Case Study: Pakistan Earthquake

Situation

On October 8, 2005, a 7.6 magnitude earthquake hit Northern Pakistan killing 80,000 people and injuring 106,000 in collapsing buildings, landslides and rockslides. An additional 30 million lost their homes because they were constructed with stone, brick, concrete and unreinforced masonry. Since it was a school day, many children died in collapsing schools. Since it was Ramadan, most people were taking a nap after their predawn meal and did not have time to escape.

Women were disproportionately affected. They accounted for 75% of the displaced. Since women are the primary caretakers, they were responsible for the injured, elderly, men and children. The lack of activity led to increased emotional, physical and sexual abuse of women. Cultural norms and childcare responsibilities prevented women from accessing relief centers. Women were also systematically marginalized because they were not registered as household heads and thus ineligible for food distributions.

Context

While PTSD seems to be the easy mental health diagnosis following a disaster, some groups do not fit the DSM IV criteria. Some researchers have suggested that these variations may reflect cross-cultural differences. For example, Mexican survivors are likely to report panic attacks, depression, pain, physical illness, weakness, and weight loss. While these symptoms do not fit the PTSD mold, they are important to understanding the subjective experience of post traumatic stress.

Pakistan is a developing Muslim country. Mental health is considered the result of being able to differentiate between good and evil and choosing to live according to the Quran and Haddith. Islamic spiritual healing focuses on identifying a purposeful way of “being in the world” and on holding a strong devotion to Allah’s will. Health professionals incorporate religious beliefs into their practice.

Mental Health Response

When Mental Health Outreach Project (MHOP) volunteers arrived 3 months after the quake, mental health services were limited and often cost-prohibitive. Their initial assessment of levels of PTSD suggested that those with higher levels of education suffered significantly less than those with low levels of education because they had better cognitive abilities to understand the nature of the disaster and had better resources to rebuild their lives after the disaster.

The MHOP used a 6-step bio-psychosocial and spiritual model.

1. Encourage survivors to express their feelings. Common responses demonstrated fear, anger, survivor guilt and sadness. “I can not do laundry again because I see the earthquake.”
2. Empathize and validate. Reassure victims that their feelings were normal in group settings.
3. Promote a sense of purpose. Ask questions aimed at developing insight, e.g. “What lessons, meanings or positive associations did you discover as a result of this disaster?” Many responded that it was a punishment by Allah. These comments were acknowledged, then steered towards steps that the survivor might have taken to bringing their life closer towards Allah’s will.
4. Disseminate information about earthquakes and earthquake preparedness.
5. Teach breathing and movement exercises. Visualize a passage or prayer from the Quran while you breathe from your diaphragm.

Relevance

This study reinforces the importance of adapting therapy techniques to the embedded culture. Across cultures, a pattern of therapy seems to be emerging. Victims need a safe forum where they can express their feelings and share in the experiences of others. Promoting positive meaning making helps survivors accept what has happened and move on. Breathing exercises help relieve panic attacks. What objects are used in therapy sessions today? Is there an opportunity to improve on existing design or to create something entirely new?

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. 55-71. Print.

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