Survivor centric strategies and nimble resileince in the recovery proceess after a disaster

Survivor centric strategies and nimble resilience in the recovery process after a disaster

Joseph O. Prewitt Diaz

This commentary is to share a vision from the other side of a prism of disaster recovery that up to now has been presented to the disaster affected people after Hurricane Sandy.  It is mid June 2013, to this day the New York Times, the Daily News and other major newspapers in the area are reporting in the hundreds of thousands people are still living in temporary shelters. The U.S. Congress didn’t approve disaster aid until January 28, 2013 (http://www.nytimes.com/2013/01/29/nyregion/congress-gives-final-approval-to-hurricane-sandy-aid.html?_r=0).

Disaster-affected people in New York and New Jersey, have suffered lack of basic needs, severe weather, and support system that were not familiar to them. In addition the attempt to offer assistance for secondary stressors were foreign to them. A mismatch between the people and the way of life in place versus the way the Federal Government has planned the recovery operations has increased the insecurities, distrust and the fear of being uprooted from their place.

The tug between the external organizations with pre-planned programs to assist disaster affected people and the meaning that the disaster affected people are giving to a changing strengths and meaning of place may be serving as a block to the rebuilding of the places within neighborhoods and communities (Noji, 2005). Place is important concept to understand how people recover from a disaster in a large urban center since most research on place has been conducted in urban centers (Giernyn, 2000).

Survivor centric consultation, decision making by the disaster affected people in the re-establishment of place, the use if nimble approaches to foster resilience through psychosocial support techniques (Hobfoll et al. (2007); Prewitt Diaz, 2008b) to address the secondary stressors are the basic strategies needed to resolve the grit lock to services in New York and New Jersey.

Place is the perception in time and place of built and natural space that is constructed through narratives, stories, and networks. Historical, cultural, social, ecological and physicals attributes  are torn and re-woven according to the attitudes and feelings of people that find themselves in the eye of the storms, the peripheral turbulence, or who have lost themselves in the winds of despair (Sullivan, Schuster, Kuehn, Doble & Morais; 2009). Place includes leaving and coming back, cultural identity with others in the place, family connections, or this is the only place they know. There is nowhere to go, there is no way out. The multigenerational families, that developed the place, disbanded, the economy has collapsed. The only thing that remains is hope.

Having been displaced the night of Hurricane Sandy meant that the disaster-affected person didn’t know where they were or what was their place. To have no place means that disaster affected people were lost. There may be a lot of nice people trying to keep you calm but deep inside you know your place is gone. What are the next steps ponders the disaster-affected person. There were no words of comfort that could alleviate the feeling of being lost, disappearing, loosing connections, living in constant vigilance and being driven and governed by fear.

Prewitt Diaz & Dayal (2008) found with there work in the 2004 tsunami, that the key to meaning of recovery is found in place. The process of finding place is an inner and outer journey that fosters the capacity to locate place, give it meaning, and solidify the sense of belonging. Place holds the key to new beginnings. Place is the nature of a people joined together by their past and present, joined together by their aspirations for the future. The simplest explanation for what turns a group of people into a place is a shared narrative. Place is both a story and a history (Prewitt Diaz & Dayal 2008).

A nimble vision of resilience permits that homeostasis between built and natural environment in interaction with human beings may be the pathway to re-establish place. Defining as an end goal enhancing resilience provides an opportunity to disaster affected people to examine their place through mapping in its entirety, identifying the important elements of the place that enhance  resilience.

Psychosocial support provides a space for disaster-affected people to two specific phases (1) psychological first aid during the emergency phase. Psychological first aid entails basic, non-intrusive pragmatic care with a focus on listening but not forcing talk, assessing needs and concerns, ensuring that basic needs are met, encouraging social support from significant others and protecting from further harm (SPHERE Manual, 2011, p. 335).  and (2) trains community workers to provide basic emotional and practical support to the disaster affected people in addressing the challenges of secondary stressors, by activating social networks, community trusted traditional support, and supporting age appropriate centers (SPHERE, 2011, p. 334).  The efforts of psychosocial support should be community based in that international guidance suggests: (1) enable community members including marginalized people to strengthen community self-help and social support, (2) as part of early recovery, initiate plans to develop a sustainable community by advocating for basic needs and activating community networks to provide practical support (MHPSS, 2007; SPHERE 2011).

Psychosocial support facilitates the development of social spaces that encourage and sustain a quality of interaction wherein people feel they can touch, shape and be shaped by accessible conversation. These suggest a combination of localness and proximity that helps people to stay in touch. In such places, people feel a sense of voice that reverberates and creates resonance with events and processes that affect their lives. These activities may reduce the feelings of uprootedness, alienation and placelessness (Fullilove;1996).

