After the deluge

M. thinks of death every time he remembers how the flood waters engulfed his house and small business unit. The 48-year-old resident of Thiruvalla in Kerala is haunted by the fact that he lost a lifetime’s earnings in the rains that lashed his town last week. What else can he do but take his life, he asks in despair.

Psychologists are keeping a close watch on the businessman at a relief camp. Since the heavy rains that started on August 8, flooding many parts of Kerala and leaving at least seven lakh people homeless, relief operations have rescued thousands, who have been housed in 5,000-odd temporary relief camps.

Health experts are coming across more and more people suffering from depression or severe anxiety. At least three have committed suicide so far.

“M. is so severely depressed that he wants to end his life,” says psychiatrist Roy Abraham Kallivayalil, who has been counselling him. “I spent considerable time telling him that all his material losses would be taken care of by the government,” says the secretary general of the World Psychiatric Association.

Abraham has seen at least 200 people with abnormal psychological conditions in Chenganoor and Thiruvalla, two of the areas most affected by the recent floods which claimed at least 220 lives. “Many of them have been nurturing suicidal thoughts and are greatly depressed about their losses — economic or otherwise. In most cases, mental trauma has manifested itself as numbness or a dazed feeling,” he says.

But the reality will start hitting the people as they start going back home, the psychiatrist warns. Shino Varghese knows what Abraham is talking about. The 38-year-old resident of Maradi panchayat in Muvattupuzha could not believe his eyes when he returned home from a relief camp earlier this week. “It seemed as if someone had come in and wreaked havoc. The household items were dumped all over and the floor was covered with knee-deep clay and slush. I was in shock and despair,” he says.

According to the World Health Organization (WHO), 30-40 per cent of the victims of catastrophic natural disasters suffer from major mental distress and require counselling.

“The floods have had a psychological impact for sure. It will take just three days of steady rain for people to abandon their homes now. The fear has set in,” says Varghese.

For days now, Kerala has been in the news with its tales of collaboration and compassion. For hundreds of people such as Sara John, senior project officer at a Kochi-based research institute, the floods revealed the strength of the people.

She recalls a text message she received from an unknown number late at night on August 16. John, marooned on the second floor of her house in Thottakkattukara near Aluva with her five-year-old daughter and elderly parents, was watching the rainwater rising steadily when the phone buzzed. “I don’t know who you are, but you are my sister,” the text said.

It left a lump in her throat, but also reassured her. Calls and texts from strangers and officials gave her confidence and hope. They reached out on John’s mobile after her friends tried to organise help for the family. “They didn’t just call or text once, but kept it up through the night. They addressed me as chechi (elder sister). A man in Saudi Arabia, whose family had been rescued from my neighbourhood, called several times to assure me that help would arrive soon,” John says.

The family survived on a small supply of biscuits, bread and water, while John zealously saved the charge on her phone. “I watched videos and learned how to keep the battery charged. We tied a red cloth on a stick and waited,” she adds. The wait ended on the evening of August 17.

***

A week after the deluge, the rescue operations are winding up, while large-scale rebuilding and rehabilitation will be the next long-drawn step. But meanwhile, there are concerns about the mental scars that the floods have left behind.

“Mental health is now a pressing issue among flood victims. The state health system is very good and cases of physical trauma and spread of infectious diseases are being actively addressed. Psychological issues, on the other hand, may tend to be a larger problem,” says Dr Sulfi N, secretary, Indian Medical Association (IMA), Kerala. The government is paying heed to this growing concern. State culture minister E K Balan on Tuesday urged artistes in the state to visit relief camps to help victims get over their trauma. “There is a realisation that mental trauma needs to be taken care of,” says Dr Srijith N Kumar, former president of IMA (Kerala) . “As part of the relief operations, we are inviting artistes, big or small, to come and perform in the camps so that victims get some emotional relief and lighten up.”

The state health department has ordered that at least two psychology experts or counsellors be sent to each relief camp. IMA Kerala has set up a panel of psychiatrists across the districts to tend to people in the camps.

“Children and senior citizens are particularly vulnerable, as are lactating mothers. At the moment, what we are witnessing among victims is anxiety. This can, in the long term, turn into PTSD or post-traumatic stress disorder,” warns Sulfi.

