Survivors of Cyclone Nargis continue to suffer from pervasive trauma, further challenging the process of rebuilding shattered lives.
"I've seen a lot of people who are very sad, very anxious and afraid that the wind will blow away everything that's left," said Kaz de Jong, a trauma specialist with the medical charity Médecins Sans Frontières, who has just returned from a two-week assessment mission to the delta. However, he said he was impressed by people trying to fight back, despite the extent of the misery.
An estimated 133,000 people are dead or missing after the category four storm slammed into Myanmar's Ayeyarwady Delta on 2 and 3 May, leaving an estimated 2.4 million destitute.
Many survivors obsessively replay images of the disaster in their minds – particularly the last sight of their loved ones, many of whom were swept away or drowned by the tidal surge that swept up to 35km inland.
Others have trouble sleeping and suffer from palpitations and high blood pressure – all symptoms of accumulated stress, De Jong said.
According to De Jong, many survivors, including children, appeared withdrawn or reported lacking any energy to face the future.
"You all are worried about rice, but people must have motivation to eat it. But at this moment, my life isn't worth living – I've lost all my family," one elderly woman told him.
Despair and despondency are "normal", given the extent of the losses that people have suffered, but limit their ability to rebuild their lives, MSF explained, adding that signs of acute psychological problems were rare.
MSF is working to set up support networks to help victims deal with and recover emotionally from their shocking losses, and to prevent more acute psychological problems.
"We need to help people recover and make their lives worth living," he said.
To do that, MSF is trying to identify community leaders and give them basic training in stress management so they can monitor the most vulnerable people, such as children and the elderly who are the only survivors in their family, and help people manage their anxieties.
Such techniques include asking Buddhist monks to lead villagers in meditation, encouraging people to openly express their feelings about their experiences, and coaching survivors to think about lost family members only during certain times of day – to prevent them from dwelling obsessively on their memories.
In addition, MSF is deploying professional local counsellors to the delta.
Many other NGOs are also working with local communities to try to help them understand how they can provide psycho-social support for fellow community members, so they can cope with the crisis and their losses.
"In Asia, people aren't typically very open about talking about their feelings so people suffer in silence," James East, a spokesman for World Vision, told IRIN.
"We will work with the community and train up people, and help them to recognise the symptoms of trauma," East said.
 Photo: Contributor/IRIN  |
| A child stands along the river banks of Kawhmu village in the delta region. Many chldren are traumatised by the events of the cyclone and reportedly lack any energy to face the future |
Meanwhile, more than a month on, health workers in the Ayeyarwady Delta are working hard to prevent outbreaks of water and mosquito-borne diseases that could claim an even higher toll among the displaced survivors, many of whom are now crowded into temporary settlements in regional towns.
So far, MSF, which had a large operation in Myanmar before the disaster and rapidly deployed many of its health workers into the disaster zone, says its 43 health teams have yet to detect any major disease outbreaks, although they have treated tens of thousands of storm-related injuries, and are now seeing more cases of severe diarrhoea and acute respiratory tract infections.
Heavy monsoon rains provide one of the main sources of clean drinking water in the area, and aid workers have distributed jerry cans to help survivors collect the rain, although concerns about waterborne disease remain high, given ongoing problems with access to clean water, soap and basic sanitation facilities.
On 10 June, the health cluster, led by the World Health Organization (WHO), reported that its disease early warning system had detected 685 cases of acute respiratory infections, 117 cases of bloody diarrhoea, and three cases of dengue fever.
While a high number of cases of dengue fever is normal for this region at this time of year, greater numbers are expected this year given the living conditions after the cyclone, WHO said.
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