Disaster-Affected People In Bangladesh Increasing The Provision Of Mental Health Care For Vulnerable – Women Must Constitute At Least Half Of The Team

We have proposed the adoption of a mental health and psychosocial support framework developed by WHO after the 2004 Indian Ocean tsunami, as a step towards this.

This must be applicable to the postcyclone and ‘post flood’ context of Bangladesh, and it will include both clinical and nonmedical, social approaches to supporting traumatized and vulnerable survivors. By the way, the key to success will be the ability to train and support the unique, ‘pre existing’ potential workforce for the non medical component -the 50000 strong workforce of Cyclone Preparedness Programme volunteers -alongside the country’s extensive network of communitybased health workers, who could provide simple clinical services as necessary.

The frequency and intensity of floods and cyclones is expected to rise in Bangladesh for a reason of climate change.

With hospital support as necessary, the work at Levels 1 and 2 may be led by community mental health teams on a mobile or outreach basis. Therefore, women must constitute at least half of the team, whose members should also have good skills in nonmedical and psychosocial support. Now let me tell you something. I know that the teams must ideally consist of 3 4 staff, some amount of whom are locally recruited to ensure awareness and understanding of the prevailing cultural norms. That said, the burden of mental illness is also expected to increase in the country, with that. Just think for a moment. There’re therefore strong grounds to mainstream mental health problems into disaster response in a more comprehensive fashion.

Geography and ‘socio economic’ status also interact to determine the extent of an individual’s susceptibility to these storms.

By definition, poor people also have relatively fewer resources to prepare for or recover from disasters. Known thus, both women and the poor in Bangladesh are at disproportionately greater physical risk from cyclones than other population groups. Poverty rates are higher in these ‘low lying’, climatically vulnerable coastal regions than they are elsewhere in the country, that means that there’re simply more poor people in the areas that most possibly will be struck by cyclones than there my be if poverty rates were more evenly distributed around the country, as indicated above.

These disasters did not impact the populations in the affected areas equally.

a lot of reasons for this will be on the basis of the different physiological capacities of women and men to run, swim, or hold on to steady objects, that means that women might be more going to be swept away by water or high winds. Bangladeshi women face a socially constructed, ‘genderspecific’ vulnerability which, it is convincingly argued, is responsible for a large proportion of this excess mortality. This is where it starts getting entertaining, right, am I correct? This vulnerability is manifested in heaps of ways, as below. That said, analysis of the mortality figures from among the affected areas in the 1991 cyclone, let’s say, revealed that the death rate was 71 per 1000 among women aged ’20 44′, as compared to 15 per 1000 for men in similar age group. Yes, that’s right! These figures reflect the gender survival differentials seen in many natural disasters.

From childhood, girls and boys learn quite a few gender based behavioral restrictions, and these ensure an enforced separation of women and men throughout their lives. While also hindering her ability to ‘relocate’ to a safer area before a storm, his section builds a case for the institutionalisation of a communitybased. This can both impede a woman’s access to information about cycloneinduced floods, thereby denying her the opportunity to prepare in advance. Unless they are accompanied by a male relative, these restrictions are exemplified by purdah. Among other things. Or homestead. Then again, after which we present a brief review of plenty of the major weatherrelated disasters to have struck Bangladesh over the last 45years, we first provide the broad context by describing various significant events in Bangladesh’s political history, followed by the ‘post disaster’ mental health burdens observed in the country and elsewhere in South Asia after particular events. We propose an adaptation of the World Health Organisation’s ‘Framework for Mental Health and Psychosocial Support after Tsunami’ for use after future natural disasters in Bangladesh. However, the policies and actors who are currently engaged in responding to natural disasters are so introduced.

The authors acknowledge the European Commission for financial support of INTREC.

