Welcome to the OPENPediatrics World Shared
Practices Forum. I’m Judy Palfrey, the director of Global Pediatrics Program in the Department
of Medicine at Boston Children’s Hospital. This is one of a series of forums being hosted
by OPENPediatrics on global health issues. We’ve chosen to focus on post-disaster children’s
mental health. We’re doing this because of the increasing incurrence of disasters, the
fact that they can happen absolutely anywhere, and also, that they affect disproportionately,
with a profound effect on the most vulnerable in our societies, which is especially true
for women and children. But there is an emerging understanding in
child health of the mental health consequences of disasters. There are now a number of interventions
and best practices, and child health and mental health professionals around the globe can
apply these. With me today to discuss this topic is Dr.
Duncan Maru. He’s the co-founder and the chief strategy officer and a board member of Possible,
an NGO that provides medical care in Nepal. Duncan is also a faculty member at the Harvard
Medical School and at the Brigham and Women’s Division of Global Health Equity. He practices
part-time on the Complex Care Service at Boston Children’s Hospital. Also joining me is Dr. Myron Belfer, who’s
Professor of Psychiatry at the Harvard Medical School and the children’s hospital. He was
the senior advisor on child and adolescent mental health at the World Health Organization.
And he’s dealt with issues related to mental health for children worldwide. Welcome. Duncan, you have personally experienced one
of the worst earthquakes in Nepal. Can you share with us the impact of this on children
and families and your experience? The earthquake was certainly one of the most
challenging and tragic events in a country that has suffered a series of tragic events
over the last several decades. I was there in Nepal in the far western part of the country
on April 25. And we felt just some slight shocks. In my work, we’re at a government-owned hospital
in which our organization independently manages that hospital on a public-private partnership.
And so I was surrounded by a number of our leadership team and our clinicians and nurses.
And in that immediate period, what was so challenging was the lack of information. The
earthquake happened right around noontime. And immediately some of our staff got text
messages from some of their relatives saying something– that this awful event had happened.
And then over the course of the day, we got our– each layers of our telecommunications
infrastructure, which is something in the far-west of Nepal we had invested in heavily–
they sort of went down. And so we were at a point throughout the course
of the first 24 hours where we didn’t know whether 1,000 people had died, whether 10,000
people had died, whether 100,000 people had died. And so there was just that sense of
confusion. Again, we weren’t in the epicenter– or we were over 300 kilometers away from the
epicenter. It takes 30 hours for us to get from where we are to Kathmandu. And yet that
experience of confusion and then also that immediate sort of sense of loss and experience
of loss. Fortunately, none of our staff members– we
have about 120 full-time employees all based in the far-west– and none of our staff had
lost any lives or lost any loved ones. And yet there was this sort of national sense
of mourning and loss immediately. And I recall one of our staff positions, a
young doctor who’d recently graduated from medical school two or three years before,
and he came to me in tears saying that Sundhara, this large, sort of iconic white tower, centuries
old, had fallen. And in that instant, over 200 people had lost their lives. And at the
same time, this and a large number of other very deeply important spiritual and cultural
structures had been destroyed. So you had this loss of both the past and the present
at the same moment. And that was incredibly difficult for our team and for so many of
my colleagues. I subsequently traveled from the far-west
back to Kathmandu. And it was an eerie experience because where we were, life was just going
on. But we knew where we were headed was going to be an area of great devastation. And that was certainly mentally– spiritually–
a very challenging experience for myself and the colleagues that were traveling with us.
