The need for community-based psychological support for inhabitants of areas at high risk for natuaral disaster in Vietnam

JOURNAL OF SCIENCE OF HNUE Interdisciplinary Science, 2013, Vol. 58, No. 5, pp. 102-109 This paper is available online at THE NEED FOR COMMUNITY-BASED PSYCHOLOGICAL SUPPORT FOR INHABITANTS OF AREAS AT HIGH RISK FOR NATUARAL DISASTER IN VIETNAM Tran Thi Le Thu Faculty of Psychology and Education, Hanoi National University of Education Abstract. This article concentrates on analyzing the psychological problems of inhabitants prior to natural disaster or during and after natural disaster and it analyzes the negative impact of psychological difficulties on the lives of inhabitants based on previous studies which show the needs of inhabitants. In addition, it proposes building up and implementing a community-based psychological support program for the inhabitants of areas at high risk of natural disaster in Vietnam. Keywords: Community-based psychological support, natural disasters, hurricanes, typhoons, tornadoes, floods, landslides, wildfires, psychological problems, psychological difficulties, disaster prone provinces, stress, and crisis. 1. Introduction Every year the Vietnamese media provides information on the current status and influence of natural disaster in different areas in Vietnam. The Viet Nam Red Cross (VNRC) has also reported the effect of natural disasters. These reports focus mainly on economic loss or physical damage. The psychological problems of inhabitants prior to, during or after natural disasters have rarely been addressed. The psychological consequences are serious and exist long after natural disasters occur [1]. When 94 VNRC volunteers were trained in 13 disasters prone areas, it was seen that most of the volunteers had experienced the strong need forpsychological support before a natural disaster or during and after a natural disaster. All of the volunteers asked for more training so they they could acquire the professional skills needed to provide community-based psychological support [6]. VNRC has identified 33 disaster prone provinces. Of these, only 25 now benefit from the VNRC project. This project focuses on physical and material support, ignoring psychological support entirely. Received February 19, 2013. Accepted May 2, 2013. Contact Tran Thi Le Thu, e-mail address: thule1509@gmail.com 102 The need for community-based psychological support for inhabitants of areas at high risk... This article analyzes and discusses the basic theory and data-based status of establishing the community-based psychological support for inhabitant (prior to natural disasters and during and after natural disasters) who live in areas at high risk of natural disaster in Viet Nam. 2. Content 2.1. Psychological problems of inhabitants prior to natural disaster or during and after natural disasters In the 33 disaster prone provinces in Viet Nam, different types of natural disasters may occur. Each natural disaster bring with it crisis conditions and consequences which are physical, material and psychological. Inhabitants of every age, sex and culture can experience psychological problems. In the following I summarize some forms of psychological crisis as felt by Westerners who have experienced specific natural disasters, referring to studies that have been done outside of Vietnam. 2.1.1. Hurricanes and Typhoons Hurricanes and typhoons are usually predicted days to weeks in advance, giving communities time to prepare. Although communities can be made aware of the potential danger, there is always uncertainty about the exact location of a storm’s strike. Although these predictions give families time to gather supplies and prepare their homes and children, such activities in and of themselves may generate fear and anxiety (Zenere & Lazarus, 1999, [10]). After experiencing a hurricane, the survivors often experience emotional and physical reactions. For example, their startle response to sound may be acute in the months following, and subsequent storms may trigger a panic reaction due to the fear that another hurricane is coming. Following Hurricane Katrina in New Orleans, 44% of parents surveyed (106 out of 242) indicated that their children developed mental health symptoms, including depression, anxiety and difficulty sleeping (Weisler, Barbee, & Townsend, 2006). Furthermore, survivors may experience survivor’s guilt if they were unharmed while other family members were injured or killed. Honeycutt, Nasser, Banner, Mapp, and DuPont (2008) found that experiencing guilt following Hurricane Katrina, along with fear, anger, and sadness, were predictors of trauma anxiety. Similarly, a study following the 1982 flooding in Nagasaki, Japan, revealed that the number of people feeling depression and anxiety increased 3 months after the flood. Five months after the flood, patients with depressive and posttraumatic stress symptoms began visiting hospitals (Araki, 