Helping children rebuild broken lives
It was such an unfortunate nightmare for Northern Mindanao when Typhoon Sendong, very similar to the man-made log and mudslide disaster that hit Infanta, Quezon, left more than a thousand dead and hundreds still missing in Iligan City in Lanao del Norte and Cagayan de Oro City in Misamis Oriental. The rest of the casualties were from Sibulan, Valencia and Dumaguete City in Negros Oriental; Zamboanga del Norte; Compostela Valley; and Bukidnon.
In such times of disasters, children are the most helpless victims. Disaster intervention tools for interviewing children at risk have been developed by child psychiatrists of the UP-PGH who have been involved in disaster work since 1990.
Part of the intervention tools is the Critical Incidence Stress Debriefing (now referred to as psychosocial processing). It was used for the survivors of the 1990 earthquake and this technology has been passed on to various government and NGOs engaged in disaster work. The PGH team that did the trainors’ workshop in 2005 in Infanta, Quezon, six months after the disaster, found acute symptoms of Post-Traumatic Stress Disorder (PTSD) among those who underwent psychosocial debriefing. This indicated that one psychosocial processing was not enough. Those who were subjected to initial psychosocial processing must be followed up at least four times. If symptoms of anxiety and depression persist longer than a month, there is a need for professional help to abate the symptoms of PTSD.
Multiple Group Psychosocial Processing (MGPSP) consists of a series of group sessions for ventilation and sharing of experiences, and feelings and reactions of the victims after the critical incident or disaster. Disaster psychosocial strategies should be done and developed for teachers, parents and children and the community, depending on specific psychosocial needs of the community and on the phase of disaster. Teacher/parent modules for training workshops, coloring books and comics should be prepared and designed for a specific disaster.
Who are the children at risk?
Children with high risk to develop symptoms of PTSD after a disaster are the following:
[1] children who got trapped in fallen structures, with or without physical injuries;
[2] children who witnessed a relative or a friend die during or after the disaster;
[3] children who got displaced by the disaster;
[4] children with one or more members of the family dying after the disaster; and
[5] children who had a prior crisis or illness before the disaster.
Screening tools
Here are screening tools that can be used in assessing children survivors of a disaster:
[1] SRQ (Self-rating questionnaire) – It has been earlier validated in community health studies;
[2] Psychosocial assessment form – This was used in the mud/log slide tragedy in Infanta, Quezon;
[3] Coloring books and comics – These can be distributed to elementary schoolchildren. Elementary school students indicating symptoms in the coloring book are to be recommended for MGPSP.
[4] Sand Play Technique – Some children are reluctant to cooperate during psychiatric assessment. Various factors can hamper a child’s cooperation; among them are poor verbal skills, negativism or anxiety. The sand play technique is a non-verbal technique that can be used both for [a] building rapport; [b] diagnostic purposes; [c] expressing through a symbolic language within a defined space and thus serves as a useful means of facilitating the interview process; [d] improving a child’s cooperation during clinical assessment; [e] evaluating the child and in planning appropriate treatment; [f] helping introverted children and children with poor verbal skills to express themselves more freely using this method and thus convey their abilities, characteristics, and focus of concern. This technique makes use of a shallow rectangular sand tray, half-filled with sand and a variety of miniature figures, which the child uses “to build a picture or create a world” in 20 minutes. The miniature toys selected by the child, the way the child arranges them in the tray, the child’s use of space and the themes represented in the scene all serve as reflective measures.
Children identified to be at risk after the initial psychosocial processing are then subjected to multiple group psychosocial processing by trained group facilitators. Children who still manifest symptoms after four group sessions should be referred to the child psychiatrist for individual therapy. A single psychosocial processing with no follow-up is not recommended.
Listed below are school integrated activities found very beneficial to the children survivors of natural calamities:
[1] Theme writing allows and encourages children to express their feelings especially if a hospitalized disaster survivor child was unable to attend the burial of a loved one who died in the calamity.
[2] Story telling is also a tool that allows ventilation of feelings.
[3] Literary and musical programs like reading poems or holding singing contests are activities that help children cope with the disaster.
[4] Sports activities and physical exercise help relieve stress.
[5] Commemorative events like reciting daily the three o’clock prayer for disaster victims also hasten the grieving process.
With the bayanihan spirit that has been shown by our countrymen to help the survivors of the most recent tragedy, there is indeed hope that the survivors can rise above the rubble of their destroyed homes and move on with their extended lives.
By the way, people involved in the disaster rehabilitation will find very helpful the book entitled Ginhawa - Well -being in the Aftermath of Disaster edited by Dr. Lourdes Ladrido-Ignacio and published by the Philippine Psychiatric Association, Inc. and the World Association for Psychosocial Rehabilitation. For more information, please call 635-9858 or 525-1767.
(Email me at nina.halilijao@gmail.com. A blessed and prosperous New Year to all!)