We started entering into this sort of chaos of what had just transpired. And so I know that the discussion today is
about how a disaster might affect the mental health of children. And I’ll just say, it
was– again, for somebody who really didn’t feel the effects as dramatically or as tragically
as so many of the families, it’s very difficult to describe how awful a scenario has been
for many, many families, many children, many parents throughout the affected areas of the
country. So we know that when something like this happens,
there’s confusion, there’s displacement, living conditions that people end up in are just
terrible. Can you tell us just a little bit about the sort of magnitude of what happened
with the Nepal disaster, just as an example for what we see? So there were over 8,700 deaths that occurred
as a result of the earthquake. And as with many disasters that happen in settings of
poverty, we often don’t have very precise statistics. And it’s particularly troubling
to think that there are absolutely people who died for whom their lives are essentially
unaccounted for. And economically, the country has such a weakened
economy for a number of deep historical and political reasons. But it’s an economy of
$20 billion a year GDP. I mean, that’s far less than even the smallest state economy
in the United States, as an example, and for a country of 30 million people. And nearly
half of the entire economy is expected to have sustained losses. So somewhere around
the order of 9 billion dollars is– and it may even be, as far as the cost of this. So the cost of this, while actually relatively
small compared to the costs of, say, the Japanese tsunami of 2011, relative to the size of the
country, the size of the economy, it just– it’s incredible. Clearly massive. So let’s just turn now to
the audience to ask a question. And when you respond, could you please leave your city
and country. “Have you or any of your colleagues been in a disaster? What mental health challenges
do you or do they feel are most important to address after a disaster?” So let’s just step back for a second and ask
why it is that we’re focusing on this today. The reason is that we’re seeing these disasters–
we’re getting reports of these disasters– increasingly in this century. And the impact
of these disasters, as you can see in Nepal, is stunning. And the kinds of things that
we see, obviously, are death, injuries, loss of property. We see displacement and loss
of livelihood. And they hit the vulnerable populations more frequently and with greater
impact. Let’s just look at some information on that. The IRC has actually tracked, since around
the turn of the century, the impact of how many people are killed by disasters. And then
they’ve looked at that in terms of low human development versus high versus very high.
And the difference is six-fold in some of the years that we’ve seen so that it’s almost
a perfect storm when a disaster hits a vulnerable area. The preparedness, the response is just
very, very different in– if you would contrast, for instance, Haiti and Chile. Same kinds
of earthquakes– preparedness in one, no preparedness in the other. Much more poverty, et cetera.
In fact, in this particular slide, that green is by far got to be Haiti. And I would just add that I appreciate your
use of the term “disasters” as opposed to “natural disasters”– and I think your graphic
here really highlights this– that the large-scale disasters and loss of life are largely, ultimately,
the result of some form of lack of preparedness or some form of, ultimately, the fallibility
of humans in our societies. And I think that, again, the Nepal case is very telling of that,
where the deaths were– yes, the proximal cause was the earthquake, but the root causes
were poor governance around building codes and infrastructure and lack of livelihoods
and lack of financial means by which to build well and build safe homes and build safe institutions. And we can see here that this is just very,
very dramatic no matter what kind of disaster it is. So that the low development, the areas
of poverty, the areas of poor governance– as you indicate– really set populations up,
whether it’s volcanoes or windstorms or earthquakes or droughts or floods. And of course, within
those populations are vulnerable women and children. And this is the reason that we want to emphasize
a little bit what happens to our children, particularly, in these situations. And obviously,
in terms of physical effects, there’s death, there’s the loss of a parent, putting someone
in an orphan status. There are crush injuries. There’s all kinds of difficulties when there’s
lack of medical services. But we also have the mental health effects.
And just the impact of being through something like this, we all have a normal reaction.