2006) and 1 year following the flood, suicide rates rose. Although the hurricane event may last only a short time, survivors can be involved with the disaster aftermath for months or even years. Property destruction can be overwhelming. For example, following Hurricane Katrina many neighborhoods were 103 Tran Thi Le Thu destroyed. People suffered from dehydration and food poisoning, and subsequent flooding resulted in rancid smells due to sewage, rotten food, debris, toxic chemicals and gasoline. Because of the flooding and lack of electricity, mildewwas common in the walls of houses that were still standing. Following this disaster, families are attempting to reconstruct their lives and are required to deal with many different people and multiple agencies (e.g., insurance adjustors and electricians). A study of children affected by Hurricane Andrew explored student adjustment 3, 7, and 10 months post disaster and revealed that many were showing symptoms of posttraumatic stress disorder (PTSD). Although PTSD symptoms declined over time, a substantial level of symptomatology was observed up to 10 months after the disaster. Similarly, a study in Japan following the 23rd typhoon of the 2004 season revealed that even 1 year later, approximately 33% of 600 respondents reported that their lives were not back to normal and 28% of respondents were at high risk for PTSD (Fujii, Goto, & Kato, 2006, [1]). The impact and the duration of the effects were often greatest for those who evacuated their homes or who no longer had a home when they returned. 2.1.2. Tornadoes Tornadoes can bring mass destruction in a matter of minutes, and individuals typically have little time to prepare. Confusion and frustration often follow. People experience sensations during tornadoes that may generate coping challenges later, such as difficulty tolerating the sounds of trains or jets. In addition, as with other natural disasters, people have a difficult time coping with the sights and odors of destruction. For example, the May 1999 tornado in Oklahoma destroyed thousands of homes, killed 45 people, and injured 597 others. Research showed that even 1 year after the tornado, children still experienced both internalized and externalized symptoms, such as anxiety, reexperiencing the event and a sense of a shortened future (Evans & Oehler-Stinnett, 2006). In addition, self-reports and parents’ reports of children’s fear in response to tornadoes indicated increased posttraumatic distress (Lack & Sullivan, 2008). In Vietnam psychological crisis before or after a disaster are seldom a real concern of state organizations and the psychological impact of tornadoes on Vietnamese people has not been investigated. It can be presumed that psychological problems exist longer after a disaster occurs. 2.1.3. Floods Flooding is a very common type of natural disaster. Flash floods are the most dangerous in that they occur without warning, the move at intense speeds, tear out trees and destroy roads and bridges, and they wreck buildings. In cases of dam failure, the water released can be especially destructive. In the aftermath of the Buffalo Creek disaster in 1972 in which a dam in West Virginia collapsed, 224 children from the area were evaluated using interviews, storytelling, and projective measures. It was reported that most 104 The need for community-based psychological support for inhabitants of areas at high risk... of the children who survived the flood experienced psychological distress. The two most significant predictors of impairment were the degree of disaster exposure and perceptions of family reactions (Newman, 1976). Floods such as those that occurred in the Midwest during 1993 give residents and governments more time to prepare because they are aware of the rising river levels. Sensations that may generate as they cope with the disaster include seeing the desolation of the landscape, smelling sludge and sodden property, experiencing the cold and wet, and dealing with vast amounts of mud. Most floods do not recede overnight and many residents have to wait days or weeks before they can begin the cleanup. As noted by Feinberg (1999), “Flood waters sometimes take quite a while to recede and the extended agony of waiting to see what is left after your home has been under water for a month aggravates an exceedingly stressful emotional situation.” 