1 INTRODUCTION AND METHODOLOGY AFTERLIFE FROM TURBULENT TIDE The turbulent waves of Tsunami struck the shores of Tamil

Nadu on 26 th December 2004 unleashing unforeseen miseries in the lives of coastal communities. The waves of destruction washed away countless lives, inflicted severe injuries, ravaged homes and livelihoods thereby shattering family networks and hopes for a better future. In Tamil Nadu, 376 villages faced the brunt of the disaster. It is estimated that about 1/3rd of the affected people are from the under privileged and socially excluded groups who had to face abject poverty because of the ravages inflicted by the Tsunami. The Government brought in rehabilitative measures with the involvement of the Tamil Nadu Slum Clearance Board (TNSCB), which is a quasi-Governmental organization that aims to provide basic amenities to slum dwellers. The TNSCB has extended its service to the Tsunami affected people in the Chennai city and facilitate a community oriented recovery process called TEAP. The Tsunami Emergency Assistant Project (TEAP) was designed to cover 15,000 families in Chennai at a total cost of Rs.498 lakhs with the funds from Asian Development Bank. The service implemented into the rehabilitation sites at Semmenchery and Kargil Nagar. The Afterlife or the life after tsunami were Substandard and Inadequate pertaining to the Health Intervention in spite of different livelihood support programme and inadequate. This is the common statement from the population of Semmenchery rehabilitation site. This motivated the researcher to study the Health Intervention for Rehabilitated population affected by Tsunami at Semmenchery. Statement of problem The research study is based on the problem identified by the researcher in a community and the concept of Post-Disaster Health Intervention. It is the health problems tackled and troubles encountered for general health by a rehabilitated population affected by a disaster, Tsunami.

2 Need and importance of study The purpose of this study is not just to research and highlight the Health Intervention to Rehabilitated population affected by Tsunami. But rather to result in findings which will further carry on in future research, as this study is pertaining to Disaster and Massive Emergency Health Management and Intervention.

Objectives General Objective To study the health intervention to rehabilitated population affected by tsunami. Specific Objectives To study the immediate health assistance at temporary sheds. To study the psychological measures taken for the victims. To study the benefits granted from health insurance. To study the effective implementation of Polyclinics. To analyze the infrastructure facilities established pertaining to health. To study the present health status of the community.

Field of study The researcher conducted and collect the research data at Semmenchery, in Kancheepuram district, a Rehabilitation and a Resettlement area. Research design The researcher conducted the research using Descriptive Research design. This design is a scientific method which involves observing and describing the behavior of the group without influencing the group in any way. The reason to use this design is because it is specific and focuses on particular aspects or the dimensions of the problem studied. Sampling frame

Universe: The population of Semmenchery rehabilitation and resettlement tenements.

Sampling technique: The Probability sampling method is used, so that every item of the universe has an equal chance of inclusion in the sample.

Sample size: An optimum sample of totally 50 respondents.

Tools of data collection The tool used for collecting data was Interview Schedule since most of the respondents would be illiterate. This method is useful in extensive enquiries and leads to fairly reliable results. Definitions Operational Definition Post-Disaster Health Intervention here describes the focus on the Post-Tsunami factors of intervention for the victims health whose life has been rehabilitated. Conceptual Definition

Post-Disaster: Post refers after and WHO defines Disaster as "any occurrence, that causes damage, ecological disruption, loss of human life, deterioration of health and health services, on a scale sufficient to warrant an extraordinary response from outside the affected community or area. Many public health practitioners would characterize a disaster as a "sudden, extraordinary calamity or catastrophe, which affects or threatens health".

Health: According to WHO Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Intervention: The act or fact of interfering so as to modify any measures whose purpose is to improve health or alter the course of disease.

4 Organization of the study The researcher has divided the whole study into different chapters with suitable headings which is done mainly for the purpose of convenience and easy reference for the readers. This will also ensure interest in the minds of the readers, because it is sequentially arranged to have a better reading. Chapter I consists of Introduction, Statement of the problem, Need and importance of the study, Objectives of the study, methodology of study and definition of terms. Chapter II deals with review of literature, which comprises of compiled literature available from books, journals and magazines. Chapter III deals with analysis and interpretation which comprises of the data collected presented through the tables and other statistical diagrams. Chapter IV deals with the main findings of the study and suggestions given by the researcher. Chapter V consists of summary and conclusion of the study. The bibliography includes the details of books, magazines, websites that were used as literature for the study. Appendix contains a copy of tool of data collection.