And children are no different. So it’s a shocking event. There’s loss. There’s confusion. There’s
displacement. And then, as I think Myron will talk just a little bit about in a minute,
when we move people to facilities to take care of them, there’s overcrowding. There’s
all kinds of problems in the displacement. So we do know something about how these things
affect children. And we do know and have been learning, really looking at this pretty much
since the Turkey earthquake many years ago and UNICEF coming in, that children react
in very specific ways and that the timing of that you can almost predict. So within the first 72 hours, children are
surprised, they’re even numb, they’re very disoriented, they’re lost, they’re scared,
they don’t know where they are. And we often see sleep disturbances. And parents can be
very distressed that the child can’t sleep, they’re waking up, and they’re anxious. In the first month, they regress. If they’re
a four-year-old, they become a three-year-old. If they’re a three-year-old, they become a
two-year-old. So they’ll begin to do things like bed-wetting, baby talk, and thumb-sucking,
things of that sort. And they cannot bear to be alone. They’re scared. They have appetite
loss and sleep disorders. All of this is normal reaction and the kinds
of reactions that every child is going to have. Later on, if we follow the children
out, whatever kind of disaster it is, they’re going to be a little bit anxious about going
to school. They’re going to have headaches and body pains, food refusal, excessive eating,
and then repetitive play, sometimes playing out the traumatic event. But all of this is normal. It’s just normal
behavior, and over time, it will dissipate, particularly if the parents know this, which
is one of the things, as mental health and child health providers, we need to do anticipatory
guidance. This is going to happen. It’s not bad. It doesn’t mean your child is sick. On the other hand, there are some differences
between boys and girls. Boys are going to act out more. Girls are going to become a
little bit more withdrawn. And then finally– and this is in Myron’s
bailiwick, but I’ll just set you up a little bit– for children who do have– are more
vulnerable, they may have exaggerated and extended responses, including post-traumatic
stress. And that’s probably kids who have more severe exposure. They may have more of
an underlying mental health disorder to begin with. Or they don’t have adequate support
during the time of the problem. So we also know that children with developmental
disorders, abused children, children who have health conditions, and children who are the
temperamental extremes– the shy children and the very outgoing children– may be hurt
more at the time. So these are little tips that we’ve learned
over time, particularly through the American Academy of Pediatrics with the disaster courses
and so forth. And the reason I’m sharing this is at the time of the 2010 Haiti and Chile
events, I actually went to some of these places to share with parents these kinds of pieces
of information. And I understood back from the families and the teachers that this was
really helpful to be grounded in this– small thing to do but a kind of thing that we could
do. But what we’d love to do now is turn now to
the audience to ask a question. And when you respond, could you please leave your city
and country. “What practices do you have in place at your
hospital for evaluating and treating child mental health in a post-disaster period?” But what we’d love to do now is turn to you,
Myron, the real expert on this. You’ve had the opportunity to observe so many of these
terrible disasters. You’ve worked with the World Health Organization. You’ve thought
deeply about this. You’ve written about it. Can you share with us some of the best practices
that we’re now learning? I’m very pleased to do that, Judy. I think
it’s very important to understand that there are guidelines that exist now. The World Health
Organization, the United Nations, and some other groups have developed guidelines, such
as the Sphere guidelines, that are well-accepted internationally. There’s also been inter-agency
task force on guidelines for responding to disaster. These present information that has
been well-vetted, well-discussed by a variety of individuals. It’s important to understand that, but then
I think all these guidelines have to be adapted for the local environment. In other words,
each environment has its own unique issues. And it’s not appropriate to simply take one
guideline, develop for one setting, and assume that it’s perfectly appropriate in the other
setting. It’s very important to consider best practices
in general, but more important, I think in a way, is to not do harm. In other words,
a big worry in responding to disasters is to not do harm. And the reason I say that
is that responding to disasters is in a way analogous to an unregulated industry, OK?
There are many people who respond to disasters with a good deal of background, understanding
what’s an appropriate response. But there are non-governmental organizations and other
agents who respond without much understanding of child development, of abnormal development,
of normal development, and they do things that may inadvertently– I hope inadvertently–
do harm to children. They may expose them to stress. They may intervene
too aggressively, which in itself becomes a trauma for the children who’ve already been
traumatized. So there are many general considerations in this idea of doing no harm for children. When it comes to thinking about what is really
appropriate, we have to think about what is the developmental age of the child, in other
words, what’s really appropriate for the child, and be sensitive to what you suggested before–
is pre-existing conditions. Some children are clearly more vulnerable
than others. Children with pre-existing mental disorders are particularly vulnerable. And
for instance, in the barracks in Indonesia after the tsunami, we saw a young girl running
around, running around, and people said, oh, she’s hyperactive, or maybe she’s retarded.
