IN Wan Mohd Zammani Wan Mohd Ramli’s thirteen years as a firefighter, one case has haunted him.
“I can never forget this traffic accident involving a 13-year-old girl. I had personally attended to the victim and accompanied her to the hospital, ” he recalls.
Wan Mohd Zammani is attached to the Putrajaya Fire and Rescue Department’s Emergency Medical Rescue Services (EMRS) unit, and provides on-site early medical attention to victims or fellow firefighters during operations.
“I couldn’t leave her after we arrived at the hospital, even though it was past my working hours. I continued to stay by her side so that I could monitor her condition, ” he shares.
“What really touched me was the moment she took her last breath – it was only when the girl’s mother had arrived by her bedside. It was as if she was waiting to see her mother again before leaving.”
The incident emotionally affected him, he says, making him feel “down”.
“I had really hoped that she would recover...she was in a very critical stage during the rescue.”
There are instances where after a particularly harrowing operation, a firefighter might feel reluctant to engage in similar cases, Wan Mohd Zammani admits. However, after receiving encouragement from colleagues and reflecting on the nature of their duties, they will take up the mantle once again.
Wan Mohd Zammani credits his mental endurance to the close bond between his colleagues.
“I was able to recover thanks to the strong support from my friends in the department, ” he says, adding that it reignited his drive to return to work.
Malaysia’s firemen are known as jacks of all trades. They rescue people and animals, put out fires, assist during floods and come to the aid of road accident victims. Just last Sunday, Larkin firefighter Ismarul Nizam Isnin was named a hero after successfully convincing a 10-year-old girl to come down from the ledge of the 19th floor of an apartment building.
What many sometimes forget, however, is how their work is not only physically tough but also emotionally demanding.
Procedural practices can help the firemen deal with the stress. Post-operation debriefing sessions are another way to reflect and release any tense emotions that officers may have after their duties. To cope with the mental stresses involved in the duties of a first-responder, firemen across the country can also turn to Mohd Marzi Mahmud.
Mohd Marzi is a psychologist from the Public Services Department (JPA) stationed under the Psychology Unit of the Fire and Rescue Department (Bomba). While he covers a wide range of mental health-related services, Mohd Marzi says his focus is in providing counselling services to more than 14,000 Bomba officers and staff across the country.
It is particularly important for first responders to care for their psychological well-being, says Mohd Marzi, as low mental resilience may expose a person to trauma or inability to adapt to situations.
Although he is the sole psychologist serving the Bomba, Marzi says the department goes out of its way to provide whatever necessities it can, including sending him out across the country so that firemen from all states can receive psychological support.
At times, observant superior officers refer team members to the psychology unit for counselling if they think that the firemen under their command are suffering from stress.
“The department is very supportive. For example in terms of facilities, by providing counselling and therapy rooms, ” he says.
However, he admits that having only one psychology officer can be limiting.
In the past, when dealing with particularly distressing operations such as the incident involving the death of six Bomba divers during a water rescue operation in Puchong, psychologists were called in from other ministries to help provide counselling services.
“I believe it would be a good move to expand the psychology team so that we can help firemen across the country, ” he says.
To further improve on mental health awareness, Mohd Marzi and psychology officers from various governmental agencies under JPA’s supervision are in the process of creating a psychological support self-care manual for first responders.
Changing the mental health narrative for first responders
For many of us, witnessing shocking scenes of tragedy or disaster can leave an impact that can be emotionally scarring.
But for first responders, that is routine. Resilience is thus vital.
Not only must first responders keep their composure when confronted with grisly scenes, but they must also carry out their duties skillfully no matter the emergency. These men and women must maintain a resolute presence as they are looked to for assistance and support during times of distress.
However, constant exposure to extreme situations may put first responders at risk of various mental health consequences such as Acute Stress Disorder (ASD), Post-Traumatic Stress Disorder (PTSD), compassion fatigue, and burnout.
Dr Muhammad Haniff Abdullah, who is secretary-general of disaster preparedness NGO Nadim Malaysia, believes that there needs to be a change in attitude about how we approach the issue of mental health of first responders.
Their mental well-being is equally important to that of the victims, he stresses.
There is a social expectation holding many back from seeking psychological support, Dr Haniff notes: “We feel that as first responders, we are supposed to help rather than seek help.
“From my experience and based on research, there is this narrative that workers’ psychological support is less important than that of the victims. In fact, many of the workers themselves feel that their suffering is less than victims.