REVIEW OF LITERATURE

TSUNAMI EMERGENCY ASSISTANCE PROJECT (TEAP) TEAP An overview The TEAP was designed to cover 15,000 families in Chennai at a total cost of Rs. 498 laks. TNSCB with the Asian Development Bank funds extended its services to Tsunami affected families in coastal areas of Chennai and adopted a special strategy towards social and economic rehabilitation site is Semmenchery and Kargil Nagar. The project also covered the urban coastal population Thiruvallur districts covering 25,000 families. To accelerate the economic recovery in the affected areas, plans were devised towards initiating and facilitating sustainable livelihood activities. ADBs TEAP assistance created a platform for piloting innovative interventions and to explore various avenues for promoting sustainable income generation activities for the communities in the Chennai Metropolitan Area. The affected families resettled in the various resettlement areas were in need of an alternative livelihood programme and towards developing their living conditions. The TNSCB has adopted two primary approaches. To provide permanent housing with basic amenities Initiate livelihood recovery initiatives through promotions of income generation Activities, Small scale business and Micro credit for those who lost their livelihood in the Tsunami The TNSCB had drafted implementation modalities so that these resources will be made available for the most vulnerable people in the Tsunami affected areas who were in need of hand holding and support. From shambles to shelter: The Tsunami had completely rendered the coastal communities homeless. They were seeking refuge in various Government buildings near the villages. The lack of shelter was a serious concern as it exposed the disaster affected communities to lack of safety and security. The women and children were in need of privacy and thus there was a need for shelters. To address this issues the Government

6 constructed mass shelters in the available lands closest to their place of habitation. One of the biggest resettlement sites set up by the Government was located at Kargil nagar for the Tsunami affected people of Northern Chennai. Nearly 2136 dwelling units were erected to accommodate the people from the villages of Anna Nagar, Pallavan Nagar Pallam, Thideer Nagar Pallam, Power Kuppam Pallam, Power Kuppam, Srinivasapuram and Thideer Nagar od Chennai District and Masthan Koil and Appar Nagar from Thiruvallur District. More than 2000 families were provided with shelters in 8 blocks (AH) in the resettlement sites.Livelihood Initiatives for Women SHGs a) Solid Waste Management: One of the innovative livelihood ventures pursued is the management of Solid Waste by SHG women. Under this venture, 4000 waste baskets have been provided, 2at each household at Semmenchery. The two waste baskets are differentiated by colors. The Green Friend (garbage collector) collect the waste at doorsteps every day with the help of tricycles provided, and dump the waste at the common dumping yard allotted for the purpose. The project has also envisaged provision of cleaning equipments and materials like hand gloves, boots, caps and uniforms to the Green Friends. This initiative has helped the members to earn regular incomes. These people who are employed for collecting garbage are responsible for creating a clean environment through regular garbage collection and spraying of disinfectant powder. This project being operated with supervisors is monitored by the NGO Hand in Hand. b) Vermi Compost: The bio-degradable waste generated and dumped in the dumping yards will be transformed into vermin compost and organic compost which again will serve as a livelihood option. This project envisages the employment of women, offering steady income generation, preserving a clean and friendly environment and to enhance the quality of the life of families. The project will also involve the supply of organic manure to promote organic cultivation.

c) Production of Sanitary Napkin & Baby Products: 16 women from 8 SHGs, trained in the production of Sanitary Napkins and Baby products formed a federation name Valarpirai Women Federation. This federation was mentored

7 to setup a production unit for manufacturing Sanitary Napkins and Baby products. An SSI certificate from the District Industrial Center, Kanchipuram wad obtained in the name of unit.

d) WHO: MENTAL HEALTH ASSISTANCE TO THE POPULATIONS AFFECTED BY THE TSUNAMI IN ASIA Viewing the situation from a public health perspective (i.e., a population perspective), rather than a clinician's perspective, we see the situation as follows. Although there are no reliable data on numbers of people with mental health problems in the tsunami-affected countries, the following rule-of-thumb estimates give context to the likely size of the problem. These rates vary with setting (e.g. involving socio cultural factors, current and previous disaster exposure) and assessment method and give a very rough indication of what WHO expects the extent of morbidity and distress to be. We see three groups each requiring a different response: People with mild psychological distress that resolves within a few days or weeks: A very rough estimate would be that perhaps 20-40% of the tsunami-affected population falls in this group. These people do not need any specific intervention. People either with moderate or severe psychological distress that may resolve with time or with mild distress that may remain chronic: This group is estimated to be 3050% of the tsunami-affected population and covers the people that tend to be labelled with psychiatric diagnoses in many surveys involving psychiatric instruments that have not been validated for the local cultural and disaster-affected context. This group would benefit from a range of social and basic psychological interventions that are considered helpful to reduce distress. (These interventions - which are generally made available to anybody (whether or not they have disorder) in a variety of sectors - tend to be called 'psychosocial' by humanitarian and development workers. Traditionally mental health specialists have used the term 'psychosocial intervention' to describe non-biological mental health interventions for people with mental disorders, which is in contrast to t

