Sunday, April 17, 2011


This school had had 40 children studying when the tsunami hit and all of them were killed. Many schools were near the beach so it was not unusual for all of the children in a building to be killed.


One evening in Sri Lanka, we drove around the area where the tsunami hit. There were collapsed buildings, dead trees and considerable debris on the beaches. One standing building had had 40 children studying inside. All were killed when the water swept through the window. Many schools were near the beach, so it was not unusual for all the students in a school to be killed.

Our team visited a refugee camp that held 125 families with 300 children. Fifteen members of this group died in the tsunami. In the camp, the parents reported that at first, the children had nightmares and would wake up and run, shouting, “The tsunami is coming!” Certain sounds, such as a flushing toilet, would cause some of them to jump up and run away.

The Danish, in cooperation with a local nongovernmental organization, sponsored this particular camp.

The 12-by-15-foot rooms were intended for full families. The walls were corrugated metal, and the roofs were covered with plaited straw for coolness. We were told it will be more than a year before regular housing is available.

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In our training program, we had 125 teachers crowded into a room that would have been uncomfortable for 30 because of the temperature. An additional 25 or 30 other participants waited outside because we had no room for them.

All wanted to learn methods to help their students cope with the twin traumas of personal risk and loss of friends and relatives.

We found out later that 20 faith healers were mixed in with the other participants. It seems that the locals preferred going to them with their symptoms rather than the few physicians in the area. We later met with these faith healers for a separate session.

The first morning, I had a feeling that our program was becoming a disaster in itself. We statrted two hours late. Our hotel was an hour’s drive from the classroom, and our host, whose car had been leading our van, hit one of the myriad of motorcyclists plying the narrow roads. He took the victim to the hospital.

Complicating the picture, our team--Arshad Husain, child psychiatrist and director of the International Center for Psychosocial Trauma at the University of Missouri-Columbia; Judith Milner, a child psychiatrist from Seattle; and I, a psychologist-- had taken 36 hours to get from Columbia to Sri Lanka’s capital, Colombo.

Colombo was a nine-hour drive across the mountains. We avoided the better coastal roads because rebels had put snipers in the area.

The road over the mountains was one lane, making passing difficult. The road was in disrepair, with bucking-bronco bumps that prevented sleep. This was probably the most difficult ride of any I have taken in my many trips into disaster areas. As a result, we were all a bit the worse for jet lag and a lack of sleep at the start of the program.

It became clear in the first hour of our presentation that many of the psychological concepts we were talking about, such as post-traumatic stress disorder, were completely new to our audience. Our interactive teaching methods also confused the participants, who were used to straight lecture. At the end of the first morning, the question in my mind was: “Can this program be saved?”

Things began to improve in the afternoon. We asked the participants to focus on their own symptoms after the tsunami and the symptoms of their students and helped them organize those symptoms into a system.

In our team’s debriefing that evening, we decided many of our participants were themselves having post-traumatic stress reactions. We decided to scrap our published program and focus on teaching them exercises they could use in the classroom to help their students.

The next day, with a larger classroom at a different site, we taught them four methods of relaxation to deal with tension, ways to use the students as support for one another and other basic methods of reducing stress. The teachers were cooperative and responsive.

Husain experienced several traumas of his own. He had flashbacks of the motorcyclist who smashed into the window on his side of the car, hurtling through the air. One morning in the dark, he fell into a stairwell that was not protected by a railing, giving him not only swollen places on his body but also extreme caution around stairs.

We had three other training programs to run, so our time in the area was short. The team believed that because of the intensity with which the participants had applied themselves, they had gained skills that will allow them to treat victims of post-traumatic stress disorder in the area.

In the area of Sri Lanka hardest hit by the tsunami 24 of the 125 participants in our training program were faith healers. This is a faith healers hospital with beds for four patients.

Tuesday, April 5, 2011



With the recent earthquakes around the world I feel that some readers would like to know what happens in a third world country (like Haiti) when the quake hits. I have a number of stories about quakes the most detailed of which was working the trauma zone in India after the 2001 disaster that was made much worse by corruption and incompetence.

A small miracle: The 8-month-old baby the nurse was holding in her arms had three burn-like scars on her face. She had been trapped under rubble for four days in her dead mother’s arms, her father and eight siblings lying crushed around her.

Victims of the earthquake are attended to in a tent hospital in the city of Anjar. The highest estimate reported 80,000 dead and many more wounded.   (Rajesh Parikh photo)

At the time was in the earthquake zone in western India, a scene of rubble, millions of people left homeless, wandering cows, filth and a mood of general hopelessness.

