(Ninth of a series)
Jean still does not know what happened to her father, who was old and ailing but valiantly sent his children to safer grounds until he was swept away by raging waters that washed out his home.
Maria Christiana cannot help but weep at the memory of how her mother lost her hold and helplessly bobbed up and down in the torrent as relatives tried in vain to reach her.
Nelson recalls the floodwaters rising to 5 meters and the wind gusting that it hurt his eyes and he could not recognize people from his perch on the second floor of his house.
When it was over, he saw bodies floating on the water all around. More than 50 of his neighbors perished.
These are people who on the surface seem to have moved on, people who apparently have risen out of their grief and are bravely soldiering on, serving their communities as barangay officials and Basic Ecclesial Community (BEC) leaders.
The stories of many more who stare blankly in the shadows, or are seen walking aimlessly in the streets, their eyes glazed and their clothes in tatters, scavenging for food or whatever can be salvaged out of the debris, have yet to enter the records of those who take account of Yolanda’s fallout on the survivors’ mental health.
Mental health
Physical rehabilitation usually takes center stage in the disaster response of the government and aid agencies. Quite fittingly, livelihood and housing are the top priorities. But it needs to be said that the hidden wounds of loss and grief demand equal priority.
The World Health Organization (WHO) estimates that 800,000 survivors of Yolanda would need some form of medical help to save them from depression and other mental disorders. About 80,000, or one in 10, according to WHO country representative Julie Hall, would need medication.
Children
The traumatic effect on the children is particularly severe. Serving as icon for the thousands of emotionally damaged orphaned children is Rebecca, a 13-year-old who was rescued on the sixth day after the disaster.
For days she lay under the rubble, surrounded by the decomposing bodies of her family and relatives. At the hospital, she hardly spoke a word as her wounds were treated.
BBC captured for the watching world the haunting image of her sitting stock-still, shoulders hunched and curved inward, staring somberly at empty space, perhaps replaying in her mind the terror of the wind and waves that wrenched her loved ones away.
The physical injuries will heal in time, but the inner lacerations will likely stay if left unattended.
Traumatized institutions
The trauma in Tacloban was so massive that it partly accounts, apart from the static of politics, for the critical delays and the failure to respond decisively in the early days of the aftermath.
The experience seems to have shaken and demobilized the entire population. From the mayor down to the lowest functionary in the barangays (villages), the dysfunction was such that the mechanisms of government ground to a halt.
It is usual in disaster situations to at least have stable institutions that humanitarian agencies can tap as partners on the ground, like the local government, schools, churches and hospitals. All these institutions were destroyed or badly impaired during Yolanda and could not function.
In the first five days, it is said, government was completely absent. Roselyn emerged from the ruins of her house to look for help and found that “[t]here was no one to call.”
The leaders of Barangay 89, when asked what they needed, startingly said, “coupon bond.” They had no paper to write on, no ballpens and other supplies, and they had not been paid since the typhoon hit.
When asked why, they said it seemed the barangay treasurer had either gone to Manila or was dead or missing. All their records had been washed away, there was no one to do the payroll, and the local bureaucracy was in such disarray that no one knew where to turn. The city employees had been rendered homeless and had to hole up and set up quarters in City Hall.
Psychospiritual stress
With the city largely in ruins, many residents sank into hopelessness and despair.
In the initial series of psychospiritual interventions conducted by the Institute for Studies in Asian Church and Culture (Isacc), one participant confided that he felt more despair in the aftermath than during the typhoon. Faced with the task of having to rebuild without any resources left, he felt depressed and saw the future as utterly bleak.
At least two mothers gave up when they saw their small children swept away by the floodwaters. They tried to commit suicide by letting go and drinking in the filthy waters, hoping to drown themselves. Miraculously, they survived, and so did the children, except one.
Many survivors felt tragicomic at being reduced to evacuees, pointing to their pants, T-shirts and even underwear as all relief. People from the middle class felt humiliated at being forced to be dependent and having to live in other people’s houses.
Looting
Adding to the blot in the memory of many was the recollection of having participated in the looting. Trembling, some recounted stories of carting away groceries from a shopping mall or getting on one’s hands and knees to grab medicines spilled on wet floors, all the while praying for forgiveness.
A bedraggled woman, a baby on her hip, insisted that those who looted appliances and other goods were strangers. “They were not from Tacloban. We only looted food,” she said. “We did it out of hunger,” most people said.
Nevertheless, this left pangs of shame and guilt that linger to this day.
Stressors
A survey done in December and February among participants in Isacc’s psychospiritual seminars showed that survivors suffered many stressors during and after Yolanda:
More than half of the respondents (55.8 percent) at one point thought that they might die.
Many more (68.6 percent) thought they would be seriously injured.
Most had damaged homes (88.5 percent).
Most of them required food and water aid (85.2 percent).
About 22 percent were physically injured.
