Introduction
I
arrived to Haiti a week after a 7.0 earthquake struck Haiti in 2010. I was part
of an Israeli aid group, FIRST & Israaid, specialized in medical and
psycho-social support, and later continued to work with the local NGO PRODEV, while collaborating in one camp with JPHERO.
As
we started work in the first two camps in Port-au Prince, we immediately noticed
that information given to children and adults was not received in a holistic
way, for example, the use of the terminology "earthquake” referring to a
geological phenomenon was problematic. The people of Haiti were processing the
event in the context of their cultural and religious perceptions. Thus, we felt
that they needed to hear the information
we were presenting in their own language and with their own terminologies.
Accordingly, we adjusted our response.
Our
team designed a questionnaire based on proven psychological tools and anthropological
fieldwork methodology. The overall aim of the questionnaire was to help us
better understand the Haitian people’s perception of the disaster. I assumed
that, if we understood the cultural perception of the people and their
perceived needs, we would be able to provide them with information they could
understand, which in turn would reduce their stress and feelings of uncertainty. For instance, we
found that the people called the earthquake "gulu gulu", so we started
using that word in addition to “earthquake” in our psycho-education sessions.
We found that using local words and phrases helped us communicate better and
build trust. Adding that we spoke about the universal phenomenon by giving
examples that earth quake happen all over the world to all religions.
Key findings of our January 2010
survey
Over
a two-day period in January 2010, we carried out a random survey based on the
questionnaire we had designed of 100 volunteer participants in Petion Vile Club
camp, consisting
of a diverse camp population in terms of different age group, sex and
socio-economic background. This resulted in the return of 73 completed
questionnaires and the completion of six interviews. Among others, we found that
80% of the population believed that God had caused the earthquack and were
surprised to learn that around 60% believed that another disaster would strike
soon.
We
also found that 95% of the survey participants had a wide range of physical symptoms,
ranging from increased heart rates, to sleeping problems, nervousness and fear
of noise (Figure 1).
Figure 1 Survey results: Types of physical
symptoms experiences
Our
cultural-based model for psycho-social disaster assistance
We
integrated the findings of the survey into a modification of our program to
better reflect the Haitian culture and belief system. We understood that if we
wanted the community’s cooperation we needed to accept their basic perception
of the world, their religion (both Christianity and voodoo, and triggers for reward
or punishment). This new psycho-social approach respected the beliefs and
knowledge of the community and, at the same time, facilitated the processing of
universal and natural information, and also supported more appropriately
self-coping and family-coping tools. The resulting model comprised of three-stage intervention model (Figure 2) that
allowed us to reach different community groups. This structure also enabled us
to "fade into" the rehabilitation phase, particularly in the
education sector facilitating the rebuilding of communities around shared
institutions.
Figure
2 Three-stage psycho-social
intervention model
The
three-stage psycho-social intervention model comprised of activities that were
designed to be built on top of each other, starting with activities for
children, followed by work with parents and adults, and finally joint community
activities.
First
circle of intervention: Children
1.
Social games that emphasize
cooperation, positive experience, a sense of success, group encouragement and
building trust between group members;
2.
Games that incorporate local
songs and dances and emphasize creating common ground, mutual creativity, and
incorporating group members as leaders and participants;
3.
Drawing and providing a
psycho-social explanation for earthquakes, common reactions to trauma and tips
for further treatment;
4.
Intervention for younger
children focusing on drawing scary/ happy images;
5.
Older children (from second
grade onward) drawing with a wider set of instructions.
Second
circle of intervention: Group psycho-education for adults and parents
1.
What is an earthquake? Universality
and objective geological explanations, using cultural objectivity;
2.
Explanations on common reactions
to trauma and stress;
3.
The parental role and its
derivative complexity after disaster;
4.
Ways to deal with stress and
uncertainty.
Third
circle of intervention : Mass community activities
1.
Restoring
hope, mainly for children but including the whole community;
2.
Mass
sport, drama and music activities, which also involve parents in order to
create activeness and joy within the community [restore hope].