But fortunately we were able to see her and do a diagnostic evaluation. And the reality
was that she was psychotic. And it had been perhaps present for a longer time, but in
any event, it was amenable to treatment. And once it was treated, it made a big difference.
To leave a child like that untreated can be very disturbing in the context of a barracks,
in a context of any sort of disaster where people are preoccupied with a lot of other
issues at that time. One of the things that I’m concerned about
in terms of responding, in terms of best practices, is understanding what the environment is for
the children. There’s a picture that I have of the barracks with children who look very
happy. You can see them there. But look at the environment that they’re living in at
that time, that sewage that’s running down in those side places. They have virtually
nothing to play with, and they have an absence of clothing, an absence of parenting, absence
of supervision, all things that are necessary for normal development under any circumstances.
But the problems are magnified in the confines of a barracks and in a post-disaster situation
where people have been displaced. And there’s a lot written about toxic environments. And
these barracks and other places where people are placed after disasters often become a
very toxic environment. So we don’t know what the trajectory of development
is for these children. The best thing we can do is, as a best practice, is provide stability
for them, provide security, provide education if they’re older, provide connection with
their family or with a school institution if that’s possible. Anything that normalizes
the environment for the child is something that is very, very important. So in addition, I think we have to also consider
the period after the acute emergency. What happens after that first month? Too often,
I’m afraid, when the television cameras go away, when the appeal for funds subsides,
there’s not the attention of what’s necessary to intervene, to support families at that
time. Because many of families are actually more vulnerable after this initial phase as
they come to the realization that they don’t have the economic means they had before. They’re
cut off from their institutions. The schools may not be in place. And therefore, all of
these institutions have to be rebuilt so that they can normalize their environments. The parents themselves are stressed. So when
we think about what to do for the mental health of children, we have to realize, as it is
under any circumstance, that if the parents are not feeling comfortable, they’re not feeling
hopeful for the future, it’s going to be difficult for the children to have that same feeling. There’s some also very specific kinds of problems
that come up in this period where we need to intervene as best practices. One of the
problems that comes up often when we see money coming into barracks following displacement,
following a natural disaster or any kind of disaster, is that the money is utilized in
perhaps the wrong way. In other words, that we see money siphoned into the purchase of
alcohol, drugs, motorcycles. And correspondingly, we see that the death
rate increases, or the rate of violence increases, which is counterproductive, certainly not
on the trajectory that you want to go, which is to heal people and to give them a sense
of normalcy. In this next slide, you can see what happens
when the response dwindles. These youngsters originally had people with them playing games.
But after the people left, the play area is no longer functional, and these kids are on
their own. Where should they be? They should be in school, but unfortunately, there isn’t
a good school near them. There isn’t any school near them because the barracks has been isolated
from the rest of the community. They’ve been displaced. We’ve found in Indonesia, as I think you know
very well, that displacement from your place where you used to live is one of the critical
factors in stressing individuals. So these kids have been displaced. They don’t have
the same function. In the next slide, you can see the environment.
