember to not just give out fish but teach them to fish (i.e. designed to be preventive).
3. The new situation. This is a new traumatic situation and these are the actions. They are psychosocial, psycho spiritual, and psycho-corporal.  Define and communicate who you will go to in a situation of risk or emergency. Coordinate with religious leaders who can support. Learn bodywork techniques.
4. With social justice leaders. Group work. Share own experiences of violence and pain, re-establish their connections with their emotions.  Need to move people from assuming the victim position. Humanize, rebalance family life. Promote forgiveness and reconciliation. Raise awareness of own fears that can lead to violence. Reflection/reframing violence on broader level. Leaders look at causes of violence on larger political and economic level.  Don’t think that any situation is permanent so don’t get disheartened.
5. Self-care. Mind-body-spirit-social. Family, honor or reestablish social networks,  ancestors, culture. Those with self-esteem who look after themselves can look after others.
6. Organization. Reclaim human rights and social justice and denounce impunity.
Evaluation. It is ongoing and permanent, because these are participatory processes, the planning is based on what has happened in the past, so we need to know whether we are heading in the right direction and whether we are achieving what we want to, or else have to adapt program. This entails evaluation, planning, and follow up.

Document 2. Suggested Elements for Trauma Recovery Programs

Elements that contribute to a good Trauma Recovery Program:

* Replicable without using professionals so that large numbers of people can be served
* Include basic needs:  relearning how to do practical things, finding safety and figuring out how to stay safe;
* Takes into account the reconstructing of community and trust
* Empowerment that comes from re-engagement (i.e. political activity, relationships) framed around root causes of the trauma
* Main goal of the recovery program = the person is better able to function and re-engage with others to improve the situation

Components of "tool kit" that can choose from (i.e. not all are necessary or useful):

* Importance of their trusting their own perceptions and building self-esteem
* Address changes in brain physiology from trauma—problem solving, memory formation, planning, making good choices
* Exercises to re-integrate focus/brain
* Relaxation
* Building awareness about trauma—basic education
* Body work
* Psychotherapy 
* Teaching coping skills
* Discharging bound energy (from flight or flight response)
* Alternatives to “Fight of Flight”—engagement techniques
* Spiritual framework--construction of meaning, reframing experience
* Returning past experiences to past, not in the present—a challenge in dealing with the traumas that are in the present
* Have a realistic possibility of a future
* Developing capacity to plan ahead
* Building resilience. Self care even during a crisis. (Looking at one’s own needs and responding them.) Make a model that recognizes that in order to help others need to take care of self.
* Setting goals and checking in

Need independent research that includes academics, providers and recipients in order to discover what are the elements of a trauma recovery program that are the most effective and under what circumstances.

Document 3. Ideas for Evaluation of Trauma Recovery Programs

Why evaluate?
* so we can trust that something really works
* so we can hear the voices of participants in more than just formal written evaluations following a workshop
* to learn from and adapt or adjust what we doing at each stage of the process --the initial through the final product
* to check if we are really doing what we set out to do
* to evaluate what is lacking so that we can improve our successes, the fruits of our work and the objectives

What are the challenges?
* The context since there are many diverse factors that influence a person
* Are we evaluating the process of trauma recovery, the workshop or the trauma itself?
* A challenge in the methodology is defining the appropriate results: reduce nightmares? get the person back to work? etc

Thoughts about Method
* How do we evaluate models in the context of permanent traumatization? Can we use traditional models for this reality?
* Do we use quantitative or qualitative factors? A variety of sources?
* Can case studies be used to help in the initial evaluation and then build on this?
* If someone is just present in the recovery workshop and doesn't participate but reports feeling better at the end, is this valid and how does one evaluate recovery? How do we measure impact of recovery program?
* Can you compare the impact of different types of treatments?
* Need to take into account cultural factors, previous health factors of the individual
* Need to take into account the evaluation team -- its feelings, goals, limits, etc.
* Need to start simple with pre and post questionnaires and then develop more fully an evaluation of trauma treatment programs

Suggestions:
* Take into account the variables in the scientific literature
* Take into account the social justice and human rights proposals
* Take into account what is important for the people recovering i.e. start with interviews in order to identify pertinent variables, generate a questionnaire based on this information that can be used before and after the intervention
*  Use a theoretical framework that includes interdisciplinary input.

Document 4. Self-Care and Integration

Thoughts from our own experiences in seeking integration through self-care

* Important to begin with one's own work and keep at it as we participate in any type of recovery work with others
* Many groups that offer emotional support or political work also have their own methods of violence and bad practices that can re-injure people
* Have to really validate that each person can do the work they need in their own way and not feel pressured by others to invalidate their own process
* Need to stay present on all five levels - body, mind, spiritual, emotional, social -  and be constantly present to oneself while working with others
* Trauma is frozen pain and pain leads to illness and acting out emotionally and socially and need to help people through bodywork to release that pain into consciousness
* Need to help ourselves and others move from victim to proactive and empowered
* Need to prevent people who have been victimized from being re-victimized (ex. woman who reports a rape and is not believed)

Where do we go from here?

Specific Tasks that People Took On:

(1) Penn, with Pat and Julieta's help, will write up a short Final Report and make it available to all participants (in English and Spanish).  This will include electronically sending everyone's email so everyone including Ali Gohar, Julieta and Elena have.
The complete notes (in a mixture of English and Spanish) can be sent to anyone who requests.  Also Paul's notes (in Spanish) are available directly through Paul Stucky.

(2) Rachael and Saskia will take the four documents that came out of the conference (Context For Trauma Recovery, Suggested Elements for a Recovery Program, Ideas for Evaluation of Recovery Programs, Self-Care and Integration) and polish them up so that they might be used outside of the conference participants. Patty will help to make sure that they are also available in Spanish.

(3) Patty will get resource suggestions (books etc.) from all the participants and send out to everyone.

(4) Paul, Saskia, Rachael and Beth with the help of Margy will begin to look at some methods for moving forward on the idea of doing research. Pat offered her site for trying out these methods if  appropriate.

(5) Jenny and Patty with help from Penn will write up an article that includes the reports and can be used by the activist community.

(6) Jenny and Patty together with Julieta will look into deepchangegathering.org, a group that is working to bring together frontline activists, funders and others in order to better integrate the healing arts into social change activism. Deep Change will be presenting a workshop at the US Social Forum in Michigan in 2010.  Jenny, Patty and Julieta will investigate how we might work with them.

(7) Beth will put together a questionnaire by email that will be a six-month follow-up with the participants of the conference.

(8) Saskia will see if she might have time to do some on-going coordinating of the group since Penn can not take that task on now.

(9) Beth and Margy are willing and available to be consulted on way to develop programs of pychological back-up for activist groups. Pat Floerke is also.

In addition
* People can take this work and see how it might give direction to their own lives and work
* Think about a type of cross-cultural work that people might do together
* Research the various models that exist for crisis and disaster intervention with focus on trauma
* Consider coming back together again
 
Evaluation
Improvements:
* More structured work together in the future

* Positives: Appreciation for the work of Penn for coordinating, Julieta for notetaking and Elena for translating and Kairos staff for the beautiful space and their hospitality and to all of us who shared our lives and were open with our minds and hearts!