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Wei Jiang, M.D.
Associate Professor
Internal Medicine / Psychiatry & Behavioral Sciences
October 31, 2008
One World, One Aim:
Promote Mental Health post
Catastrophic Disasters____Experience of the Duke Voluntary Medical
Team to the 5.12 Earthquake Zone in Sichuan, China
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Objectives
Brief review of the 5.12 Earthquake and
the physical consequences of the quake
Recount the experience of the Duke
Voluntary Medical Team serving thevictims of the earthquake
Discussion of rules of international aid inpromoting post disaster mental health
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Sichuan Province, China The
Heaven of the Country
Beautiful Mountain Scenery,Natural Preservations,
Home of Giant Panda,Modern Cities,
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2:28 pm. May 12, 2008 (ChinaTime)
A 7.9 Richter Scale
Earthquake Strikes Sichuan.
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Approximately half of the
2,400 studentsin the school
were killed
during the quake
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The Premier
Comforting parent-less children
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Chinese Government Updateearly September 2008
Magnitude: 8.1 Richter scale
Casualties: 79,800Missing individuals: 17,300
Displaced population:10 million
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Psychological Impact of Mass Disaster
The WHO estimates:
after disaster, the prevalent rate of mild-to-moderate and severe mental disorders areliable to increase to 20%, and 3-4%
respectively, among the affected population The rates are higher in population affected
by mass disaster; 30-50% of 2004 Asia
Tsunami were thought to suffer moderate-to-severe emotional distress
Davidson & McFarlane J Clin Psychiatry 2006;67
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Psychological Impact of Mass Disaster
Common psychosomatic problems post disaster:
Acute stress reaction
PTSD and subclinical PTSD symptoms
Depression
Anxiety
Various somatic symptoms
If the post traumatic mental disorders are not managedappropriately, they may last for the rest of the life in
many sufferers and adversely effect their physicalconditions and shorten their life expectancies
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Psychiatric Service in China
only 17,000 certified psychiatrists;
approximate 1/10 of psychiatrists to
patients ratio in developed country
They are located in psychiatric facilitiesand a few tertiary hospitals in large cities
No community based psychological /psychiatric care prior to the quake
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Sichuan is the largest province in China
with a population surpass 100 million 40,000 to 50,000 severely mental ill
patients in Sichuan who were not under
psychiatric care 3 months post quake
Quickly trained volunteers provided
psychological counseling for certain quakevictims
Psychiatric Service in China
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Forming a Medical Team to Help Out
To mainly provide psycho-psychiatric
treatment to survivors of the earthquake To provide professional assistance to local
health providers in caring for quake survivors
To understand the infrastructure of post-quake mental health rehabilitation and
acceptance of victims to mental health
service
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Because mental health being provided by
International aids is constrained by languagebarriers, members of the Duke team are all
Chinese speaking and knowing local culture
Green lights given by the Chinese Embassy inUS, Local Chinese governments of Sichuan
province, and the Ministry of Health Department
of China
Warm welcome and eager expectation sent from
Huaxi Hospital where we are assigned to work
Forming a Medical Team to Help Out
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The Journey of the Duke Team
Aug 23-24 RDU to Beijing to Chengdu
Aug 25-27 Inpatient service in Huaxi hospital
Aug 28 Bailing Town refugee camp
Aug 29-31 Red & White Town refugee camp
Sept 1 An Xian refugee camp
Sept 2 Preparation for training and lecture on inpatient
service
Sept 3-4 Training local and remote mental health providers
Sept 5 Rehabilitation center & ICU for severely injuredvictims
Sept 6 to Beijing; meetings
Sept 7 Meetings; then return to USA
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Hiking into the small village__Wu Gui Ping Village
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The Damage is Devastatingand the Victims are Resilient
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Psychosomatic Symptomsare Common
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Based on our observation, at least 50% of those
victims experience post disaster psychosomatic
symptoms and would benefit from psychologicaland/or psychiatric interventions.
Symptomatology wise, we observed mainly
various spectrums of anxiety symptoms andpsychosomatic manifestations are most
prevalent.
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Highly Skilled Experts but Too Few
to Meet the Needs of Numerous
Victims
Psych-psychiatric Intervention isWell Accepted by Local Victims as
Far as the Term of Psychiatry is
not Used
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How may International Aids Help on
Promoting Post Disaster MentalHealth in a Foreign Country?
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Differ from post disaster surgical intervention orinfectious disease control, mental health
rehabilitation post disaster is much more
complex
It requires involvement of many aspects such as
governmental support, financial resource, social-environmental conditions, and preference and/or
acceptance of victims, etc.
It therefore particularly requires verbalcommunication and understanding of local culture.
However, in reality, very limited number of trained mental
health providers is able to master the foreign languageand familiar with local culture.
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Despite we speak Chinese and know
local culture, to reach our goals, we needto:
Ascertain Effective Communication
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We were assigned to Huaxi Hospital, thebiggest hospital in Asia (>4,000 inpatient beds).
People we were going to collaborate with didnot know us, neither did we know them.
Although we were eager to help, our
presentation could be perceived as a burden andintrusion, especially in situation that the localhealth providers had been working very hard
since the quake and exhausted. To have to takeus in while not knowing how well we are, itsstressful.
Our Effective Tactics
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Be respectful, rather than suspicious
Be open-minded, politely requesting, rather than
veiled, impudently demanding
Be a team player do whatever its needed,
rather than a leader direct on others Be considering, validating, flexible,
accommodating, and perseverant
Be an active player and take initiatives
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Services provided by International teams in thequake zone thus far focused on trainings of promotingmental health rehabilitation.
Along with the progress of time and conditions, theneed for face-to-face supervision on difficult cases andconsultation and assistance on psychological processing
of the health providers become pressing.In an environment where mental health had not
been appreciated for years, dissemination and
penetration of it becomes more challengingAs a consequence, the demand for language
proficiency and communicating skills become evenstronger.
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Few teams have the luxury of
possessing all features, therefore:
Teaming up with Various Areas of
Expertise
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You are the best!
Aftermath Comments
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The importance of ensuring provision of
mental health to victims of disaster is todaylargely accepted
But implementation has been difficult in
many nations, including China
The pyramidal Effort of the MissionThe pyramidal Effort of the Mission
Th L th I tTh L th I t
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Care for single patientCare for single patient
Care for patients with local medical teamCare for patients with local medical team
Enhancing capabil ity of local medical professionalsEnhancing capability of local medical professionals
Establish communityEstablish community--based care systembased care system
Improvement / modification of infrastructures of the care systemImprovement / modification of infrastructures of the care system
The Larger the Impact,The Larger the Impact,the Heavier Work Load, and the Greater Challengethe Heavier Work Load, and the Greater Challenge
Aftermath Comments
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Provision of mental health post catastrophicdisaster is a long process which may last for
several years. Therefore, enormous challengescontinue in maintaining the provision.
International aids tend to flush in soon after
the disaster, then die down; rescue resourcesdeplete; and personnel fatigue.
N tt h biti i t ti l
Aftermath Comments
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No matter how ambitious an international
aid wishes to accomplish toward provision of
mental health service post disaster, what anindividual aid may offer solely may be quite
limited.
Nevertheless, the effort of organizingsuch an aid to travel to a foreign country is
tremendous and may overweigh the amount
of service the aid actually provide.
Aftermath Comments
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Therefore, international consortiashould be ideal in order to elicit and
mobilize expertise and financial resources.
By working together with centralized
coordination at a national or global level,the country suffers from a catastrophicdisaster, and consequently the world,
would have a better handle on disastermental health.
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G t f l
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Gratefulness
to the Victims
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Thank You