May 7, 1999

The earthquake that rocked the western Colombian cities of Armenia and Pereira January 25 killed at least 1,000 people and injured thousands more. Hundreds of people were left homeless after numerous buildings were destroyed.

The Colombian Psychiatric Association (CPA) is participating in the recovery effort by sponsoring training seminars on the psychiatric aspects of disasters in Bogota, the capitol, and Pereira-Armenia, according to APA President Rodrigo Muņoz, M.D., who met with CPA leaders, psychiatrists from Pereira and Armenia, and university representatives in Bogota in March.

Muņoz told Psychiatric News that initially the participants in the seminars will be psychiatrists who will be leading multi-disciplinary groups that include nurses, psychologists, and social workers. These teams will conduct outreach to victims. The seminars will also be open to psychiatrists from neighboring countries, including Venezuela, Ecuador, Bolivia, and Peru.

Two local psychiatrists in Armenia and Pereira are already working with groups of volunteers using local mental health materials and information on disasters brought by Muņoz. He also brought psychotropic medications.

Muņoz continued, "We believe, based on past experience, that the hardest period for victims is usually several weeks after the disaster occurs, when they have recovered from their initial shock and become more aware of their losses. That is when depression and anxiety can be severe and chronic."

Disaster expert Raquel Cohen, M.D., agreed. She will be leading the training seminars assisted by APA members Jorge Lievano, M.D., and Edgar Patino, M.D. Ishak Levav, M.D., from the Pan American Health Organization (PAHO) also will attend.

Cohen told Psychiatric News that Colombia has a history of natural disasters and that she trained some psychiatrists there in 1988, including the group leader in Pereira, after a volcano buried the town of Armero.

Although 90 percent of victims eventually recover from a disaster within a year, 10 percent have unresolved issues that need further psychiatric care, she said.

"Most people suffer from acute stress disorder, but a small percentage will experience major depression, anxiety, and PTSD," said Cohen, immediate past chair of APA's Committee on Psychiatric Dimensions of Disasters and a professor of psychiatry at the University of Miami School of Medicine.

She described three phases of victims' reactions. "Understanding when these occur is important so we can treat the symptoms appropriately," said Cohen, also a consultant to the PAHO disaster section.

Immediately after the disaster, victims are euphoric that they have survived. In the next few weeks, however, they struggle with shock, feeling paralyzed, and a lot of denial, Cohen observed.

From about four to 12 weeks after the disaster, the reality of the loss sets in and depression occurs. "A lot of work needs to be done to process what has happened and mourn the loss of their homes and neighborhoods," said Cohen.

At about four months, victims are ready to begin reconstructing their lives by rebuilding their homes and neighborhoods and returning to work, observed Cohen.

Cohen said she uses a crisis-oriented model in her training that emphasizes helping victims get back on their feet. "The goal is to help people recover a sense of equilibrium."

Team members interview victims about their experiences, feelings, and sleeping and eating patterns, said Cohen.

If team members detect the presence of psychiatric disorders, they attempt to refer individuals to psychiatrists or mental health professionals. Cohen noted that some underdeveloped countries do not have many psychiatrists, especially in rural areas.

As a result, she has learned to make use of the resources available. For example, some communities have a tradition of lay groups helping each other with psychological problems.

"You have to adapt the content of your training to the level of volunteers, with psychiatrists at the top to lay people at the bottom. You must also consider the cultural, symbolic, and traditional aspects of the local people."

Because the vast majority of people in Central and South America are Roman Catholic, "we try to reach out to local priests, who can be very helpful especially regarding issues surrounding death," said Cohen.