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Orientation for volunteers going into flood affected areas Dr. Narmeen Hamid Idara-e-Taleem-o-Agahi Lahore, September 2011.

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Presentation on theme: "Orientation for volunteers going into flood affected areas Dr. Narmeen Hamid Idara-e-Taleem-o-Agahi Lahore, September 2011."— Presentation transcript:

1 Orientation for volunteers going into flood affected areas Dr. Narmeen Hamid Idara-e-Taleem-o-Agahi Lahore, September 2011

2 Objectives To prepare you about what to expect To enable you to support the survivors in a sensitive and appropriate way To optimize your time and the resources at your disposal by helping you function effectively, intelligently and in an organized way To enable you to give a message of strength, hope and solidarity and to empower the survivors rather than make them dependent.

3 What to expect Situation constantly changing depending on Water level Resources available When rescue and aid teams have arrived So important to think on your feet and assess situation on the ground

4 If the situation is acute: Prioritize Rescue Shelter First aid and prioritization of vulnerable groups like children, elderly, pregnant women and the disabled Food

5 If the situation is more stable: Health Hygiene (personal, food) Water Sanitation Women’s specific needs Children’s specific needs

6 Physical Health Problems Gastro-intestinal infections (water borne, faeco-oral route, poor hygiene) Vector borne, like malaria, dengue Respiratory infections Skin infections/eye infections Insect and snake bites Injuries

7 Mental Health/Psychological Problems Grief, depression, despondency, hopelessness, crying Fear, anxiety, nervousness, worrying Guilt (for surviving, for not having been able to save others, etc.) Feeling helpless and vulnerable Sleep disturbances: insomnia, bad dreams, nightmares Irritability, moodiness, anger Repeated flashbacks: feelings of “re-living” the experience, often accompanied by anxiety Increased marital conflict or other interpersonal conflict Difficulty concentrating, remembering; slow thinking Difficulty making decisions and planning Feelings of being detached from your body or from your experiences, as if they are not happening to you Feelings of ineffectiveness, shame, despair, guilt Self-destructive and impulsive behaviour Suicidal ideation or attempts Positive reactions such as acceptance, hoping, planning for the future, involvement in support operations and activities Physical manifestation of mental stress:Headaches, digestive problems, diffuse muscular pains, sweats and chills, tremors

8 So How Can You Help?

9 Initial management of physical illness Prior to referral to doctors/medical camp Diarrhoea/dehydration: ORS/rice water/home made ORS Fever: medication Insect bites: anti-allergic, creams like fucicort Cuts, grazes: cleaning and bandaging Boils, skin lesions: clean, apply disinfectant like dettol, gentian violet

10 Preventive Measures & Hygiene Education

11 Clean Water: perhaps the most important intervention of all Options: Bottled water Water purifying tablets/sachets Boiling Chemical dis-infection Sunlight (letting the water stand in sunlight for a few hours)

12 Chemical Dis-infection *Examine the physical appearance of the water. *When emergency dis-infection is necessary, disinfectants are less effective in cloudy, murky or colored water. *Filter murky or colored water through clean cloths or allow it to settle. *It is better to both settle and filter. *After filtering until it is clear, or allowing all dirt and other particles to settle, draw off the clean and clear water for dis- infection. *Water prepared for dis-infection should be stored only in clean, covered, containers, not subject to corrosion. *Chemical dis-infection with chlorine/iodine (details in next slide)

13 Method of Chemical Dis-infection Chlorine (in the form of unscented bleach) and iodine are the two chemicals commonly used to treat water. Filter murky or colored water through clean cloths or allow it to settle. It is better to both settle and filter. Leave out in the sun for 6-8 hours. You can use a non-scented, household chlorine bleach that contains a chlorine compound to disinfect water. (1/8 teaspoon or 8 drops in one litre of water. One standard bucket contains approx. 8 litres therefore one teaspoon in one bucket) You can use tincture of iodine to disinfect filtered and settled water. Common household iodine from the medicine chest or first aid kit may be used to disinfect water. Add 5 drops per liter. For both, mix thorougly and then let the solution stand for at least 30 minutes before using. Phatkari (alum) can be used to clear turbid water, which can then be filtered. When buckets are not available, clay gharras are good for this purpose.

14 Personal hygiene Wash hands with soap, after using the toilet, before and after eating Cut nails If available, advise use of miswaak for oral hygiene Where possible advise washing, changing of dirty clothes Advise special care of spaces between fingers and toes, where fungal infections will grow. Need to keep clean and dry.

15 Food Hygiene Inspect food that is being cooked How is it being served? Are plates being used? Are they being washed? Is food coming in plastic bags? How are the bags being disposed? Encourage all lactating mothers to continue breast feeding. Facilitate by providing private place. This can be a life saving measure for infants.