“These are men and women who are exposed to long hours of work. They are at risk of injury or illness due to lack of sanitation, different food, working in dangerous or life threatening sites, exposed to difficult conditions, exposure to dead bodies. It can be tiring, ” he notes, explaining that the severity and frequency of the operations plays a big role in their mental wellbeing.
As a medical doctor specialising in disaster mental health, Dr Haniff has a personal interest in the issue. He has also conducted various disaster preparedness programmes and training for community leaders and members of the public.
He recommends awareness programmes for first responders to prepare them for the mental health risks they might encounter.
“There should also be an early detection programme in place where if first responders experience certain symptoms, they will know where to go and what help to get.”
There are organisations and agencies that have these plans in place, but there are still many that do not, Dr Haniff points out.
In some cases, employers may have unrealistic expectations of the adaptive capabilities of their first responders, he adds.
“Of course the victims are important but those who go and help also need help.”
Malaysia Civil Defence Force (APM) Training Management Division Director Asst. Commr. (CD) Mulliadi Al-Hamdi Ladin recognises only too well the physical and psychological tax that first responders face.
“During Ops Daulat in Lahad Datu in 2013, several APM members were emotionally and mentally affected after going through incidents which they had never experienced before such as hearing bombs explode and gunshots being fired at close range.
“We did not know where the sounds were coming from, but we could hear it clearly. Some APM members experienced mental health issues long after the operation ended, ” recalls Mulliadi, who has been with APM for thirteen years and was the former Sabah APM director.
Among the functions of APM are responding to distress calls and providing rescue services. They also serve the public during times of disasters, crises, and emergencies.
Ops Daulat was a turning point for the agency and sparked a change to be more aware of mental health, he says.
Right after, an initiative was taken up to focus on mental health awareness, management and recovery.
One proposal was to set up a team providing psychological assistance and support to the department’s staff and members of the public before, during and after operations.
“Another big incident we experienced was the Ranau Earthquake of 2015. But the situation was different from Ops Daulat. This time, there were no bouts of depression from the APM members but there was fear. There were those who had physical reactions such as sweating and shaking, ” says Mulliadi, who notes that the after-
effects of Ranau did not last long compared to Lahad Datu – affected staff recovered after two months.
However, he emphasises that not everyone would react the same way and different circumstances affect people differently.
“After these incidents, we saw that there was a need for psychological support so that recovery can be hastened. Our duties do not stop after just one operation, we have to move on to the next case where our help is needed.
“Many believe that we have a special kind of immunity due to the uniforms we wear. However, we are still humans. It is just that we are trained to help and save people.”
APM is in the midst of developing a new training course on early psychological treatment which will be implemented nationwide, tentatively by this year. It is working in cooperation with the Health Ministry, Welfare Department and humanitarian aid organisation Mercy Malaysia to provide psychological and mental health assistance to APM officers taking part in operations.
“There needs to be a team consisting of officers who have skills in psychological and mental health treatment. This would be a good addition to improve the psycho-social support for our first responders, ” adds Mulliadi.
The Health Ministry is also taking a bigger interest in the mental health of its first responders.
To reflect this step, the updates to the National Guidelines and Standard Operating Procedures (SOP) on Mental Health and Psychosocial Support in Disasters by the ministry will emphasise the role played by first responders during disasters and how best to care for their mental wellbeing. Among the updates in the proposed amendments include mental health screenings before being sent onto the field, pre and post-deployment mental health procedures, a self-care component, and assigning medical cards to those involved in disaster relief efforts, says an officer from the ministry’s Disease Control Division.
The updated guideline is in its final draft stages and is expected to be implemented early next year says Mental Health, Substance Abuse & Violent Injury, and Prevention Sector Head Dr Nurashikin Ibrahim.
It has received input from various ministries and agencies including the Women, Family and Community Development Ministry, IMAM Response and Relief Team (Imaret), armed forces, National Disaster Management Agency (NADMA), Civil Defence Force (APM) and others.
“Whoever contributes to this guideline is able to access and use it, ” says Dr Nurashikin, who refers to the guideline as a “joint-venture.”
The ministry is also assisting some NGOs by providing training for their first responders. However, there is still much more to do, particularly when addressing the mental health of first responders not involved in crisis areas, she says.
“When we talk about mental health and support systems, I think the way forward is to encourage all agencies to provide that support system within their own organisation. It is already being done, but priority needs to be put there. Ministries have their own psychology unit, perhaps they need to expand and have a team (of psychologists) each.”
A difficulty faced is limitations in terms of human resources. Currently, there are about 200 counsellors and psychology officers in the Health Ministry. While ministries such as the Women, Family and Community Development, and Health ministries have many counsellors under their purview, others are required to have
a minimum of one psychology officer