Part II of II: Before Rebuilding Can Begin, Disaster Survivors Must Sift Through Emotional Aftermath

Cynthia Long, Managing Editor, DisasterRelief.org
Every day, Bahar Gaylayan, a young psychologist in a Turkish state hospital, listens to shocking stories from earthquake survivors still trying to cope with the trauma of the event. It's been more than two months since the second of two deadly quakes rocked northwestern Turkey, but aftershocks continue to rumble through the region and tension is high.

Thousands lost their homes and are living in crowded tent cities, but even those with intact homes have had their lives disrupted. Afraid strong aftershocks will crumble flimsy buildings, many people are still sleeping in tents set up outside of their houses and apartment buildings. Even in Istanbul, more than 60 miles from the disaster zone, residents report sleeping under sturdy steel canopies, some wearing helmets.

Most people living in or near the disaster zone are experiencing post-traumatic stress, the long term effects of which can be psychologically debilitating, according to mental health professionals.

Telling the Earthquake "Story" Hastens Recovery

To help people cope with their anxiety, the government, relief organizations, and hospital psychiatry departments, like the one where Gaylayan works, have established counseling programs that allow people to tell their frightening earthquake stories as a means of discharging their fear. The need is so widespread that the Bakirkoy State Hospital in Izmit has established a special unit for earthquake survivors.

"The most important thing is for people to tell their story," said Jill Hoffman, an American Red Cross mental health counselor. "Each time they tell their story it's less charged."

Talking about the symptoms of their fears also helps release the strain and people tell Gaylayan about their nightmares, short tempers, and unshakable anxiety. The men seem to display more severe symptoms, according to Gaylayan, and she listens to their accounts of unpredictable panic attacks, feelings of hopelessness, and depression.

"Males cannot express themselves as easily as women, they're supposed to be strong and unafraid," Gaylayan said. "If the man is perceived as being unafraid, his wife and children will be less frightened. Plus, men think of themselves as the providers for the family and feel frustrated by relying on aid from outsiders after losing their homes and possessions to the earthquake. The stress is tremendous."

But counselors like Gaylayan try to assure survivors that it's normal to be afraid after a terrifying earthquake, that fear and anxiety are "normal reactions to an abnormal event." After talking about the effects of their fears, counselors urge people to remember the abnormal event and recount what happened when the earthquake struck. For some, especially those who watched loved ones die, the memory is acutely painful and prolonged counseling is necessary. For others, the memory is terrifying but becomes manageable when confronted.

For everybody, recalling the horrifying moments when the earth shook is a harrowing experience--even for trained psychologists. Although Gaylayan listens to earthquake stories every day, upon recalling her own experience when she was trapped for hours with her husband and child under mountains of shifting rubble, tears rolled down her face.

Support Groups Allow Survivors to Talk About Experiences

Understanding the need to tell their own earthquake stories, survivors living in tent cities--often with the help of organizations like the Turkish Psychological Association--have established different support groups. The "Women's Association," for example, has its own tent in a Turkish Red Crescent camp in Adapazari. It's a spacious tent, and sewing machines are scattered about. The floor is covered with colorful Turkish rugs and gas lanterns cast a warm glow in which the women gather to sew, drink tea, and chat. While discussions aren't limited to the disaster, conversations often lead to the earthquake and the daily struggles of living in a tent city.

Not only are the women able to relieve stress by expressing their fears and concerns, they are also actively participating in the recovery of their community. While chatting and sipping tea, the women sew quilts, embroider pillow and cushion covers, and create finger puppets, scarves, and hats.

After they have a vast assortment, they sell their hand-sewn creations at a Women's Association Bazaar, the proceeds of which go directly to earthquake reconstruction programs.

"They are actively improving their own circumstances and contributing to the improvement of the community, which empowers them," said Jill Hoffman, American Red Cross mental health counselor. "The more people get involved with their own recovery and the more active they are, the less apt they are to get depressed and feel hopeless."

The Turkish Psychological Association has established a similar program for children in the Adapazari tent city. In the children's tent, volunteer psychologists encourage the young people to express themselves through art. Most of them long to return to a normal home life, and their pictures and Play-Doh and Leggo sculptures are often of big, beautiful houses the children would like to someday live in, according to volunteers.

Programs Focus on Children

Many psychological organizations specifically target children in their programs. The Duzce Education Group, for example, provides education and game facilities for children living in tent cities. Initiated by students of Istanbul's Bosphorus University, the organization's mission is to provide a "nurturing place where children can play and learn."

"After the November 12 earthquake that was centered in the city of Duzce, several students from our university worked as translators at hospitals set up by the Egyptian and Israeli governments," said Kirsten Sadler, a professor of molecular biology and genetics at Bosphorus University. "They were particularly struck by the terrible conditions of the children there--many of them had lost friends, family, or even parents. Even though the life toll from this earthquake was not even close to the big one last summer, the psychological damage is enormous. The psychology of the whole country was severely damaged after last summer, many people still live in fear that everything they have could be wiped out in a matter of seconds. The entire city of Duzce moved literally into the streets. Thousands of them are still living there, and it is very hard on the children. Our students wanted to create a safe and educational place for the kids to come."

Child earthquake survivors are at a particular psychological risk because of their difficulty in understanding what happened, according to Sadler. Added to that are the stresses of being part of a displaced population. "The caretakers themselves have suffered incredible losses, and the entire population is living in tents. Therefore it is virtually impossible to create an environment for the children which allows them to feel safe," Sadler said. "In addition, the hardships of the life there--outdoor toilets, public baths, no cooking facilities, and crowded tents sometimes occupied by more than one family--make it nearly impossible for the children to play or to gain some sense of normalcy in their lives.

"Formal counseling services for the children in this setting is not a realistic option, since the government simply does not have the trained staff or resources to organize such an effort. Therefore, we are trying to provide a place where the children can be children--playing and learning--and where they can have an opportunity to work out some of their issues through play, physical activity, and creative expression."

Earthquake Preparedness Education Eases Anxiety

Just like adult earthquake survivors, children experience a loss of control and a sense of vulnerability after the disaster. Mental health professionals tackle these problems through education and raising awareness about earthquakes.

"You can't control earthquakes, you can't control the shaking, but you can be prepared for the next disaster," said Jill Hoffman of the American Red Cross.

School programs teach children to duck under desks if sirens blare during the day, or to curl up in the fetal position with a pillow over their heads if a quake strikes while they are at home.

Teachers urge their students' parents to move heavy furniture away from doorways and beds and to develop a safety and evacuation plan. Parents and kids are also encouraged to pack an emergency bag filled with water, a change of clothes, flashlights, and items that make them feel safe, such as a favorite teddy bear. The bags, they are told, should be kept by the door so they can be easily grabbed if the family needs to evacuate.

"Families need to develop an internal frame from which they feel safe," Hoffman said. "No one is ever prepared, physically or emotionally, for everything falling down around you, but you can minimize the risk and, therefore, minimize the anxiety."

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