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2015年9月13日 (日)

Educational and Psychosocial Support after Nepal earthquake (1)

Educational and Psychosocial Support after Nepal earthquake (1)


   We visited a school in Nepal on 11th September 2015.The trip took 3 hours and a half by a car from Katmandu city center. I had a lecture about educational and psychosocial support after the Nepal earthquake. 38 principals from stricken area have participated. They told us: “Many children live in a tent, they are afraid of sounds or tremors and they don’t want to study after the earthquake”. For disaster prevention education, a teacher said: “ When we felt the shake of an earthquake, we have taught the children that they should to take refuge under their desk. However, this was a mistake. The earthquake happened on a Saturday. If the earthquake had occurred on a weekday, possibly children would have fallen victims of the collapsed school building”.


  The purpose of this visit is to explore the possibility of the long-term support project by the specialists of Nepal and Japan.






 We have been engaged in the Mental Health and Psychosocial Support Project by JICA and All-China Women’s Federation after Sichuan earthquake in 2008 for five years. I quote the report of the Ministry of Foreign Affairs.




JICA has carried out diverse reconstruction support activities since the Great Sichuan Earthquake. Among the efforts, the Mental Health and Psychosocial Support Project for the Sichuan Earthquake has been implemented from 2009 to 2014. JICA has been working to establish systems that enable appropriate and continuous psychological support rooted in the communities in five model sites together with the All-China Women's Federation, which provides educational, welfare and other assistance to women, children and elderly people.




By the way, I found the following website saying: Psychologists stay home: Nepal doesn't need you”.




This website shows the similarity and the difference between our approach and Western approach.




>I am reluctant to medicalise suffering in the aftermath of a natural disaster: symptoms of distress are a normal reaction to an abnormal situation and labelling does not help at an early stage.


私は自然災害の余波の中で 苦しんでいる人たちに医学的処置をすることには気が進みません:苦脳の症状は異常な状況での正常な反応です、早い段階での医学的なラベル付けは役に立ちません。


 I agree with this opinion except “symptoms”. I distinguish “symptoms” and “trauma reactions”.




>Of course, after a disaster strikes, everyone is in distress.


But that doesn’t mean everybody needs to see a mental health practitioner.




I agree with the opinion that victims in the acute phase (for three months after disaster) don’t need counseling from the mental health practitioner. But I don’t stay at home. I advise that the board of education in stricken area makes the prolonged supporting system of five years and ten years for children. Then, we tell teachers how the children affected disaster should cope with their traumatic stress reactions and daily stress reactions.




Yet, we know from research that in the aftermath of a natural disaster psychologists armed with “talking therapies” have little to contribute:survivors need to go through the natural grief process and the vast majority will not develop post-traumatic stress disorder (PTSD), nor any other psychological disorder.


>I'll say it anyway: please let's not rush in with well-meaning psychosocial programmes.

Especially, let us avoid flooding Nepal with Western-style “talking therapies” delivered via translators.



This “talking therapies” may mean “psychological debriefing”. After Kobe earthquake in 1995, U.S. team recommended psychological debriefing Mitchell,1983). But, I did not do “Debriefing”. I believe it is important to recover a feeling of safety and sense of security rather than letting feelings out. We proposed victims in the shelter the Relax-"Dohsa-hou" originally developed in Japan. Ten or more victims tried to relax with “Dohsa-hou” each time we had a workshop. They gave us many affirmative comments, for example, "I feel refreshed." "I could sleep very well.




I am visiting together with members of NEDO (Nepal Educational Development Organization). NEDO aims to help Nepalese disadvantaged children to attend the school by financial supporting program. NEDO Japan is headed by its founding director Professor Dr. Manoj Shrestha. NEDO’s executive committee consisting several directors take responsibility for their projects.





Today (12th September 2015), two youths who have received support of the scholarship of NEDO guided us Swayambhu temple in which some buildings collapsed in the earthquake. They also lost their own house in the earthquake. They were wise, kind and calm. They told me that they were meditating daily.

The thing which I would like to tell to Western specialists is the next:

Please do not apply your theory and method for pyschological support after disaster to the people of a stricken area.

First, please listen to the method of stress management of the people of Asia.

Please think of how to overcome difficulty, together.








I agree this opinion: the vast majority will not develop post-traumatic stress disorder (PTSD).But, I disagree “ nor any other psychological disorder”.

 This estimates the rate of stress related disorders too much low. The disaster gives three stressors to a person at the same time. There are traumatic stressor, loss stressor, and daily life stressor. Daily life stressor as like parents' economic matters and a quarrel causes children stress-related disorders. The educational and psychosocial support after a disaster needs for children affected by the disaster for 10 years or 20 years.


私は大部分の人がPTSDにならないという意見には賛成です。しかし、他の心理的障害もみられない という意見には賛成できません。これは、ストレス関連障害の率をあまりに低く見積もっています。災害は3つのストレッサー、トラウマストレッサー・喪失ストレッサー・日常生活ストレッサーを同時にもたらします。両親の経済問題やケンカなどの日常生活ストレッサーが子どもにストレス関連障害を引き起こしていきます。災害後の教育・心理社会的支援が10年、20年を視野に入れて被災した子どもには必要です。


Mostly what needs to be encouraged is "humane, supportive and practical help to fellow human beings suffering serious crisis events" as prescribed by the principles of Psychological First Aid (PFA).


I agree with this opinion in acute phase. PFA is correct guideline for acute phase. For a disaster victim, safety is the most necessary experience. But, PFA did not write about disaster prevention education after a disaster. I visited the school together with the specialist of architecture. The earthquakes don't kill people, houses collapsed by it do. You have to change the method of refuge with earthquake resistance of a building. 

The survivors trend to avoid soon the word "earthquake" after feeling safety.  But, strong avoidance is a risk pf stress related disorders. The key components of our educational and psychosocial support are offering safety and comfort to the victims, helping them create bonds with other people, and providing expression and challenge. Safety and comfort have 1,Safety 2,Psycho-education about Stress and Trauma 3,Stress management as like relaxation. Expression has 4,Self Check about Stress and Trauma 5,Expressing Life Experience 6,Expressing Traumatic Experience. Challenge has 6,Expressing Traumatic Experience,7,In Vivo Exposure,8,Mourning Process. Bonding is necessary to all components. Although they are not safe, forcing them expression and challenge gives them a secondary traumatization.



また生存者はまもなく安全を感じられるようになったのちに、“地震”という言葉を避けるようになります。強い回避はストレス障害のリスクです。私たちの教育・心理社会的支援の鍵コンポーネントは、安心、絆、表現、チャレンジです。安全・安心は、1.安全、2.ストレスとトラウマの心理教育、3.リラックス法などのストレスマネジメントです。表現は、4.ストレスやトラウマのセフルチェック、5.日常生活体験の表現、6.トラウマ体験の表現です。チャレンジは、6.トラウマ体験の表現、7.現実エクスポージャー、8.服喪追悼 です。絆はすべてのコンポーネントに必要です。この順番が大切です。安全でないのに表現やチャレンジを強いることは、二次被害を与えます。

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