We
witnessed that this activity was becoming more popular every day. More and more
members of the community took part as dancers, assistances and watchers.
The
theory behind the model
Children
after disasters need interventions that support the functional continuity of
life (Klingman, 1992). The impact phase creates high emotional insecurity and
may cause anxiety and physical changes. In recent years, interventions are implemented
within the community settings, and for children, schools are the primary
institute that can provide help (Leo and Rato Bario, 2010).
The usage of physical education is fundamental. Physical activities include
many elements that can improve the lives of those affected at the physical and
mental level, but also enable improvements in other aspects, such as: body
image, social skills, self-confidence, persistence and more. Physical activity
is a combined factor inside a group that can create inclusion and equality
between the participants (Ley and Rato Barrrio, 2010).
Siedentop
(1994) has suggested sport education as a method of developing social skills
and managing skills. Hellison (2003) has developed a focused model aimed at
teaching responsibility through physical education. His model uses five levels,
built of different levels of responsibility- from understanding to performing, in
different circles - me, and others and transit it to real life. Eldar (2006) applied
a wider model, using physical activity as "support context" for
teaching and obtaining learning habits, social habits and emotional abilities.
Thus,
physical education creates a "safe zone" for children and adults,
while creating opportunities to determine a shared status and common goals .
After playing together it is easier to raise common worries and needs.
The
psycho-social education component was based on giving information and creating a
safe space for raising questions, observations and developing solutions. It was
a mechanism, through which we were able to identify needs and refer people to
other organizations for specific assistance.
We
wanted to implement a psycho-social interventions with a a different approach,
that could offer an easy transition to rehabilitation:
§ We used local language phrases, because
we believed that language is crucial for trust, understanding and perception of
situations, feelings and action.
§ We built the intervention upon
community characteristics.
§ We hired local educational staff
members that implemented the program together with us from the fifth day, and
continued on to lead the activities by themselves with us present 50% of the
time after 15 days. We made arrangements so that they could continue for at
least three months after our departure. Training the trainers was a main
component of our program, so that local staff members would become proficient.
§ After a month, we opened schools in two
camps as a focal institution and safe place for the children and the community.
It was important to us that the program would have continuity for at least
three months to help the community and identify children/ and adults, who needed
more focused help.
§ We did substantial work through physical
activities - an empowering intervention that matched the Haitian culture and
the people’s perceptions and experiences they shared with us. The majority of
those we interacted with said they were "feeling it in the body"- the
fear, the stress, the memories from the quake. [Therefore, also working on
improving physical well-being became a natural priority.?]
§ Consequently, using physical activity
was a frame for the psycho-social program, and not a tool by itself. Although
we knew that physical activity is an effective way to cope with stress, we knew
that it could be much more useful in combination with other techniques.
Implementation
into the psycho-social program
-
For
the psycho-social program, we identified two areas – (1) religious beliefs and (2)
physical stress - as the main important targets. We re-organized our
psycho-social meetings accordingly:
1. The explanation of earthquakes was rebuilt as an international phenomenon
that occur everywhere and in all religions.
2. We drew a map of the earth and provided scientific explanations for the
occurrence of earthquakes.
3. We used balls to explain the aftershocks.
4. We collaborated with the physicians to offer a detailed explanation of the
physical symptoms they experienced, as individuals and as parents.
5. We explained how the stress may influence the children and the family.
6. We empowered the family and the community as the primary responders by
talking on the situation and reflect that the community shares same
"basket" of problems, and teaching stress coping mechanisms on
several subjects:
- Sleeping problems.
- Physical calming by breathing, easy physical activities.
- Children in stress and how we can help them as family.
and more.
-
We aimed at transferring "control" back to the people through
information and education, and away from rumors. We did not argue with the
perception of the "act of God", but we provided information and
taught skills to help them gain active behavior for their own well-being.
The
next steps were to train local community members to lead the psycho-social
intervention and rebuild schools as core institutions for the children that would
provide a safe place and give parents time for themselves to cope, work and
start rebuilding their lives.