8 way the term 'psychosocial' is used these days by humanitarian and development workers.) People with mental disorders - mild and moderate mental disorder: In general populations, 12-month prevalence rates of mild and moderate common mental disorders (e.g., mild and moderate depression and anxiety disorders, including PTSD) are on average about 10% in countries across the world (World Mental Health Survey 2000 data). This rate is likely to rise - possibly to 20% - after exposure to severe trauma and resource loss. Over a number of years, through natural recovery, rates may go down and settle at a lower rate, possibly at 15% in severely affected areas. Thus, in short, as a result of disaster, the population rates of disorder are expected to increase by about 5-10%. A misconception is that PTSD is the main or most important mental disorder resulting from disaster. PTSD is only one of a range of (frequently co-morbid) common mental disorders (mood and anxiety disorders), which tend to make up the mild and moderate mental disorders, and which become more prevalent after disaster. The low-level of helpseeking behaviour for PTSD symptoms in many non-western cultures suggests that PTSD is not the focus of many trauma survivors. Consequently, WHO is concerned that agencies are over-emphasizing PTSD and are creating narrowly defined, vertical (standalone) services that do not serve people with other mental problems. This way of working could waste precious resources. Severe mental disorder: Severe mental disorder that tends to severely disable daily functioning (psychosis, severe depression, severely disabling anxiety, severe substance abuse, etc.) is approx. 2-3% in general populations of countries across the world (World Mental Health Survey 2000 data). People with these disorders may experience inability to undertake life-sustaining care (of self or of their children); incapacitating distress; or social unmanageability. The 2-3% rate may be expected to go-up (e.g. to roughly 3-4%) after exposure to severe trauma and loss. Trauma and loss (a) may exacerbate previous mental illness (e.g., it may turn moderate depression into severe depression), and (b) may cause a severe form of trauma-induced common mental disorder in some people.

MENTAL HEALTH EFFECTS LINGER AFTER TSUNAMI TUESDAY, April 19 (HealthDay News) -- Swedish tourists who saw the most severe trauma in the wake of the 2004 Indian Ocean tsunami have taken longer than their peers to recover psychologically, a new study has found."Exposure was associated with increased levels of post-traumatic stress reactions, even three years after the disaster," researchers report in a study led by Kerstin Bergh Johannesson of Uppsala University Hospital. Those who lost a loved one were especially affected. The researchers tracked almost 3,500 Swedish survivors of the tsunami, which killed nearly 230,000 people in 14 countries. Most of those monitored by the study were on vacation in Southeast Asia when the tsunami hit. About 98% of those with low levels of exposure to trauma had a "resilient" response, but only 77% of those with high levels of exposure did, the study reported. Among those who lost a loved one, only about half had a "resilient" response. The findings are reported in the Journal of Nervous and Mental Disease. Three years after the tsunami, researchers found mental health issues in 28% of those who'd had high levels of exposure, 20% of those with medium levels and 43% of those who had lost a loved one. Women, younger people, those with lower education and people with previous mental illnesses were more likely to have taken longer to recover. "This study highlights the long-term negative effects of severe exposure and traumatic loss, which appear to slow down recovery," the researchers wrote. "Identification of symptoms and subsequent support or trauma-focused psychotherapy might facilitate optimal recovery."

HEALTH INSURANCE Nagapattinam, Jan 24. (PTI): A health insurance scheme, supported by the Prime Minister's Relief Fund, has been launched for tsunami victims in Nagapattinam district of Tamil Nadu. As many as 50,593 beneficiaries have already been identified to avail of the