2.1.4. Landslides Landslides are not always predictable. Sudden releases of earth, rock and debris on slopes can result from natural causes such as excessive rain, erosion, groundwater or earthquake, or in some instances by human activities such as grading or development. Landslides occur around the world, with increased risk in areas that receive large amounts of rain or have steep slopes. The knowledge that homes and people have been buried further complicates the immediate crisis response activities in which machinery and workers are clearing debris to uncover structures and people underneath. The initial 72 hours can be very stressful for children and families as rescue efforts work to locate survivors amid the debris. During June 2007, heavy monsoon rainfall in Chittagong, Bangladesh (a city of 5 million residents), caused landslides that engulfed homes around the hilly areas of the city, leaving over one third of the city under mud or water. Despite previous warnings from experts regarding the increasing likelihood of landslides, the illegal removal of trees in the hills persisted. More than 2 million people were affected with over 125 fatalities, including over 50 children, with the total at more than 200 casualties. During this same monsoon period, in the adjacent district of Cox’s Bazar, 400,000 people were marooned by floodwaters. Thus, the effects of landslides may also be exacerbated by coinciding flooding in affected regions (Sarwar, 2008). Catapano et al.’s (2001) study of the psychological consequences of the May 1998 landslide in Sarno, Italy, found higher rates of PTSD among those in the community, relative to a control group from another nearby community. The study emphasized the importance of providing support and interventions to members of communities experiencing landslides and other natural disasters. 105 Tran Thi Le Thu 2.1.5. Wildfires Each year, wildfires occur on every continent except Antarctica. The most common cause of the wildfires in each region varies. For instance, in the United States, Canada and northwest China, lightning is the major source of ignition. In Mexico, Central America, South America, Africa, Southeast Asia, Fiji and New Zealand, most wildfires can be attributed to human activities such as agriculture and land-conversion burning. Human carelessness is a major cause of wildfires in China and the Mediterranean basin. In Australia, the source of wildfires can be traced to both lightning strikes and human activities, such as machinery sparks (International Association of Wild land Fire, 2011). There is often some warning of an advancing wildfire, however, depending on the wind and terrain, the direction and speed of a spreading wildfire can change abruptly. The timing of the warning can vary from one neighborhood to the next. Although some people may have hours (or even days) to evacuate, others will have only a few minutes to gather their belongings and leave their homes. Even if evacuation is not ultimately necessary, preparing for the possibility can be frightening for children, particularly if they are seeing television images of homes burning nearby. For example, in the summer of 2007 and 2009, over 50,000 residents in the suburbs of Athens, Greece, were evacuated as a result of rapidly spreading wildfires that destroyed over 1 million acres and over 1,000 homes and took weeks to fully contain. During the months of June through September 2007, over 3,000 wildfires were recorded throughout Greece (International Strategy for Disaster Reduction, 2007, 2009). Reactions immediately following a wildfire may include emotional and physical exhaustion. According to related research reported by La Greca et al. (1996), several important considerations relate to the potential effects on children. In some instances, children may experience survivor guilt that their own home was left unharmed while others’ homes were completely destroyed. In general, one might expect greater symptomatology in children to be associated with more frightening experiences during the wildfire, such as physical proximity or visual exposure to the fire, and with greater levels of damage to their communities and homes. The sights, sounds, and smells of a wildfire often generate fear and anxiety. Consequently, similar sensations, such as the smell of smoke, may generate distress among children in the months that follow. Given the scale of most wildfires, individuals living outside the ravages of the fires may still feel exposed to the danger from drifting clouds of smoke, flames on the horizon and television reports. Some children may also react to follow-up news coverage after the fire and even weather reports that talk about dry fire conditions. Even though a wildfire will last for only a specific period of time, survivors may be involved with the disaster’s aftermath for months or even years (Bolton, O’Ryan, Udwin, Boyle, & Yule, 2000; La Greca, Vernberg, Silverman, Vogel, & Prinstein, 1994). 