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Humanity First Medical February 2011 Update. Long-term psychosocial consequences of a disaster.

Aftermath of the Pakistan earthquake 2005 (UN) Haiti 2010 Earthquake (Humanity First UK Team).

February 2011
(Vol 2, Issue 2)

Welcome to the Humanity First Medical update. With these updates, we aim to keep you informed about Humanity First medical activities and talk about the latest in news and controversies, in relation to our line of work with these updates. Please visit our website Humanity First Medical for more about our activities, wish to contribute or need to contact the Humanity First Medical team.

In this months update I wish to introduce good friend and a real humanitarian Dr Naeem, whose, PhD from Southampton University is based on his work in disaster areas. He as a clinical consultant developed funding streams in the United Kingdom, which led to forming, developing and training a team on ground in Pakistan to carry out his research work. I am pleased to say that he has shown keen interest in Humanity First Medical and has agreed to spare some of his valuable time to tell us about his research work in relation to our line of work. This is particularly relevant to the latest in the press about Haiti, as it stands in 2011 one year after the earthquake. In the next update I hope to update you about Marks interview on the same to a London daily. Meanwhile, over to Dr Naeem.

Long term psychosocial consequences of a disaster

Dr Farooq Naeem MBBS, MSc, MRCPsych, PhD Post-traumatic stress disorders (PTSD) can develop after any catastrophic disaster event which involves witnessing death and serious injury. With PTSD, such an event would lead to relentless feelings of helplessness, fear and horror.

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Symptoms of post-traumatic stress disorders (PTSD) can continue over a long period of time. In our earlier work in Pakistan, when we surveyed Afghans refugees and Afghans returning to Afghanistan, a very high rate of post-traumatic stress disorders was found 1 . This survey was conducted in 2003 a long time after the end of Afghan-Russian war. There are a limited number of long-term studies on the subject and the only other long term studies of the effect of trauma has been conducted among US war veterans which shows similar findings and that PTSD may continue for up to two decades. In relation to psychological effects after a disaster event I wish to mention a couple of important points. First the psychological effect of trauma is less damaging in case of natural disasters, compared with manmade disasters. Second, the effect of trauma tends to be cumulative. Pakistan over recent years has suffered a series of relentless sequential disasters in the form of floods, earth quakes, violence, wars and terrorism. This is relevant to both deprived and non-deprived societies in the country. In a survey study in Islamabad (capital of Pakistan)2, which has recently been hit by acts of terrorism, high rates of post traumatic stress symptoms were reported by those watching 3 or more hours of the news channel. I dont wish to discourage you from watching television but in our research paper we concluded that watching TV channels is likely to have a cumulative effect, in relation to daily events, when can lead to increased stress and related psychological problems. Finally, I wish to brush up on issues related to humanitarian work conducted by various humanitarian agencies. In another study, of the general public in Kashmir, 18 months after the 2005 Kashmir earthquake, we endeavoured to explore the medium term effects of trauma. Again, unsurprisingly, we found high rates of psychiatric morbidity 3 but interestingly this did not appear to be a simplistic consequence of the earthquake. At the time of our research, aid workers, news papers, philanthropists, international and national charities had left or were leaving. People reported a loss of a system of support, including their religious and spiritual places, like mosques and shrines of saints. Loss of houses and community systems meant that elders lost respect. People who had previously survived on traditional healers were now left with limited or no access to modern medicine. The local populations during this help period got used to the available modern health facilities for one year. As the agencies pulled out, people became more miserable than before. Even worst, younger people got used to working on very high wages for international agencies. They were now unhappy not only because of their psychological problems, loss of system of support, but also because they were unable to find a highly paid job again. I will conclude by saying that acute humanitarian work is important and crucial in helping disaster stricken communities. However careful planning is needed which should also lay emphasis on long-term planning for the communities. During the acute phase, when agencies offer help, people are in shock or denial. Post-traumatic stress disorder symptoms might only start to appear, when the helping agencies start to disappear from the scene.

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References
1. Mufti K, Naeem F, Chaudry HR et al. Post-traumatic stress disorder among Afghan refugees following war. International psychiatry. Volume 4 Number 1 January 2007, 7-9 2. Taj R, Ayub M, Naeem F. PTSD symptoms in Islamabad due to watching news channels (submitted for publication). 3. Naeem F, Ayub M, Masood K et al. Prevalence and pychosocial risk factors of PTSD: 18 months after Kashmir earthquake in Pakistan. Journal of Affective Disorders. 10 November 2010 (available online)

We wish to thank UN/UNICEF media team for providing some of the pictures in this newsletter

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