10 scheme and the enrolment process would be completed by March 2007, District Collector Tenkasi S Jawahar said in a statement on Monday. To identify the beneficiaries, selection committees headed by panchayat presidents and municipal ward councilors have been formed. Under this scheme, families consisting of five members living Below Poverty Line, could avail of the scheme for medical expenses to the tune of Rs 30,000 in a year from the United India Insurance Co, he said. Twelve private hospitals have been roped in to provide treatment for the needy, he said. . The NGOs/Hospitals who participated in running the polyclinics are as follows: Montfort Community Development Society (MCDS): This NGO runs a Clinic on Wheels and cater to the health needs of the community in general. The unit consists of a Doctor and a health coordinator who come in the bus on every Mondays from 10:00 to 13:00. After the allotment of tenement, the NGO is using the tenement and serves the needy patients. Medicines are also provided. Apart from mobile clinic, awareness programmes on Cancer, Aids atc., and health camps are also conducted. DDHS, Kanchipuram: the DDHS, Kanchipuram was running the clinic on Mondays and Thursdays initially but later they switched to Fridays for their services. A health Inspector and village nurse come and attend to the needs of the patients. Free medicines are provided. Special immunization camps against Polio and Hepatitis B, medical checkups under Varumun Kappoom Scheme. About 800 people and 1360 children have benefited from the Varumun Kappoom Scheme and pulse polio immunization programme respectively. Chettinad hospitals: this hospital wad running the clinic on Mondays initially in the areas of Pediatrics and Gynecology. An awareness programme on the importance of Mothers Milk was conducted during breast feeding week (1st week of August). The hospital stopped its services as its out post started functioning near to the entrance of the scheme on the OMR. The hospital also provided medical assistance to the tsunami affected families under the United India insurance scheme of the Prime Ministers relief fund.

11 Kanchi Kamakodi trust & KKR ENT hospitals: The above two hospitals came initially for few weeks and later on stopped their services and requested for referral cases if any for treatment. Sri Sai healing trust: They cater to the general health ailments of the community on Wednesdays from 10:00 to 14:00. A team of doctor, medical assistants attend to the needs of the patients. Free medicines are provided. On average 80patients attended their clinic and on the whole 8412 patients have benefited. Sri Ramachandra medical college and hospital: This hospital was providing their services initially on Thursdays. Medicines were not provided which was very much expected from the community. The same was expressed to the hospital authorities, but they could not meet the needs and stopped their services. A Psycho Social awareness programme with special emphasis on the Prevention of Suicide was conducted by the Doctors of the hospital for the students of high school in coordination with TEAP staff. Around 50 students were benefitted. HUMA hospital: This hospital came to provide their services for screening of T.B on referral basis. Life Line hospital: They served the community on Saturdays for two hours with their Smile on Wheels and free medicines are also provided. Community Development Organization Trust (CDOT): They provided medical services on general health ailment initially, but have stopped their services completely. Times Foundation Isha Tsunami Relief Government PHC: A 30 bedded hospital under the PPP mode is constructed by the Times Foundation at the scheme and it is inaugurated and handed over to the Health Department. This hospital is a real boon to the under privileged families rehabilitee at Semmenhery. Coordination of CD wing: TNSCB, Community Development Wing coordinated with G section of the Board for the allotment of tenements for the polyclinic, with the Executive Engineer, Division II for the maintenance of the polyclinic, with the NGOs/Hospitals in conduct of the clinic and with the green friends in keeping the clinic clean. Coordination with the community in making the best use of the services provided. CANCER AWARENESS WALK

12 All over the world 2nd, 4th & 15th February is observed as Cancer Survivors Day, World Cancer Day. In this regard can-stop conducted a cancer awareness walk with the support of Tamil Nadu Slum Clearance Board at Semmenchery Housing Board for Slum Dwellers on 27th February 2011 (Sunday) at 09:00 hrs with the objective of creating cancer awareness for community people. Mr.C.N. Ramadas I.A.S, retired Secretary to Government of India was the special invitee for the programme and addressed the participants. Dr.Senthil (SMF) gave an awareness talk about the cancer. Followed by Mr.Nirmal Raj, Community Development Officer (TNSCB) talked about the importance of cancer awareness to the public. The NSS team from St.Thomas College did a street play based on the theme Anti-tobacco & cancer awareness. Mr.C.N.Ramadas flagged off the cancer awareness walk among with Dr.Vijaya Bharathi Rangarajan, founder of can-stop, Mr.Nirmal Raj, Community Development Officer (TNSCB); around 250 people participated in this walkathon along with school children, SHGs, trainees & can-stop volunteers. The people carried placards, banner and chanted different slogans relating to anti-tobacco and cancer awareness. After the walk refreshments was provided to the participants. WORLD NO-TOBACCO DAY AT SEMMENCHERY The world No-Tobacco day is observed on the 31st of May every year. In order to create awareness on the evil effects of tobacco , awareness on cancer, to the rehabilitated community at Semmenchery , MCDS NGO, in collaboration with tobacco cessation clinic of cancer institute (WIA), adayar observed the world no-tobacco day at Semmenchery on 10/06/2009. Psychologists and Volunteers of cancer institute, adayar, staff of MCDS and about 120 women, SHG members and children participated in the programme. Programme commenced with the speech on the awareness of the tobacco by Mr.Gopinath, Psychologist of the cancer institute. The main features covered in the speech are There are 3000 types of poisonous substance in tobacco that is chewable (Panparag, Hans) and 4000 types in tobacco that is smoked i.e., Cigarette, Bedi. 90% of the mouth, throat and lungs cancer are caused by use of tobacco.

