Vector Volume 11 Issue 1 - 2017
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increase the incidence of disasters – both man-made and<br />
natural – and that developing countries will be most affected<br />
in terms of number and severity. It has been shown that the<br />
risk of PTSD also rises proportionate to increase in severity<br />
and frequency of such events.[15]<br />
Several factors worsen the impact of disasters. Houses<br />
are often of inferior build quality, which reduces the ability<br />
to withstand severe forces.[7] Slums and communities<br />
experiencing poverty are also likely to be built in disasterprone<br />
areas such as flood plains because their inhabitants<br />
are unable to obtain property in safer areas.<br />
In the immediate aftermath of these events, LMIC may<br />
struggle to adequately treat the problems of their citizens<br />
due to limited training and capacity of healthcare and<br />
aid professionals.[10] The World Health Organization has<br />
recognised the role of unskilled aid workers in assessing<br />
mental health conditions and have devised a framework to<br />
use in these circumstances.[16] Untrained or poorly-organised<br />
humanitarian aid and destruction of primary infrastructure<br />
may also constitute secondary stressors following natural<br />
disasters and may compound the initial trauma of the<br />
event. Improper, or lack of, information dissemination may<br />
lead to anxiety and depression about food distribution, with<br />
negatively impacts on community wellbeing.[3]<br />
Determinants of effectiveness of public health responses<br />
One of the difficulties surrounding mental health disaster<br />
response is the changeable nature of the assistance<br />
required. Systems required in the immediate aftermath to aid<br />
those dealing with loss, physical impairment and adaptation<br />
to a different way of life are vastly different as some people<br />
return to their original occupations and homes.[3] Pre-disaster<br />
planning should involve a multidisciplinary team of healthcare<br />
professionals, infrastructure experts and politicians to create<br />
lasting policies that are effective and easily implemented.<br />
Disparities in the availability, accessibility and quality of<br />
mental healthcare due to ethnicity are well-documented. This<br />
may be due to language barriers, fears regarding insurance<br />
and monetary constraints, geographical difficulties<br />
(especially in rural communities), mental health stigma and<br />
lack of education.[7] Addressing these barriers may increase<br />
uptake of such services and reduce the incidence of mental<br />
health-related decrease in quality of life for those most at<br />
risk.<br />
Solutions include the validation and normalisation of<br />
distress reactions, so individuals feel they are experiencing<br />
legitimate reactions, rather than moments of weakness.<br />
[7] It is important to recognise the role of communities and<br />
to establish programs which value interdependence rather<br />
than independence in such situations. Promoting community<br />
action and initiatives will increase community resilience and<br />
realisation of the true impact of shared events.<br />
Cultural competence and sensitivity in foreign aid workers<br />
is essential to effective integration of support services,<br />
as well as the recognition that cultural competence is an<br />
ongoing learning process rather than an end-state.[16] It<br />
is important to identify the causes of potential stigma and<br />
mistrust in order to properly engage minorities in healthcare.<br />
Rituals and traditions from the cultures of those affected may<br />
also be utilised and integrated into care solutions, thus using<br />
innovative interventions to circumvent such difficulties. Finally,<br />
it is critical that aid workers and all stakeholders advocate,<br />
facilitate and conduct research into the incidence of mental<br />
illness and effective treatment solutions for mental illness in<br />
affected populations to increase efficacy of interventions in<br />
the future.[1]<br />
Disaster-derived mental illness: a contemporary<br />
perspective<br />
Disasters today are often man-made, as in the case of<br />
conflict. There is scarce research into the impact of such<br />
political conflict in LMIC. Of the research exists, it has been<br />
shown that women and people with a past history of mental<br />
illness have the greatest risk of developing mental disorders<br />
post-event.[17] Higher levels of constant political terror –<br />
measured on a scale that stratified countries according<br />
to the frequency of politically-motivated crises – directly<br />
correlated with higher rates of PTSD and depression.[18]<br />
Resource limitation directly impacts on the quality and<br />
quantity of care provided because LMIC must allocate fiscal<br />
resources frugally. They often chose to apportion money<br />
only to the most severely-affected populations, where the<br />
greatest benefit would be attained. This, in addition to the<br />
deterioration of healthcare services in wartime, culminates<br />
in a dearth of services for all but the most severely affected.<br />
The current global political climate, with the rise of<br />
nationalism and the unprecedented numbers of people<br />
displaced by conflict worldwide, also raise a number of<br />
considerations with respect to disaster preparedness.<br />
[19] There are more people displaced by conflict than ever<br />
before, seeking relocation in countries with greater stability<br />
and economic opportunity. The mental health of refugees<br />
is also influenced by the circumstances in the country of<br />
their resettlement. For example, a study of Latino and Asian<br />
refugees arriving in America found that those who experienced<br />
discrimination, unemployment or who experienced uncertainty<br />
due to unpredictable health insurance had lower self-rated<br />
mental health.[19] These post-settlement factors had a<br />
greater impact on their mental health than pre-settlement<br />
trauma, including war-related trauma.[19] This reflects the<br />
detrimental effect of hostile attitudes from the host country<br />
towards displaced individuals, and should be considered in<br />
the provision of mental health services for these affected<br />
communities.<br />
The impact of political instability on disaster responses<br />
in LMIC was also demonstrated following the earthquake in<br />
Nepal’s Gorkha region. Nepal has a GDP of only $20 billion<br />
USD, and an extremely limited capacity to fund disaster<br />
relief operations. Political instability and slow constitutional<br />
development following abolition of the region’s monarchy has<br />
prevented ratification of rigorous governance surrounding<br />
disaster prevention efforts, such as building codes, which<br />
may have reduced the impact of such an event.<br />
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