Who ever thought that lessons learned in the war in Bosnia would have applicability to life in New Jersey? Video images of death and destruction, desperate people running for their lives, buildings collapsed and survivors glassy-eyed with sorrow and exhaustion. The pictures of war were grainy and distant in the 1990s.

But there were those who traveled to Bosnia from faraway points, witnessing the horrors firsthand, and more importantly bringing with them some expertise, a fresh pair of hands and energy. Among those was Cheryl Kennedy, a psychiatrist on the faculty of UMDNJ-New Jersey Medical School, who first went there in 1995 with the UN-affiliated group Medicine for Peace. Its mission: to provide medical and psychological services to victims of war.

Kennedy traveled thousands of miles to the front lines to address the emotional responses of several hundred Muslim and Bosnian refugees from Serb communities whose homes and possessions had been destroyed, and whose friends and family had been maimed and killed, in the tidal wave of "ethnic cleansing." She returned each fall for five years to do follow-up with this same group, and was available for consultation year-round via email. Severe forms of post traumatic stress disorder (PTSD) affected more than 40 percent of adults and children, she says, and there was little in the way of medical and psychiatric services.

Interestingly, the symptoms she saw in Bosnia – and taught local teachers and other interested adults to recognize and address – are not much different from what many in our country are experiencing now. Children had bad dreams, regressed to earlier stages of development, became more clingy and filled with fear that violent events would happen again, that their parents would disappear and that children would not be safe. Adults had intrusive thoughts, sleep disturbances, nightmares, depression, and felt anxious and disturbed. They tried to go about their normal routines only to find they were not normal, could not concentrate, accomplished little and gravitated to small groups to talk. Emotions often rose to the surface easily: a word, a look, a memory might set off a dribble of tears or a full-fledged crying jag.

When these reactions come on soon after a traumatic event, it’s called acute stress disorder. "Most people feel this way for a short period of time," Kennedy explains, "but the distress lessens in a week or two." But when the reactions continue for weeks or months, or only emerge after a period of time (sometimes up to six months later), they seem to be more enduring, she says.

The psychiatrist explains that lack of proper burial rituals drags things out for the grieving and bereaved, creating more long-lived problems. In addition, for many Bosnians, years of displacement caused health effects to go on and on.

Given any major trauma, about one quarter of those affected will have enduring symptoms of PTSD that require mental health intervention, experts say, and the longer you wait, the harder it is to treat. It was this knowledge that drove Kennedy to the Jersey City docks on September 12, and then back again from 4 p.m. to midnight on subsequent days, to do what she could for police and other rescue workers arriving there from the disaster site to eat and rest. She was doing double duty, working days at the University, first helping to ready UMDNJ-University Hospital for a possible onslaught of seriously injured patients following the collapse of the World Trade Center, then running debriefing and support groups for employees on the Newark campus.

Kennedy describes the Jersey City waterfront as buzzing with the activities of search and rescue teams, some with dogs, many young and eager yet unprepared for what they would encounter, ready to board the boats that would take them the short distance across the river to a scene of hell. She also tells of the tents where those same workers returned many hours later needing medical care for various cuts and bruises, broken bones, and eyes stinging with smoke and debris, but also for many invisible injuries, from lung damage caused by inhalation of toxic fumes to mental anguish. "No one really knew or digested how dangerous it was on site. They were coming back across the river in boats. Vietnam vets, members of the homicide squad, longtime cops and firefighters, and they were floored by what they saw. Experienced members of demolition crews didn’t quite realize that heavy equipment couldn’t be used. This was hands-on," she recounts.

All in all, what she found was an emotional terrain not very different from that in war-torn Bosnia. She helped where she could, mingling and chatting with those who wanted to talk. "Some of these guys talked and talked and they were grateful for someone who would just listen," she says, "but police and firemen and the military are a different breed." Responding emotionally is equated with loss of control and instability, Kennedy observes, but even this group found a way to tell about the horrific destruction they had witnessed. And she listened.

And what about those whose symptoms don’t ebb and go away over a period of weeks or months? The door is always open, she says, and email is a terrific way to keep communication open. Some rescue workers have already taken her up on her offer to continue their conversation via email.

"There will be many who still need to deal with the guilt of surviving when so many friends and coworkers have died," she concludes. "The ramifications are enormous."

top of page

HealthState Home The magazine of the University of Medicine and Dentistry of New Jersey