Disasters can happen anytime and at anyplace. Natural disasters are so frequent that one generally attributes it to fate. Sometimes the destructive forces of Nature become so strong that all our plans and policies fall like cards. We become helpless infront of the mighty Nature. When everything comes to an end, wherever one looks, the sight of the helpless victims fills our eyes. Children’s become orphans. Husbands lose their wives and vice-versa. The scenes are extremely painful. Lots of money in the form of grants flows for reconstruction. The obvious question that comes to ones mind is:
Is monetary help really meets their needs?
The answer will be in negative. Scenes horrendous in nature, fear, trauma and stress do engulf them. They are living dead.
The only solution to the problem is Psychological Support. In many projects a good psychological support program misses.
We have to explore those and that’s what humanity is all about.
Psychological support has become an important component of the disaster preparation and response repertoire. This occurred in the background of the need to understand mechanisms for the reduction of hazards related to disasters. The United Nations International Decade for Natural Disaster Reduction (IDNDR), 1990-99, was dedicated to promoting solutions to reduce risks from natural hazards (ISDR 2002). But it’s not always Natural Disasters that happens and leaves a scar in the minds of the people. It’s also man-made situations or accidents, which do lead to devastations. Now, it is recognized that riots, industrial accidents, acts of terrorism, internal displacement and insurgency are also roots cause for Psychological Trauma for the people. Though, these types of support are being carried out by different organizations, yet we have to do more. We need an effective trauma management throughout the World. Trauma includes major injury of all types — disasters, auto accidents, falls, industrial accidents, burns, shootings etc. Serious trauma is the leading killer of humans. Millions across the World are disabled and some permanently. If we look through the doors of history, we will find that by middle of 1970s, the growth and development of mental hospitals was the main approach for the provision of mental health services.
In India, several disasters took place. Among them is Bangalore circus tragedy (1981). It was a major disaster and the lessons learned were ‘High Emotional Stress and morbidity by survivors not addressed by health personnel’.
Bhopal Gas Leak disaster: (December 1984) where, physicians and other health personnel’s were not prepared to offer psychological support to the victims. Even till today, the horrible memories haunt them.
Orissa Cyclone was another example. Left over 10,000 dead. Approximately 15 million affected and displaced. Initial and two year surveys show high emotional stress present among survivors.
The Gujarat earthquake was another example. Over 20,000 people dead in acute phase and 100,000 with severe disabilities. Good health care, with no psychological support when many needed emotional care is the root cause of creation of secondary disasters.
Many lessons were learned but still remains a serious issue less addressed. When we talk of improved technologies; use of GIS and Remote Sensing, mitigation policies, construction and renovation, we seldom talk of this soft part of humanity, which makes us a Human. The response to any type of crisis should also include Psychological First Aid, Crisis Intervention, Defusing, Education and solution-focused counseling. Psychological support then must be framed within the existing and accepted methodologies of the continuum of disasters. Different types of trauma may affect the victims. There are different ways in which the response may affect the survivors.
i) Major elements of loss
ii) Exposure to bodies
iii) Degradation and Humiliation in cases of trauma motivated by racial or religious reasons
iv) Forced separation and relocation.
Depending upon the types of disasters, the survivor may assume different types of emotional roles:
i) The survivor assumes the role of victim and responds as victimized.
ii) The survivor assumes the role of victor and responds to the event in an active way that will foster problem-solving skills and learning and will make the person resilient after the event.
Now if we take the second point and move forward, we could surely able to make experts who have not only faced the crisis but also channel their experience towards better Psychological Support. The Psychological support program does not perceive the survivors as passive actors during an emergency or a disaster, but relies on the resourcefulness of the survivor and the capacity of individuals and communities to become resilient.
So, the ways to move forward are:
i) Pre-disaster Management:
Design and implement psychological first- aid training
ii) During the disaster: People’s response based on previous knowledge and level of coping
iii) Post Disaster: Assessment and treatment of Psychological Symptoms
iv) End Result: Reduce responses of distress and negative behavioral changes McFarlane (1995), who studied the relationship between training and preparation to post-disaster said that education about possible disaster experiences and how to deal with them, training through simulations and awareness of likely psychological reactions in both responders and survivors are very helpful. In general, the professional community would benefit from focusing on psychological support before, during and after a disaster.
Community people react differently before a disaster and after a disaster.
This is a period, when a community reacts in various ways. Members of the community may be anxious when a disaster is imminent, especially if they have not experienced one before and they may not respond adequately to the event. When a disaster cannot be predicted; let’s take the example of earthquakes or a volcanic eruptions, the community may become anxious and over-respond to the event, which may be detrimental to their well being. The common sources of anxiety include the threat to ones own life and the safety and well being of others, such as partners or children.
During a Disaster:
The impact of a disaster varies according to the type of disaster and the amount of warning that the survivors have had prior to the event. The roles of each variable affecting the survivors will predicate the emotional response. For example, threat, exposure, loss and dislocation will be determinants of a survivor’s patterns of adjustment. A person’s actions are geared to protection of the self and others, especially children, family members and those who are weak and helpless.
Here comes the effects of “altruism”, which is frequent and people will place their lives at risk to help others. Some people experience “shock”, especially when the disaster is unexpected, which adds their feelings of helplessness and powerlessness. Another common response is to be disorganized or stunned and people may not be able to respond appropriately to protect themselves and their families. Such disorganized behavior may extend in the post-disaster phase and so one may find people wandering aimlessly in the devastation. This reaction may reflect distortions in responses to severe disaster stressors and may indicate a level of dissociation. After a disaster, any people face complications.
The most important among them are:
a) Emotional reactions in the form of somatic complaints such as sleep disturbance
d) Social effects
e) Relationship or work difficulties
So, all these state the importance of psychological care in the case of disaster management. Psychological care is always required in such types of incidents. As (Garmezy, 1983) states that the ‘role of psychological care is to foster individual and community resilience. Individual resilience applies to the capacity to recover from a negative experience with renewed enthusiasm and an increased capacity to respond positively to a subsequent stressful event. The communities should be well trained so that a resilient community takes action to enhance the personal and collective capacity of its citizens and institutions to respond to, and influence the course of social and economic change.
Some factors which can help in positive outcomes are:
a) Recognizing and reinforcing people’s strengths
b) Providing clear and accurate information and education
c) Reinforcing supportive networks
d) Supporting and developing community strengths and process
Apart from these the Psychological Team should be able to give:
• Give practical assistance, information and emotional support.
• Respect traditional beliefs and customs and accommodate the family’s needs as far as possible.
• Provide counseling for the woman/family and allow for reflection on the event.
• Explain the problem to help reduce anxiety and guilt. Many women/families blame themselves for what has happened.
• Listen and express understanding and acceptance of the woman’s feelings. Nonverbal communication may speak louder than words: a squeeze of the hand or a look of concern can say an enormous amount.
• Repeat information several times and give written information, if possible. People experiencing an emergency will not remember much of what is said to them.
• Health care providers may feel anger, guilt, sorrow, pain and frustration in the face of obstetric emergencies that may lead them to avoid the woman/family. Showing emotion is not a weakness.
• Remember to care for staff who themselves may experience guilt, grief, confusion and other emotions.
If these issues are given importance, we can move one step ahead in creation of a Safer, Stronger, Greener and a Disaster Free World for us as well as for our future generations.
Thanks and Regards,
Mr. Mainak Majumdar
Disaster Management Specialist and Consultant