Imprint Content Editors Naeimehossadat Hosseini Maryam Fakhri Layout / Design Aidin Parnia
Authors Zahra Zeinali Naeimehossadat Hosseini Maryam Fakhri Marsa Hashemi Fereshte Tavakkoli Shiva Fakhari Parnian Daneshpajouhnejad Our Orange Path Isfahan SCOPH Newsletter August 2012; Issue 2 (s); Year 1 Contact Isfahan SCOPH / IFMSA-IRAN www.scoph-isf.ir scoph.isf@gmail.com Isfahan Standing Committee on Public Health - IRAN Medical Student’s Association International Federation of Medical Students’ Associations
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t was an evening like any other; reading books, studying and preparing for the exams, working on projects, replying emails and surfing the web when many of us came across the news of the earthquake in the north western part of Iran. The news was shocking, brief and not very informative. It took some time until details of the disaster were announced: up to one hundred villages have been destroyed and hundreds of people are injured or dead… Everybody’s minds were just flowing with different kinds of ideas of how to be of help to our countrymen… In times like this each person’s help can be valuable if used in the best place. But how to find the best place… Like many others, we, the IFMSA-Iran members, decided to find a way to be our most useful selves in the process of reaching out to Eastern Azerbaijan earthquake victims. And the whole process, from the very first sparks and the very first phone calls and emails has been (and is) a unique -albeit sad- experience for us.
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During this time I came to learn that in times of need and when “time” is not on your side, the most valuable asset is team work. And I had the opportunity of working with an amazing and dedicated team of friends from SCOPH (Isfahan and Tehran), SCORP and the whole IFMSA-Iran members. As I’m writing these few lines in the very last minute, we are still trying to organize to send more volunteer students to the disaster areas and planning further help. The thing that I learnt as a member of the big public health family (and I’m mentioning public health because addressing problems with a “public health” point of view is different… e.g. you are more concerned about epidemics of diseases and preventing spread of infections in the disaster area by providing clean water and isolating those with respiratory diseases, than other “individual medical problems”) was that we should always be prepared for the unknown, by having pre-formed groups and organizations
and proper networks for communication. And we should include different kinds of educational and “awareness� projects about our local problems and concerns before having to face them like this: spontaneously. And that working with a dedicated team (such as our wonderful SCOPH team) is all you need to succeed. I am sure that we will keep doing our best to help the earthquake victims, and I hope that people will recover from this disaster soon enough and never have to face such hardship in their lives again.
Varzaghan; East Azerbaijan; Iran (earthquake affected area) From left: Naser Yousefzade (President of IFMSA-IRAN), Gholamreza Baqeri
Dream Big, Dream Orange. Zahra Zeinali National Officer on Public Health, IFMSA-IRAN
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My heart was shaking, just like the earth under your feet!
My hands were shaking, just like your voice when calling your family members under debris! All my thoughts got destroyed seeing your destroyed home! My tear dropped down, just like the roof of your shelter! And all my words crumbled down beside a mound of ruin supposed to be your house the other day… What can I do for you? For your heart…your empty hands…your agape questioner eyes…your dusty cloths…and the voice which is not heard anymore unless as a moan! Forgive me for not being right beside you! I wish I were! By Maryam Fakhri
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Maryam Fakhri; Planning and Development Officer of Isfahan SCOPH (IFMSA-IRAN)
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n August 11, 2012 two twin earthquakes of 6.4 and 6.3 magnitude struck northwestern Iran affecting Varzghan, Haris, Ahar and Tabriz resulting in over 300 fatalities and thousands of injured people based on official records. The main shakes were followed by almost a hundred of devastating aftershocks by which all Iranian people’s lives were actually shaking as well. It was a real disaster and a shock for all Iranians. They knew it as their compassionate duty to provide humanitarian help to people affected in such a catastrophe. People were performing great beside dispatched relief and rescue teams and they went to the affected areas voluntarily to do something beyond showing long distant verbal condolences. But all those attempts should have been organized and managed somehow. A great number of charity campaigns aimed at donating money, medical and hygiene supplies, lending support in any way possible. Social media offered ways that people could assist the on-going relief efforts motivating people for blood donation in first days and neighbor countries expressed their condolences and offered help until the Red Crescent Society of Islamic Republic of Iran (IRCS) declared that external assistance was not required and there was no need for assistance of international organizations.
ISNA Photo by Mona Hoobehfekr
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Helping affected people was conducted in 3 phases: The 1st phase was to rescue affected people lives and seeking for alive individuals. In the second phase primary essential goods including family tents, body bag, relief package, food package, blanket, heating light, coleman water cooler, canned food, potable water, washing powder, bar of soaps, rice, cooking oil, sugar and cubic sugar, Tea, cereals and date were distributed among affected people. The two previous main phases were mainly conducted by expert governmental teams. The third phase which needs the volunteer contribution of people at most, is to face the second line complications of survivors and managing further life threatening health hazards such as probable contaminations and communicable diseases as well as mental health issues.