As we got off the airplane at a military airport near the epicenter of the quake, our orientation to the disaster began. There was the story of someone taking a baby’s arm away from a dog and of the nursing mother whose head was crushed by falling concrete but whose baby was found alive in her arms two days after the quake.

The man in charge of doling out services in Bhuj, the city hit hardest by the 7.7 magnitude earthquake, said he had been on the fourth floor of a five-story building when it hit. He couldn’t figure out what all the shaking and noise were and thought at first that someone had set off a bomb. When the shaking stopped and he could stand, he found that the first three floors of the building had disappeared and that the fourth floor was now the first.

Arshad Husain, team leader of MU’s International Center for Psychosocial Trauma, and psychologists Kathy Dewein and I were visiting at the epicenter of the January earthquake in Guiarat Province, India. We had just finished a successful two-day workshop on post-trauma stress reactions for 220 mental health professionals in Bombay, and were on a tour of the disaster area. We ran short workshops for teachers, mental health professionals and doctors and tried to understand the impact on the local population. The trip was supported by Doctors for Global Relief.

The earthquake had hit at 8:45 a.m. Jan. 26, a bank holiday, the equivalent of the Fourth of July in the United States. It would have been worse if people had not been out and about. Fifteen thousand of Bhuj’s 150,000 people were killed, and 90 percent of the buildings in the city were destroyed.

The highest estimate of the number of deaths that we heard in the United States before we left was 30,000. Here, at the epicenter of the earthquake, which had done serious damage as far as 250 miles away, our informants said 80,000 dead was a conservative estimation. The destruction of many villages and small cities was complete, a sight that made the larger number seem reasonable.

The geophysical engineer I met said he had mapped the area 20 years ago in preparation for building dams. As the water in dams has increased, there has been a corresponding increase in the number of tremors. He has a theory that as water seeps into the limestone underpinning, it hits hot spots and creates steam pressure that influences the fractures, causing the shift. None of the dams, however, collapsed. He reminded us that politics and commercial factors influenced where dams were built.

In the towns we visited, narrow roads had been cleared into the areas of destruction. As we drove into the rubble, we saw wild pigs scavenging and cows by the dozens. Some buildings were standing, but many were rubble. When we got out to walk, our guide pointed out sad facts: Three bodies lie unrecovered under that one. That one has a 15-year-old girl under it. Over there are 15 bodies.

I did not notice any smell from bodies, so decay must have been complete.

Post-traumatic stress reactions

One of our first contacts, a manager of supply distribution in Bhuj, said there were no psychological problems. This was a message we were to hear again and again, sometimes from people who after a few minutes of talking would burst into tears. The manager said that he was a good man and that God did not want him to die. The implication was that only those who deserved to died. He said the rescue operations of digging people out of the wreckage started within the first hour but that people here did not know it was an earthquake until three or four hours later. He at first thought it was a bomb.

The development director of Life for Relief and Development, or NGO, a nongovernmental organization, said she was aware of 143 orphans. Placement, she said, would be a real problem. She said people are afraid to go into buildings. They go in and come out fast. One of the main stress symptoms we found was that people would not sleep inside buildings with a roof.

Contrary to the first reports I received, she said there are many signs of fearfulness. The earthquake was very loud, and any noise now upsets people. The earth first moved side to side and then up and down. Tremors keep coming and last a couple of minutes. When standing, some people feel the earth move even when it doesn’t and must lie down to make it stop. Many parents wouldn’t let their children out of their sight, which made it hard to manage getting food and working.

We met with 24 teachers in Bhuj. At first, they were confused about what we were doing. They said the main symptom of the children in their classes was sensitivity to any noise that reminds them of the earthquake. Many are having nightmares, and of course no one wants to sleep inside a building. We emphasized how normal these responses were and worked with them on techniques that might help: role-playing, storytelling, safe place and breathing exercises. The teachers were able to joke with us and laugh, which was a good sign.

Above, because of poor construction and failure to follow building codes, many buildings in Anjar collapsed in the earthquake, trapping thousands of people. Below, Kathy Dewein, a Columbia psychologist, holds a baby who was sick from exposure to the elements because its family insisted on sleeping outside after the earthquake.  Rajesh Parikh photo (above)  Wayne Anderson photo (below)

There were stories of guilt. One father jerked his son away from a tree only to see a wall fall on the son, killing him.

In the streets, many people greeted us with smiles. It seemed strange to see so much smiling in the midst of so much destruction. We wondered whether they were still in the heroic stage, with disillusionment yet to come.

