Disaster is an unpleasant word that brings a picture of untold sufferings of
human lives to our minds. We live in a world where there are sources of
potentials harm or situations with a potential to cause loss around us. An
event or hazard is called a disaster when it threatens property, lives and is
unforeseen and often very sudden. World Health Organization defines disaster as
a severe disruption of ecological and psychosocial status that greatly exceeds
the coping capacity of affected community.
Indias disaster profile shows that 56 per cent of land is prone to
earthquake, 12 per cent of land is vulnerable to flood, 28 per cent is affected
by drought, and eight per cent is threatened by cyclone. Landslide is also
becoming a common disaster in hilly areas due to deforestation and unplanned
urbanization. Other types of disasters include industrial ones like the Bhopal
gas tragedy, mine blasts, epidemic outbreaks like plague, SARS, accidents,
fires, etc.
India is also facing serious man-made disasters like communal riots like the
Godhra carnage, ethnic conflicts, refugee problems, internal displacement, etc.
Another common disaster is sudden collapse of multistory buildings in metros
taking lives in varied intensities. Heat wave, cold wave, avalanche, hailstorm
are some other natural disasters. Similarly, man-made disasters like festival
and pilgrimage disaster, food poisoning and alcohol tragedies are increasing
day by day.
However, disasters like the 2004 killer tsunami are quite devastating for the
affected people. The rescue, relief and rehabilitation operations are usually
carried out after any disaster, but it is crucial to create a pool of human
resources to respond to the psychological need of affected community. Emotional
problems following disaster often tend to be neglected. This happens because it
is relatively invisible when compared to damage of lives, physical health and
property. In recent times, suicides by farmers due to drought and related
reasons are recognized as psychological problems arising out of long continued
trauma due to economic burden a slow disaster.
A disaster is a very complex multidimensional phenomenon and it leaves a
profound trail of suffering. It impacts all spheres of community physical,
economic, social and emotional. All the four impacts are inseparably
interconnected. They have a cyclic effect on each other. Therefore,
intervention in one area will help bring change in other areas and also help
develop a holistic care model.
Now what is psychosocial care? Why is it required for disaster-affected
community? Psychosocial care is operationally defined as the process that deals
with the broad range of psychological problems and promotes the restoration of
social cohesion infrastructure as well as the independence and dignity of the
individuals and groups. It also serves to prevent pathologic development and
further dislocation. Psychological support for people affected by emergencies
and disasters has arisen out from universal human response to reach out and
comfort those who are shocked or suffering, and to protect and to help them.
The challenges that are considered for disaster-affected people while taking
care of emotional needs are severe stress and trauma; sudden displacement,
difficulties of living in camps; uncertainty about the future and
unpredictability of future disaster threat; and process of rebuilding of
personal, family and community life.
The Bangalore-based National Institute of Mental Health and Neuroscience
(NIMHANS) is recognized as the nodal centre in psychosocial care in disasters
in India. The institute worked with tsunami survivors all over India and
southeast Asia and has a very long experience of working with various kinds of
disasters in India. The institute has standardized the training module with the
necessary training materials to empower people at different levels based on
field experience. The basic principles of disaster management follow
psychosocial care in reconciliation, wherein the individuals become aware of
the loss, accept and accelerate the recovery mechanisms using internal and
external resources. The basic tenets of psychological care programme are to
recognize the psychological need as an essential part of overall relief,
rehabilitation, and reconstruction effort. It is important to provide
psychological care as a spectrum of care including housing, livelihood,
paralegal,
compensation, rights and justice, health care, and self help. It is made
possible through community level workers engaged in relief, rehabilitation and
reconstruction to receive skills for essential psychosocial care as a part of
overall rebuilding process of disaster-hit community.
The response to disaster is mostly dependant on magnitude, occurrence,
suddenness and type. The response of the individuals may be adaptive or
maladaptive. The adaptive responses allow individuals to overcome difficulties
caused by disaster. The maladaptive reaction can include denial, ineffective
actions, etc. It can be prevented or if it occurs, it can be treated. It is
influenced by factors like age, level of education and exposure, marital
status, physical health, personality type, coping skills, losses and social
support. The community response will reflect the level of preparedness, social
support, leadership and past experience.
