Reaching Resilience

A new manual entitled Reaching Resilience (www.reachingresilience.org) is a “must read” for those persons engaged in planning long-term recovery. The book includes eight key points on how to collect data, engaging stakeholders and designing flexible interventions. Each key point is divided into three sections: (1) Why it is important?, (2) Action Points, and (3) Pointers. The publishers of this manual are CARE Nederland, Groupe URD and the Disaster Studies of Wageningen University. By reading this manual and experimenting with the tools it provides, after contextualization, you can’t go wrong. 

Non-qualified immigrants are unseen and unheard after Hurricane Sandy in New York: Let my people be heard!!!

FEMA and other federal and state agencies only provide assistance to holders of Social Security Cards. These cards are issued after a person that is a (1) noncitizen national or a  (2) qualified aliens.  After Hurricane Sandy the primary source of disaster relief: the Individual and Household program and/or the Small Business Administration, was not available people that were not holders of social security cards, the so called non-qualified immigrants. (http://www.fema.gov/news-release/2013/01/22/who-qualifies-fema-disaster-assistance).

On Staten Island,  residents were surveyed (MRNY, 2012) in South Beach, Midland Beach, New Dorp Beach and Oakwood. These neighborhoods were located in New York City’s Zone A evacuation zones during Sandy. They experienced significant damage during the storm. According to the 2010 Census, 18% of residents of Midland Beach and 15% of residents of South Beach were born in another country.

On Long Island, residents of   Brentwood, Central Islip, Bayshore, Babylon, Patchogue and Long Beach were surveyed. Long Island’s immigrant population has more than doubled in the past few decades to just over 465,000 residents, accounting for more than 16 percent of the general population. According to the 2010 Census, more than 68% of Brentwood residents, 52% of neighboring Central Islip residents, and more than 29% of Patchogue residents were Latino or Hispanic.  For further information see MRNY (December 2012). Unmet Needs Superstorm Sandy and Immigrant Communalities. New York.

Most of the non-qualified immigrants are Latino’s from Central, South America and the Caribbean Island of Dominican Republic. In Long Island there is a cohort of Puerto Ricans 9although they qualify for assistance because they are U.S. citizens by birth).

The finding suggest that (1) people have lost their home, source of employment, or transportation that would take them to the place of work, and that the assistance provided by NGO’s is not sufficient to satisfy their long term needs. (2) there are strains, and emotional outburst amongst neighbors having to do with who received assistance and who did not, and (3) willing to participate in cash for work programs.

Alegria et al (2007) suggest that one of the ingrained qualities of the Latino population is the social connection. They are frequent participants of civic activities and show a willingness to help neighbors in times of need. This is the case after Hurricane Sandy except that this group is neither seen or heard by the decision makers. They are clamoring for a place in the table, where they can have a say on their future and the future of their families.

The literature on community based psychosocial support and Latinos suggest that lower-income Latino’s have been found at lower-risk of psychiatric disorders (Alegria, Canino, Simson, &Grant, 2006). Other studies (Breslau et al., 2006 and Gonzalez, Haan, & Hinton 2005) have found higher depressive symptom that may be caused by acculturative stress.

If acculturative stress is compounded by the traumatic stress resulting from the displacement, and fears generated by Hurricane Sandy, then there are long term needs for psychosocial support amongst this population that (1) focuses on (community and individual interactions that provide disaster affected people a web of social networks perceived as caring and available in times of  need, (2) targets weaving the connections among family, friends, and place that will strengthen the mechanism of social connections, and (3) provide psychosocial support activities, that serve as stress-buffering for post disaster secondary stressors.

Finally alleviate the fear of people coming forward and actively participating on the planning tables of FEMA, and other NGO’s by granting a moratorium on migratory status. Their contribution is very important for the future of our nation.

RELOCATION MUST BE CLIENT CENTRIC, AND COGNIZANT THAT IN CIRCUMSTANCES SUCH AS HURRICANE SANDY PSYCHOSOCIAL SUPPORT MUST CONTINue AS PART OF LONG TER RECOVERY

This weekend of spoke with one of my colleagues that is currently in New Jersey. The call came out of the blue, so I asked, ”how is it going”, after a long pause he shared his feelings for a while. I asked what were the three basic problems disaster affected people were facing: (1) lack of appropriate housing, (2) upper respiratory injections due to the mold, and (3) mental health issues to deal with secondary stressors. “It is so bad that whole families are impacted now and will be impacted for life”. “The sad part is that we don’t have protocols in place to deal with all the small issues that are turning into insurmountable mountains for these people”

Recovery must consider the psychosocial context and well being of the affected families. Such is the case with displaced people not recognized by FEMA such “as non resident aliens”. Relocation is an acute and short-term life events; except for those without government assistance it becomes a long-term life event. It imposes a considerable amount of stress because when the disaster affected people are forced to move because of an impending catastrophe, they know they will loose everything they had. This perspective minimizes the dynamic quality of mobility and ignores the longer term health and behavioral health consequences of the relocation that unfold gradually as the disaster affected families moved from the shelters to temporary housing, to living with relatives and hopefully back in their place.

