In quake-hit Nepal, victims need help to heal emotional scars

  • Sanchita Sharma, Hindustan Times, New Delhi
  • Updated: May 01, 2015 11:48 IST

Priyanka Uniyal was 6 years old when her home in Uttarkashi district collapsed and crushed her family of 7 in the 6.8 magnitude earthquake that hit Uttarakhand in 1991.

"I was asleep with my sister and woke up to my mother screaming and the earth shaking. The house was falling down around us, we ran, but everyone died," recalls Uniyal.

Uniyal was found buried under rubble 14 hours later, clinging to her lifeless sister.

"Priya did not speak for weeks after being rescued. A neighbour took her in and she took to following her new 'mum' around the camp, crying hysterically if she lost sight of her," says Hemlata Rawat, 44, a schoolteacher from Dehradun who worked as a volunteer at two camps in Uttarkashi.

A month later, Uniyal moved in with her aunt in Meerut, where she now lives and works a nurse.

"That night is etched in my memory, but I do not recall the rescue or much of what happened immediately afterward. But whenever the earth shakes or there is thunder or sudden loud sound, I feel I cannot breathe. I feel buried alive," says Uniyal.

She has never visited the mountains or her village since the tragedy.

In Nepal where the 7.9 magnitude earthquake killed more than 6,000 and affected 8 million people, victims just like Uniyal will need help not only to rebuild their lives but assistance to heal emotional scars too.

"It is natural to be shaken after a dangerous event and most people develop acute stress disorder (ASD) with symptoms of shock, but even the very serious signs – nightmares, insomnia, anxiety, palpitation, getting up in cold sweat – do not last for more than a few weeks. It becomes post-traumatic stress disorder (PTSD) when the symptoms become chronic," says Dr Samir Parikh, head, mental health and behavioral sciences, Fortis Hospitals.

Psychological aftershocks

PTSD is characterised by flashbacks, nightmares, sleeplessness, difficulty concentrating and irritability following severe shock and mental stress.

Uniyal, he says, has the classic signs of PTSD.

"She is displaying 'avoidance', where the person stays away from reminders of the experience, and 're-experiencing', where reminders make the person relive the trauma, including the physical symptoms and feelings they experienced when it was occurring," says Dr Parikh.

The United Nations' children's agency has said almost 1 million children urgently need help after the deadly earthquake in Nepal.

With thousands of children camping out in the open in the capital Kathmandu after their homes were destroyed in last Saturday's quake, Unicef warned of the risk of disease.

"At least 940,000 children living in areas severely affected by (the) earthquake in Nepal are in urgent need of humanitarian assistance," it said in a statement.

A study of 268 disaster-affected children aged 14-16 years in a high school in Uttarkashi district found that roughly one in three (32.8%) continued to suffer from trauma-related stress disorder after three months of the disaster, reported researchers from St John's Medical College in The International Journal of Health System and Disaster Management in November 2014 .

The findings highlight the need for providing interventions for PTSD, which continues to be ignored in resource-strapped developing countries.

Low-cost interventions work and the Tamil Nadu government proved this when they helped thousands of child survivors face their nightmares and demons after the tsunami in 2004.

In partnership with Unicef and Nehru Yuva Kendra Sangathan, the government used crayons, puppets, dance, song and yoga to help children overcome the terror of the killer wave that wiped their families and home.

All images children drew initially were dark and gloomy – overcast skies, flooded villages, dead animals and uprooted trees – but by the end of 12 weeks, the sun started shining and the children were back playing cricket on the beach.

Prescription cure

At times, psychological support is not enough and sedatives are prescribed. Sedatives work by lowering levels of the human stress hormone called cortisol, which is released by the body in response to mental and physical stress.

New research, however, shows it is better to allow the body's natural mechanism to slowly heal because sedatives interfere with the mind's ability to consolidate memories and recover from flashbacks.

A study from the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, in the European Journal of Neuropsychopharmacology last year found that benzodiazepines, the most popular class of sedative that includes diazepam, interfere with the body's natural coping mechanisms and hamper recovery.

Some popular brandnames for benzodiazepines in India are Alprax, Alprocontin, Anzilum; Pacyl, Restyl, Tranax, Xycalm and Zolam.

"Popping sedatives and sleeping pills to reduce anxiety after a traumatic experience may offer temporary relief, but it does not help you cope with trauma in the long run," says Dr Parikh.

"To feel safe, you need psychosocial support from your family, friends and community."

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