This looked nicer initially, but like in many places, the barracks that were built were
built out of plywood. Plywood doesn’t survive very well in a tropical environment. So gradually,
there’s a degradation of the environment for the entire family. And with that comes a feeling
of hopelessness, depression, and the children gradually may withdraw. They may not feel
hopeful. Since the barracks themselves may be isolated, they don’t get to school. And
when they do get to school, often the education comes in a form that may not be culturally
appropriate. So the UN has a School-in-a-Box. I don’t know
if you’ve seen the School-in-a-Box, but it’s a big plastic cylinder that comes out. It’s
not often culturally appropriate. Or sometimes children go and the grade that they’re put
in is not appropriate for where they were before. So education no longer becomes a positive
experience for them at that particular time. So, many of these things come together. And
while we’re concerned about post-traumatic stress disorder at one end of the spectrum,
what we’re equally concerned about are garden variety mental problems. They’re really mental
health problems– anxiety, depression, kinds of problems that can be dealt with where you
can train people that you don’t have to be a psychiatrist to deal with helping people
to deal with their anxiety, with their depression, with other kinds of problems that they may
have. It really takes, though, a sensitivity and
a recognition that your children have these problems. And there are training programs
that can really help to increase the literacy about this type of problem. And the interventions,
then– the best practices– are to not be overly intrusive, to not go up to children
and say, oh, you must feel terrible. That was a terrible thing you experienced. How
was it to see somebody who was dead? That really doesn’t soothe and help the children
heal. It can be more traumatic for the children. Likewise, there are some interventions that
seemingly are innocuous, but they may be quite counterproductive. One NGO that I saw in a
disaster situation in Thailand, they were doing cranial massage. Now I’m sure that cranial
massage must feel quite good. On the other hand, is it really an intervention to deal
with any particular psychological problem? In Turkey, there was an intervention where
they put children in one of these bubbles where they bounce up and down. It’s often
used for parties. One hour in the bubble was supposed to cure you of your post-traumatic
stress disorder. I think there’s very little evidence for that. Yet, because it’s an unregulated
industry, we don’t have often the kind of vetting that’s necessary. And lastly, I think that we need to build
a legacy. When we have so many people coming in who have the resources and sometimes the
knowledge for programming, we need to leave something behind that’s positive, either through
training, through integrating schools with health facilities to try to build a capacity,
as Duncan was saying. One of the problems with disasters is it shows up the weaknesses
in the overall infrastructure that’s present. And often, there’s already been a pre-existing
weakness in the mental health infrastructure in just so many of these areas. So there’s
both an opportunity as well as the downside of what’s occurred. And lastly, I think a really important mental
health point– and Duncan alluded to it but didn’t say it specifically about himself–
was that your personal experience is in itself a mental health issue– how to not burn out,
how to not be so adversely affected. It’s very interesting that the half-life of people
working in disasters is relatively short because of the difficulty that they have in terms
of coping with the kind of stresses that they face. And I think a story that was most important
for me to understand was in China. Well, when there was a Sichuan earthquake, we did an
assessment, and we spoke to the teachers there. And the teachers said, well, you know, we’re
expected to do this for the children and this for the parents and this for the school. But
nobody’s asked us what we need. We’ve also suffered loss. We also have certain needs.
And I think you find that in many of these disaster areas that the people who are being
asked to provide care– if they’re not from the outside– have also suffered a lot of
the same stresses that the people who were intended have. In closing, one of the consequences of what
I mentioned in terms of the expenditure of money is that this is the barracks one year
later, OK? And what it speaks to, unfortunately, is the lack of involvement in men in more
productive enterprises. There was no work for them. There was a great deal of alcohol
abuse and a good deal of violence, violence towards women. It’s not shown in this particular
picture, but we saw women who had suffered a good deal of physical abuse. And you see,
also, a great deal of pregnancy, some wanted, some maybe not wanted. I’d like to turn now to the audience to ask
our colleagues around the world a question. When you reply, could you please state your
city and country location. The question is this– how much of a challenge is it for you,
in your setting, to get across the idea that children have a mental life? Myron, you’ve talked about reestablishing
routines for children. And I know that one of the experiences we had in Chile was that,
based on all the information up until that point and particularly the information from
UNICEF and so forth, the Chilean government set up a big telethon to open schools. And
they were able to fund a school for every single area that had been devastated, and
the country just poured money out to do this. And actually, the interesting thing was they
used containers. They used ship containers. And you can make a school out of four ship
containers or six ship containers. And that certainly seemed to be a way to reestablish
some normalcy even for the children who were in camps. But talk just a little bit more– both of
you– in terms of returning to normalcy for children and how important that is. I think school is the environment that children
are used to, that’s supportive for them. It’s also the environment where they socialize.
