Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Mental health relief after disasters: Mens sana in corpore laborum
- Debarati Guha-Sapir, Wilbert van Panhuis (21 May 2005)
-
Disasters: thrust on early warning and contemporary mitigation measures is needed for better long term prospects
- Dr. Rajesh Chauhan, Sandeepa Chauhan. Freelance Medical Reporter & Aid Worker. Shruti Chauhan. Shivendra Pratap Singh Chauhan. (21 May 2005)
-
Children of a Lesser God
- Awori J Hayanga (27 May 2005)
-
WHO - How effective?
- Visahan yogendran (28 May 2005)
-
Disaster psychiatry.Need for appraisal and awareness
- Hadi Hussain (28 January 2006)
|
|
|||
|
Debarati Guha-Sapir, Professor Dept of Epidemiology and Public Health, Catholic University of Louvain 3094 Clos Chapelle aux Champs, Wilbert van Panhuis
Send response to journal:
|
The Editorial on Aid after disasters (BMJ 2005;330:1160-1161) is right on the mark. Recently, there has been an increase in the psycho- social component in emergency relief action. Donors increasingly feel morally bound to provide funding for psycho-social relief although many aid providers are not necessarily qualified for these services, discrediting those who are, in the process. From an epidemiological perspective, the evidence base for these services needs strengthening. Moreover, effectiveness or cost-benefits of psycho-social interventions in post-disaster relief are unknown, raising questions on opportunity costs of this aid. On a recent post-tsunami mission to Aceh, we analysed patient records between Jan 11 and 31st 2005, from a large Red Cross hospital and interviewed several medical NGOs providing relief. Out of 1174 consultations, 9.6 % (113) had a psychiatric disease as the main diagnosis. Diagnoses ranged from anxiety, insomnia, depression to psychosomatic disorders. There was no severe psychiatric illness except one schizophrenia patient. Most patients were adults and only 7% were <12 years. Better understanding of age related vulnerability would improve targeting psycho-social services. We are convinced that psychological shock is an important and neglected issue after devastating events such as the tsunami. Losing family, home and livelihood will traumatise a normal person in any culture but time and natural resilience comes into play for recovery for most victims. Nonetheless, some will require professional help. In addition, severely ill patients from the pre-disaster period will need continued care in the aftermath. We were encouraged in Aceh, by a few humanitarian agencies who are using pragmatic approaches to deal with victims of grief and hopelessness. Instead of western traditional interventions such as counselling, they engage victims in physical activities such as building their own homes and their lives. The victims themselves reported to us simply that they are able to sleep again after a day’s work. Competing interests: None declared |
|||
|
|
|||
|
Dr. Rajesh Chauhan, Consultant, Family Medicine & Communicable Diseases 309/9 A.V. Colony, Sikandra, AGRA -282007. INDIA., Sandeepa Chauhan. Freelance Medical Reporter & Aid Worker. Shruti Chauhan. Shivendra Pratap Singh Chauhan.
Send response to journal:
|
Dear Editor, In general, the tropical countries are witnessing a continuous run of disasters. If it was Tsunamis now that had caught the world attention more, it was floods and earthquakes later at several other places. Benevolence from developed countries would be continuously anticipated, as in the past, for this cycle of disasters is bound to continue unabated. Rather than waiting for the aftermath for benevolence to begin, a new thinking on how to make this tropical belt more resilient is required and perhaps this would turn out to be more logical in the long run. Historically, disasters are continuing since time immemorial and are not going to be wished away so easily. Sooner or later, the developed world shall be mired with ‘chronic fatigue syndrome’ over having to extend relief repeatedly. Generation and devising of early warning systems should be explored as one of the foremost priority with the vast wherewithal available at the beck and call of the developed world. Next, development of contemporary mitigation measures that are also suitable, are in league with, and also consonant to the tropical lifestyles, should be explored as a long term ploy. Both these strategies will carry the innate strength for better long term results and help in thwarting recurrent colossal loss and damage. These measures shall also appeal to the affected communities and will assist in making them more resilient and save them from ignominy. With regards. 1. Dr. Rajesh Chauhan
2. Sandeepa Chauhan
3. Shruti Chauhan. 4. Shivendra Pratap Singh Chauhan. References: 1. Ommeren M, Saxena S, Saraceno B. Aid after disasters. BMJ 2005; 330: 1160-61. 2. Chauhan R, Singh AK, Kushwah P, et al. Disaster relief: can we think differently. CMAJ 11 May 2005. http://www.cmaj.ca/cgi/eletters/172/3/301#2489 Competing interests: None declared |
|||
|
|
|||
|
Awori J Hayanga, Surgery Resident The Jophns Hopkins Hospital, Baltimore MD 21287
Send response to journal:
|
