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Zimbabwe: Treating psychological trauma after cyclone Idai
In the initial phase of the response to Cyclone Idai, the focus was on emergency care for acute medical conditions. This meant conditions such as trauma, fractures, dislocations, lacerations, head and spinal injuries.
It also included all sorts of other conditions and potential emergencies: burns that had become septic due to patients not being able to access to health facilities, patients with epilepsy or asthma who didn’t have access to medication, pregnant women in labour, eclampsia (a dangerous pregnancy complication), hypertensive urgencies etc.
A new phase
As we transitioned into phase two of the post-cyclone intervention, other medical concerns came into focus. These included non-communicable disease (NCD) care, medication supply, mental health issues and vaccination for preventable diseases.
The torrential rains and winds of Cyclone Idai meant medical records washed away, roads were damaged making access to care a challenge while medication stocks were inadequate.
All this has hampered comprehensive care for non-communicable diseases, a category which includes diseases such as diabetes and heart disease. MSF is providing “gap fill” medications until normal supplies can be resumed.
The psychological trauma has been deeply embedded in the minds of affected survivors.
The generic response in African culture to the question “How are you” is “I am fine”, usually accompanied with a routine smile. Whether the individual is genuinely fine or perhaps deeply tormented by recent or past occurrences is a discussion for another day.
This culture of always being “fine” has been deeply entrenched in us and is difficult to change. Nevertheless, I will try and be a bit brave and discuss this issue without fear and with as much objectivity as is feasible.
Thinking about mental health in the aftermath of the cyclone reminds me of a slogan for HIV in the early 2000s. We used to say that with regards to HIV not everyone is infected but all are affected.
For Cyclone Idai all are affected, in Zimbabwe, regionally in Southern Africa and globally as well. The only difference is the degree of psychological trauma inflicted.
People have shared many horror stories with our teams during the post-cyclone period.
There are entire families that perished as houses collapsed and others were washed away – especially in Copper, Ngorima where there were rows of buildings along the river banks that were destroyed when the River Nyahode burst its banks.
Many families saw money or valuables washed away, along with other important documents and medical records, leaving them without a livelihood. In MSF’s stabilization center in Chimanimani, one elderly hypertensive patient reported that she had lost all her medical records and that her grandchildren had passed on as well.
A bleak future for child-headed families
Another heart-wrenching story I heard was of a fifteen-year-old boy who was the sole survivor of a family of five from Rusitu.
He was admitted to Chipinge District Hospital after the cyclone so he could be treated for multiple soft tissue injuries, but the deep psychological anguish he was in was evident. He was mute, avoiding eye-contact. Tears kept flowing down his cheeks as he sat on the hospital bed.
The only time he spoke was to say he wanted his mother. The villagers who rescued him found him alone and it is highly probable that the rest of his family had perished.
As we talk to survivors, our teams have heard about families, whose sole bread-winners perished in the cyclone or its aftermath, leading to newly single-parent families, or even child-led families.
Many surviving family members are currently devastated and feeling hopeless.
Some survivors have told our teams that they remain haunted by the sights and screams of people they were unable to save from the floods.
Other survivors are suffering from night terrors and insomnia. The events of the cyclone and its aftermath flash back through their minds at night, and as a result they cannot sleep.
Farm workers reported spending their nights wide awake, standing and wrapped up in blankets. They also report poor eating habits, feelings of apprehension and worthlessness.
Some people we’ve spoken to suffer from “survivor guilt”, where they feel they did not deserve to live and for their loved ones to perish. They report feelings of self-defeat and self-loathing. This is a manifestation of post-traumatic stress disorder (PTSD).
Another family our teams have spoken to had completed their permanent house and were to move in just before the cyclone happened.
There was no infrastructural damage to their new home, but the family has been unable to move into their new home due to phobia – an overwhelming fear resulting from hearing the ordeals narrated by other survivors.
