News 29 of 211

New Prescription for Traumatic Times

A veteran soldier who lost a leg when he stepped on a landmine has a job in a road crew. Cambodia.  Photo: Masaru Goto / World Bank

2009-01

Do international relief agencies need to look at new ways to help people recover from natural disasters and wars? Should their methods be more adaptable to local conditions and less reflective of Western biases?

Those are the tough questions at the heart of the Trauma and Global Health Program, a project housed at McGill University’s Douglas Mental Health University Institute in Montréal. The Institute, also affiliated with the World Health Organization (WHO), conducts on-the-ground research in four countries – Guatemala, Nepal, Peru, and Sri Lanka — where both long-term civil conflicts and periodic natural disasters have been facts of life.

The innovative program is one of 14 partnerships between Canadian and developing-country researchers funded by Teasdale-Corti grants, a program of the Global Health Research Initiative (GHRI). The GHRI is a unique partnership of five Canadian agencies (IDRC, the Canadian Institutes of Health Research, Health Canada, the Canadian International Development Agency, and the Public Health Agency of Canada).

What makes the McGill-based initiative different from other Teasdale-Corti projects, is its exclusive focus on mental health. Specifically, the project addresses the way responses to catastrophes can affect survivors’ long-term psychological well-being.

Finding the “best fit” for healing and coping

While acknowledging the international community has good intentions in delivering assistance and relief, project researchers believe more attention must be paid to how relevant these initiatives are to local realities. In the aftermath of earthquakes or massacres, says Duncan Pedersen, the project’s Montréal-based co-principal investigator, those agencies will routinely “fly in dozens of trauma counselors with a checklist for post-traumatic stress disorder, to identify cases on the ground and start ‘debriefing’ or other treatment interventions, with little, if any, further assessment and follow-up.”

“We have assessed this method,” Pedersen continues, “and we think these are incomplete and often inappropriate interventions, which may lead to more harm than good. They are based on premises from the West. First, if you take the case of Rwanda, words like ‘stress,’ ‘trauma,’ or ‘post-traumatic stress’ do not exist in their vocabulary. Second, not all cultures necessarily relieve their symptoms by debriefing. Some societies — like the highland Quechua indigenous populations in Peru — try to initiate the healing process by refraining from remembering traumatic events. In this context, a Western-based intervention… may be counterproductive because it re-traumatizes people.”

Decades of sorrow

It’s almost universally accepted that the scale of problems created by war and natural calamities is immense. In the four countries where project researchers are active, the statistics tell stories of almost incalculable sorrow. In Guatemala, for example, 36 years of civil unrest have left 300 000 people dead and more than a million displaced.

Although tragedies like these have been unfolding in developing countries for many years, Pedersen says it was the September 11, 2001 attacks in the United States that prompted an exponential increase in the number of studies examining the psychological toll that episodes of extreme violence take on survivors.

Strengthening the forces of resilience

Research brings the broader picture into focus. It’s clear, for example, that survivors can face an assortment of long-term health problems, including heightened risks of alcoholism and drug abuse, and increased exposure to infectious disease.

One of the most tragic examples of the latter is the spike of HIV infections in Rwanda following the conflict – a rise that has been linked to the systematic use of rape as a weapon.

There is also a distinct – though not fully explained – correlation between rises in interpersonal violence (such as assaults, murders, and spousal abuse) and conditions of war and civil conflict. In 2002, the WHO reported 1.6 million deaths each year due to violent events – half due to suicide, one-third to homicide; and the rest war-related.

Despite the bleak reality that the aftershocks of war and disaster may be felt for generations, researchers say they’ve gained insight into how international agencies can more effectively help the recovery process.

“We are interested in strengthening the forces of resilience,” says Marina Piazza, co-principal investigator of the Peruvian component, based at Cayetano Heredia University in Lima.

Solutions rooted in local soil

To do so, she says, requires recognizing communities’ own traditions, and religious and cultural frameworks that help them cope with loss. It’s also vital to pay attention to the specific circumstances created by disaster and conflict.

In Peru, for example, following the devastating earthquake in 2007, widows found themselves outside the male-centered labour market and less able to benefit from the community-based practices that once sustained them. Interventions, therefore, must integrate this vulnerable group back into society.

A blueprint for recovery

International agencies also need to consider that, with the onset of a crisis, community members may find material aid more helpful than counselling. “…We need to try to sew the social fabric back together – to look at most basic needs, to question what health services are still in place, what schools are still operational, if there are roads to transport needed basic goods, etc,” says Piazza.

Duncan Pedersen agrees. In the aftermath of a disaster, “people are asking ‘Can I send my children back to school?’ ‘How can I get some food and rebuild my house?’ ‘How can I protect my family from the pillaging that’s going on?’ We as professionals are concerned with trauma and diseases, but the priorities in communities tend to be different.”

Events unfolding in some areas recovering from war and disaster seem to offer blueprints for how both the practical and psychological needs of communities can be met. When Guatemalan refugees returned from Mexico, for instance, they began exhuming the bodies of relatives killed in massacres, so they could receive a respectful burial. This is an act of great symbolic value, but one which can also lead to new material efforts to rebuild communities.

Ritual combined with rebuilding

“To say good-bye to your relatives like this is a way to begin the healing process,” explains Victor Lopez, the co-principal investigator for Guatemala and a researcher at the Centre for Psycho-Social Research in Guatemala City. “But it’s more complex than that. It has social, even legal implications. This could be the starting point to start asking for reparations, and that would be very important for the recovery and social development of these communities.”

As communities begin looking toward the future, Lopez says one of the most important roles of international agencies is to “accompany them in their efforts and provide whatever support is required in direct consultation with the survivors and affected communities.”

Stephen Dale is an Ottawa-based writer.

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News 29 of 211