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Mending minds


As Japan begins the long process of cleaning up and rebuilding after the March tsunami, the process of healing the internal wounds is also just beginning.

The violent heaving and swaying seemed to go on forever. Furniture crashed to the floor as cupboards ejected their contents in a cacophony of shattering glass and splintering wood. “It went on for so long,” Hitomi Asano says of the earthquake. “I didn’t think it would ever stop.”

Living in a country as seismically volatile as Japan, Asano had experienced plenty of earthquakes, but nothing like the one she felt at 02:46 on 11 March. Amid the wail of tsunami sirens, Asano, 50, rushed to pick up her 10-year-old daughter from her Ishinomaki primary school five minutes away.

Despite the warnings, Asano says she didn’t believe the sea would ever reach her home more than 1 kilometre from the coast.

“We ran upstairs and ten seconds after we reached the first floor, the tsunami flooded in,” she says, sitting in the gymnasium of her daughter’s school, one of scores of evacuation centres set up to house survivors in the region. “The water reached up to the ceiling of the ground floor. My car was destroyed.”

Ishinomaki was hit particularly hard. Once a vibrant coastal city, backed by lush, green mountains, large swathes of it have been flattened, evoking images of a decimated Hiroshima in August 1945. More than 160,000 people used to live in this Miyagi Prefecture settlement, many working in the fishing industry and pulp mills. Almost 3,000 people have been confirmed dead and a similar number remain missing.

That first freezing night on the first-floor balcony of their damaged home was a lonely one for Asano and her daughter. “I was listening to the radio as the aftershocks came one after the other,” Asano says. “There was no sound and there was no light. It was so dark. I just didn’t know what was happening.”

From physical to psychological

As in most calamities of this scale, the focus of the initial humanitarian response was on providing physical relief. The Japanese Red Cross Society (JRCS) immediately deployed medical teams to stricken towns and sent blankets and other much-needed supplies.

Understanding the importance of psychological care following disasters, the JRCS also organized and dispatched teams of psychosocial professionals to help those traumatized survivors. The first workers arrived at the Ishinomaki Red Cross Hospital three days after the earthquake. By the middle of May, there were 289 psychosocial workers offering care and support in the main affected areas. (In total, around 8,000 Red Cross staff in Japan, including doctors and nurses, have received psychosocial training.)

In late April, JRCS nurse Mayumi Oguri arrived at the evacuation centre where Asano is living with another 300 local residents. (There were 1,800 people living in the same space for the first three weeks after the disaster.) Oguri is head of a three-person psychosocial support team from Nagoya that relieved another group of psychosocial support workers.

Sitting on the traditional Japanese straw tatami mat-lined floor of the school gymnasium, she says her team assesses the mental state of the people at the centre by walking around and talking, listening and offering opportunities for more private, emotional discussions. They also watch for tell-tale signs of post-traumatic stress such as insomnia, flashbacks, irritability and seclusion.

Children and the elderly, Oguri says, are particularly vulnerable. “We’re seeing a general trend at the moment of some kids mimicking what happened in the tsunami and even pretending to bury people,” the 41-year-old nurse says. “It’s a part of dealing with the situation and the play-acting isn’t such a worry. Parents have to show that they will protect their children and offer them peace of mind. The children should be able to cry if they want to and not swallow their feelings.”

Trouble under the surface

While the world has marvelled at the resilience and stoicism of the Japanese in the aftermath of the disaster, trouble may be brewing underneath the seemingly stolid exterior of some Japanese, particularly for men in a culture that extols silent endurance.

“Men tend to feel responsible for protecting their families, so they tend to overstretch themselves, and they don’t have the chance to release their stress,” Oguri says. “They never express their feelings in public, so I try small talk with men. Then I consider a private place where they can talk further and express their feelings without being seen by others.”

But it appears that Japan as a society is growing more aware of the dangers of keeping emotions bottled in. A notice on the wall of the shelter from the prefectural government advertises a counselling hotline for those suffering from nightmares, bouts of anger or depression. Asano, the designated leader of the shelter, says she is conscious of the importance of facilitating communication between evacuees.

She explains how the cardboard ‘walls’ separating evacuees’ personal spaces in the gymnasium were planned to allow for both privacy and interaction. “Between families, there is always an elderly single person with lower partitions, so they can easily talk with the people on either side,” she says. “With good communication, we feel less stress and are less worried.”

As Asano talks, a group of children announce that it’s time to fill up the portable toilets outside with fresh water. Almost immediately, young and old alike shuffle outside, form a human chain and begin passing buckets of water along the line. Such practices, as well as mealtimes and organized entertainment, say experts, help to reinforce the idea of community.

A sense of routine

Psychologist Nana Wiedemann, head of IFRC’s Reference Centre for Psychosocial Support in Copenhagen, Denmark, says that assigning roles to survivors adds a sense of meaning to their situation, as does introducing some familiar elements of everyday life.

“It would be very important to establish some kind of routine,” she explains. “Of course, this is not a normal situation, but things like cooking food, playing with the children, taking care of the elderly and being a part of defining what the group needs and how these needs can be met are important.”

People typically wake up at the centre at around 05:30 each morning. Some head to work through the debris-strewn streets, littered with upturned cars and boats, while others return to their homes to salvage possessions or begin repairs.

The Japanese government aims to relocate all evacuees to temporary housing by the end of August. Tokyo-based clinical psychologist Andrew Grimes says this will be an important step towards improving mental health. “Those living in evacuation shelters have added stresses in that they lack privacy,” he says. “So it may be harder to grieve and share their feelings and comfort each other fully.”

The JRCS says it will continue its psychosocial activities until the end of June before deciding if its teams still need to be deployed. Even after evacuees move into temporary housing, Oguri says it’s vital that they continue to be monitored and provided with follow-up health and mental care.

Clinical psychologist Grimes agrees: “A rise in the number of people in the disaster zone suffering from depression and alcohol abuse may well be seen in time.”

As for Asano, she doesn’t know yet if she’ll return to live in her home as she worries about the future threat of tsunami. For now, she remains focused on helping others at the centre slowly piece together their lives. “Maybe I work hard because I don’t want to remember that day or have nightmares,” she says, before rushing off to organize the evening’s entertainment.

By Nick Jones
Nick Jones is a freelance journalist based in Tokyo.


Evacuees Kazuko Hiraushi and her husband Yoshidaka observe a minute’s silence in memory of the victims at an evacuation centre near a devastated area in Rikuzentakata, northern Japan, in March.
Photo: ©REUTERS/Kim Kyung-Hoon, courtesy













“We’re seeing a general trend at the moment of some kids mimicking what happened in the tsunami and even pretending to bury people.”
Mayumi Oguri,
Japanese Red Cross
Society nurse

















“I was listening to the radio as the aftershocks came one after the other. There was no sound and there was no light. It was so dark. I just didn’t know what was happening.”
Hitomi Asano,
50, who survived the 11 March tsunami and earthquake.










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