Case Study: Earthquake in Armenia

Situation

The earthquake in Armenia on December 7, 1988 measured 6.9 Richter. It killed 130,000 people, handicapped another 500,000, and orphaned 500,000 children. The physical damage was estimated at US$20 billion. The Armenians were intelligent, hard-working, peaceful, family-oriented and hospitable people. They have survived the Ottoman-Turkish genocide, 70 years of oppression under Communism, and the ongoing territorial conflict with Azerbaijan that led some 200,000 refugees to the earthquake-prone area. Seismologists described the quake area as a “structural knot,” engendered by the interaction of several rigid plates. This paralleled the sociopolitical and economic situation: political agitation, tension, anger, resentment, disappointment and mistrust, due to rigid attitudes.

The event was largely unanticipated. Two-thirds of Leninakan (population 300,000), Armenia’s second-largest city was destroyed. At the epicenter, Spitak (population: 30,000) was leveled. In the area, all hospitals, schools, and community centers were severely damaged or destroyed. Survivors were forced to travel four to six hours away to the capital, Yerevan, to receive medical attention. Survivors had no areas left intact in their community through which to seek support. Men stayed to clean up while women and children were moved the the capital and other Soviet Republics. These relocations and separations further aggravated the trauma.

Within the first 10 days, over US$50 million in goods, food and supplies were delivered to Yerevan’s airport from around the world, overwhelming the damaged distribution system. Planes that managed to land just unloaded goods on the runway. Assistance routed through Moscow did not make it to Armenia in its entirety. This lasted until Armenian volunteer organizations took over the distribution and management of the funds and goods. In spite of overwhelming international attention, there was no organized rescue effort. Efforts were disorganized and began too late. Rescue equipment was either broken or insufficient.

Short-term impact

86% of children displayed at least 4 of the following 10 symptoms:

1. separation anxiety intensified during the night
2. refusing to go to school
3. refusing to sleep or to be left alone
4. conduct disorders
5. sleep disturbances manifested by bad dreams, frequent awakenings, difficulty falling asleep
6. regressive behavior manifested by thumb sucking, enuresis and clinging behaviors
7. hyperactivity
8. withdrawal
9. inability to concentrate
10. somatic complaints

83% of adolescents had severe levels of PTSD characterized by the following:

1. withdrawal
2. lack of concentration
3. aggressive tendencies
4. nightmares
5. unusually poor grades in courses in which they had excelled prior to the earthquake
6. irritability
7. increased reports of episodic daydreaming

81% of adults had severe PTSD.

98% of survivors did not have access to a mental health professional.

Response

After the earthquake, the Mental Health Outreach Project (MHOP) was established to assess levels of PTSD in survivors and establish a rehabilitation program. Mental health professionals with fluency in Armenian, some knowledge of the culture and emotional stability were selected as volunteers. Based on prior experience, those without knowledge of the language and culture arrived at erroneous conclusions and drained limited resources by requiring translators. Each interdisciplinary team included a psychiatrist, a psychologist, and a psychiatric nurse or social worker. Each team was joined by a local mental health professional for the purposes of mentoring.

Planning occurred in February 1989 and was reevaluated and modified in August 1989. During this phase, 40 volunteers helped 3,500 survivors. Developing a trusting relationship was crucial. Volunteers possessed a broad range of therapeutic expertise including art therapy, biofeedback, the coloring storybook, drawings, family therapy, group therapy, instruction booklets, logotherapy, meditation, play therapy, pharmacotherapy, and short-term psychotherapy. A six-month follow-up revealed that those receiving care were coping more effectively (78%), less depressed (50%), and scored lower on the test for PTSD (80%). In comparison, those that did not receive care expressed feelings of hopelessness, anger, despair, and apathy. The incidence of suicide, homicide, aggressive outbursts, substance abuse, and spousal and child abuse had increased. One year later, only 19% of the housing had been completed, leaving thousands still in need of homes. About 90% of the refugees had severe PTSD from their treatment by the Azberbaijanis.

Meaning-making

Six weeks after the earthquake, 20% attributed a positive value and meaning to the disaster. Survivors that were trapped in the “Why did this happen?” mindset showed more severe signs of PTSD. This type of thinking forced the survivor to remain in the past, in the role of the victim, without a rational or satisfactory answer. It also left the survivor with self-induced guilt leading to self-destructive behavior. The implication that trauma and disaster happen to bad, sinful or unworthy people attributes a negative value to the disaster. These survivors connected the earthquake to the genocide and globalized all their historic unresolved traumas in one and became overwhelmed by the memories. In contrast, those who attributed a positive meaning focused on the present moment and the meaningful experiences they gained by helping or receiving help. One survivor stated, “Look how the world has come to help us. The closed Soviet system has opened its doors. There is more communication, caring and sharing.”

Relevance

This case identifies a number of design opportunities in alleviating the symptoms of PTSD. Foremost is this notion of meaning-making. How can we move people from a victim mindset to positive one? Are there objects that mental health professionals use as tools in counseling that allow them to serve a greater number in the same amount of time? Can a mental self-help kit be effective as a take-home module after or in place of a therapy session? In the absence of social workers, how can survivors and volunteers rapidly organize themselves to match community services with community needs?

Kalayjian, Ani, and Dominique Eugene. Mass Trauma and Emotional Healing around the World: Rituals and Practices for Resilience and Meaning-making. Santa Barbara, CA: Praeger, 2010. 1-21. Print.

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