October 30, 2006
The National Disaster Management Authority has now made a provision for psycho-social counselling of victims of natural calamities. The NDMA, which has been entrusted with the task of framing India's first-ever National Disaster Management Policy, feels that psycho-social counselling of victims will reduce their mental trauma and bring them back to normal life at a faster pace.
The National Disaster Management Policy, which is likely to be in place by New Year, lays emphasis on mental relief as much as on physical succour. The NDMA is all set to submit its draft policy to Prime Minister Manmohan Singh in a couple of week for Cabinet approval and necessary legislation.
Addressing trauma or psychological injury in natural or man-made calamities has always been a Herculean task. Governments and social workers worldwide encounter the delicate situation of supplying relief to victims vis-à-vis consoling them to reduce the untold mental trauma or shock they had undergone.
But the case had been quite different in India all these years. Central and State governments as also humanitarian aid groups simply concentrated on providing relief and rehabilitation. They did not focus on psychological counselling to reduce mental and physical trauma. Consequently, the victims continued to suffer mentally for many years despite being rehabilitated physically. The tsunami that hit the Indian Ocean two years ago had opened the eyes of policy makers and planners in India forcing them to come out with a disaster management policy with a thrust on psycho-social counselling.
"Management of trauma, both mental and physical, is an important issue in case of natural calamities. We can reduce the physical trauma but managing the mental trauma is not an easy task. We are going in for a comprehensive approach with regard to psycho-social support and trauma counselling. One of the suggestions we have received is to involve the victims in relief works so that it could lessen their mental shock," National Disaster Management Authority member Lt. Gen (rtd) Dr JR Bhardwaj said.
Dr Bhardwaj, who was in Hyderabad recently along with NDMA vice-chairman Gen NC Vij and other members for a feedback from intellectuals and scientists on the draft National Disaster Management Policy, admitted that India was not well equipped to tackle trauma cases in major disasters or calamities. The NDM policy will lay down certain guidelines on this issue.
Unfortunately in India trauma care is yet to receive its due importance as an emergency medical service. Even in big cities trauma care does not form part of the regular medical service.
Internationally renowned trauma care expert David Romig of the Emergency Medical Care Service, San Francisco, USA, feels that lack of basic trauma care in India was one of the main reasons for the escalation in the number of deaths, be it in accidents or natural calamities. "Doctors alone cannot do it. There should be proper awareness among people too," Romig, who was in the country recently, pointed out.
This is precisely the reason why the NDMA has plans to involve the local community in relief and rehabilitation programmes. It also aims at creating awareness, providing the infrastructure and ensuring access to the infrastructure in emergency situations.
The major task the NDMA is going to put on the shoulders of the Central and the State governments is upgradation of the existing medical services including state-of-the-art ambulance facilities. The country need to train paramedical staff to deal with natural calamities, which warrant mandatory trauma care during what health experts call the "golden hour" (the crucial period immediately after the tragedy).
"Victims of natural disasters or major man-made accidents require professional psychological care to reduce the emotional injuries or mental trauma. After every calamity, people live in a state of shock and their emotional recovery could take years. We cannot fill up the loss, but we can certain reduce their suffering through psycho-social counselling," Fr P Balaswamy, director of Social Service Centre, Vijayawada, observed.
The Social Service Centre and the Indian Red Cross Society experimented with what they called "community-based disaster management programme" in areas affected by Tsunami in Krishna district. They adopted a two-pronged strategy - built houses for the victims and took up community interaction, a simple psychological technique but with greater soothing effect. This concept is novel to India and NDMA has collected tips from these two organisations for adoption on a larger level in the country.
"In natural calamities many victims suffer from psychosomatic symptoms of trauma including listlessness, headaches, nightmares, chest pain and anxiety. If we do not attend to them, some of them may turn to destructive behaviours, like alcoholism, domestic violence or crime. There will always be a sufficient number of cases of mentally debility life. Feelings such as empathy and compassion can make a difference for hopeless and confused people," says senior psychiatrist Dr Indla Ramasubba Reddy.
Health and community workers, who participated in relief works in cyclones and floods, suggest that communities must to taught how to get those affected to speak on the calamity. Special care should be taken of children and they must be encouraged to act out their feelings and fears through paintings, sports, competitions and theatre activities. "Otherwise, we could be looking at a lost generation," Dr Ramasubba Reddy warns.
According to Dr Bhardwaj, the most common psychological reaction among disaster survivors are symptoms of acute stress and even psychological trauma and post traumatic stress disorder. Crisis intervention is also needed.
"Soon after natural calamities, we should not only focus on individual needs but also concentrate on community-based interventions to enhance the capacity of the community to provide appropriate support to people," suggests Fr Balaswamy.
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