They have insufficient resources to protect themselves, when they are struck by disaster, to adequately rebuild their lives after the event, or to access the medical services that they urgently require. In the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication, The funders had no role in the design of this paper. On top of this, there’re also important social determinants that increase the human impact of major storms and floods, these geographical factors combine to make the country physically vulnerable to natural disasters. Quite a few coastal district residents are ‘low income’ agricultural workers, the majority of whom are landless and relatively ‘assetpoor’. A well-known fact that is. Prime among these is the fact that poverty rates in coastal districts of Bangladesh are significantly above the national average. Known in spite of people’s resilience and adaptive capacity when confronted by adversity, now this chronic lack of resources can leave the poor facing further vulnerability to future, major weather events.

And therefore, for those who survive, to suffering from some sort of ‘disaster related’ mental health illness, Bangladesh particularly vulnerable to dying in natural disasters.

These determinants are at least partially amenable to change through policy and action, while deeply entrenched. While for the poor, it’s the fact that they are, by definition, only able to afford to live in the most climatically dangerous, and underserved parts of the country, For women, it’s largely since the enforced gender separation, or purdah, that they endure. It’s aafter the partition of ritish India in 1947.

WHO estimates that up to 50 of survivors may have psychosocial needs that could benefit from this sort of community based approach. Now also imposed upon the East, there was an unequal division of power between the two ‘wings’ of the country. Especially so when Urdu was designated as the sole official state language, hitherto spoken only in the West. Country’s capital city and main powerbase was in what was after that, West Pakistan, that corresponds to the current Islamic Republic of Pakistan. As well as strengthening community networks through activities that facilitate isolated people to meet each other and generate mutual support, Levels 3 and 4 focus on the training of traditional healers, teachers, religious leaders, women leaders and similar community leaders to provide support.

With over half a million people lost to disaster events since a number of these people have died during floods or cyclones, bangladesh has the highest natural disaster mortality rate globally, both of which most probably will become more frequent due to global climate change.

Actually the government’s postdisaster response strategy has focused, increasingly effectively, on the physical needs of survivors, through the provision of shelter, food and medical care, in order to date. I know that the serious and widespread mental health consequences of natural disasters in Bangladesh have with that said, this Debate article proposes a practical model that will facilitate the provision of comprehensive and effective ‘post disaster’ mental health services for vulnerable Bangladeshis on a sustainable basis.

Authors declare that they have no competing interests. Emergency phase, quite a few people within the affected populations are left with some extent of psychological or mental health problems, after this acute. Depressive symptoms or major depressive disorder, these can include ‘posttraumatic’ stress disorder substance abuse, and aggression. Now look, the immediate concern after a natural disaster is naturally to ensure that survivors receive the basic necessities to sustain lifespan, just like shelter, food, safe water, and sanitation.

The Bhola cyclone was perhaps the deadliest tropical storm of all time.

Accordingly the teams must include local, suitably trained people. Further, to facilitate programme sustainability, the teams going to be integrated into any local network of governmental and nongovernmental organizations already present in this location. It struck Bangladesh in November 1970 with a massive storm surge that killed an estimated 300000 people in coastal areas of the country, and adversely affected the lives of five million more people. One is that the mental health teams going to be aware of the socioeconomic status, culture, traditions, language and local livelihood patterns of the populations that they are working with. However, the evidence presented in this paper also indicates that special care and attention will be given to those whose social conditions make them most vulnerable to mental health problems -women and the poor -both looking at the how to physically make contact with them, and looking at the specific support that they may require. Now this means that services need to be provided through both primary health care and community settings. Some key fundamentals have been identified as essential to providing an appropriate and sustainable mental health response after natural disasters. However, 280000 cattle, around 100000 fishing boats also contributed to major political changes in the country.

It’s a well-known fact that the Bangladesh Climate Change Strategy and Action Plan provides a detailed roadmap outlining the country’s response to climate change. Up until now, the provision of such support was inadequate. Now this Debate paper has argued for a realignment of post disaster assistance in Bangladesh. No specific mention is made out of mental health, the core pillars of action identified in the document aims to ensure ‘Food security, social protection and health’. That said, this issue might be addressed as a matter of urgency, with the likely increase in severity and frequency of major weather events in Bangladesh due to climate change. Now let me tell you something. Large proportion of the survivors -and especially women and the poor -are deeply traumatized and need psychosocial support, the Cyclone Preparedness Programme has greatly reduced mortality rates in natural disasters. It is the broadly effective work already conducted by the Cyclone Preparedness Programme, mostly there’s also a need to respond to the socially determined vulnerability of particular categories of people -specifically women and the poor -and to place a much stronger emphasis on mental health care and support for these groups.

