Allison Male is a 36-year-old British psychologist. She arrived in Pakistani-administered Kashmir just days after the October 8 earthquake struck and her task is to provide psychosocial support to survivors of the disaster. She has also worked with Doctors Without Borders/Médecins Sans Frontières (MSF) in Liberia and Burundi. The following is from her diary.
– Allison Male
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Just got a call from my recruiter. Allison, you are needed in Pakistan, will you go? I only needed 2 seconds to make up my mind.
Waiting at the airport for my plane to Islamabad. I'm feeling restless and scared in some way. I just hope I will be strong enough to cope with the suffering the earthquake has brought upon the people.
I'm in the van heading towards Bagh, a province badly damaged by the earthquake, and where our help is badly needed. I'm vomiting all the time, I hope my restlessness hasn't affected my body, but I just think the airline company has upset my stomach. The trip is slow; many vans filled with relief goods are making their way up to Bagh. Relatives and other people touched by this catastrophe...all wanting to help in some kind of way.
It's late and dark when we arrive at Bagh. Some team members have set up a base at the Girls College. The three-storey building has collapsed completely, leaving 40 to 50 bodies in the basement. An image comes into my mind of these young girls screaming for help...but I push the image back again.
When I get out of my tent I walk into the reality of Bagh. Stones and dust everywhere, only a few houses are still standing. The town is a complete mess. Some volunteering doctors have set up tents. People stand in line with all kinds of injuries. Family members are being transported on bed or carried on backs. The wounds look terrible but what touches me the most is the despair and pain in their eyes. At the same time people are crowding around the newly arrived trucks, hoping to find food and tents. Winter will be coming soon...how will they survive without a house?
I wonder where to start. What can I do to alleviate the soul of those people when there is so much destruction all over? So many basic needs not yet covered? I know that it is important to be available to hear what they have been through. I know that by explaining and reassuring them about the physical and psychological reactions they may face I might help them to regain some control of their life. I know that I have to support them in a way that reinforces their strength and natural coping mechanisms so as to help them to overcome this crisis... but where to start?
I decided to visit the principal of the Girls College, who is living just next to the school and our base. She welcomes me into what looks like a kitchen, the only walls remaining after the earthquake. She tells me how the earth shook on the 8th of October at 8:55, how she fell down and how from the ground she witnessed how her school building collapsed. Her students were screaming and crying for help. I can see tears coming to her eyes. She says she would like to leave to Islamabad, but she feels she cannot leave before the dead bodies are recovered from the school building. At this time two of her students walk in. They survived and are paying her a visit to ask if she needs any help.
So I watch them sitting together peeling garlic and cutting tomatoes. How normal things can be so healing... They invite me to come and look at their destroyed house, so we cross the river to the other side of the mountains. On the way I cross people searching in the stones, trying to recover some goods. One of the girls tells me that losing her house felt like losing her mother. Her house, which was once a safe place that welcomed her and accepted her, a place full of memories and family. Her face turns sad when she concludes that she will never be able to find this "home" again.
I have just been walking around trying to find people willing to work with me. Everybody seems so much occupied by working on their own survival, it seems an impossible task. Some say that 80 percent of the population of Bagh has died, two-thirds of every age group. Many children were at school at this time, many women were in the house taking care of the family.
I can see more and more cars filled with families, moving away from this area. People tell me that it was God's will, that God has punished them for their sins. By coincidence I meet Fatma, who was working as a primary school teacher at Pearl Valley School. She was able to get all her children out of the building. She's bored staying in her tent, and is very willing to help me.
We have started supporting what was once the District Hospital. Patients are pouring in, some stayed wounded in their village for days, no means of getting help. I have been sitting down on the patients' beds, Fatma on my side translating for me and listening to their stories.
Stories of how they lost their loved ones, how they tried to pull out their children and sometimes didn't succeed. Tears come while they speak, first they try to hide it, but when I say it's alright to cry it feels as if something breaks inside them. So we just sit silent while I hold their hand.
We have started an outpatient department in Birpani, another village 20 km from Bagh. All health facilities are down.
I explain to the people waiting on the benches outside why I am here and show them the chair where Fatma and I can listen to them. One by one people come to talk to us. The first man tells me how he lost his wife and three children together with the house that he built with his own hands. He's ashamed to cry in front of me, as he is a man and when I ask him how he can find strength to get through the coming days he starts sharing his tears with me.
