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From the Bangkok Post Tues. Jan. 18th, 2005... People can endure only so much pain More than three weeks after the killer waves struck six provinces along the Andaman coast, the anguish of survivors remains endless. While many have not yet found missing relatives, others have proceeded to the next painful step of rebuilding their lives from scratch If people in good health are finding it hard to pick up the pieces, those disabled by the catastrophe have that much more with which to contend. The Public Health Ministry has estimated that 10% of the 8,457 injured are physically and mentally disabled by the tsunami that hit the provinces of Phangnga, Phuket, Krabi, Ranong, Trang and Satun on Dec 26. Being an official estimate, it is likely conservative. Villagers, fishermen and their children have had their arms or legs amputated as a result of severe injuries caused by the impact of the waves, the trees they uprooted and other debris To address these people's short-term problems, the Medical Services Department has allocated 10 million baht for the production of artificial limbs, wheelchairs, walkers and tripods. For their long-term rehabilitation, the department plans to work with the Labour and Social Development and Human Security ministries on the provision of physical therapy, occupational training and loans. Loss of limbs and the accompanying impaired mobility will be particularly hard on fishermen, although amazing advances have been made in prostheses. Some will be able to adapt, others may venture into new occupations. Those who find both difficult will need more help. While physical disabilities cannot be classified as more or less serious than psychological damage, the loss of an arm or leg is visible, and quantifiable, and the treatment obvious. But the emotional shock of those who lost family and friends does not immediately meet the eye, and they will need a great deal of time to come to terms with their pain. In addition, some of the physically disabled are also psychologically distressed by a perceived loss of independence. The World Health Organisation has pointed out that it is not only residents of and visitors to the disaster areas who are vulnerable to stress. Volunteers and professionals carrying out gruesome relief work will also need help. Earlier reports suggested that more than 1,000 people in the six provinces had sought psychiatric help, including 600 from Phangnga, the worst affected province. An unknown number may never come forward as social stigma dies hard. The Mental Health Department is taking charge of the task of assisting the emotionally disturbed, fielding teams to affected areas. The importance of drawing on all the social capital that exists cannot be overemphasised _ including the family, the community, volunteers and religious practitioners. And the government and experts must be generous in dispensing advice and training. Wachira Pengjuntr, the Mental Health Department's deputy director-general, has emphasised the importance of getting victims involved in rebuilding their communities. The rationale behind transforming victims into relief workers is that this will help rehabilitate the individuals and their societies. For many of the survivors, fear and guilt loom large. The fear stems from the images and sounds of the destruction, which will revisit these people for a long time to come, in dreams and in waking life. Some people may turn away from the sea indefinitely, which will be tragic for fishermen if they cannot adopt a new livelihood. Guilt will haunt people who lost relatives to the killer waves, and the task of psychologists will be to train social workers in the art of persuading them that there is nothing they could have done. The saddest population of survivors may be the orphans, who number at least 400 in Thailand and are a source of special concern. Those approaching the age of reason and who are yet unable to express their grief will need sustained help. They should be encouraged to engage in play and creative activities, as suggested by Unicef and paediatricians, at home as well as at school. Anuraj Manibhandu is Editorial Pages Editor, Bangkok Post |