One Year After Nargis: Souls take more time to heal
May 05, 2009
On May 2 last year, Nargis Cyclone destroyed everything in its path in the South of Myanmar. It left behind 140’000 dead and missing and immense damage. To help those who survived to cope with their grief and suffering, MSF teams have been providing mental health support to populations in the Irrawaddy delta for the past ten months. As the one year anniversary of the tragic event approaches, MSF counselors are working to assist people with increased levels of anxiety and re-traumatization.
One year after cyclone Nargis massively damaged the Irrawady delta, reconstruction work is in process, thanks to the effort of many national and international agencies. After the first emergency phase ended, emphasis is now on rebuilding shelters and restoring livelihoods, especially agriculture and fishing. It will still take many years until the situation gets back to normal in the mostly rural areas that compose the Southern tip of Myanmar. However, houses are being gradually rebuilt and paddies are once again being farmed, in what used to be the country’s rice bowl. Villagers are again fishing on the rivers, some boats are carrying food and goods from one village to another, and children are wandering around freely after the end of the school year.
No more dead bodies are floating in the many river branches that later plunge into the Andaman Sea, but the memories of the dreadful event that cost the lives of 140,000 people last year are still haunting the two million people who survived and lost their loved ones. To alleviate this invisible suffering, Médecins Sans Frontières has been providing mental health support to populations in the delta for the past 10 months.
MSF teams intervened within 48 hours after cyclone Nargis hit Myanmar, with dozens of aid workers dispatched to the delta, distributing tons of relief supplies and providing medical treatments. Very soon it became clear to the medical teams on the ground that a great number of survivors seen at the clinics were suffering from post traumatic stress, in many cases presented as psychosomatic complaints. In the following weeks, three MSF mental health experts were sent to the disaster area to assess the situation. They reported that the population was working “on automatic pilot” to take care of basic needs and noted characteristic reactions such as sleeping disorders, nightmares and anxiety, especially about future livelihoods. Many people were not only severely traumatized by the event, but also grieving the loss of their relatives.
Having also suffered significant losses and being traumatized themselves, the monks and other religious authorities were overwhelmed and impaired in providing their usual support and comfort to the population.
Kaz De JONG, one of the MSF experts, recalled meeting people who said they feel fearful, for numerous reasons including that of returning to the places where they experienced such horror and/or encountering one of the numerous dead bodies being unearthed by the ongoing rains. Another less recognized issue was that of change forced upon many of the affected population. This was exemplified for Kaz when he encountered a grandmother grasping a small child, “I’ve become a mother again, my whole family is gone, the only ones left are myself and this baby girl.”
Group and individual counselling
In response to the significant number of people displaying signs of ill mental health, MSF included psychosocial activities in its assistance to Nargis victims. It included individual and group counseling sessions, the establishment of community groups, the running of a school in a camp for displaced persons and training community health workers.
From August 2008 to March 2009, MSF counsellors provided group counselling to 56’000 Nargis victims. This technique helps to reinforce the natural capacities to cope with a traumatic event. The counsellors also held more than 3100 individual sessions with people who showed severe trauma symptoms or who asked if they could share their thoughts and feelings with them.
MSF also started a Psychosocial and Mental Health Intervention training program for local counsellors. Thirteen of them were trained in July and August 2008 and could soon start their work in one of the worst affected areas of the delta, near the town of Setsan. “The context in which we work has many neglected social problems like poverty, lack of education, poor health care and no prior exposure to the concept of counseling. Confidentiality and privacy are also important aspects, requiring a great deal of education and explanations”, says Dr. Sylvia WAMSER, MSF clinical psychologist and psychotherapist, who initiated and managed the mental health project in Set San town for the past months.
Meanwhile, MSF international mental health specialists also trained medical staff on psychological consequences of a traumatic experience, detection of psychological sufferance and basic management of the cases.
“The major challenge was that we came to work in a country where mental health is a new concept and a lot of sensitivity and care was needed to explain and clarify what we were actually doing. A major factor in our psycho education and general mental health approach was to integrate existing resources (community as well as religious supports) in our work with the beneficiaries”, says Dr. Sylvia Wamser.
“In addition, the wide spread belief that “restless” souls of people who died may appear in the form of disrupting, unpleasant dreams or appearances of that person equals the psychological concept of flashbacks, nightmares. This belief is very strong and is also the reason for hours of monks’ chanting, donations and anniversaries. For this reason the step of ‘normalizing’ reactions after a critical incident was very important and had to be handled with special care. The basis of our success with this intervention was to teach patients relaxation techniques and to facilitate their ability to open up and to talk about their feelings and guaranteeing them professional confidentiality.”
Potential anniversary reactions
By the end of 2008, MSF counsellors noticed that the main presenting symptoms were shifting from posttraumatic stress reactions to anxiety symptoms. This may have been related to the overall concern about the possibility of future cyclones. As the anniversary of the catastrophe approached, there was a clear need to address this issue and explain to the population that there might be a re-occurrence of old symptoms which they felt after Nargis. “This is typical for victims of traumatic incidents who have not fully resolved their traumatic experience and thus are getting re traumatized by isolated stressors”, explains Dr Sylvia Wamser. MSF teams have recently distributed thousands of printed leaflets on disaster preparedness and potential anniversary reactions and discussed these issues in group psycho education sessions.
