[Assam] Psychosocial care- Dr Gayatri Gogoi (Horizon, The Assam Tribune, 11.08.2007)

[Buljit Buragohain]

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.
 India’s 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 don’t 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 men’s 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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