About 10 percent showed signs of posttraumatic stress disorder (PTSD), and 5 percent lost members of their immediate family. One participant lost 15 of her relatives, eight dead and seven missing.
It is worth noting that among those with possible PTSD, more than 80 percent belonged to the group of participants from churches and faith-based organizations.
This could be due to the fact that those who are working in faith-based organizations were not only helping distressed communities, but were also attending to the logistical needs of churches and organizations who have come to help, and this in a situation where they themselves were victims and needed help.
It could also be that those who are serious about their faith tended to be disabled by perplexities posed by the realities they had to face. It was observed that the first group, composed of faculty members from two universities in Tacloban, were much more expressive and open about the distress they experienced.
Those coming from faith-based organizations were much more reticent, and slow in disclosing their anguish and difficulties. The disconnect between what they know of God and the experience of death and destruction on so massive a scale had caused a great deal of internal dissonance.
One survivor, for instance, spoke of her resentment and anger at those who thoughtlessly threw Bible verses at her and so piously sought to comfort her in her loss. “They said, ‘God has a purpose for it.’ They are better, as they know the purpose. How come I don’t?”
The ongoing journey
Psychospiritual interventions are important because they deal with people’s innermost feelings and hopes. These could either tap into those resources of the soul that enable disaster survivors to rise up and walk, or more deeply disempower them into helpless despondency and despair.
Sensing this, groups of counselors and psychologists trooped to Tacloban to do debriefings and offer spiritual help. These have had varying degrees of effectiveness.
A local social welfare officer complained that some groups doing debriefings simply opened up fresh wounds, and then left the people twisting in the wind psychologically, causing more mental disturbances, particularly in children.
On the other hand, some groups did help in relieving trauma by doing competent psychological first aid and sensitive spiritual succor.
Recently, survivors were queried on how it has been for them, a year after Yolanda. One informant said that the people are tired of debriefings and reliving all over again painful memories without any real healing happening.
There is a limit, it seems, to mere psychological tools in dealing with psychological, and especially spiritual, wounds.
One lesson
One lesson emerging from all these experiences is the need to intentionally deal with the psychological and spiritual fallout of disasters. The magnitude of what we are dealing with in the wake of Yolanda has caught us flatfooted. We are being challenged to critique not only our assumptions in doing disaster response, but also the paradigm that frames it.
Much of the literature in doing disaster risk reduction and management is skewed toward highly technologized ways of handling disaster, without regard to the sociocultural context in which it happens and its impact on the mental health and coping capacity of survivors.
There is increasing awareness that disasters are also man-made and not only “acts of God.” Our life systems are such that both the environment and our people, especially the poor, are exposed to preventable risks.
Likewise, the destructive impact of Yolanda could have been mitigated by competent and decisive leadership, especially in the case of Tacloban.
The exasperating intrusion of petty politics proved deadly. Medical professionals informed us that thousands of lives could have been saved if help had come during the first five days. Many of those who could have survived died for lack of food, water and medicines, especially the children and the elderly.
In a culture where people naturally turn to the supernatural when faced with forces beyond their control, the spiritual and psychological resources that could buttress resilience are left largely untapped. Perhaps this is due to the secularist orientation of aid agencies from the north and their organizational extensions and ruling proxies in southern countries like ours.
Lack of culture-fit
Part of the dysfunctions in delivery of aid may be partly accounted to this lack of culture-fit.
In the Two-Thirds World, the poor are deeply religious.
Government and international aid agencies, however, are ideologically secularists.
They tend to focus on the merely physical and relegate to the sidelines the task of dealing with the disabling spiritual perplexities and psychological disorientation that arise out of disaster situations.
The sheer magnitude of those needing some kind of psychological and spiritual intervention has surfaced the need for more community-based approaches.
‘Each one, help one’
Communities can be engaged as a healing resource through an “each one, help one” program where lay helpers are trained in psychological first aid as well as in sensitive spiritual counseling.
We have found this a viable alternative that could be resorted to while putting in place a local referral system for those needing specialized care by mental health professionals.
Similarly, there exists in the culture a spiritual infrastructure for dealing with the massive need to mourn the dead.
During Holy Week, Isacc innovated community healing rituals based on traditional commemorations of the Passion of Christ-the Cenaculo, Siete Palabras and Salubong on Easter Sunday.
This creative reconstruction of cultural memory proved to be a moving way of releasing and honoring the dead of its adopted community, Barangay 89.
An index of the healing power of this is perhaps the fact that Barangay 89, one of the hardest hit in terms of its number of dead and extent of devastation, has been recognized as one of the top three barangays showing signs of speedy recovery.
This is in spite of its being low on the city’s priority list of housing and other forms of assistance.
Clearly, Super Typhoon Yolanda is an invitation to pay more attention to the inner needs and life issues of those who have to cope with the aftermath of a disaster.
(Editor’s Note: The writer is the president of the Institute for Studies in Asian Church and Culture.)