13 In a year more than 10,00,000 people are affected by the use of tobacco. When compared to non-smoker, the life span of the smoker is less by 22 to 26 years. 14 minutes in life is reduced by each cigarette for the smokers. Cancer is curable if diagnosed at earlier stage. Direct Impact: In order to have more impact on the participants Mr.Shurfudeen, who has recovered from oral cancer and speaking using electro larynx shared his experience and requested the participants not to use tobacco. Special Address: The Community Development Officer delivered a special address on the occasion insisting on the role of women and SHG members have in creating a No Tobacco Community. Awareness Rally: A rally by the SHG members was lagged off by the CDO which covered the area with placards depicting awareness messages. Slogans on the issues were also pronounced by the participant. Pamphlets on the evils of tobacco were also distributed. Street Plays: Three street plays on the evils of tobacco and about cancer was enacted by the student volunteers of Madras Christian College at three different places. The street plays received a good response from the public. Intervention of MCDS: MCDS NGO in collaboration with cancer institute (WIA), adayar is implementing a special programme on cancer at Semmenchery. 300people with practice of using tobacco are identified, screened for cancer and if found would be treated. The other tobacco users would be counseled to get rid from the use of tobacco. An animator residing at Semmenchery has also been appointed for this purpose. The participants were highlighted about the above said programme. Catch them young: as the children from this rehabilitated community are prone to the use of tobacco products at their young age. It is better to catch them young in order to have a tobacco free future generation. So it is proposed to have awareness programme exclusively for the school children of Semmenchery. Vote of thanks was proposed by Mr.Arul, coordinator, MCDS. Then the participants were distributed with refreshments.

14 The programme came to its close with the participants saying Together we can create a Tobacco free community. I. INTERVIEW SCHEDULE To study Immediate health assistance at temporary sheds 1. How long after Tsunami were you allotted temporary sheds? a) Within a week b) Within a month c) After a month d) Not at all 2. How Hygienic was that place? a) Fully hygienic b) Partially hygienic c) Not at all hygienic 3. How often the health assistance was made available to you? a) Everyday b) Weekly once c) Monthly twice/thrice d) Not at all 4. Which were the Agencies that played a major role in providing health assistance? a) TNSCB b) Don Bosco Anbu Illam c) CDOT d) Others, specify ________

II.

To study the Psychological measures taken for the Tsunami victims

15 5. Did you suffer from any post-disaster mental illness? a) Yes b) No c) Not aware 6. Were you given any kind of mental health intervention? a) Yes b) No c) Not aware III. To study the benefits granted from health insurance 7. Were you provided Tsunami health insurance card? a) Yes b) No 8. Did you benefit from the insurance? a) Yes b) No 9. If yes, in which hospital? a) Chettinad hospital b) Others

IV.

To study the effective implementation of Polyclinics 10. Have you visited the PHC at tenements 3333 & 3334? a) Yes b) No c) Not aware

11. Have you undergone any awareness/training programme on health?

16 a) Yes b) No

12. If yes, Specify through which department? a) Governments b) NGOs c) Private Hospitals

13. Were you given free treatment including the medicines? a) Yes b) No

V.

To study the infrastructure facilities established pertaining to health 14. In case for medical treatment, do you visit the local PHC? a) Yes b) No

15. Do you make proper disposal of domestic waste according to Solid waste management - green friends suggestion? a) Yes b) No 16. Did you make use of the Sanitary napkins manufactured by valar pirai SHG, in your locality? a) Yes b) No c) Not aware

17 17. Do you make use of the Gym near the community hall? a) Yes b) No c) Not aware

VI.

To study the present health status of the community 18. From the following, what were the major diseases here in the past one year? a) Vector borne illness b) Jaundice c) Typhoid d) Diarrhea

19. If yes, no. of days of Loss of employment / academics in the past one year? a) Yes b) No

20. What are the unhygienic conditions in your place? a) Water stagnation b) Unclean drinking water c) Improper disposal of waste d) Others, specify________

22. Age:

18 23. Gender: M / F / TG

19