Determined not to repeat identical mistake, among the first major actions of the newly independent Bangladeshi government, in 1972, was to establish the Cyclone Preparedness Programme. That said, this work is accomplished by around 50000 trained volunteers who, among other things, build cyclone shelters, assist with evacuation and rescue, conduct first aid and emergency relief work, and in addition support survivors after cyclones. Did you know that the CPP’s vision is to minimize loss of lives and properties in cyclonic disaster by strengthening the capacity in disaster management of the coastal people of Bangladesh. Today that’s run by the Ministry of Disaster Management Relief in collaboration with the Bangladesh Red Crescent Society.

Health expenditure in Bangladesh was 7percent of GDP in 2011, of which just 44 is spent on mental health.

NN had the idea for the study and led the first draft of the manuscript. Bangladesh’s 161 million people are served by just 90 psychiatrists. Certainly, jK coordinated the process and finalized the manuscript. Considering the above said. BW contributed to the first draft of the manuscript. YB, IK and LT participated in the design of the study and helped to draft the manuscript. So there’s no social insurance scheme coverage for mental disorders, and there’s only one mental health hospital in that of the country. Now let me tell you something. All authors read and approved the final manuscript. Sounds familiardoes it not, am I correct? Even when they live in the very places where disaster related mental health care needs are the greatest, rural residents suffer more from the lack of mental health services than urban residents.

It’s an interesting fact that the scale of the major weather events that Bangladesh has faced -and in one way or the other will continue to face -is briefly illustrated by the following examples of cyclones and floods that have hit the country over the past five decades. Meanwhile, health worker teams implemented appropriate health care intervention measures. Volunteer workforce was deployed to distribute food and safe drinking water, after the storm. Actually the affected populations appreciated the disaster effort, though it’s vital to note that many also said they would have liked volunteers and health workers to stay longer in the cyclone impacted areas. At the time of Cyclone Sidr in 2007, nearly 4000 cyclone shelters -multi storied buildings, raised above groundlevel on concrete pillars so as to resist storm surges -were operational.

The first of these is flooding.

Women and the poor are actively sought out and provided for because The framework is ‘community based’, it includes both medical and non clinical components, and it will be adapted. These services could’ve been run by Bangladesh’s preexisting 50000strong Cyclone Preparedness Programme workforce, alongside the country’s extensive network of communitybased health workers, after training. With serious adverse consequences for millions of people, in extreme years, nearly 70percentage of the country can be inundated. Collectively these rivers drain a total of about 7 million square kilometers, including the Himalaya mountains, and they cause flooding in Bangladesh every year. Also, in response to the 2004 Indian Ocean tsunami, the World Health Organisation developed a framework for providing mental health and psychosocial support after major disasters, that, we argue, might be adapted to Bangladeshi postcyclone and post flood contexts. This is the case. Bangladesh is home to the world’s largest delta, formed by the Ganges, Brahmaputra and Meghna rivers. On top of this, flooding effectively fertilizes much of the country’s agricultural land, and society has adapted itself to this annual event.

Women shoulder the primary responsibility to look after and protect children -who may cling to their bodies and obstruct their movements -as well as the elderly. Naturally, the primary focus will be on providing for the physical needs of the tens of millions of people who will face these various natural disasters. The scale of the challenge that lies ahead is immense, This may hamper their efforts to remain safe, and it could also reduce their chances of being rescued. a lot of survivors endure extraordinary suffering and loss, and a proportion of these require some sort of psychological support to can be available. I know it’s nonetheless clear that a significant proportion of the population still require mental health support years after the event, while the relative figures for different psychiatric conditions may vary between different disasters. Usually, this particular combination of mental health care services goes somewhat further than the extent of services called for in the recently developed ‘Balanced Care Model’ for mental health care in lowincome settings like Bangladesh. By the way, a population based survey conducted in south India 5years after the catastrophic Indian Ocean tsunami of 2004 found that 78 of the sample group still had some sort of psychiatric morbidity. Specialist mental health care workers are So there’s no specific mention created from ‘community based’ services.