The importance of emotional reactions to disaster needs to be recognized.
These emotional reactions are normal response to abnormal situation. These are
common and experienced by everyone. No one who has experienced a disaster is
untouched by it. The reactions manifest differently at different periods of
time after disaster. Rehabilitation and rebuilding is a slow process and takes
time. The behavioral reactions can be loss of interest in life; reduced
activity; lack of energy; overactivity and inability to rest (restlessness);
taking intoxicants like cigarette, alcohol, betel nut; difficulty in
concentration; sleep disturbances and related problems. The human minds react
in terms of fight or flight in traumatic situations.
Often people go to doctor for bodily complaints. However, these symptoms dont
have any physical cause but a result of emotional stress the person undergoes.
For instance, headache can be both physical as well as emotional. Some common
physical reactions are headache, tiredness, tense muscles, palpitation,
irregular heartbeat, poor appetite, abdominal pain, vomiting sensation, vague
sensation in arms, legs, chest or all over body.
Stress also makes the individual to exhibit lots of emotional symptoms such as
fear, vigilance and anxiety, helplessness, sadness and guilt, thinking about
the same thing again and again, suicidal thoughts, anger, irritability and so
on. All these symptoms can lead a man to a mentally handicapped stage if it
continues for a long time. Under such a situation, the person will be unable to
carry out normal works efficiently.
Stress due to disaster again triggers some unforeseen difficulties what are
called relational reactions. These reactions can lower the quality of
interpersonal relationship and interactions with others. These are like poor
support by families, lack of trust, change of roles and responsibility, lack of
emotion, disagreement argument and unpleasantness. There is a need to meet
the affected people and help them to deal with the changes they experience.
These changes make them even more stressed and anxious. It is important to not
just work with the individual affected by trauma but also with their family
members to help the individual get adequate care and support within the family
setup.
The psychological reactions change over time. So, it is essential to
understand the different reactions in phases and in specific manner. So,
immediate normal reaction would be an outcry with fear sadness and rage
followed by denial for one to two weeks. In contrast, if someone is
overwhelmed, it is also abnormal. The most common normal delayed reaction is
grief. It is painful and at times, becomes unbearable. It is a combination of
many emotions like sadness, distress, depression, yearning for what has been
lost, anger, guilt, sleeplessness, loss of appetite, severe irritability,
suicidal tendency, to be upset acutely and similar sort of reactions. People
with such reactions can be helped to come out of grief by encouraging them to
share their feelings openly and honestly. Practising relaxation, deep breathing
exercise, listening to music and getting in other life activities will help
them to manage the grief.
The study of impact of biological responses on the brain shows that prolonged
continuous stress can lead to inappropriate pairing of traumatic memory with
distress and then initiate a cascade of secondary biological alteration
including the structural changes in the brain. The vulnerable groups who are at
risk of developing intense psychological distress are women, children, aged and
physically handicapped people. The women have 56 to 70 per cent chance of
developing abnormal reactions in contrast to mens 30 to 44 per cent.
Post-traumatic stress on children staying in the camps after disaster is high
with moderate symptoms. Post-traumatic stress disorder is a cluster of symptoms
like experiencing the same event again which are painful and come uninvited;
extreme avoidance of all kinds of activities and situations reminiscent of
traumatic event; hyper vigilance means inability to relax, constantly alert and
fearful; panic reactions; acute outburst sometimes violence. So,
psychosocial care plays an important role in recovery of these symptoms with
the help of education and support, anxiety management and life style
modification, etc.
The psychological caregivers in the community are community level workers.
They may be anganwadi workers, ANMs, schoolteachers, NGO workers, volunteers,
local community leaders, panchayat members and those who belong to that
community as well. These caregivers from the community play a crucial role in
the rebuilding efforts after any disaster. In Orissa supercyclone, the
Snehkarmis and in Gujarat earthquake the Viklang Bandhus provided psychosocial
care to the disaster survivors.
The relief, rehabilitation and reconstruction initiatives should include
psychosocial care as an essential part of care and rehabilitation. Those who
receive the spectrum of care would have less emotional reactions and have
better functionality and quality of life.
Dr Gayatri Gogoi
(The Assam Tribune,11.08.2007)
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