MSF integrates psycho-social care into Myanmar emergency program
One month after cyclone Nargis hit Myanmar, Medecins Sans Frontieres (MSF) staff continue to come across people who remain totally without aid. Whilst the need for clean water, food, shelter and medical assistance remains critical in the Irrawaddy Delta, another issue has become increasingly apparent among the population – a significant level of psycho-social trauma.
MSF Mental Health expert, Kaz De Jong, travelled to the Delta in June to assess the situation. His assessment describes a worrying scenario, in which some of the worst affected communities continue to wait for assistance, whilst others cannot imagine how to begin facing up to the destruction. "Confronted by a woman who could not find the will to eat, provided me with just a glimpse of the desolation that thousands of people in the worst affected areas are suffering. She explained that she was thankful for the food being delivered but asked if we could also find her the motivation to eat it", said Kaz.
With generations wiped out, families torn apart and whole villages destroyed, the level of distress is extensive. “When you approach a community you can see the level of loss mirrored in people’s faces and responses. Those who have been less affected, having undergone around a 20% loss which is in itself unimaginable, are utilising their natural coping mechanisms. They are active in coming together to care for each other and organise the community. In contrast, those who live in areas that were more heavily affected, stare at you with empty faces - the natural coping mechanisms obliterated and communities broken apart”.
In addition to the huge losses and want of basic needs, Kaz explains some of the less obvious challenges people are also facing. He heard many stories from 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 recognised issue is 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.”
In this context, MSF medical staff has recorded a growing number of psycho-social complaints including lethargy, profound sadness/depression, anxiety, difficulty sleeping, hyper-tension, palpitations, and non-specific body complaints. To try and address these issues, MSF is now integrating a mental health and psycho-social program into their emergency response efforts in the areas of Labutta and Hangyi, where MSF continues to deliver food, water and sanitation, shelter and primary healthcare. “An integrated approach is important in order to address all of the critical issues - people’s recovery environment and personal mental health and well being,” explains Kaz. “A team of community health workers, trained in case detection and referral, will work to raise awareness of key issues such as stress and hygiene and to have the facilities put in place to assist people within the communities. They will work together with our experienced health teams and counsellors (provided with additional training in trauma care) who will provide in-depth psychosocial and mental health support. The counsellors are nationals who have been recruited from our longer standing MSF projects based in Myanmar.”
Other efforts will see MSF teams working to mobilise communities to strengthen their self-help structures and develop support groups and activities. Plans are in place to expand services to assist those who remain without any aid.
MSF national staff,who began working on the ground in the Delta just 48 hours after the incident began, are also being given the appropriate support and care. The conditions in which they are working are physically very hard with the rainy season, basic hygiene and living situation contributing to the challenges the staff have to endure. That is in addition to the huge emotional strain of encountering so much suffering and in some cases, baring their own losses. Despite the difficult circumstances, Kaz De Jong encountered a strong sense of motivation amongst the staff to go on assisting their fellow countrymen, most of whom have chosen to go on working in the Delta region.
To bolster the natural team support mechanisms already present, MSF has also set up a buddy system, along with staff rotation and de-briefing systems specific to requirements.
*Note - all quotes by MSF Mental Health expert Kaz De Jong
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