Concretely,
we started looking for community members to replace us. We aimed at young
educators or persons with therapeutic or community experience who knew English
and were open [to learn?], so we could apply a two-directional learning process
and would be able to give feedback to each other. We identified three community
members and trained them, learned from them local games and songs and, after ten
days, the mobilized groups took over and carried out the interventions with our
guidance.
After
three weeks, we decided to open a school in our main IDP camp (Petion Ville-
club). At the time, we were collaborating with the local NGO, PRODEV, and the camp manager NGO-
JP HERO, and agreed to open a school, which would also serve as a first community rehabilitation point.
The
school program was design together by an Haitian education expert and myself. We
integrated the basic core subjects of the Haitian education system and our
psycho-social program, art, music and sports. We developed a teacher’s training
program and an administrative component.
We gradually enlarged the school, added classes and opened a community
center. Between February and April 2010, PRODEV opened 12 schools and 8
kindergartens in different camps and neighborhoods. All staff members were
Haitian, to whom we provided intensive training and guidance, as the main
leaders and resilience builders of the school.
Recommendations
Based
on our experience in Haiti, I suggest a time line of psycho-social intervention
post-disaster that includes four main components:
1.
Fast intervention to reduce post trauma and stress symptoms.
2.
Reliance on local community members.
3.
Adaptive program to local needs and culture.
4.
Fast progression to the rehabilitation stage.
Suggested
timelines:
Day
1-5 after the disaster- entering the field: starting working with the
community, mainly the children on "first aid" small interventions.
Day
3-10: cultural assessment and adjusting of programs accordingly.
Day
10-20: program implementation, connecting to local organization/NGO and the
start of training local community members
Day
25-30: the opening or delivery of knowledge to the education system and to
professional therapeutic organizations.
Summery
The Haiti model
taught us much about the implementation
of psycho-social interventions based on a cultural understanding of the affected
local community, that we believe re transferable to other disasters. I believe
that the perception of the local community is the key factor in rebuilding
community resilience. I found that building trust in the community by working
with different age groups, relying on community members, advising the community
and having a sound exit strategy were key elements in effective coping and the
overall successes of the program. In Haiti, the main intent was to shift the
weight from outside forces to internal individual forces, but in other cultures
the main focus might be different. Integrating psycho-social interventions in
the educational system offers the parents a safe place for their children, gives
the community a new local center, and is the catalyst for building community
resilience. The strength of this approach was the building of the intervention
"language" while understanding the real needs of the community by
working with them daily, and transferring the leading to them.
References
Eldar, E. 2006.
Educating through the physical- Procedures and implementation.
International
Journal of Behavioral and Consulting Therapy. 2(3): 399-415.
Hellison, D.
2004. Teaching Responsibility through
Physical Education. Human
Kinetics.
Klingman, A.
1992. The contribution of mental health services to community- wide
emergency
reorganization and management during the 1991 Gulf War. Social Psychology International, 13: 195-206.
Ley, C., & Rato Barrio, M. 2010. Movement, Games
and Sport in Psychosocial
intervention:
a Critical Discussion of it Potential and Limitations within Cooperation for
Development. Intervention, 8(2):
106-120.
Siedentop, D. 1994. Sport Education; Quality PE trough
Positive Sport Experience.
Human
Kinetics.
Wolmer, l.,
Hamiel, S., & Laor, N. 2011. Preventing Children's Posttraumatic Stress
After
Disasters with Teacher- Based Interventions: A Controlled Study. Journal of
the American Academy of Child & Adolescent Psychiatry, 50(4): 340-348.
About the Author (me):
B.A. in special Education
M.A. in Geography of Disaster Areas
M.A. in Anthropology
Project manager of education in emergencies, community emergency
preparedness and response, and psycho- social intervention.
Haiti- January- October 2010 with FIRST
& Israaid and PRODEV- project manager- psycho- social intervention and camp
schools project.