CRSI (2011) suggests that there are four steps that the community, place or neighborhood has to do to take charge of their own destinies: (1) an understanding of the meaning of resilience for the disaster affected people, (2) a practical measure of resilience in action, (3) simple usable tools and process that will help the disaster affected people to move forward and tangible benefit is that flow from their efforts. Resilience when applied to disaster-affected people is nimble. It is the quality of places that faces, moves, through and bounce back from difficulty, damage, or destructive experience with a spirit that pursues and stays in touch with purposeful life.

This commentary describes how a psychosocial support approach can enhance the communication between those that support a survivor centric approach to recovery and the Government “fit all” methodologies. The paper proposes a systematic approach using place, resilience, and psychosocial support to achieve client centric solutions and develop nimble resilience. 

Sources available upon request.

Pssychosocial path to recovery after the Oklahoma City Tornadoes

Psychosocial path to recovery after the Oklahoma City Tornadoes

Joseph O. Prewitt Diaz[1]

Psychosocial refers to the emotional reaction of a person when they realize that they are experiencing an event for which they are not physically equipped to manage successfully. There are three central factors in psychosocial support: behavioral, spiritual and social. The behavioral part is usually addressed with behavioral health strategies (i.e. crisis intervention, counseling or psychological first aid). Spiritual care is often a component used to address death and destruction. The social component emerges after the immediate crisis and last for a longer period of time, and it usually alleviates the traumatic stress as a result of secondary stressors (i.e. returning to normalcy, re-establishment of place, reconstruction of neighborhood and homes, and assisting the recovery efforts in the community).

As I write this commentary there are search and rescue activities going on. We are not sure how hard the tornadoes hit, but we know there are some very specific actions that need to take place in the next days, weeks and months. Below are six essential steps:

·      Alleviate fear by facilitating linking with family, neighbors, community and friends.

·      Assure safety and security through satisfying basic needs, providing shelter, and initiate behavioral health and spiritual care activities that promote calmness.

·      Engage disaster affected people in conducting assessment of the affected area, focusing on prioritizing the need for natural and built structures that are needed to begin the recovery process (i.e. school, day care, hospital, senior center, churches, and community stores).

·      Disaster affected people identify their immediate needs and received assistance with temporary shelter, neighborhood cleanup campaigns, and defining steps in the recovery. This will provide guidance to external partners and interested people.

·      Promote Neighbor-to-Neighbor psychosocial support, and activities for children, the elderly and those with functional needs.

·      Take time to rest, through celebrations and information. At first of the little steps to recovery and later community wide celebrations, fairs, and other collaborative activities.

This is a time when the affected community needs external assistance, however in the coming days and weeks recovery should be people centric. Giving a voice at the decision making table to the affected neighbors will go a long way to enhancing resilience, and promoting physical, spiritual and psychological well being.

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[1] Dr. Prewitt Diaz (jprewittdiaz@gmail.com) has over 30 years of experience in community recovery post-disasters. He served as Senior Psychosocial Advisor for a major INGO during the recovery after the 2004 South Asia Tsunami, and was awarded the 2008 APA International Humanitarian Award. He is the CEO of the Center for Psychosocial Support in Disasters

In honor of human capacities in West, TX and Boston, MA

There is no way to explain the emotional toll of so many man-made disasters in the last week. The immediate response is to feel overwhelmed, helpless, and hopeless. Fortunately, with the passage of words, reframing your thought process from the events from terrible things to small miracles and the exhibit of resilience of the human spirit. Two elderly people come to my awareness. The first one was a 78 year old who was blown away by the bombing in the finish line at Boston. One would have thought that this man was hurt, yet he managed to get up complete the marathon and participate in a TV interview a couple of hours later. The other was an older fellow who experienced that silo explosion last night. When he came on TV this morning he was bloodied and seemed that he had just experienced a horrible experience, which he did, about an hour ago he came back on TV, composed, shaved, and with the assurance that all was well.   

We have been taught about these types of reactions. These two old guys were doing the best they could do, to re-assure the public that all was well. They were bringing a calming effect to the situation. Altruism and compassion are two behaviors that we saw in both explosions (Boston and West). Everyone was helping each other as much as they could. Allowing the community members to actively participate in their own recovery is a very healing activity. It builds up the resilience of the individual and the community. I would be interested in following up on some of that population that seemed victimized by these two explosions a year from now. I am sure and assured, by my religious beliefs, that they will be victorious!!!

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...