Psychiatrists Help Victims Cope with Earthquake Trauma

Psychiatrist Manoj Shah, M.D., was preparing to fly from New York City to Ahmedabad, India, on January 26 to visit his parents when he got the news. This city of 4 million in the state of Gujarat had been hit by a massive earthquake registering 7.9 on the Richter scale.

His parents were unharmed. Although their home was damaged, they were among the fortunate. Thousands others perished in the rubble or were injured by the debris. Others lost family members, homes, and businesses, according to news reports.

By the time Shah’s plane landed in India, he had decided to organize psychological counseling for the victims. He believed that more victims could be reached through establishing a group counseling center than through counseling individuals. Shah is an advisor to the board of the Mental Health Research and Education Trust in Ahmedabad, a philanthropic organization that funds mental health projects. He is also an assistant professor of psychiatry at Albert Einstein College of Medicine in New York City.

“I approached them with my idea because I wanted the support of a local organization that could provide funding for administrative costs and oversight when I left. The trustees approved my proposal and found a building for the counseling center in the city near public transportation,” Shah told Psychiatric News.

He also needed volunteers to provide counseling at the center at no cost to the victims. He met with the heads of the local schools of medicine, psychiatry, and psychology to discuss his idea.

“We wanted many disciplines to be involved because there are only 60 psychiatrists in Ahmedabad, who are overwhelmed by the demand for their services,” said Shah.

Because yoga can reduce stress, he enlisted the help of several trained professionals to teach relaxation and breathing exercises to the earthquake victims in the city’s parks.

The center opened February 15, the day Shah returned to the United States. There is a group for those who lost relatives and another for those who lost their homes, businesses, or both. Those who witnessed the destruction but weren’t harmed participate in a third group. Each group offers between three and six crisis-oriented sessions.

“We divided [the people] into three groups realizing that their needs and issues would be different,” said Shah.

The groups are led by psychiatry residents, psychologists, or psychology students who volunteer a few hours a week at the center. Four senior psychiatrists affiliated with academic institutions supervise their work, he explained.

“The people are experiencing symptoms of anxiety or fear, sleep deprivation, nightmares, panic, and depression,” said Shah. Many people are sleeping outside rather than in their homes because they are afraid the buildings will collapse if aftershocks occur, he observed.

“A goal of the counseling is to validate their fears but also help restore some sense of normalcy. We provide practical information about aftershocks and suggest using a structural engineer to evaluate the safety of their homes,” said Shah.

To help children traumatized by the quake, Shah met with schoolteachers in Ahmedabad to train them in art and play therapy and physical education.

The next step is to have teams of mental health professionals, schoolteachers, and yoga professionals offer their services at community centers where displaced people are living.

Shah is also planning to conduct research on how well these interventions worked.

S. Arshad Husain, M.D., director of the International Center for Psychosocial Trauma at the University of Missouri-Columbia School of Medicine (see story on page 13), traveled to several stricken Indian cities in late February with two psychologists from the center.

His team trained 230 physicians, including psychiatrists and mental health professionals, in trauma techniques in Bombay, where they practiced. “Some had already traveled to Gujarat state to help victims and others were planning to go there,” said Husain.

The goal is to encourage people to talk about what happened and why and dispel myths. Some people believe that those who perished were punished for being bad, while the survivors were rewarded for being good, Husain told Psychiatric News.

Husain points out that more natural disasters have occurred in developed countries between 1960 and 1987 than underdeveloped ones, but that the casualties are 70 times higher in underdeveloped countries.

His team also visited Ahmedabad, where they trained about 50 mental health professionals who were working independently or with relief agencies to help disaster victims.

In spite of their efforts to help the earthquake victims, many psychiatrists and mental health professionals expressed frustration and guilt to Husain about not doing more.

“We realized that they were traumatized and suggested forming a support group to share their experiences, frustrations, and concerns on a regular basis,” said Husain.

A major goal of his trip was to help children traumatized by the earthquake. Husain and his colleagues trained several local schoolteachers in Bhuj and Anjar in art and play therapy and group relaxation techniques.

“Teachers are a natural resource in places where mental health professionals are scarce. Another advantage is that the children already know and trust them,” said Husain.

Both cities in Gujarat, near the earthquake’s epicenter, were nearly destroyed. Among the thousands who died in Anjar were 400 school children who were marching outside when the buildings around them collapsed, burying them in the rubble, said Husain.

Since returning to Missouri last month, Husain and his colleagues sent instructional manuals to India designed for parents, teachers, and mental health professionals to help children recover from the earthquake. The manuals will be translated into the local language. ▪