Reactions to natural disasters are delicate international matters. Spiegel, in a very recent report divided these disasters into natural disasters and complex emergencies. He cited political opinion or backlash, as a predominant determining factor affecting response to these events. [1] These responses, however, may instead be influenced more strongly by vested economic interest. By Spiegel’s definition, Iraq in 2003 should possibly have constituted a “complex emergency” as indeed would Afghanistan. Rife with opposing political opinion as to the timing of intervention, there would have been, by his definition, a reluctance to intervene in such crises. Complex emergencies may not be those that are merely politically risky, they may instead be economically risky. Southeast Asia houses production lines that are immediately recognizable to the western consumer[2] whereas sub- Saharan Africa does not boast these. When a tsunami hits Asia , it is a disaster because, aside from the profound human loss, it is an economic disaster too. Darfur and The Democratic Republic of Congo (DRC) offer little value to the middle European and American retailer. The extent of western response to these is governed more by philanthropic emotion than by economics. The former is often short-lived and initial projected pledges post disaster fall by up to 60% when the funds are eventually paid.[3] In Sudan, maternal mortality rates are as high as 865 per 100 000. [4] The life expectancy in the DRC is 37 years (69 in the US, 70 in the UK) [3]. Half of all in-patient consultations in sub-Saharan Africa are related to malaria, accounting for 40% of all public expenditure and resulting in an approximate 1.3 % growth penalty per year.[4] Snow et al point out that true estimates may be up to 50% higher than WHO estimates. [3] Each individually a disaster. Remarkably, aid to Africa was reduced by US $1.5 billion in 2003. The complexity, therefore, more accurately lies in justifying the stifled , even silent response to 315 million people living on less than $1 a day, or to 25.4 million HIV positive individuals without access to antiretroviral medication, [5] or, of course, to Rwanda’s infamous genocide. Spiegel’s assertion that these areas are too remote for media access in this global arena of digital satellite imaging is surprising. Let us take another look at the definition. If a disaster occurs in a region of any economic standing, then it is worthy of attention and assistance and so will receive both, but if it occurs in a region of lesser economic potential, then it seeems to evolve into a complex emergency and response seems varied and inconsistent. REFERENCES 1 Spiegel PB. Differences in world responses to natural disasters and complex emergencies. JAMA. 2005 Apr 20;293(15):1915-8. 2 Sachs, JD. The End of Poverty. Economic Possibilities for Our Time. The Penguin Press, New York 2005. 3 Snow RW, Guerra CA, Noor AM, Myint HY, Hay SI. The global distribution of clinical episodes of Plasmodium falciparum malaria. Nature. 2005 Mar 10;434(7030):214-7. 4 World Health Organization. 2003. The Africa malaria report 2003. Geneva: World Health Organization/UNICEF http://www.rbm.who.int/cmc_upload/0/000/015/370/RBMInfosheet_3.htm 5 http://www.kff.org/hivaids Competing interests: None declared |
|||
|
|
|||
|
Visahan yogendran, Surgeon-Sri Lanka Sri Lanka
Send response to journal:
|
I live and work in Sri Lanka. Sri lanka suffered the most due to Boxing day Tsunami. I agree with all the comments which have been made by you in the article. But those could be followed in an ideal situation.WHO visit the affected for a short period only. When cameras leave WHO usualy follows them. In this circumstances it is natural for unplanned volunteer organizations to take over the vacuum left by the WHO. I agree- they do not work in a organized mannner but if asked by the affected people, these organizations do give some relief- mainly for the children who have been affected by Tsunami and who suffer from PTSD. WHO organizations have very expensive way of doing things- luxury vehicles, five star hotels and first class flights. WHO should change its practice. ( at present it is estimated that about only 10% of the funds reach the affected. 90% of the money is required to run the WHO) Will the practice change. Unlikely. Solution- find an alternative. Competing interests: None declared |
|||
|
|
|||
|
Hadi Hussain, Senior research fellow Army Medical College,Department Of community health sciences
Send response to journal:
|
The W.H.O. defines a disaster as a “severe disruption, ecological and psychosocial, which greatly exceeds the coping capacity of the affected community”. Disaster psychiatry deals with epidemiological approach to understanding and treating the effects of mass casualty situation. Disaster brings in multifaceted events, which results in social, political, economic, personal, physical and psychological upheaval. The world has witnessed multiple disasters in the recent era, which has traumatized the psyche of individuals,communities and indeed nations with global repercussions. Recent disaster brought on by the earthquake in NorthernPakistan has caused an overwhelming effect on the minds of people. The national psyche has remained in the grip of violence and terrorism for over twenty years now but the difference is that the recent disaster was a natural calamity