The second and more dramatic natural disaster that afflicts Bangladesh is the cyclone.

Over 35 million people live in the coastal zone of the country, all of whom are, to a greater or lesser degree, regularly exposed to these cyclones and their associated storm surges. Coming in from the south, via the Bay of Bengal, 15 significant cyclones have struck Bangladesh since 1960. Whenever accounting for between 80percent and 90 of all global cyclonerelated losses regarding the lives and property,, they are the deadliest.

This issue was illustrated by a 1996 study conducted in the Tangail district of Bangladesh, four months after a tornado had killed 600 people.

In another survey, conducted two months after Cyclone Sidr in 2007, 25 of 750 survivors were found to have posttraumatic stress disorder, 18percent had major depressive disorder, 16percentage had somatoform disorder, and 15 had a mixed anxiety and depressive disorder. As well as their need for psychological assistance, the study assessed the psychological effect of the tornado on people living in the position and it found that 66 of the disasteraffected people were traumatized and in need of psychological help.

Then the disaster planning protocols that was enacted over the past few decades have substantially decreased death rates over time, all of the storms described here were very large. That said, this means that there’re now more survivors than before, that in turn highlights the critical importance of ensuring good mental health support for vulnerable survivors who have experienced trauma and loss. Now this Debate article has arisen out of the work of the multicountry ‘INTREC’ programme that examines the social determinants of health in low and middleincome countries. Of course we therefore propose a practical model to provide appropriate and effective ‘postdisaster’ services for these vulnerable populations on a sustainable basis. With women and the poor among the most vulnerable, our aim here’s to highlight the fact that the degree of risk for postdisaster mental illness in Bangladesh is largely determined by social factors. These two groups are currently also systematically underserved by the country’s mental health services.

In Bangladesh, the rural poor who live in low lying, floodprone or coastal areas, are most vulnerable to natural disasters. Women make up a disproportionate share of the poor in Bangladesh, that is another reason for their increasing vulnerability to mental illness problems for reasons that are entirely socially determined. Evidence from this review suggests that they are also inherently at greater risk of acquiring post disaster mental illness.

After the event.

Anger over this and similar political and economic problems led to the emergence in the early 1950s of an independence movement, that finally boiled over in 197071″ into the Bangladesh Liberation War. Now, a major trigger for this Liberation War was a massive cyclone, the official response to which was seen by many in the East as being completely inadequate, as explained further below. Normally, even when available, women may not always access health care because of cultural restrictions or household responsibilities. Anyways, independence from the West was eventually gained, and the new state of Bangladesh was born in 1971, guided by a constitution which asserted the fundamentals of nationalism, socialism, democracy, and secularism.

Right after a major cyclone killed around 10000 people in after the storm, the intervention could perhaps follow an approach adopted in Orissa state in India, a team of psychiatrists and psychologists made regular visits to amidst the affected areas.

The intervention was positively evaluated, and could form the basis for similar approaches in Bangladesh, that could consequently be more rigorously evaluated and further improved. On top of selfhelp groups for mutual support, they also set up shortstay homes for orphans and widows from the storm. For instance, whenever listening patiently, and guidance, the volunteers received training in supportive psychotherapy which included empathy. Now let me tell you something. Their visits were supported by local volunteers, similar to imams, community leaders, and teachers.

Amongst the model’s essential premises is that post disaster mental health interventions need to cover both clinical interventions and basic, non clinical, psychological support interventions.

Indeed, even though the destruction brought about by the 2004 tsunami caused great distress in dozens of the population, the increase in mental disorders that required psychiatric now this majority will benefit from a range of ‘nonmedical’, social, and basic psychological interventions that can help to reduce distress. Clinical interventions are required for only a small proportion of disaster affected populations.