There are some other families whose houses were not completely destroyed but now suffer from phobia and are currently camping at the Methodist church. They shared their traumatic experience with our MSF nurse, Walter Mugoni, who was part of MSF’s outreach team.
The impact of alcohol
My colleague Norman Magaya, an MSF mental health nurse, tells me that his team who are providing counselling and psychosocial support have seen people who have resorted to the bottle or other addictive substances to numb themselves to the feelings of despair, grief and horrific memories.
Norman explained that for those worst affected by alcohol, the overwhelming sense of loss, helplessness and hopelessness has led to some becoming victims of substance-induced psychosis, drug and alcohol abuse, and alcoholic hallucinations and depression. This is in addition to the already existing loss and grief that most individuals and families are undergoing.
Patients who were previously diagnosed as having psychiatric conditions such as schizophrenia often deteriorate when exposed to an intense emotional event such as the floods and resultant destruction that Cyclone Idai brought with her.
I wonder how the survivors will resume their usual lives with any semblance of normalcy.
Health care workers
During our explorations and assessments of the medical needs in different areas, we noticed that some of the health care workers we spoke to had what appeared to be psychosomatic disorders. This is a condition whereby people often describe different complaints – commonly muscular skeletal pains – yet there is no clear pathological etiology (that’s to say, no clear physical cause for the pain).
These kinds of pains are often a response to a deeply traumatic event. On taking further history from the individual it becomes evident that the underlying issue is the patient’s recent traumatic experiences.
Other healthcare workers in the area have developed anxiety disorders and post-traumatic stress disorder. This is not just after the horrific events of the cyclone, but also from hearing the stories told by patients consulted at the clinics and hospitals.
To top this up, the work schedules for health care workers have been intense since the cyclone and some have not managed to go on leave yet.
It’s not just health care workers. Other paramedical staff are also affected. For example, when the morgue attendants were overwhelmed, others such as drivers were tasked with assisting in their challenging duties, with some reporting symptoms such as initial flashbacks and loss of appetite.
Counselling has been offered by the MSF team.
MSF teams have been working to help survivors struggling with their mental health by offering direct support to people affected through both group and individual counselling sessions, as well as by training health care workers on providing psychological first aid support and coping strategies.
The most common mental health conditions identified have been post-traumatic stress disorder (PTSD), anxiety and psychosomatic disorder.
So far, 862 people have been part of our group therapy sessions. We’ve been holding the sessions at all the clinics supported by MSF, as well as at the camps that have been set up to house the people who have lost their homes in the cyclone, and also at a large local estate/farm.
Of the people who have come to the group sessions, it’s interesting to see that teams have seen nearly twice as many women as men (289 males and 573 females). This reflects what we know about health-seeking behavior patterns here more generally.
Group therapy isn’t right for everyone, so our teams are also doing individual counselling sessions of which they’ve done 32 so far. The majority have been at clinics (27 sessions at the clinic in hard-hit Chimanimani for example), but we’ve also done individual counselling sessions at a camp for displaced people, and a hotel.
And we are not only working with adults! The MSF team here has been running play therapy sessions for children, who have lived through the cyclone too, and also need support.
This natural catastrophe in Zimbabwe has reminded me of my own country, Kenya, and all the manmade and natural catastrophes that, over the years, have shaken us to our core.
Borrowing from lessons learnt in Kenya, after the terrorist bombings the country has been through since 1998, professional counselors were mobilised from both government and private institutions and were dispatched to offer psychological support to all affected citizens here in Zimbabwe.
This is alongside the psychological support given to survivors of Cyclone Idai by MSF mental health nurses and counselors in Chimanimani.
My heart bleeds for this nation as it’s the first incident of such a huge magnitude. The mental trauma will take a long time for all affected to recover.
However, with adequate support from the ministry of health, civil society, religious groups and NGOs, I believe it is feasible to reach out to all affected by Cyclone Idai.