Another boy comes to tell me that last Saturday he bought a fruit juice for his big sister, like he always does on Saturday. But when he got home his sister was dead under the stones of his house. He doesn't know who to give the fruit juice to now. So many stories...so much loss. I wonder how these people will find the strength to recover.
I pack the chairs and check with Fatma how she's feeling.
Somebody calls me... It's the first man I saw today. He hands me a vegetable from his garden. â€˜May God bless you and your family,' he says. And I realized how blessed I am.
I feel I need to see the patients again at the hospital. I can see that their physical pain is decreasing but the emotional pain is growing. People are realizing more and more what they have lost and are worrying about the future they will have. Family members of the patients are sitting together and sharing their sorrow.
Another outpatient department was set up today at our base in the Girls College. People are coming with minor complaints and a big need of telling their story.
Three babies were born today at the hospital... Life continues. Miracles happen to: a little baby boy, trapped under the stones for 10 hours, survived but is suffering from pneumonia.
I feel like I am walking in an unreal world. Normal life is growing again, little stores opening with fresh vegetables, people washing clothes. But at the background of these images I see a completely destroyed town, knowing that some buildings are covering victims of the earthquake.
At certain points in town I can smell death and I imagine what life the people had before the earthquake changed it.
A lady asked me today if I was eating and sleeping well. She had just told me that she had lost 300 of her community members in Mallot and 7 of her close family members. I told her how amazed I was by her caring for me, and who was caring for her... After she just talked and talked to me, telling me how she used to comb her daughter's beautiful hair, how proud she was of her son who came home with 3 master's degrees. She told me how she spent 25 years educating and holding her children and how God took them away in 2 minutes. And how she wished he would take her life soon too for she saw no reason more to continue.
I have heard stories of men shooting themselves, surrounded by the dead bodies of their families members and not seeing any reason more for them to live. I just hope that their souls find peace.
I most worry about the patients in the hospital. In fact it's mainly the children that touch me the most. The look in the eyes of pain, of joy for life lost. Some don't want to eat, others refuse to speak and another girl just started screaming today when I looked at her plastered leg.
We have given them crayons and are reading them some stories to bring back some normality in this abnormal life.
He had lost 10 kilograms in two weeks and had been having a high fever since the same time. Allison, could you talk to this man? I found out that in the two weeks after the earthquake he had been part of a rescue team, digging out dead bodies from the stones. He told me about the arm and legs he found scattered between the stones, but the worst was when he had to amputate the arm and leg of his cousin before he could get his dead body out of the ruins. Did he feel guilt, I asked him? He agreed and I could see how his body started to shake. Could he forgive himself, was my next question? A quick smile was his response. Only God can forgive me he answered me.
She worries me this girl of seven years old. She lost her bigger sister in the earthquake and fractured her leg herself. Her doll lays unpacked on her bed, all she does is hold on to her mother's scarf, looking at me with an empty face. I have tried reading her stories, showing her coloring books, but I cannot wake up her interest.
I decide to give her some space and check on her in the afternoon.
When I get back in the afternoon my translator tells me that the seven-year-old girl was discharged and that she took the coloring book. I'm very glad she did...
People here are in Ramadan period and continue to fast although their living conditions are so difficult. I like the moment of the day when people start to prepare to break the fasting. I decide to walk back from the hospital, the sun setting slowly on this ravaged town. Smells of incense meet me on my walk. I see families gathering around the graveyard. I notice that the town's clock stopped at 8:45, the earthquake was at 8:55.
I feel humbled walking through the streets, everybody greeting me, waving to me or thanking me for my help. These people are so special, although their heart has suffered so much loss, it has remained warm enough to welcome me inside.
I hardly recognized her when she passed me and then I remembered I saw her some days ago at the clinic. Her father brought his six-year-old daughter because since the earthquake she was refusing to eat. I asked her what her favorite food was and she said it was an apple. She was visiting her auntie far away from Bagh during the earthquake and when she returned home she found her house completely destroyed. She didn't like the life in the tent and she wondered what had happened to all her toys in her house. I gave her some vitamins, telling her that vitamins are like apples. So when she felt like eating an apple again she could stop taking the vitamins. She looked so different when she passed me this morning. I said the local greeting to her father and asked him how his daughter was. Much better, he said and thanked me for the help. They walked off holding hands. Then all of a sudden she ran back to me and said: "I started eating apples again yesterday..."