People in towns close to the epicenter seemed to have a combination of hopelessness, fatalism, denial and the strength to pick themselves up and go on with their lives. In a minimally damaged part of Anjar, we saw children at a religious school in a large tent, children playing marbles, women carrying heavy loads of rubble on their heads, a factory making some kind of grain chips and lots of kids to follow Kathy around. This is the town where 400 children marching in a parade were crushed by falling walls.

We passed mile after mile of tents, many of them in yards of intact houses. But people refused to sleep in the houses. In one area of the country where a major earthquake had occurred eight years ago, there were still people who would not sleep inside a building.

One of the first people I met in Bombay was an architect who had just come back from the earthquake area. He had an interesting problem. He needed to design a building that could be put up cheaply and quickly and that the people would be willing to sleep in at night. What he was considering was a 12-foot-by-15-foot room with 3-foot-high walls to keep out snakes and rats but with a soft siding and roof from that point on.

When we returned from the disaster area 10 days later, the architect had put up a sample model building using brick for the sides and a green plastic for the rest of the sides and the ceiling. It could be constructed for $125 a unit. Communal centers would provide faucets for water and toilet facilities.

The Nongovernmental organizations

The Indian government was not set up to deal with disasters of this magnitude. There is no equivalent of our Federal Emergency Management Agency. The disaster was worse than it should have been. Several newspaper articles talked of cheating builders who had shorted the quality of cement, callous officials who refused to act even when they had supplies and a government that seemed paralyzed by the sheer size of the disaster.

Instead, much of the aid was coming from nongovernmental organizations, both inside and outside of India. They were deciding what relief efforts were needed and were collecting the materials in places such as Bombay and bringing them in. There is no central organization coordinating, so each NGO makes its own arrangements and wants separate recognition.

A woman in an makeshift tent hospital in Anjar awaits word of a relative.
(Rajesh Parikh photo)

We did see food lines where people were standing for prepared meals. They moved slowly, and I was told a person might stand in line all day for just one small meal. The director of one of the NGOs I talked to did not like this approach and believed that as much food as possible should be given to groups and families for their own preparation because that made things seem more routine and speeded up the return to normal.

One director I met said that lower castes, Muslims and small villages were being ignored, so her group was giving them special attention. She said politicians are holding tents to sell for their own profit. Humanitarian-aid blankets are showing up on the market in Bombay. She showed me records of where they should have gone.

Communities donating supplies and people working around the clock to rescue survivors, selflessly sharing what little they had, countered this lack of government intervention.

Our reactions

We were fortunate. Where we stayed, there was running water - not drinkable - and electricity. Cots were set up in a courtyard for us. This was the first time in years that I’ve slept with my clothes on. That all is not well with the children was shown by the young girl in the family who awoke during the night screaming, "Save me, save me."

The organization of our workshop in Bombay ran smoothly, and the participants called it a great success. That has been our usual experience. But things were not as well-organized in the disaster area. People didn’t know what to expect of us. Once exposed to us, they wanted more. With better organization, we could have given them much more.

Our housing was often open air

For example, in Ahmedabad, we were supposed to give four hours of training and ended up with two and a half. There were many among the 50 mental health workers and psychiatrists in this group who themselves were in need of therapy. They have a feeling of not knowing what to do and believe the disaster was so great that nothing they do will make a difference.

They were expecting the impossible of themselves. We had driven six hours covering 250 miles to get to Ahmedabad, which means the destruction area is bigger than the state of Missouri.

One part of our training is on secondary traumatization - helping the helpers cope with their reactions to being exposed to the pain and mental anguish of the victims. Besides helping the doctors, mental health professionals and teachers cope with their own reactions, we team members have to cope with our own reactions.

On my first trip to India in 1981, I was a tourist with a travel group organized in England. We used a railway boxcar as housing and cooked our meals in the area outside the car.

A woman picks through the ruins in Bhuj, near the earthquake’s epicenter, for personal belongings.  (Wayne Anderson photo)

I came back traumatized by the scenes of poverty, of being steadily bombarded by mutilated beggars and minus 20 pounds because the spice-laden foods did miserable things to my digestive system. I had nightmares and feelings of sadness for a long period after I returned home.

Coming home after this recent trip, I also had tension dreams, jet lag, major digestive upsets and, most of all, feelings of sadness that the people were coping with the terrible aftermath of the earthquake on top of the poverty. At times, it is heartbreaking.

In Bombay, we met with the American counsel general, his wife and three local professionals to discuss what we had seen and give our observations about what needed to be done.

The need is overwhelming. The team and I had feelings that, however small, we made a contribution and did what we could to make a difference.