106 The need for community-based psychological support for inhabitants of areas at high risk... 2.2. International community-based psychological support programs Traditional approaches to natural disaster assistance have often neglected the psychological impact of crises on effected populations. There is growing recognition they psychological wounds heal slowly and often go unrecognized and untreated after crises and disasters. Addressing the psychological as well as the physical needs of a population affected by crises has become a prominent concern in international humanitarian assistance and is now component of many development programs, including disaster preparedness and relief operations. The International Federation of Red Cross and Red Crescent Societies has been a pioneer in the development of psychological support programs. Since 1991, the International Federation has been developing its Psychological Support Program. A Federation Reference Center for Psychological Support was established in 1993 and has since then been a partner in the development of psychological support activities and in assisting national societies in providing an essential service: psychological support to people in need. The demand for psychological support is reflected in the increasing number of requests received by the reference center from national societies that want to develop psychological support responses. Psychological support is about mobilizing the power of humanity. With a basic understanding of the psychological issues faced by those they will serve as well as the challenges to their own psychological well-being when dealing with people in distress, volunteers will be more prepared for successful interaction, feeling more confident and less anxious about encountering difficult circumstances. The first edition of a community-based psychological support training manual was published in January 2003 by the International Federation of Red Cross and Red Crescent Societies. This training manual including six modules: (1) Psychological support, (2) Stress and coping, (3) Supportive communication, (4) Promoting community self- help, (5) Populations with special needs and (6) helping the helpers. The manual is also including 4 annexes which help the trainers and trainees understand more about the content of the training. This manual is intended for those whose would like to train Red Cross- Red Crescent volunteers in psychological support. For the trainer, a mental health background is not mandatory, but a good understanding of social work, psychology or psychiatry is crucial. The manual can be used as an aid for trainers, who can translate and adapt it to the language and customs of their particular region. Training on psychological support can be given as a separate program or may support an already existing program as a component of disaster preparedness, first aid or social welfare. The goal in both instances is to strengthen the quality of care for beneficiaries and provide adequate support for the 107 Tran Thi Le Thu helpers themselves. The National Association of School Psychologists (NASP) of the United States of America provides school safety and crisis resources on their website. The NASP has made the materials available free of charge to the public in order to improve the ability of children and youth to cope with traumatic or unsetting events. The material includes a section on ‘natural disasters’ which presents a series of articles and studies. There are many other psychological support programs for people with high risk of experiencing natural disasters which we can refer to should we wish to build up and develop a specific program in Vietnam. Basic research and studies are needed to determine the needs and current status in Vietnam. When the groundwork is completed to some degree, we can start to develop a training program and provide a guide book to communities. 3. Conclusion and proposed ideas Proposed ideas on how to create a community-based psychological support program in Vietnam: The basic theory and data-based analyses indicate that there is the need for a psychological support program for Vietnamese inhabitants who live in the areas with high risk of natural disaster. This need is quite urgent and I propose that the following ideas for developing a program be acted upon as soon as possible: (1) Psychologists trained in applied psychology should set up the group of specialists who will carry out studies on the psychological needs of people who live in areas with a high risk of natural disaster. (2) Study foreign psychology support programs to understand how and why they work successfully, adapt that program to the Vietnamese culture and local needs. (3) Develop a program that focuses on those who have real needs. The program should integrate common support activities that will benefit those who have experienced natural disasters. (4) Train psychologists in the specialization of ‘community-based psychological support’. (5) Set up a network of people and organizations who will study the psychological effect of natural disasters and develop a program that will include the staff of Vietnam Red Cross staff members and local and foreign volunteers so that we can have updated information. REFERENCES [1] Fujii, S., Goto, T., & Kato, H., 2006. Influences of Typhoon on mental health. Journal of Psychological Trauma (Japanese), No 2, pp.19–30, retrieved from 108 The need for community-based psycho