as opposed to the man-mediated terrorism. It has been debated that mental agonies have precipitated physical ailments or exacerbated it, which is evidenced by the recent upsurge in physical ailments to a considerable extent.1 The presence of terrorism has shocked the world, the examples are 9/11, London bombing and suicide bomb blasts in Pakistan, which was reflected in both print and electronic media. The current disaster has further traumatized the psyche of the nation. It has generally been noticed that people who have witnessed or suffered from the effects of disaster or terrorism have experienced severe depression and anxiety.2 There was a 20% increase in the incidence of posttraumatic stress disorder among residents of New York, following 9/11 event.3 Magnitude of drug and alcohol abuse was also raised.4 There were also reports of sleep problems, confusion and transient regression to early developmental stages among children.5 Posttraumatic stress disorder (PTSD) has been described in children exposed to a variety of traumatic experiences.6 Many reports have given evidence that there was precipitation of florid psychosis in already vulnerable individuals and upsurge and/or exacerbation of physical ailments in parallel with the mental disorders, which further pushed the communities to greater economic burden as a consequence. There exists a scientific basis for the practice of psychiatry in the aftermath of disasters. Most of the extensive literature, over the past 30 years, suggests that disasters have psychopathological consequences as well as medical and social ones.7 It had required a team of psychologic experts to help rehabilitate the victims of Tsunami recently. Under the circumstances, the mental health professionals have a great responsibility to help the masses in coming to terms with the effects on mind. There are challenges in dealing with the issues related to disasters, which are more pertinent than the everyday presentations. The limitations are that the existing number of mental health professionals is not enough; they are not motivated to handle these issues and lack training to combat in such situations. We do not have any specialty such as Emergency Psychiatry nor is there a training component in undergraduate or postgraduate psychiatry. A psychiatrist’s ability to respond to disasters requires knowledge base in the operations of the emergency management system, the responsibilities of the public health system and the role of voluntary agencies in disaster response.8 The aims related to psychiatric intervention in theface of disaster, are to minimize the immediate emotional and psychological input by education, support and treatment, assist people in returning to their pre-disaster level of functioning and identify people at risk for long- term mental health consequences of disaster. There is also a requirement for the psychiatrists to be familiar with their own personal sensitivities, their skill in conducting de-briefing sessions and EMDR (eye movement desensitization reprocessing), and familiarity with outreach model of practice and liaison with non-mental health agencies.9 Moreover, the issues of existence of prior psychiatric history, psychosocial problems before the disaster, extent of exposure to disaster itself and lack of perceived psychosocial support after the event are vitally important for the mental health professionals to review and deal it effectively. It is the need of time that future mental health professionals should be well-versed with the disaster related psychiatric practice and also there is the dire need of inclusion of special chapters in the undergraduate curriculum as well as practical training at postgraduate level. Without these steps, all the other interventions will remain incomplete in addressing the psychological issues of the victims. REFERENCES 1. Ng V, Norwood A. Psychological trauma, physical health and somatisation. Ann Acad Med Singapore 2000, 29: 658-61. 2. Galca S, Ahern J, Resnick H, Kilpatrick D, Bucavalas M, Gold J, et al. Psychological sequelae of the September 11 terrorist attack in NewYork.N Engl J Med 2002; 346: 982-7. 3. Katz C, Pellegrino L, Pandya A, Ng A, Delisi L. Research on psychiatric outcomes and interventions subsequent to disasters: a review of literature. Psychiatry Res 2002; 110: 201-7. 4. Ursano R, McCaughey B, Fullerton C. Individual and communityvresponses to trauma and disaster. Cambridge University Press 1995; 3-21. 5. Goenjian A, Molina L, Steinberg A, Fairbanks L, Alvarez M, Goenjian H. Posttraumatic stress and depressive reactions among Nicaraguan adolescents after Hurricane Mitch. Am JPsychiatry 2001;158: 788-94. 6. Pfefferbaun B. Posttraumatic stress disorder in children: a review of the past 10 years. J Am Acad Adolesc Psychiatry 1997, 36:1503-11. 7. Katz CL, Pellegrino L, Pandya A. Ng A, De Lisi LE. Research on psychiatric outcomes and interventions subsequent to disaster : a review of the literature. Psychiatry Res 2002, 110: 201-17. 8. Holmes A. System issues for psychiatrists responding to disasters. Psychiatr Clin North Am 2004, 27: 541-58. 9. McQuistion H, Katz C. The September 11, 2001 disaster: some Department of Psychiatry, Hamdard University, Karachi Competing interests: None declared |
|||