Based on our experience and the existing research we propose that there are deleterious health and mental health effects caused by disaster related relocation, not only the immediate circumstances surrounding a move, but also the broader context of the individual’s residential history, the perception of well being in place, the current situation, and the aspiration for the future.  

Psychosocial Support and Disasters: THE VOICES OF DISASTER-AFFECTED PEOPLE MUST BE HEA...

Psychosocial Support and Disasters: THE VOICES OF DISASTER-AFFECTED PEOPLE MUST BE HEA...: Re-establishment of the built or natural “place” is more important to disaster-affected people than the areas emphasized by the govern...

THE VOICES OF DISASTER-AFFECTED PEOPLE MUST BE HEARD

Re-establishment of the built or natural “place” is more important to disaster-affected people than the areas emphasized by the government, i.e., mitigating damages and fostering resilience.  This point was clearly made by residents of the Rockaways in New York, which was devastated by Hurricane Sandy. In a meeting with federal, state, and local politicians, these residents voiced their desire to be heard. Moreover, last month, John Corri,[2] the co-founder of Friends of Rockaway Beach, was emphatic and clear when he indicated that his neighbors have expressed their concerns that they simply want their voices to be heard.  “We are talking about the future of Rockaway, and this is not the time for outside agencies to be dictating what’s best for us. This is our town and we want a seat at the table when it’s time to plan out our future.”[3]

Moreover, other New York residents are seemingly at greater peril. Make the Road New York (MRNY) a New York community-based umbrella organization conducted a study of Staten Island and Long Island amongst “non-qualified aliens,” i.e., non-qualified immigrants that have been barred from receiving monetary assistance from FEMA or unemployment benefits. Some within this group have children who are US citizens, but they are afraid to apply for services because they fear the possibility of deportation.[4] The umbrella organization has been able to document that thousands of families have lost their safety nets and community networks and are currently relying solely on their own emotional strength. Their needs include but are not limited to the following: (1) housing and the ability to re-establish their “place,” (2) supplemental nutritional assistance, (3) opportunities to become engaged in the reconstruction of their communities in a “cash for work” program or other type of labor reform, and (4) inclusion by FEMA and partner agencies (i.e., to actively seek out the people in need and provide psychosocial support for all those in this cohort).[5]

Interestingly, the federal government tends to agree with this community and its members. A report released by FEMA (2011) indicates “recovery can be successful only when it is locally driven, and the community [place] takes ownership of the process. The visioning process should be inclusive, reaching out to all stakeholders in the community for input [emphasis added].”[6]

In this instance, we have the following stakeholders: (1) a disaster-affected people from the Rockways clamoring to be heard regarding their thoughts about the future of their own built and natural place amidst the plans presented by external stakeholders for the recovery of that place; (2) a population of disaster-affected people from Long Island and Staten Island who have not received the full complement of services because of their immigrant status but still need to re-establish their places and four identified steps to improve their recovery process, and (3) a government agency and their respective partners who seem to agree that disaster-affected people must take ownership of their recovery and their place and be given the opportunity to provide input on the visioning for the future of their respective place.

However, the situation is missing a schematic of service delivery. The International Convention of the Protection of the Rights of Migrants and their Families and the International Standards proposed by the SPHERE Project propose a path that could resolve the existing situation. A gestation period during which disaster-affected people are given opportunities to express their frustration and share their dreams for the future is necessary; this is important in the immediate future due to the efforts to develop action steps moving forward, and it is necessary as a preventive method to reduce mental health issues that could arise a year from now.

Using psychosocial support as a platform, a non-governmental agency (NGO) would become responsible for meeting disaster-affected people in their respective places to identify their geographical space and outline their needs, hopes, and aspirations related to re-establishing their place. Community people would then be trained to weave pre-existing networks, develop new ones, and provide psychological first aid (i.e., provide an opportunity for people to voice their experiences and desires, thus generating calmness and contributing to visioning for the future). The NGO would then identify protective factors and challenges, prioritize potential projects to improve place (e.g., clean-up campaigns for the natural and built spaces and neighbor to neighbor projects focused on reconstructing housing) provide funding for these work projects, and provide children with emotional and educational assistance through after-school programs. 

