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Friday, April 22, 2011
Giving voice to trauma-hit victims
Survivors must be heard, must not feel alone, experts say
By MIZUHO AOKI
When the gigantic tsunami hit the Tohoku region on March 11, Kazuya Kikuchi was just getting out of his truck at Sendai port. As he saw the killer waves swallow up a bunch of brand new Toyotas at the harbor waiting to be shipped, he was frozen by the surreal sound of metal against metal - a sound he said he will never forget.
After the cars' alarm systems set off a cacaphony of honking, Kikuchi ran into a nearby building and dashed up five flights of stairs, getting away just in time.
Kikuchi was spared, but the things he saw and the terror he felt that day have been haunting him ever since.
"I haven't been able to have a decent night's sleep in the past several weeks. My sleep has been cut short," the truck driver in his 40s said during an interview in Shiogama, Miyagi Prefecture. "The scene and that sound keep coming back."
Kikuchi's problems are not unusual, experts say. They are just part of a wide range of reactions that people have when exposed to overwhelming stress. Other reactions include depression, headaches and eating disorders.
After going through a life-threatening experience like the Great East Japan Earthquake, many people can be expected to contract stress-related ailments. Although the majority recover within about a month, the scale of the calamity --- which left about 27,600 people dead or missing - may have caused such deep mental trauma that a much longer healing time is needed. Even those with no immediate signs of trauma are at risk of developing symptoms months or years later, experts say.
"The more devastating a disaster is, the longer the stress reactions tend to drag on. Also, in this scale of catastrophe, trauma and stress tend to appear later. We have to be aware that some may start to suffer from posttraumatic stress disorder six months or a year after exposure to the traumatic event," said Kaori Ono, a professor at Sonoda Gakuen Women's University in Kobe who specializes in disaster nursing.
"People have been talking more about rebuilding the area recently, and I'm worried that those who are still unable to let their emotions out may suffer more by feeling left behind. Considering the scale of the disaster, the long-term support of medical professionals is crucial," said Ono, who visited shelters in Sendai a week after the tsunami struck.
The importance of dealing with psychological trauma caused by natural disasters gained nationwide recognition in 1995 after the Great Hanshin Earthquake slammed Kobe and claimed nearly 6,500 lives in the Kansai region.
According to a survey conducted by the Hyogo Institute for Traumatic Stress, 54.1 percent of 106 respondents who survived the earthquake but lost family members were still displaying symptoms of PTSD as recently as 2009, 14 years after the calamity.
To prevent people from developing PTSD and to help them recover, it is important to listen intently to what they say, experts note. And to provide such support to the thousands of people in grief, the help of trained professionals, as well as people close to the survivors, is necessary, they say.
"It's important for disaster victims to express their feelings. And it's important for them to have someone to listen to their stories receptively," Ono said. Speaking about their traumatic events helps them understand their experiences, and that leads to the recovery process, she explained.
But listeners should be aware that discussing or remembering traumatic events sometimes deepens a person's grief, she warned. So instead of asking suvivors to talk about their feelings, it is better to wait for them to initiate the discussion and let them say what they want in order to determine their needs, Ono said.
Heeding the lessons of the Hanshin quake, areas outside the disaster zone have been dispatching "kokoro no kea chiimu" (care teams for the heart) made up of psychiatrists, nurses and psychotherapists to the Tohoku region since March 11.
So far, 38 teams comprising 767 medical professionals have visited Fukushima, Miyagi and Iwate prefectures. As of Tuesday, 26 teams made up of 124 people were in the area, according to the health ministry.
It is not known how long the "heart care" teams will continue to stay in the area, but their help will be needed at least until the evacuees enter temporary housing, experts say.
Satoe Kasuga, a public health nurse who was dispatched from Tokyo to the devastated Iwate city of Rikuzentakata in March, said part of the job is to let the survivors know they are not alone.
"What we, the heart care team, do is visit each person in the shelters or houses and ask them things like how is their blood pressure or whether they are sleeping well," Kasuga said. "By asking them about such daily things, in my experience, many began talking about the disaster."
"And if we think they need medical help, we tell psychiatrists to examine them," Kasuga said. "For their recovery, their own healing ability is vital. What we can do is support that healing power."
Apart from pouring out their emotions, the most important thing in the recovery process is for the victims to have a safe and secure life and human relationships, said Naoki Kumagai, psychiatrist at the Bureau of Social Welfare and Public Health.
After the Hanshin quake, many old people began suffering from isolation and loneliness after moving into temporary housing because they had lost their community, Kumagai said. "The continuation of community should be taken into consideration."
Ono of Sonoda Gakuen said mental support is not enough.
"There is nothing that the medical teams can achieve solely on their own. Without the stabilization of people's lives and environment, they cannot have peace of mind. Until they get that, all we can do is give them as much support as possible and try not to make their suffering deeper," she said.