It’s the environment that bridges a lot of issues for children. Even when the home is
a difficult place, the school can be a very supportive environment for a child. Unfortunately, in a disaster situation, schools
may be destroyed. And there’s really the need to reconstitute those schools. It’s helpful
if the school could be reconstituted as close to the children as possible so that it doesn’t
become another trauma to try to get to the school. In other words, are the children being
put at risk in the school? I think also, as I may have mentioned before
when talking about best practices, the school, when it’s established, should be as close
to the school that the children are used to and that the curriculum that they have be
as appropriate, age-appropriate, as possible. And the teachers who are teaching in the school
should be supported as well. I don’t think you can ask a teacher to go back into the
school in a disaster situation and teach as if nothing had happened, OK? I think they
have to be sensitive that some children are going to have the kind of psychological responses
that we talked about before. And they have to be prepared to respond to that. One thing they have to also be very careful
about is not extruding children because of some of these behaviors but rather trying
to embrace the children and to provide that level of support for them. But schools are
a very, very important structure in the community. In Indonesia, schools are not only important
in terms of their educational importance for the children but as you know, that they’re
also the housing of the pramuka in Indonesia and similar kinds of entities and other societies
where children are involved in activities that reach out into the community, or they
involve religious activities. So the school is a central component of normalizing the
life of a child. We’re going to show you the thoughts of Doug
Ahlers who’s pulled together community engagement efforts all around the globe. Doug Ahlers
is a senior fellow at the Program on Crisis Leadership and a former lecturer in public
policy at the Harvard Kennedy School. He’s also the founder of the Broadmoor Project
and the Recupera Chile Project. These are collaborative redevelopment efforts devoted
to rebuilding the disaster devastated communities of New Orleans and Bio Bio, Chile. Generally we break disaster response and recovery
into four phases after a disaster. The first phase is the emergency phase or response phase,
which is immediately after the disaster. Then comes the restoration phase where you have
the bringing back of basic services, lifelines, utilities, city services, and things like
temporary schools, temporary shelter, temporary housing. And then there is the recovery phase
where you’re doing the rebuilding of the permanent infrastructure, rebuilding of permanent homes,
permanent public buildings, repairing roads and highways, bridges, et cetera. Then you
have the betterment phase, which is the fourth and final phase, which is really where you
make improvements after a disaster. Now, the betterment phase does not always
happen after a disaster, but in general, people really want to see improvements to either
safety or quality of life after a disaster. And disaster, while very tragic, does tend
to have some opportunities that present themselves to build back better than before, and that
happens in the betterment phase. A lot of the research on this comes from Eugene
Haas and Bob Kates. So what they identified through the research was, of these overlapping
phases, they each roughly have an order of magnitude between them. So for example, the
restoration phase is about 10 times the length of the emergency phase. And the recovery phase
is about 10 times the length of the restoration phase. The betterment phase doesn’t quite fit into
this because it has such a long time frame. It can be 10, 15, 20 years to do betterment
projects. For example, in San Francisco, just last year they finally reopened the Bay Bridge
as a seismically safe structure. And that was 20 years after the Loma Prieta earthquake
of 1989. Roughly speaking, the way we look at these
phases is, for example, if the emergency phase takes four weeks, then the restoration phase
will take 40 weeks. And then the recovery phase will take 400 weeks. So if we think about these curves, they’re
each overlapping, and they each have slightly different shapes to them. So the emergency
phase is a very steep curve. It has a very steep left tail, peaks very quickly, and then
falls off fairly quickly as the emergency response phase wraps up. Whereas the restoration
phase is a slightly longer curve, still fairly steep, has a fairly steep left tail, but it,
too, peaks fairly quickly and then tails off on the right tail fairly quickly. The recovery curve is a much wider curve.