16 Waste Disposal Three categories of waste disposal in the field: Human waste – faeces and urine Liquid waste – liquid kitchen and bath waste Rubbish – combustible and non-combustible solids

17 Human Waste Disposal:Types of Latrines 1. Cat-hole latrine A hole approximately one foot deep and one foot in diameter After use, a cat-hole must be completely filled in and the dirt packed down 2. Straddle trench latrine If people remaining in one place for up to three days. Trench is dug one foot wide, two and one half feet deep and at least four feet long Multiple trenches should be dug at least two feet apart

18 Contd…. 3. Bore hole latrine This type of latrine is constructed where the space available is very little. It consists of a circular hole of 0.30 to 0.40 m diameter and 5.0 to 6.0 m deep, dug in the ground by means of auger. The bore hole is covered with a suitable concrete squatting slab with a central opening and foot rests of about 0.85 m dia. Once the bore is filled up, the squatting slab and the super structure have to be moved to a new bore and the old bore should be filled up with the earth excavated from the new bore. Disadvantages with this type of latrines are foul smell and breeding of flies and mosquitoes. 4. Burnout latrines Suited to areas with high water tables, but can also be used when the ground is hard or rocky and digging is difficult or impossible A burnout latrine is in use one day and burned out the next, so take this into consideration when planning the number required * For all latrines, ensure there is provision of safety and privacy for women, wherever possible a separate location for them.

19 Disposal of liquid waste from kitchen, washing, bathing etc. Soakage pits Four square feet and four feet deep If there are 200 or more people it is recommended that you have two soakage pits Close soakage pit with compacted soil to keep away vermin and pests

20 Garbage and Rubbish Disposal Garbage Food waste that occurs during food preparation, cooking and serving Classified as either dry or wet Rubbish Non-food waste that usually comes from kitchens Classified as either combustible or non-combustible Garbage and rubbish are disposed of in one of two ways: burial or incineration After burial, compacting the earth is very important. Doing so prevents flies and rodents from entering or exiting the pit.

21 Vector and pest control Mosquitoes, flies, rats will become a problem in these areas. For mosquitoes, see if local authorities can spray stagnant water with disinfectants or if mosquito nets are available. Mosquito repellants (cheap versions are available if bought in bulk). The desi totka is ‘tara meera ka tel’ An alternative technique could be a smoke fire with wet sticks which may be tried near disposal pits. Desi technique: dhooni with local leaves/cow dung cakes Keep drinking water covered.

22 Dealing with corpses You may come across human and animal dead bodies. Contrary to common belief, there is no evidence that corpses pose a risk of disease "epidemics" after natural disasters. Most agents do not survive long in the human body after death (with the exception of HIV -which can be up to 6 days) and the source of acute infections is more likely to be the survivors. Human remains only pose health risks in a few special cases requiring specific precautions, such as deaths from cholera or haemorrhagic fevers. However, workers who routinely handle corpses may have a risk of contracting tuberculosis, bloodborne viruses (such as Hepatitis B/C and HIV), and gastrointestinal infections (such as rotavirus diarrhoea, salmonellosis, E. coli, typhoid/paratyphoid fevers, hepatitis A, shigellosis and cholera). The public and emergency workers alike should be duly informed to avoid panic and inappropriate disposal of bodies, and to take adequate precautions in handling the dead. Wash hands thourougly after handling. These bodies need to be given respectful and proper burials

23 Women’s needs Privacy Menstruation: what to use, how to dispose Pregnancy Child birth: sterile razor and string essentials Lactation

24 Children’s needs Trauma Fear Hunger Illness They need special handling.

25 Working with children Children’s reactions After a stressful experience involving loss, children’s grief is often abrupt and they may switch quickly from intense grief reactions to play and having fun. Almost all children play, even if they have gone through an intense crisis event. Younger children may behave aggressively towards caregivers or other children, while at the same time cling to their caregivers and show signs of separation anxiety. There may be changes in behaviour, e.g. regression to the behaviour of younger children such as bedwetting, thumb sucking, or not being able to sleep alone. This shows loss of trust. In such situations, stable and secure relationships are very important resources.

26 Contd. Supporting children In a crisis situation, keeping up daily routines best supports children. Restore a certain kind of routine as soon as possible, such as maintaining eating and sleeping routines. Celebrate birthdays and special occasions if possible. Children need as much normality, play and fun as possible and to be given a chance to regain their feelings of trust and safety. It is important that caregivers fulfill their roles as before, and don’t let the children take on adult roles.

