The traumatic stress after Kagera earthquake

Bukoba. The havoc that was on September 10 this year when the earthquake of 5.7 on Richter scale hit Kagera Region still lingers on the mind of Mr Twaha Katabazi, several weeks after the tremors shook the region, killing 19 people.

The 57-year-old resident of Bukoba District says his heart pounds whenever he recalls the mayhem that he witnessed on the fateful evening.

“I think it will take me several months to forget what happened. I still believe there is a day it might strike again,’’ says Mr Katabazi. Regional authorities say an estimated 126,315 people were affected and at least 16,667 houses were damaged.

That day, he recalls, the earth was rotating, moving up and down, and sideways. “I was somewhere with colleagues, watching a football match,’’ he further recalls, as he narrates a story that is still fresh in memories of most victims of the recent Kagera disaster, who spoke to Your Health.

“I can’t remember how the football match ended that day. None of us cared about the results of the game after disaster struck. My mind was lost in shock,” recounts Mr Katabazi.

In another district, Misenyi, where geologists say the earthquake originated from, the local authorities say they have been facing a hard time dealing with residents who still believe that the shocks of the earthquake haven’t actually gone away.

District Commissioner, Denis Mwilla says some residents of Murungu village in Minziro ward, where geologists from University of Dar es Salaam say was the actual epicenter of the quake, have been living in fear, believing the area is not safe anymore.

“We have been carrying out awareness campaigns through geologists, to try and calm people down,’’ says Mr Mwilla.

According to mental health experts, the fear attached to the devastating experiences such as the earthquake or other similar shocking scenarios may never stop haunting some survivors of the disasters.

People who experience the traumatic events, such as terror, rape or witnessing killings, may have reactions that include shock, anger, nervousness, fear, and even guilt, the experts say.

Although such reactions are common among survivors, and for most people, they go away over time. But for others, they may persist into a condition known as Post Traumatic Stress Disorder (PTSD).

According to University of Dar es Salaam psychologist Ignatia Mbatta, in some people, the feelings may continue and even increase, becoming so strong that they keep the victims from living a normal life.

“Some people may end up re-living the ordeal through thoughts and memories of trauma as flashbacks, nightmares and hallucinations,’’ she says.

“Children are usually more affected. There must be continuous psychological counseling to try and relieve them of that trauma in order to restore their psychological wellbeing, .”

PTSD that results from terrorist attacks has been examined in over a dozen studies of incidents in Kenya after the 1998 terrorist bombings at a US embassy, post-war reconstruction in Rwanda after 1994 genocide and others in Ireland, Israel, France, and the USA.

In countries where an earthquake disaster is known to have caused huge impact, studies have recommended various mental health interventions for the most vulnerable populations.

One study, done in 2014 China and titled, “The presence of post-traumatic stress disorder symptoms in earthquake survivors one month after a mudslide in southwest China,’’ evaluated the psychological impact of a mudslide on survivors of the Wenchuan earthquake in China about three years ago.

One month after the mudslide, the study says, the rate of PTSD symptoms was 18.7 percent. Females, the elderly, those with lower education levels, those that lacked social support, those who did not take precautionary measures, those living with children below 6 years of age, and those who had higher exposure to traumatic events, experienced a higher level of PTSD symptoms.

Findings indicated that timely rescue, abundant material help, and mental rehabilitation after a disaster play important roles in recovery, and that there were still some high-risk groups that needed attention, care, and effective intervention from healthcare professionals and society.

In Tanzania, a study published in Pub Med Journal in 2013, showed that 93 percent of children who experienced the bomb blasts that hit Mbagala suburb in 2009, were found to exhibit symptoms of PTSD.

The study, titled, “Prevalence of Post-Traumatic Stress Disorder in Children:the case of Mbagala bomb blasts in Tanzania,’’ revealed that children of all sexes were affected. “[There were] no sex differences in the PTSD cases reported,’’ reads the study in parts.

During a survey carried out by Your Health in Kagera Region, some of the victims spoke with emotional distress when they were interviewed, as they narrated how they were coping with the disaster aftermath.

