Keeping alive the “jazba”BMJ 2006; 333 doi: http://dx.doi.org/10.1136/bmj.333.7573.864 (Published 19 October 2006) Cite this as: BMJ 2006;333:864
The October 2005 earthquake in northern Pakistan traumatised the nation. More than 73 000 people were killed and 3.5 million rendered homeless. As part of the global response to the disaster, many Western mental health professionals of Pakistani origin offered help. Many had left the country years ago, but the earthquake made them return, albeit only for a short time.
What moved them? The emotional bond or guilt for abandoning their parent country? One psychiatrist from the US explained “this was our Katrina [US hurricane] and we had to do something.” Whatever it was, there was an incredible “jazba” (spirit) and a desire to help. Many professionals worked in the makeshift camps which housed the survivors, others with children in tented schools. But what now?
Most of the acute psychological reactions of the disaster have subsided but their legacy is set to be large. Pre-earthquake prevalence rates of common mental disorders were already very high and Pakistani mental health resources have long been hopelessly overstretched. In a total health budget of less than 1% of GDP, mental health does not even have a separate allowance. Despite the fact that more than 35 million people in the country are estimated to suffer from mental disorders, psychiatry is still not taught or examined in most medical schools. It is ironic that where the need is greatest the awareness among professionals is lowest.
Most of the acute psychological reactions of the disaster have subsided but their legacy is set to be large
The mental health problems of the masses in areas not directly affected by the earthquake are served by health facilities that are rudimentary at best. These people deserve the same commitment, zeal, and enthusiasm from mental health professionals, as was shown for the earthquake survivors.
Pakistan is at a crossroads and one of its many challenges is to build sustainable mental health programmes based on patient need and a clearer recognition of the factors which contribute to the high prevalence rates. These include social deprivation, lack of basic needs, denial of justice, abject poverty, and the severely compromised position of women. Underlying issues include poor governance, corruption, and mismanagement. We need to look beyond the psychological trauma of disaster and programmes such as those set up for posttraumatic stress disorders and establish comprehensive integrated mental health programmes linked with primary care services.
The October 2005 earthquake has given Pakistani psychiatry an extraordinary opportunity to redeem and redefine itself. Public and government awareness of mental health is at a high level and there is an inflow of resources to the country. Mental health professionals must seize this opportunity and push for a comprehensive national mental health programme.
Pakistani psychiatrists in the West are in a unique position to help foster change. Their response following the earthquake has shown their emotional bond to their parent country. Yet their independence from it gives them a strong voice which needs to be used to influence and inform policy and promote high standards. Their experience of working in better organised and resourced health systems in the West is a valuable transferable skill. It needs to be utilised in building capacity in teaching, training, service provision, and research. This requires close interaction and ongoing dialogue with mental health professionals in Pakistan. The “jazba” shown by Pakistani psychiatrists in the West must be kept alive, harnessed and used in the most productive way.
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