I couldn't help looking at his hands; he used them a lot while talking. Then he told me that before the earthquake he was a carpenter. He lost his five-year-old daughter, his wife got severely injured, but he was okay and he had these hands...these hands that were itching to work, itching to rebuild his destroyed house, but no tools available to start this work. I could see he was a proud man, a responsible father. During the earthquake he was making a fire outside the house, in a couple of seconds he could see the graves around him explode, bones flying around in the air, stones flying in the air like cotton wool, he said.
When I ask people what is on their mind, they often tell me that it feels like there is a stone on their head, a heavy weight on their back that they are carrying. But, this man added, I also have a stone on my heart. He told me he wanted to live his life in a good way, that it was difficult for him to beg for help, but as a result that many people in his village had already received tents while he was still without one. And it hurt him to see his village members that were once so caring and sharing become so selfish. His hands clenched in a fist, it made him so angry he said. His hands opened again towards me when I said that I admired him for the courage he had to choose the good way and that I believed he had the strength to remove this heavy stone from his head.
The individual demands for psychological care are increasing with the day. To be able to reach more people I decided today to start with group counseling. Three very different men were present, but all with the mutual experience of how the earthquake has changed their life.
Although their stories were very different, they had many things in common. Fear of a new earthquake, feeling guilty because they didn't have the strength for doing the Ramadan; concern about their near future–where were they going to spend the winter months?–and concern about the distant future–what would become of the education of their children?
One man, a teacher, got injured while rescuing the 30 children from his classroom but lost 65 of his own family members. "I keep having this dream," he said, "I see all these family members alive in my dream and we decide to have a contest in running. We all start running but... I am the only one that makes it till the end."
It started around 3 pm, the sky got dark and the wind started blowing. Sharp lightening and thundering in the sky. I could see the face of my Pakistani colleague turn white...it's like the day of the earthquake she said. Next I could hear the children in the hospital starting to cry. My stomach turned so I walked into the wards and what I saw there overwhelmed me...people with faces full of fear, all family members clutched together holding their children. All of a sudden I realized in how much fear these people still must be living.
"What have your impressions been so far," somebody asked me today and "how do you work here as a psychologist?" So I told him about the medical programs MSF is running here in which a psychologist is present. When the doctor comes across a patient with psychosomatic complaints as headache, body pains, stomachache, etc. he is referred to the psychologist. Some people even come asking for a psychologist straight away.
And then they tell their story, the story of loss but also about the fear still present in their lives. Together with the patient I try to look for their main concerns, their resources and their coping skills, what the next steps in their life will be. I try to explain to them that their reactions and feelings are normal. And they listen and I see on their faces that sharing their story has been good for them, some say it was the first time they could express themselves in this way. I feel honored to be this first person...
"I am feeling so sad," he told me, when I asked in which way I could help him. In front of me was a religious leader from a nearby village. His long white beard and his soft brown eyes full of tears. I thought his sadness was related to his loss but then he told me his sadness was brought about by the concern of the future of his people. "These are times one should be close to God," he said, "but what I see around me is that people are becoming more and more distant from God. People in his village looting and grabbing the goods out of the hands of their neighbors. How humans become animals when they try to survive." It blocked him in such a way that he himself was no longer able to pray or to talk to his community about belief.
What could he do himself as an important religious leader, I asked him. He breathed very deeply and said that he would wait until people got back to normal life so they would listen to him. But why wait, I asked him. I could see his back straighten again. I told him I would be honored to collaborate with him in his village and that a part of my job was also to go into communities to inform them about possible reactions after an earthquake and what they could do as a community to help others overcome.
Light came back into his eyes while he started arranging a date and a time for me to come. "Kotera Must Han is the name of my village," he said, and he started to pray for me and my family.
I walked through the streets of Bagh with my team members this afternoon. Ait Mubarak is what everybody is wishing one another. The Ramadan has finished and three days of celebration have started. Although the town is a little livelier with more shops opening every day, there is still a cloud of sadness hanging over Bagh. No new clothes for the children, the family members that didn't survive the earthquake cannot be visited, no money to buy the Ait food....nobody really feels like celebrating and I understand why.
The mental health team is getting bigger: two national psychologists and three social workers have joined two international psychologists. And we will need to get more people to join us because one thing everybody agrees about is the huge need of psychosocial assistance to help these people overcome the day that changed their life.