Ms Juliana Samson (45), a resident of Nsanbya ward in Bukoba Municipality in Kagera, spoke on top of her voice and was visibly angry each time she tried to narrate the story of how her house was brought down to rubbles by the quake. Her neighbors said she had been complaining to everyone since the incident took place.

“We have gotten used to her. She blames the earthquake on bad omen. But I really believe it pains her when she now thinks of rebuilding her house from scratch,’’ her neighbor, Mama Koku* said.

A cleric from the Lutheran Church in the North Western Diocese in Kagera Region, Rev Remy Rwankmezi, says that the victims of the quake can be better off if they are allowed to vent off their frustration by narrating their ordeal to other people.

“This helps them to heal their minds and souls. They can do that through expressing their emotions, speaking about their fears, pain and what actually bothers them,’’ he suggests.

After a recent tour of the quake-hit region, the Minister of Health, Community Development, Gender, Children and the Elderly, Ms Ummy Mwalimu, was of the view that rehabilitation programmes in the region must go beyond rebuilding infrastructure.

Speaking at her office in Dar es Salaam recently, she noted that the post-earthquake recovery should go hand-in-hand with healing the “invisible wounds’’ in the minds and souls of those who witnessed the “horror,” such as houses crumbling down on some of their loved ones.

After similar disasters in Tanzania in previous years, various agencies stepped in to address PTSD. After the Gongo la Mboto bomb blasts in Dar es Salaam about five years ago, the Africa Medical Research Fund (Amref) carried out training for ward counselors on how to help communities cope with emotional distress and loss.

After the blasts, in which about 20 people died and several others got injured, even a strange piece of metal on the ground or a loud sound noise that people would normally take little notice of, could arouse fear among individuals the areas affected.

Researchers were concerned that the scenarios could possibly lead to high amounts of post-traumatic stress disorders and contribute to loss of sleep, appetite, paranoia and phobias.

Amref sought to address the needs of the communities as well as building sustainable practices in the event of any future tragedies. That included training in disaster response, bereavement and the impact of trauma on children and families.

Despite its profound impact on people’s lives, PTSD is still one of the underestimated public health concerns in Tanzania. There is a clear lack of awareness campaigns among the disaster victims on the value of mental health and their right to have access to both material and psychological support.

How to cope with PTSD

Tip 1: Get moving

As well as releasing endorphins and making you feel better, by really focusing on your body and how it feels as you move, exercise can help your nervous system become “unstuck”.

Activities such as rock climbing, boxing, weight training, or martial arts can make it easier to focus on your body movements—after all, if you don’t, you could get hurt.

Aim to exercise for 30 minutes or more each day—or if it’s easier, three 10-minute spurts of exercise.

Tip 2: Self-regulate your nervous system

Learning that you can change your arousal system and calm yourself can directly challenge the sense of helplessness that is a common symptom of PTSD. Mindful breathing is a quick way to calm yourself. Simply take 60 breaths, focusing your attention on each out breath.

Tip 3: Connect with others

Once the fight or flight reflex has been triggered, face-to-face connection with people who make you feel safe and valued is the quickest, most effective way of bringing your nervous system back into balance. The kind and caring support of others can be vital to your recovery.

Tip 4: Healthy lifestyle

The symptoms of PTSD can be hard on your body so it’s important to take care of yourself and develop some healthy lifestyle habits.

Take time to relax. Relaxation techniques such as meditation, deep breathing, massage, or yoga can activate the body’s relaxation response and ease symptoms of PTSD. When a loved one has PTSD, it takes a heavy toll on your relationship and family life. You may have to take on a bigger share of household tasks, deal with the frustration of a loved one who won’t open up, or even deal with anger or disturbing behavior.

Don’t pressure your loved one into talking. It is often very difficult for people with PTSD to talk about their trauma.

For some, it can even make things worse. Never try to force your loved one to open up. Comfort often comes from your companionship and acceptance, rather than from talking.

Let your loved one take the lead, rather than telling him or her what to do. Take cues from your loved one as to how you can best provide support and companionship—that may involve talking about the traumatic event over and over again, or it may involve simply hanging out together.