Psychiatrists at Home, Abroad Respond to Needs of Nepalis
Abstract
Even as the massive tragedy of Nepal’s April earthquake became more and more clear by the day, the mental health response on the ground also grew.
The earthquake that devastated Nepal killed at least 8,000 people and injured 18,000. Over 350,000 homes were damaged or destroyed, and some eight million people have been affected by the disaster.
A Nepalese woman stands with her child outside her house that was damaged by the April earthquake. The earthquake killed more than 8,000 people and left thousands more homeless, as it flattened mountain villages and destroyed buildings and archaeological sites in the Himalayan region.
The immediate aftermath of the quake demanded rescue of those trapped in the rubble, medical care for the many injured, as well as food, clothing, and shelter for survivors. However, the mental health and psychosocial support (MHPSS) response was not far behind.
Much of that effort was coordinated by the Inter-Agency Standing Committee (IASC) MHPSS Reference Group, a U.N.-affiliated body that encompasses more than 30 organizations, including U.N. and international agencies, non-governmental organizations, and academics working on MHPSS in crisis settings.
“Whenever there is a large emergency, we organize a conference call with members that are involved in, or are planning to be involved in, the response,” Margriet Blaauw, co-chair of the IASC Reference Group for MHPSS, told Psychiatric News. “We try to get as many local agencies as possible involved in this call.”
Nepal Police and young volunteers help clear rubble from a destroyed building. The rubble was passed from person to person because of a lack of equipment.
“We are currently providing medical and other life-saving support and conducting a rapid mental health and psychosocial support assessment,” said Inka Weissbecker, Ph.D., M.P.H., a global mental health and psychosocial advisor for International Medical Corps. “We are also in touch with other mental health actors and plan to provide training in psychological first aid for various staff responding to the earthquake.”
Coordination is essential to support the 70 to 80 Nepali psychiatrists in the country, said Mona Thapa, M.D., who is from Nepal and is currently working on an addiction fellowship at Yale (Psychiatric News, September 15, 2014).
According to Thapa, Nepal was in the process of slowly switching from a hospital-centered mental health system to one based in communities before the quake hit. “After the quake, the psychiatrists began working as general doctors, doing triage, and helping out with basic needs,” Thapa said.
“The people living there are the real heroes,” said Bibhav Acharya, M.D., another Nepali who is a PGY-4 in psychiatry at the University of California, San Francisco. “They were there within seconds after the earthquake, helping each other, pulling people out of the rubble,” said Acharya.
People gathered in one of the rare open spaces in Kathmandu, the capital of Nepal, after losing their houses. Some tents were allocated to children, ensuring that they had a place to play and learn.
In some ways, prior adversity prepared Nepal for the earthquake, said Brandon Kohrt, M.D., Ph.D., an assistant professor of psychiatry, global health, and cultural anthropology at Duke University’s School of Medicine, who has worked for many years in Nepal.
A civil war from 1996 to 2006 and more recent fires and floods tested the nation’s emergency response abilities. As a result, 300 community health workers received psychological first aid training—a form of “humane, supportive, and practical help” designed to help others facing serious crises.
While the health care infrastructure in Nepal’s capital city Kathmandu was still functioning after the quake, there was an immediate shortage of medical supplies, said Acharya.
He thought about returning home but instead of getting on an airplane, he got on the phone. People in Nepal said the first thing they needed was cash to buy medical supplies.
“Being in the U.S. actually helped because we had access to electricity and stable Internet connections,” said Acharya, a board member of the American Nepal Medical Foundation, which raised more than $500,000 in small donations within a week of the quake. He then began calling wholesalers in neighboring India to coordinate shipments of medical supplies into Nepal.
Before the quake, one of Acharya’s ongoing tasks was translating the World Health Organization’s (WHO) mental health guidelines into Nepali and converting their contents into training modules for primary care physicians, most of whom had only minimal training in psychiatry.
The earthquake affected animals as well as humans. Cattle separated from their owners wandered the streets of Kathmandu. One Nepali in the capital paused to feed some of the hungry cattle.
“They see patients who obviously have mental illness but they’re not equipped to screen, diagnose, or treat them,” he said. He had created two training modules, but a week after the quake, he decided to focus on this task, which he felt would be the most immediately helpful to health workers on the ground.
Although most outside attention has focused on people newly traumatized by the quake, Acharya has heard that many people living with mental illness have been at least temporarily lost to follow-up, with no access to psychotropic medications or regular care.
To offer additional psychiatric support to the people of Nepal, language and cultural barriers must be overcome, explained Kohrt, whose Ph.D. is in anthropology.
“Foreigners could hurt rather than help because conventional psychiatric language can be taken as stigmatizing,” he said. For example, trauma and PTSD are interpreted quite differently in Nepal compared with Western societies.
“We think depression and schizophrenia are the most stigmatizing conditions, but in Nepal PTSD is even more stigmatizing,” he said. “It’s seen as your fault and talking about it can marginalize a person. Unfortunately, PTSD has been translated as ‘brain shock’ and implies something permanent and unchanging. So it is better to use ‘heart-mind difficulties’ to describe the emotions and flashbacks experienced.”
Acharya is hopeful that as Nepal rebuilds after the earthquake, it will lead to a better mental health system with more community-based care.
“Nepal has a rich history as a strong community with a strong culture that—hopefully—is going to be strengthened,” Acharya added. ■
More information on the Nepal earthquake response can be accessed here.