“Mental Health must be an integral part of an emergency intervention and must be started at an early stage of a natural disaster intervention. Our psychosocial intervention has offered people the possibility to verbalize, express and share their feelings. We hope they are now better able to understand, deal with their reactions and thus able to tap into their resources as well as be better prepared for future disasters”, concludes Jean-Sébastien MATTE, MSF Program Manager for Myanmar. “
Philippe LATOUR
One year after cyclone Nargis massively damaged the Irrawady delta, reconstruction work is in process, thanks to the effort of many national and international agencies. After the first emergency phase ended, emphasis is now on rebuilding shelters and restoring livelihoods, especially agriculture and fishing. It will still take many years until the situation gets back to normal in the mostly rural areas that compose the Southern tip of Myanmar. However, houses are being gradually rebuilt and paddies are once again being farmed, in what used to be the country’s rice bowl. Villagers are again fishing on the rivers, some boats are carrying food and goods from one village to another, and children are wandering around freely after the end of the school year.
No more dead bodies are floating in the many river branches that later plunge into the Andaman Sea, but the memories of the dreadful event that cost the lives of 140,000 people last year are still haunting the two million people who survived and lost their loved ones. To alleviate this invisible suffering, Médecins Sans Frontières has been providing mental health support to populations in the delta for the past 10 months.
MSF teams intervened within 48 hours after cyclone Nargis hit Myanmar, with dozens of aid workers dispatched to the delta, distributing tons of relief supplies and providing medical treatments. Very soon it became clear to the medical teams on the ground that a great number of survivors seen at the clinics were suffering from post traumatic stress, in many cases presented as psychosomatic complaints. In the following weeks, three MSF mental health experts were sent to the disaster area to assess the situation. They reported that the population was working “on automatic pilot” to take care of basic needs and noted characteristic reactions such as sleeping disorders, nightmares and anxiety, especially about future livelihoods. Many people were not only severely traumatized by the event, but also grieving the loss of their relatives.
Having also suffered significant losses and being traumatized themselves, the monks and other religious authorities were overwhelmed and impaired in providing their usual support and comfort to the population.
Kaz De JONG, one of the MSF experts, recalled meeting people who said they feel fearful, for numerous reasons including that of returning to the places where they experienced such horror and/or encountering one of the numerous dead bodies being unearthed by the ongoing rains. Another less recognized issue was that of change forced upon many of the affected population. This was exemplified for Kaz when he encountered a grandmother grasping a small child, “I’ve become a mother again, my whole family is gone, the only ones left are myself and this baby girl.”
Group and individual counselling
In response to the significant number of people displaying signs of ill mental health, MSF included psychosocial activities in its assistance to Nargis victims. It included individual and group counseling sessions, the establishment of community groups, the running of a school in a camp for displaced persons and training community health workers.
From August 2008 to March 2009, MSF counsellors provided group counselling to 56’000 Nargis victims. This technique helps to reinforce the natural capacities to cope with a traumatic event. The counsellors also held more than 3100 individual sessions with people who showed severe trauma symptoms or who asked if they could share their thoughts and feelings with them.
MSF also started a Psychosocial and Mental Health Intervention training program for local counsellors. Thirteen of them were trained in July and August 2008 and could soon start their work in one of the worst affected areas of the delta, near the town of Setsan. “The context in which we work has many neglected social problems like poverty, lack of education, poor health care and no prior exposure to the concept of counseling. Confidentiality and privacy are also important aspects, requiring a great deal of education and explanations”, says Dr. Sylvia WAMSER, MSF clinical psychologist and psychotherapist, who initiated and managed the mental health project in Set San town for the past months.
Meanwhile, MSF international mental health specialists also trained medical staff on psychological consequences of a traumatic experience, detection of psychological sufferance and basic management of the cases.
“The major challenge was that we came to work in a country where mental health is a new concept and a lot of sensitivity and care was needed to explain and clarify what we were actually doing. A major factor in our psycho education and general mental health approach was to integrate existing resources (community as well as religious supports) in our work with the beneficiaries”, says Dr. Sylvia Wamser.
“In addition, the wide spread belief that “restless” souls of people who died may appear in the form of disrupting, unpleasant dreams or appearances of that person equals the psychological concept of flashbacks, nightmares. This belief is very strong and is also the reason for hours of monks’ chanting, donations and anniversaries. For this reason the step of ‘normalizing’ reactions after a critical incident was very important and had to be handled with special care. The basis of our success with this intervention was to teach patients relaxation techniques and to facilitate their ability to open up and to talk about their feelings and guaranteeing them professional confidentiality.”
Potential anniversary reactions
By the end of 2008, MSF counsellors noticed that the main presenting symptoms were shifting from posttraumatic stress reactions to anxiety symptoms. This may have been related to the overall concern about the possibility of future cyclones. As the anniversary of the catastrophe approached, there was a clear need to address this issue and explain to the population that there might be a re-occurrence of old symptoms which they felt after Nargis. “This is typical for victims of traumatic incidents who have not fully resolved their traumatic experience and thus are getting re traumatized by isolated stressors”, explains Dr Sylvia Wamser. MSF teams have recently distributed thousands of printed leaflets on disaster preparedness and potential anniversary reactions and discussed these issues in group psycho education sessions.
“Mental Health must be an integral part of an emergency intervention and must be started at an early stage of a natural disaster intervention. Our psychosocial intervention has offered people the possibility to verbalize, express and share their feelings. We hope they are now better able to understand, deal with their reactions and thus able to tap into their resources as well as be better prepared for future disasters”, concludes Jean-Sébastien MATTE, MSF Program Manager for Myanmar. “
Philippe LATOUR
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