When a disaster occurs, it causes more than just damage to property. It also brings a flood of emotions.

Typically at first there is a feeling of numbness, a sense of disbelief. In this state the person appears to look lost, dazed and confused. The sense of disbelief 'that this could not have happened! Is often reflected in a lack of outward show of emotions, thus the person may appear unemotional and stunned.

These feelings are very natural reactions to an unusual situation. The full force of the emotional reactions often hit after the disaster has passed and when rebuilding begins. And this is the when exhaustion, grief, desperation and depression may set in.

It is important to pay more attention to emotional reactions once the emergency crews go home. Till then, it is appropriate to help in rectifying the physical damages.

People especially vulnerable to adverse psychological effects are:

• Women, especially mothers of young children
• Children and adolescents
• Persons with disabilities, those who are aged, mentally ill.

Preparedness

The Health worker would need to learn the skills of counseling, ie, how to interact and deal with persons in extreme psychological distress and shock (see Annexure 1). In the early stages, the following help assists people to tide over physical safety needs.

1. Provide practical help in dealing with the disaster.
   
   • Help persons get their family and belongings together.
   • Arrange for meals and encourage the setting up of a common kitchen.
   • Make arrangements for shelter and toilet.
   • Parents may be very busy; offer to look after their children.
2. Keep a look out for persons who are alone, who are in difficult circumstances like chronic illness, pregnancy, with small children, with disabilities, with mental illnesses. See that they are at least in the company of other people, who could also help in keeping them involved in the activities - like the common kitchen etc.

Rescue Phase

The immediate period after disaster strikes - this is when the immediate needs is to provide active help in relief operations, in arranging for the physical safety of people and their families and belongings.

Recovery Phase

After the immediate shock and disbelief of what has happened has passed, emotional reactions will begin to surface. These responses, affecting the old and the young alike, are considered to be normal responses after a traumatic event. These appear to be in the form of:

• Intense feelings that are sometimes unpredictable - such as
  • Over reactions to minor irritations or difficulties
  • Rapid change of moods
  • Nervousness, trembling of hands, headaches
  • Feelings of sadness, crying, not wanting to do anything, not feeling hungry, so on.
• Changes in thoughts and behaviour, and people tend to:
  • Repeatedly talk about the event, describe in vivid detail what they felt and saw.
  • Appearing to find it difficult to decide even about small issues
  • Becoming easily confused
  • Complaining of tiredness of a lack of adequate sleep and appetite.

The reactions seen in children:

Crying/Depression	Inability to concentrate
Bedwetting	Thumb sucking
Withdrawal and isolation	Nightmares
Not wanting to attend school	Headaches
Clinging/fear of being left alone	Changes in eating and sleeping habits
Regression to previous behaviors	Excessive fear of darkness
Fighting	Increase in physical complaints

Usually a child's emotional response to a disaster does not last long. Be aware that some problems may not appear immediately or may recur months after the disaster. Talking openly with children often leads to faster recovery.

A child's reaction also depends on how much destruction he or she sees during and after the disaster. If a friend or family member has been killed or seriously injured, or if the child's school or home has been severely damaged, there is a greater chance that the child will experience difficulties.

A child's age affects how the child will respond to the disaster. For example, six-year-olds may show their concerns about a catastrophe by refusing to attend school, whereas adolescents may react by arguing more with parents. It is important to explain the event in words the child can understand.

Even teenagers belong to this category, and require special treatment as they are not adults as yet. Often their distress is in the form of poor performance in school, bad temper, disobedience, etc which really masks grief.

Sometimes, mental distress is also felt as physical symptoms like fatigue, nausea and vomiting, sudden episodes of rapid heart beats, excessive thirst due to parched/dry throat, blurring of vision, hearing difficulties, weakness in legs and arms, dizziness, etc.

Interpersonal relationships also may become strained. Family members may quarrel and argue with each other over matters they could resolve easily before. This happens usually as persons are tense and easily irritated. Some people begin to stay away from others, preferring to stay alone, not interacting with even family members, and by avoiding routine activities.

Rehabilitation Phase

When reactions are severe and continue for a long time

People respond in different ways to extreme trauma. In about 20 to 30 percent people negative reactions continue or intensify to the extent that daily life gets affected. When this happens it is called Post Traumatic Stress Disorder (PTSD). Many people who experience extreme trauma do not develop PTSD.

Three categories of symptoms are associated with PTSD.

• Re-living the event through recurring nightmares or other intrusive images that occur at any time. People who suffer from PTSD also have extreme emotional or physical reactions such as chills, heart palpitations or panic when faced with reminders of the event.
• Avoiding reminders of the event, including places, people, thoughts or other activities associated with the trauma. PTSD sufferers may feel emotionally detached, withdraw from friends and family, and lose interest in everyday activities.
• Being on guard or being hyper-aroused at all times, including feeling irritability or sudden anger, having difficulty sleeping or concentrating, or being overly alert or easily startled.

People with PTSD may have low self-esteem or relationship problems or may seem disconnected from their lives.

Other problems that may mask or intensify symptoms include:

• Psychiatric problems such as depression, or another anxiety disorder like panic disorder.
• Self-destructive behavior including:
• Alcohol or drug abuse
• Suicidal impulses
• Physical complaints, any or all of which may be accompanied by depression, including:
  • Chronic pain with no medical basis (frequently gynecological problems)
  • Stomach pain or other digestive problems
  • Headaches
  • Muscle cramps or aches such as low back pain