Every activity focused on recovery is possible by maintaining a nimble posture; encouraging wide participation by the disaster-affected people in their own recovery process; becoming partners with the residents in their visions, dreams, and aspiration; and promoting the goal of enhancing resilience and well-being.

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[1] Dr. Prewitt Diaz is the recipient of the 2008 APA International Humanitarian Award and the CEO of the Center on Psychosocial Support in Disaster in Alexandria, VA.

[2] CNN iReport (March 13, 2013). Rockaway residents demand say in Sandy recovery plans. (http://ireport.conn.com/docsz/doc-946322?hpt=us_bn3).

[3] Ibid, p. 2

[4] Make the Road New York (MRNY) (December 2012). Unmet needs: Superstorm Sandy and immigrant communities in the metro New York area. p. 5

[5] Ibid, p. 10

[6] FEMA (2011). Lessons in community recovery. Washington, D.C.: Department of Homeland Security. p. 2. 

Hurricane Sandy and client centric services

Since Hurricane Sandy I have written and sent out to several journals and shorter articles to newspapers addressing two points: (1) the need for psychosocial support for all the disaster affected people and (2) the importance of engaging the disaster affected people in the recovery process and ultimately planning for their future. This morning I received the sixth note of rejection. The issues are not related to the theoretical basis of the argument but to “grammatical errors that may district the reader”. I shouldn’t feel in angst, I have lived in this country long enough to realize that outsiders are not really welcomed, especially if they have an accent or if they don’t have a mastery of the written language.

Let me try one last time to articulate what I am trying to say based on more than thirty years of experience working disaster response in over 32 countries in the world.

1.     Recovery process doesn’t belong exclusively to the external stakeholders. If the recovery plan is not viewed positively by the affected people it may not work well. Acceptance by both groups will dictate the level and quality of participation that has to take place in the development of the recovery plan if the final goal is “a resilient and healthier community”.

2.     If resettlement is necessary in areas with large number “undocumented residents”, then develop an appropriate level of assistance, have the disaster-affected people involved in designing and implementing of their recovery, and minimize adverse psychosocial negative impact.  

3.     Articulate interests and needs so as to reflect the complexity and multi-dimensionality of the recovery process. Have patience, steps toward resilience must be nimble, the gestation period with all stakeholders will strengthen the social fabric of place, neighborhood and community networks.

I  WOKE UP THIS MORNING WITH STRESS REACTION THAT OCURRED TEN YEARS AGO: THE TERRORIST ATTACK TO THE UNITED STATES ON 9/11/2001

Joseph O. Prewitt Diaz[1], PhD
September 9, 2011
Cayey, Puerto Rico

In the morning I was awakened by a dog barking in the distance. I had a slight headache, stiff neck, was shaky and hyper-vigilant. The first thing I did was make coffee and check whether the tanks were full of the generator, then I looked at the cuvert where I keep the emergency equipment. As I sat down to take my blood pressure, I realized it was a sunny day and the weather forecast, was not calling for bad weather today or the rest of the weekend. After deep breathing seeveral times I was relaxed enough to reflect on my actions this morning.

I realized that my actions were consistent with traumatic stress reactions, these reactions were due to an event that happened ten years ago. The terrorist attacks of September 11, 2001. Around that time of the year,  I always get up experiencing the transitory experience.

My name is Dr. Joseph O. Prewitt Diaz, born in Cayey, Puerto Rico. I am a psychologist specializing in humanitarian assistance. I spent most of my life working on the Disaster Services American Red Cross (ARC). The night before the attack I had returned to my daughter’s in State College, PA for a  two weeks leave from my current  position as an International Delegate serving as  ARC Regional Coordinator for recovery for Central America after Hurricane Mitch.

In my role as Coordinator of Disaster Mental Health within the Disaster Services Human Resources (DSHR) , I was part of the National Team that responded air transportation events. The decade of 1990-1999  I served in many of  the traumatic events that would change the way the nation prepares and responds to natural and manmade disasters. Some of these events were Hurricane Andrew, the attack on Murray Federal Building in Oklahoma City, several plane crashes, floods, storms, hurricanes and tornadoes. I felt sure that with the level of theoretical and practical experience I could phase any disaster, do my job and move on.

