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The war in Iraq affects people around the world. People who have seen war previously are reexperiencing their earlier encounters with massive death and destruction. And we all feel a sense of unease and sadness that the world has yet again failed to keep peace among countries and has failed to protect people from the tyranny of murderous regimes.

This war has had a fragmenting effect internationally and nationally, on many levels. Many have protested against the war, not only for its lack of basis in international law, but also because of the many lives that war destroys. Legitimate concerns also have been raised about horrific possibilities presented if Saddam Hussein was not stopped, similar to the foreboding of things to come when Hitler ruled in the 1930s. It remains to be seen whether this fragmentation will lead to yet more anguish in the world, or whether we have the integrative capacity to pull together as an international community. Whatever position we take, everyone is worried about discord and destruction in the world.

In the face of such profound fragmentation around the world, I ask that ISTSS members, each in his or her own way, increase their efforts at national and international levels to further mutual understanding and collaboration in the field.

Integrating Trauma Resources
More than ever, it is important to acknowledge and highlight the integration that is possible in the face of trauma, which is exemplified by ISTSS members, many of whom already are active internationally. They present lectures and workshops in diverse world locations, collaborate with colleagues abroad in research projects, advise on clinical matters, and participate in training and treatment-providing programs. Numerous programs, initiated by both government and nongovernment agencies, are implemented in war-torn countries around the world. Though ISTSS members participate in these programs, financial constraints prevent the majority of the local mental health professionals from joining ISTSS or attending annual meetings. In support of these colleagues, I urge members to contribute to the ISTSS Travel Grant Fund, which provides scholarships for travel costs to attend the annual meeting.

Belonging to ISTSS provides the opportunity to establish international contacts and develop international networks of collaboration--an almost hidden and vastly underestimated function of the annual meeting. For example, members from the Netherlands attended an annual meeting with the intention of establishing links with colleagues experienced in outcome research in the treatment of patients with complex PTSD. The Dutch members were able to profit from their colleagues' expertise in designing their own programs. This exchange has led to fruitful collaboration on multinational research efforts. Unfortunately, however, it seems that government and other funding sources often follow a policy in this area based on the age-old principle of penny-wise and pound-foolish--a sad state of affairs given all that is known about the cost of complex trauma-related disorders.

Benefits of Collaboration
Many ISTSS members are involved with trauma treatment and research centers. Some of these centers are fortunate to have funding, but many struggle valiantly with meager support. However, when society realizes the value of allocating available resources for trauma treatment and research, a wealth of possibilities and collaborative opportunities abound. One such example is the Center for Post-Trauma Treatment and Trauma Education, a center in Finland that has developed relationships with ISTSS members from abroad who act as consultants and trainers. This inspiring example reflects the dedication of the center's team and the emphasis Finnish society puts on education and knowledge.

Finland ranks third in the world on an educational level. It also has one of the fastest growing economies in the European Union--a combination that is not accidental. The Center for Post-Trauma Therapy and Trauma Education was described by Williams and Nurmi (2001) as one of the most well-developed trauma centers outside the continental United States. It was started in 1994, with a five-year grant from Finland's government from the money that the national Slot Machine Association reserves for good purposes. That association covers half of the center's costs. The other half is paid by health insurance, city welfare departments, other agencies and clients themselves.

The center began with a focus on acute interventions--a much-needed service that was lacking at the time. However, the staff members soon discovered that many people they tried to help through debriefing procedures and acute crisis interventions already had existing trauma histories, such as chronic child abuse and neglect. Thus the center began to invite specialists from abroad to teach workshops in the area of chronic childhood abuse and neglect. These workshops were made available to the center's own members and to the mental health community at large, and made use of specialists' expertise in the form of case consultations available to the team. When the center identified a specific domain in which more expertise was needed, it invited experts from abroad to teach, most of them ISTSS or ISSD members. For ongoing case consultations, especially for the complex cases, the team invites a specialist from abroad every two months. In addition, each year a couple of team members attend both the ISTSS and the ISSD annual meetings in North America.

Because funding has made such activities possible, the center's team members have been able to develop high professional standards with regard to trauma theory and treatment. In the spirit of cooperation with other mental health organizations and professionals, they have shared what they have learned. They frequently lecture and consult, and they have raised awareness of trauma, including childhood abuse and neglect, as a major factor affecting mental health.

When a country recognizes the devastating impact of trauma, and provides financial support to treat and prevent it, mental health professionals can accomplish a great deal. Because Finland provides significant financial support for mental health, the country may be a unique example. What the center can afford in terms of input from abroad is far from representative of most countries in the world. But the important value that the Finns and their government place on ongoing education, as well as their spirit of cooperation, should inspire everyone around the world.

Another example of an inspiring international collaboration pertaining to a country with much economic and political hardship is South Africa, a country characterized by severe traumatization as part of the apartheid's legacy. The South African Institute for Traumatic Stress, based in Johannesburg, is staffed with two gifted clinicians--Merle Friedman, ISTSS board member, and Craig Higson-Smith--both dedicated to training and research with the South African police services and local professionals. However, due to the harsh economic situation of South Africa, only so much can be done. Given this situation, the institute has contacted the Netherlands-based War Trauma Foundation, a volunteer organization consisting of specialists in the field of trauma treatment and in the implementation of mental health projects in areas of armed conflict, as well as representatives of trade and industry who are dedicated to raising funds. The South African institute fits the requirements for funding and is now able to carry out its much-needed work on a much wider scale.

Members Making a Difference
In this time of war, we must join together to keep our field functioning at its highest level in all areas of the world. Those in the trauma field likely will be needed more than ever before. Each member of ISTSS can make a difference, at home and abroad, by collaborating with colleagues, supporting trauma treatment and research programs, and educating potential funding sources-working toward integration in the face of international fragmentation.

Williams, M.B. & Nurmi, L.A. (2001). Creating a Comprehensive Trauma Center: Choices and Challenges. New York: Kluwer Plenum

E-mail o.vanderhart@fss.uu.nl or istss@istss.org.