One year after the earthquake: Médecins Sans Frontières continuously offers psychological care in Sichuan

On the 12 May 2008, a devastating earthquake hit Sichuan province, leaving more than 80,000 dead and 10 million homeless. Even after one year, the displaced people who lost their families, homes, and jobs by the quake are still suffering from psychological disorders and in need of psychological support to rebuild their lives. Médecins Sans Frontières has been continuously working in Sichuan to provide psychological care to the victims of the earthquake.

Since December 2008, a process of rebuilding the collapsed houses has been underway, but even after one year passed, a majority of people will not see big changes on their lives. “Schools and hospitals are the first priority, which will be completed in one or two years,” said Tamara Pierson, Médecins Sans Frontières' field coordinator in Sichuan. “A large number of people are still living in a temporary housing and unsure of when they can rebuild their houses. While this can be seen as a chronic situation, the overall level of the living conditions is quite stable in terms of basic; water and sanitation, security, good electrical facilities and civil structures.”
    
With one year anniversary of the quake approaching, people become sensitive and are afraid of another natural disaster. In September 2008, a heavy rain caused floods in Beichuan County, and the landslides swept away the temporary housing in Leigu. As the rainy season has begun this year, people have a heightened anxiety that raining will cause another flood and they will return to the same situation again.

Erica Pellizzari, Médecins Sans Frontières' psychological manager in Sichuan, said people are suffering mental disorders not only from the trauma caused by the quake but also by the constant anxiety for the future. “People are having a difficulty to adopt and accept the reality. It’s not only that the past experience came out as a nightmare or flashback, but people are having insomnia, lots of headache and so much complains because also of the stress, constant anxiety, and feeling hopeless for the future,” said Erica Pellizzari. “Some people are questioning about their future, since they’ve lost all they have; ‘What should I do? What will happen? Will I be able to reconstruct my house?’ We are also here to help this kind of person because it’s all linked one problem. I think the both the hard earthquake experienced and their actual condition can be understood in some cases as causing the psychological suffering.”

To address the ongoing needs of psychological support among the victims of the earthquake, Médecins Sans Frontières has been providing psychological care in Beichuan County and Mianzhu city, in collaboration with Chinese Academy of Science and Crisis Intervention Center since November 2008. Under the supervision of Médecins Sans Frontières psychologists, ten Chinese counselors provide psychological counseling at the consultation rooms set up in five temporary housing sites in Bayi School, YonXhin, Wudu, ZhuLin, and Leigu, located in the area of Mianzhu and Beichuan. The counselors conduct home visits or receive the person in the consultation room to assess possible patients and screen if the person is in need of psychological care.

“I think lots of people still need psychological support. When our counselors assess people, more or less, 50 percent of them become our patients,” said Erica Pellizzari. “Most common symptoms are sleep disturbance such as insomnia for example, constant worry or anxiety, fear that something else could happen again, constant sadness, easily crying, persistent re-experience (nightmares or flashbacks about the event) and memory or concentration difficulties. Sometimes people will suffer even one year after the traumatic event because they will not be able to improve by themselves. The symptoms are typical in people who experience such an unexpected and devastating event as an earthquake. It is professionally understood that most of the people will present symptoms after a natural disaster and little by little the symptoms will decrease, but there will be always part of the affected population that will need specialised psychological help to regain their former mental health condition.”

For the people who need psychological care, Médecins Sans Frontières counselors provide psychological counseling to help them express their trauma and to accept their feeling. Through this process of self-disclosure, people become able to accept their feeling and reality. As a result, their symptoms will decrease and they can rebuild their new lives.

Lou Junwei, a Médecins Sans Frontières counsellor working in Leigu, describes how one of his patients recovered after receiving consultations. “He lost his wife by the earthquake. Before coming to the consultation, he couldn't sleep until 1am and woke up at 3am everyday, which means he had only two hours sleep. He was very anxious and had no plan for the future. He was very sad and desperate, but he couldn't express his feeling because he has two children and had to act like a brave man. After receiving the consultations, his attitude became very positive. Now, he is working in a business with his children in Leigu.”

Before the earthquake, psychological support was very new in China, and there were a limited number of psychologists who can provide clinical psychological care. In the areas where Médecins Sans Frontières works in Sichuan, Médecins Sans Frontières is the only organisation providing individual and group psychological care. Erica Pellizzari said clinical approach is very important to diminish the symptoms of patients. “If someone is suffering from the symptoms, participating community activities such as a handcraft is positive, but it will not really reach the essence of the problem. There’s population who will only be able to improve with the clinical psychological approach,” said Erica Pellizzari. “Our project gives a constructive example to the community that therapy works and its good effect.”

By March 2009, Médecins Sans Frontières team assessed more than 650 people, followed 300 patients, and conducted about 1,500 consultations. Médecins Sans Frontières also provides training and supervising to these Chinese counsellors to help them dealing with patients and assure a good quality of care.

Médecins Sans Frontières has been working in the earthquake affected area of Sichuan, China since May 2008. Currently, 13 national and three international staffs are working to provide psychological assistance. Médecins Sans Frontières is also providing HIV/AIDS treatment in Nanning, Guangxi Zhung Autonomous Region since 2003. Médecins Sans Frontières has worked in China since 1989.

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