That night (Sept 10^th) my daughter and I sat down to plan my days. The next day I had to drive her to work, pick up a prescription, take the car to change two tires and meet for lunch. I took her to work, and when  I arrived at the pharmacy I saw on a TV a plane hitting one of the Twin Towers in New York. I remember I told the pharmacist "this movie is very realistic what it is called" the man looked at me with a dull expression, and said “that not a movie it is an accident: a  plane crashed into the twin towers" and continued to fill the prescription, a few moments after the second plane crashed. Not sure of what I had seen, I called the Headquarters of the  Red Cross in Washington to ask what was going on, the voice at the other side answered, "seems to have been a fatal plane crash in New York, give me your phone number in case we need you." I called my boss in International Services and I he told me "this is an accident, do not think you need, just relax on your holiday, thanks for checking in."

When I reached the garage, I noticed a commotion in the waiting room. No one was attending the reception desk, all customers and employees were glued to the television. No sooner had the door open when I received a call from my daughter, she said "Dad, America is under attack, a plane just crashed into the Pentagon and I can not find Joito and Jerry." I told her not to worry that I would get in tuch with them, I commented that maybe this was a drill. Several days later I learned that my son and brother had gone unscathed  from such  ominous event.

Not a minute had passed when I received a call, the voice on the other side had a serious tone "we are under attack, two planes crashed in New York, one in the Pentagon, and they are tracking a fourth plane to somewhere over Pennsylvania, report to your nearest Chapter and call me back." I understood intellectually that it was a real issue. Pancho de la Roche was not a hype man, his ability to communicate in times of crisis was accurate.  This was the real thing a thousand thoughts ran through my mind and I felt an adrenalin rush.

When I reached the chapter in State College, PA.  I checked in and immediately called Washington.  Fred forwarded my call to the Emergency Operations Center. I heard  the familiar voice of Dr. Susan Hamilton who greeted me cordially and efficiently. She explained what was happening and wanted me to prepare to leave for New York immediately. At the moment I heard from the other side "Oh my God”,” Jose hold one." Within seconds, the voice said, "José report to emergency management in Somerset, Pennsylvania, a plane just crashed there. By now you're in charge of mounting the mental health services in disasters, we will send staff when we can. " I asked how many hours" and she said, "In two or three days”.

When they arrived, I found that I was the only person from National”. I proceeded with the help of local volunteers, and the guidance from Washington to set up the DMH services that would be offered for the next four weeks, a clearinghouse for the rescuers, coordinating mental health services for the morgue, open the Family Reception Center and reported to the Center Federal Command. The next day Dr. John Weaver arrived and took over the operation, on day two Dr. Margaret Pepe who was in charge of the operation, John was in charge of dealing with the Family Center, and I was in charge of assigning the 27 volunteers.

I was sitting in the Command Center when the personnel from United Airlines put the names of the passengers of United 93. One of those passengers was a Puerto Rican professional who worked at the Census Bureau in Philadelphia, and happened to be on the plane on her way to California. In my previous trip, had the opportunity to make a presentation in Harrisburg, Pa on migration patterns of Puerto Ricans in Pennsylvania, a member of the panel had been that person.

Needless to say how difficult it was to receive this family and make notification of what happened and what we expected to happen in the coming days. The mom had a heart condition and the Red Cross made arrangements to bring a Puerto Rican cardiologist Scranton, who happened to be a volunteer, to be with family during the four days they were in Somerset.

 The commemoration ceremony was very moving. Family members were driven in a bus to the place where the plane crashed. There was not much to see, only men dressed in white uniforms and a large crater in the ground in the distance. Personalities  like representing the United States, such as  Congressman John Bertha, members of the Executive Branch, the President of the Red Cross, Laura Bush, President Bush's wife were present and offered the condolences to each family on behalf of the Nation. Then we went to a place where there was a prayer meeting, and informal visits with each family. Each family received a little crystal box with soil from where their dear one’s had come in contact with the earth. That night I met the Puerto Rican  family and had a meeting to give closure to this part of the process and make sure that all formalities had been fulfilled.

Three weeks after returning to State College, I returned to meet with my children, and that afternoon I went back to Guatemala. I stayed  in touch with my collegues, at both formally and informally with the recovery process in New York and Washington. One year later, in August 2002 I returned to Washington for an official visit of "debriefing" with peers who worked in the early days of the response. I still had not realized my traumatic response to that operation until this morning—when 9/11 came to life in my awareness.

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[1] Dr. Joseph O. Prewitt Diaz is the recipient of the APA International Humanitarian Award and the Government of India Certificate of Distinguished Service (Silver Award). He is Adjunct Professor and Director of the Disaster Law Center, School of Law, University of Puerto Rico. He continues to be an active volunteer with the Puerto Rico Chapter American Red Cross