It’s a little slower to ramp up on the left tail, has a very broad hump in the middle,
in terms of it takes a fairly long time as a lot of the work takes place for permanent
reconstruction. And then it actually has a fairly long right tail as things wrap up.
Construction projects can take years to complete. And then the betterment phase is both the
longest to ramp up, with the longest left tail, the longest hump in the middle, and
then the longest right tail as it winds down, even potentially decades later. Our goal in recovery management is to accelerate
these curves, to make them ramp up on the left tail as quickly as possible and to make
the total size of the curve as short as possible when measured in a period of time. So that
our goal is to begin recovery really day one after a disaster, try and get that left tail
started immediately after the disaster, and then accelerate that curve so that we eliminate
suffering, we eliminate loss, and we get people back into their homes, children back into
schools. We get infrastructure back running, the economy back running, businesses back
in process, people back to their place of employment and return to it a sense of normalcy
or a sense of rebuilding of the social networks and the things that are very important to
reestablish after a disaster. When we look at recovery and the field of
disaster recovery, it’s actually still a very nascent field. Recovery was long ignored as
a field. There were not many– not a lot of attention paid to it and very few professionals
working in the field up until Hurricane Katrina. Prior to that, most of the emphasis went into
the emergency or response phase or the restoration phase, which were really about life saving,
as opposed to the rebuilding and thinking about how to rebuild better after a disaster. But all of that changed with Katrina when
the United States was faced with one of the largest recovery initiatives. Recovery cost
about $150 billion. So it really focused a lot of attention on both the need for long
term recovery as part of the planning in advance of a disaster of how you think about and plan
for a disaster, as well as it required an understanding of how to do it better. And so a whole field of disaster recovery
research has emerged, looking for the best practices of how to rebuild efficiently and
effectively after a disaster and most importantly, how we can accelerate each of those recovery
curves and the phases of the recovery. And so a whole field of disaster recovery
management has now emerged, and a body of knowledge and expertise is being developed
from that. One of the key learnings that has come out
of that in terms of the lessons learned has been the importance of mental health, especially
for the vulnerable populations of children in each of the phases– the emergency, the
response and the recovery phases, and the betterment phases. So the best practice from
disaster recovery management, we’ve come to understand that we have to think about child
mental health and family mental health throughout the entire recovery process. For it’s really
years and decades that we have to think about the impacts of a disaster and its recovery
on the health and mental health of the community. So working with Doug in the post-disaster
recovery of Chile, we’ve learned a great deal about community resilience and the key role
that a few dedicated community advocates can have. In Dichato, Chile, much of the community
recovery has centered around the local school. And that’s in part because the director of
that school has had a vision that a strong reconstructed, recovered community– that
we’ve been working together with him on project Recupera Chile– that we could have a “school
in reality,” escuela de realidad, and that we would put a premium on health and mental
health, on language and literature, and on love of the sea. And that’s the very sea that
has raised up and has created many, many problems. But we’ve learned in Indonesia, when you put
those fishermen in the farms and away from the sea, all they wanted to do was go back
to what was their home, what was their livelihood. So what we’ve been doing for mental health
in the area of Chile is really to think about how to pull together mind and body, how to
teach relaxation techniques, how to plant a school garden, how to carefully identify
family, social, and mental health needs with the use of a caseworker. And the work of improving
this in the school has taken well over five years. We’re just beginning to see some improvements
and to see the community coming together. But I think I would add one last thing to
your list, Myron, and that’s persistence. Because these are not small problems. They’re
pre-existing problems then with the disaster on top. And so in order to be helpful for
the mental health of children, I think any of us who are in child health or in child
mental health, it’s a long haul that we need to be involved with. So really want to thank
you all for– Thank you. Thank you. –sharing with us such important contributions.
Thank you. Thank you very much.

Articles Tags:

Leave a Reply

Your email address will not be published. Required fields are marked *