Talking point: Community-level sessions by trained counsellors can play a vital role in helping survivors heal

***

Mental stress knows no boundaries, and doctors have also been reporting anxiety among people who have not been directly affected by the floods. “People who live by the lakes and rivers and have watched the catastrophe unfold are complaining of insomnia and headache,” adds Sulfi.

The victims experienced not just extensive material loss, but also stress brought on by the wait for rescue. Over the past few days, Naval Commander Vijay Varma watched dozens of stricken faces from the cockpit of his advanced light helicopter as survivors were hauled up from rooftops and balconies in flood-swept localities.

From morning to evening, on operations that stretched across the state, he and his team continuously battled inclement weather. Being winched into a helicopter, Varma admits, is disconcerting for a survivor already in a state of shock.

“For most of them, it is the first time in a helicopter. It is a noisy machine, so talking is out of the question. Survivors are winched up 13-14 feet amidst gushing wind and on a wildly swinging rope. Obviously, they are petrified when they are pulled in and made to sit in the open cockpit,” says Varma.

The crew tried to give survivors whatever little comfort they could offer. A few shocked ones had just slumped on the floorboard while the diver on board held them tight. “My diver has cradled a person, who was just too weak, in his arms throughout a flight. Children who are separated from parents are petrified,” Varma says. The crew on such missions ends up taking care of the survivors more than just physically. “Sometimes a pat on the back or a smile will do.”

Roji M John, member of the legislative assembly from Angamaly — one of the severely affected regions — says the situation is getting better. “Except for isolated areas that are cut off, rescue is almost over,” he says.

But this, Roji points out, is a crucial phase, when people take stock of all the damage and find their homes submerged and livestock and savings gone.

Take 70-year-old Abdul Rehmankutty. He has lived for decades in Karumalloor, not very far from the Periyar in Aluva, but has never before witnessed a deluge so destructive. “Incessant rains and the rising waters made this one deadly,” says Rehmankutty. He has lost about 4,500 plantain crop; his neighbours, too, have suffered large-scale loss in agriculture. “People are anxious and afraid. Not many have gone back home,” he adds.

Roji points out that rebuilding is a long process. “This is the time to not forget the victims, particularly for the government.”

Consultant psychiatrist PN Suresh Kumar agrees. He was part of a team of experts from Thanal Crisis Intervention Centre, Kozhikode, who visited the relief camps at Wayanad’s Valiyapara and neighbouring regions last week and found many people in need of counselling. “Most of the elderly women were in a state of shock and complained of insomnia, anxiety and fear. Some said they could not forget the sight of boulders rolling down. A few were numb and had no appetite,” he says.

While disaster survivors need immediate physical support, they subsequently require psychological aid as well. “Now they are together in the camp, getting food, clothes and medicines and are visited by elected representatives. All this have a therapeutic effect. But that might change once they find themselves on their own, left to rebuild their lives,” he adds.

Kumar suggests community-level sessions by trained counsellors to help survivors heal. “The WHO had released disaster related counselling programmes after the 2004 tsunami. Group therapies where people who have survived similar disaster share their experiences will help,” he says.

Recent news reports said Kerala government has approached the Bengaluru-based National Institute of Mental Health and Neuro-Sciences to help flood victims cope with loss. The Department of Health Sciences has also released a set of guidelines to aid post-flood recovery. While it suggests a series of health tips, it also underscores the need to tackle mental stress. It encourages people to seek psychological help and instructs practitioners to anticipate long-term mental health issues.

G Padmanabhan, a Delhi-based disaster management expert, underlines that the community is the bedrock of rehabilitation and stresses the need for psycho-sociological support for survivors. “It is easy to mobilise volunteer-based community programmes. In more serious cases, when problems persist, a patient might require medical care or short hospitalisation. It is traumatic for people to watch the strong houses they lived in being washed away or breaking apart. Some will go into depression,” he adds.

Talking and listening, says Padmanabhan, will help address such problems.

It is what John believes in too. “It is important to not let the spirit with which we helped each other fade,” she says.

P Anima and TV Jayan

COMMENT NOW