27 Contd. Children need to know Children and adolescents need information about what has happened in an age appropriate manner. They should be encouraged to ask questions. Talking is important, however children should not be overwhelmed with information that they did not ask for. It is important to be honest and to use words that children understand. Avoid letting children hear ‘adult-talk’ about frightful things and do not let them watch upsetting news stories on TV.

28 Contd. Techniques that will help children: Drawings/Art: Take paper and coloured pencils with you Games with a bat and a ball Board games like luddo Story telling

29 Providing Emotional Support

30 What about your feelings and attitude? Our feelings, beliefs and attitudes towards the people we work with have important implications for the quality of support we provide. Our attitudes are expressed through our behaviour, tone and words when communicating with people. We need to be aware of this and make an effort to challenge unhelpful attitudes and to learn skills that empower (give power to) rather than disempower (take power away from) the community. For example, do we think of these people as flood ‘victims’ or ‘survivors’? Do we consider them ‘helpless’, dependent on our help, or do we think they have the power to help themselves? Do we consider ourselves helpless in the face of this great tragedy and therefore not giving out a message of strength? Are we mentally strong enough to handle such a situation and to be able to bear possible anger, non-cooperation, depression, extreme emotions?

31 Objectives of emotional support Specific objectives of emotional support provision are to create and sustain an atmosphere of: Safety Calm Connectedness Recovery and resilience Self-efficacy and self-confidence Empowerment Hope and motivation

32 Techniques for emotional support Making the survivor comfortable Building trust Listening and validation Showing genuine support and concern (but not getting emotional yourself) Giving them space to express emotions Stroking Stroking refers to praising the survivor for taking constructive action. Distressed people are often unsure of their own abilities. Stroking them is a form of encouragement, reassurance and reinforcement, thus enhancing their self-confidence and sense of self-control. Every little step that the survivor takes in a positive direction is worth acknowledging through statements such as, “Well done! I can see that you're working very hard on this." Giving information Empowering them by encouraging them to make their own choices and empathising.

33 Empathising Empathy, or an understanding of the situation from the survivor’s point of view, is a very important skill for the support worker. Empathy is different from sympathy, which involves an element of pity. Sympathy can be disempowering as it places an immediate distance between the listener and the speaker and gives the message that the survivor has been through something unique, something that the listener cannot comprehend. Empathy, on the other hand, has an empowering message within it: that the worker is with the survivor, that s/he is trying to look at things from the survivor’s point of view and that s/he understands. This does not mean that the listener’s feeling is trivialised as something that everyone goes through, but that the emotion is understandable and natural and not something extraordinary and strange.

34 This table will help you understand the difference: Empathy I can understand what you are going through I can understand that you are feeling angry at what has happened to you I can see you are scared; it’s natural to feel scared at a time like this Simply sitting in silence while the survivor talks or cries Sympathy Poor you, it is bad that this has happened to you It is horrible that this has happened to you Don’t be scared; I’m here to help you I am so sorry for you, don’t worry, everything will be fine, please don’t cry

35 How will you organize yourselves? Don’t go if you are not accompanied by some sort of material help. The need is too acute for people to accept only verbal support right now Go as a team Divide tasks between members Make a check list based on what you have learnt today and assess situation according to that Assess the needs and the resources. Address the gaps and take over the job that no one else is doing. In all tasks, prioritize vulnerable groups who cannot fight for food or other support….children, elderly, pregnant women, disabled

36 Check List Food: availability, distribution, hygiene Health: first aid, personal hygiene Water Waste disposal Vector and pest control Women: pregnant, other issues Children: games, establishing routines Emotional support Documentation

37 It is very important to document the following: No. of families/total number of people No. of pregnant women No. of children under 5 No. of disabled No. of people needing medical assistance (if possible also note what kind, eg. X no. of people suffering from diarrhoea, y from skin infections etc.) No. of school going children From our check list, see which needs are being met and which are not…put ticks or crosses against each This will help in planning and allocating resources and in letting authorities know where and what kind of help is needed.

38 Document the relief items you are taking Please make a list of the things you are taking and the services you have provided during your trip so that these can be duly acknowledged and put up on our website and regular updates. This helps keep everything transparent as well as informing the organizers regarding which needs are being met and where gaps still exist

39 Ways to empower survivors Educate and Delegate For every responsibility that one of you assumes, find a member from the community that you will hand over the task to before you leave If possible make a committee of elders (including women) that can take charge If aid items are not enough for everybody let the committee decide how to prioritize and let them distribute in your presence. Respect and make an effort to explore local wisdom and ‘totkas’ eg they may already be practicing water purification of some sort, ‘harmals’ etc. Remember: you are there to help them help themselves

40 Leave with a message of solidarity, support and hope: We shall overcome this………… together!

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