Interview with Marlene Lee, MSF mental health officer currently working in the Sichuan earthquake

Many survivors of the Sichuan earthquake have not only lost their houses and belongings, but also friends and/or relatives. Many are still in shock after the terrible experience of the quake and clearly need psychological support. A team of four psychologists and one social worker are currently working in two locations : Long Men Shan, Pengzhou city and Hanwang, Mianzhu city, where people displaced by the quake are living in temporary settlements.

A few days ago, Marlene Lee, one of the psychologists providing mental health support to the survivors, shared with us her experience in Sichuan.

Q: What kind of mental health problems have you encountered in Sichuan after the earthquake?
A: We have seen a wide range of emotional, behavioral, and cognitive reactions, and there have been differences depending on the victim's proximity to the disaster. For example, for those victims that were seriously injured, had their homes completely destroyed, fled with just the clothes on their backs, and lost family members or friends to the earthquake, we saw a lot of indications of helplessness and hopelessness, despair, worries about the future, and concerns about physical health. For those victims who sustained relatively minor injuries, who came from areas where homes and properties were still intact, and who did not lose family members or friends, we encountered quite a lot of psychosomatic complaints, including sleep difficulties, loss of appetite, nausea, and headaches. Many individuals also said they were experiencing nightmares, feeling nervous, anxious, and easily startled, and worrying about the aftershocks.

Q: Can you give examples of some of the most severe psychological reactions after the quake?
A: I think personally for me as a psychologist, despair and hopelessness are pretty devastating kinds of things to see in a patient. I remember meeting a 102 year-old great grandfather in one of the refugee camps. It is tough to be 102 years-old and surviving your great-grandchildren. He lost all of his great-grandchildren and several of his own children as well to the quake. He could not stop crying. When you are at that age, you wonder about what your future will bring, as well as how it is that you survived this catastrophe, because you are in your own words a "useless 102 year-old," whereas your great grandchildren had a long future ahead as did the other ones that died.

Q: Among the two types of earthquake victims you have described, are there any particular groups that you think are most in need of mental health support?
A: There will be several vulnerable groups in the aftermath of any major disaster. One obvious group is young children, particularly those who have been orphaned or exposed to death and injury. Another is the elderly, and this tends to be a neglected group. A third group is comprised of those who have lost their loved ones. It is particularly difficult for parents of dead or missing children, especially with China's one-child policy. Additionally, relief workers are a group that could benefit from psychological support. Here in Sichuan, huge numbers of relief workers were involved in search and rescue work as well as providing medical aid to the victims. Due to their exposure to death and injury, relief workers require psychological support now as well as in the long term.

Q: What has MSF been doing to respond to emergency needs after the earthquake?
A: We were involved in many different activities right after the quake and what we did depended on the stage of the post-disaster situation. Essentially, however, our main activities were centered around: the assessment of mental health needs either in the hospitals or in the internally displaced people camps; providing clinical and research consultation to the West China Hospital Mental Health Center; providing psychological support to the quake victims in two hospital locations, and providing basic mental health training to medical staff at these hospitals; we have also been doing community outreach in the form of psychoeducation on common reactions to be expected after experiencing an earthquake and self-help strategies for coping with them.

Q: In your consultations, have you noticed any factors or behaviors amongst victims which have helped them to cope with the earthquake?
A: What I have seen very prominently is the strong community cohesiveness and the solidarity among the people in terms of really just supporting each other, not only at the family level but also at the community level. You hear of villagers assisting people in their village and saying to us, "You know, it is difficult time for us but we are coping okay and we think people in the other village need your help more." There is a really strong support system woven into the social fabric here. Since social support is a strong predictor of recovery after a trauma I think this is going to be one strong protective factor for the Chinese people.