Ecuador: Mental health after the earthquake

Health professionals working in the hardest-hit areas of Ecuador have felt the impact of the recent earthquake particularly deeply; they not only have to deal with the emotional impact on their patients, but the consequences for themselves and for their families. Like so many people in Ecuador, health professionals lost their homes, their projects and even their loved ones in the earthquake. The double burden of caring for people at the same time as coping with personal stress can mean that health workers need additional support. 
Lonara Rabelo, a psychologist from Brazil who works for Médecins Sans Frontières (MSF) has been in Manabi province, to the north of the country, providing training to health workers, psychologists, professors, university lectures, social workers and community leaders as well as supporting earthquake victims. The team that she was working with provided psychological care and training to more than 1,280 people. 
What is the current situation in the north of Manabi province?
The cities most affected by the earthquake have received support from the government and from NGOs, mainly through the official shelters, however people’s basic needs are still not being met in a number of smaller, unofficial camps. 
In cities like Jama, San Vicente and Bahía, to the north of the country, the earthquake has left the mental health network in a very fragile state; there were few existing mental health services and the need for them has now grown. In three months’ time an even bigger need for psychological services may emerge if people struggle to deal with the situation and start to develop chronic mental health problems.  
What is MSF doing in Manabi province?
MSF has provided training for health professionals in order to help them to deal with the personal consequences of the earthquake and to help their patients and colleagues to do the same. This has included providing training in counselling techniques and developing psychosocial programmes within health services. 
MSF has also trained community leaders, health professionals and people working in temporary shelters in how to spot the signs of a more serious mental health problem. Our teams trained more than 60 lecturers who can now run their own training to help members of their community to spot these signs. This training includes explaining the importance of coping strategies, the expected mental health reactions following a natural disaster and the importance of early diagnosis. 
MSF staff have also trained primary school teachers in group activities that can help children and families to cope following the earthquake. 
What are the main needs of the population in this region?
Before effective mental health support can be provided, people’s basic needs for shelter, food and protection need to be met. This gives people the platform that they need in order to start rebuilding their lives. For the moment, it is people who are living outside of the official shelters - sleeping in parks, schools or open areas close to their destroyed homes - who are most in need of this support. 
Three weeks after the earthquake struck we started to hear about men using alcohol to cope with the situation. An increased dependence on alcohol or drugs could become a challenge for the country in the coming months. We also met people who had lost their homes and were struggling with losing their independence. A psychologist who I was working with told me that she had lost the home she had lived in for more than 40 years. She had hoped that she would pass her house onto her children, but it was severely damaged and is now uninhabitable. Two floors of the hospital where she works were also damaged and what is left of her office has now been moved to another location. She had symptoms of stress and was suffering a great deal. Her colleagues also wanted to talk to her but she felt that she did not have enough time to talk to them as well as to her patients. She was doubly affected – she had no home, she had lost some of her personal and family identity and, at work, what little remained of her working space had been moved – many changes had taken place that were out of her control. We worked with her to see that she could regain control within the emergency situation, for example by taking a day off to spend with her family or, at work, by setting up group, psycho-educational and training plans for the people working at her hospital who needed support. People sometimes wrongly assume that psychology professionals are always strong but they too can need support and care from their families, friends and colleagues.
What is mental health work like in emergency situations?
Any emergency requires different strategies and tools in order to deliver mental health support and time is often of the essence. In this response, MSF has focused on building capacity amongst professionals to allow them to deliver psychological first aid. Our teams have also provided counselling sessions. Unlike long-term projects where patients often have a period of time to process the situation they are in, during an emergency, feelings and emotions can run high. When working on psychological first aid we try to ensure that patients are able to identify their feelings, recognise their emotions and reorganise themselves internally, to try to make sure that they do not go on to develop a chronic disorder.