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After each earthquake there are many people feeling upset or stressed, or in need of further social support for coping with stress and anxiety as a result of the tragedy. Earthquake is a devastating event and is followed by many complications for survivors. People may feel that they are no more under control and they may feel shocked and numbed, frustrated, irritable, angry and overwhelmed. Children are the most vulnerable group experiencing these beside other presentations like sleep disorders and night mares as well as getting clingier. In these cases a consoler is really needed to show the next step and the way for dealing with stress to gradually return the whole society to a relatively stable state. Through the ongoing 3rd phase psychosocial welfare centers are mentioned to give counseling services to the affected population and experienced people in this regard are announced to be required. The 4th phase will be about reconstruction and settlement supports which should take place as
soon as possible before the arrival of upcoming cold seasons. Experiencing such a catastrophe in our country, the lack of some parts is prominently clarifying. The lack of social media announcement as well as insufficient government resources for providing after earthquake support especially in the field of mental health and second line phases is more sensible. Looking back at the same experience of other countries we see that the simplest thing could be antedated was something like the existence of quake counseling and social support referral line as in many countries for such days! Being really impressed and feeling sincerely sorry for what has gone to our people, considering that we’re living in a quake-prone zone, we all hope to make such bitter unavoidable events with all accompanied exclusive experiences a light for future policies.
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Parnian Daneshpajouhnejad
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n Saturday, August 11th 2012 at 4:53 PM local time (12:23 GMT) two extremely cruel earthquakes occurred near the cities of Ahar, Varzaghan and Haris, in East Azerbaijan province, northwestern of Iran. The earthquakes struck midway between Lake Orumiyeh and the Caspian Sea and were separated by 11 minutes. The Iranian International Institute of Earthquake Engineering and Seismology (IIEES) reported a magnitude of 6.3 and 6.4 on Richter Magnitude Scale, at a depth of less than 10 kilometers. The nearest city to the epicenter (60 kilometers from Tabriz) was however Ahar, a city with a population of about one hundred thousand. More than 300 aftershocks that took place in depths like 3 or 4 kilometers have also invaded the area following the initial twin earthquakes, and were between M2.5 and M5.3. The earthquake was also felt in Armenia and Azerbaijan, with no major damage reported.
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According to published reports more than three hundred people (at least 45 in Ahar, 40 in Varzaghan, 50 in Heris) were killed and around 4500 people were injured. About forty orphans have become heads of household as a result of death of both parents. State TV has raised the toll to more than 365 villages being heavily destroyed, out of a total of 537 in the affected area. Twenty villages were also totally leveled with the ground. Over 12,000 houses were completely destroyed or heavily damaged and many have been trapped in the rubble. Electricity and phone lines were cut after the quakes in the area. The only hospital in Heris has been completely damaged and as its equipment was no longer operational, and many injured people did not survive the long way to the nearest hospital. Animals were also the victims of the earthquake. About one thousand cattle and 7000 sheep have been killed by collapsing material. Remnants of dead animals, water contamination and communicable diseases are major problems of the affected area.
FARS News
ISNA Photo by Farshid Tighehsaz
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Coping with Earthquake: What we should know? Marsa Hashemi; Isfahan SCOPH (IFMSA-IRAN)
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arthquake and other natural disasters are inevitable facts. In order to cope with this situation we should learn emergency preparedness as a way of life. In the event of major earthquake public services may not be able to help victims of earthquake because of impassive surface streets or freeways. Stress reaction is not unusual during and after earthquake. These reactions are people's attempt to cope with new situation. It's normal to experience emotional or psychological shock because of body shock after physical injury. Therefore, everyone must know how to provide their own needs for an extended period of time and also control emotions in these situations.
MEHR News
FARS News
"Normal Reaction to the Earthquake" Everyone has different reactions to same situation. But it's better to learn how to have a normal possible reaction. These reactions are considered to be normal after earthquake: Preoccupation with the earthquake and its results, Fatigue and exhaustion as time passes, getting startled easily and looking out for danger, impaired concentration and decision making and memory, feeling a sense of lack of control, anger and irritability, anxiety, increased emotions, sleep disturbance, survivor guilt, depression or grief. These reactions should be decreased but it's normal to have them for a period of week or month. Reactions can be triggered by further aftershocks, images, and particularly sounds, smells or movements that remind survivors of the experience. These reactions don't mean that people don't cope with this situation. After events such as earthquakes it's common for people to be concerned or preoccupied with their safety or the safety of others. It's normal to
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feel the urge of doing something in order to prevent further damages. There are some more susceptible populations in the society including children and old people. After an earthquake children may be afraid of injury or death, separation from their family and being left alone. The child who is dependent on adults for love, care and security fears most the loss of parents and being left alone. To control children's fear parents are the most helpful peoples. The first step for parents is to understand all fear and anxiety a child experiences and routinely and effectively help children cope with fears encountered in day to day situation. In some situations that parents are frightened, reassuring children seems to be difficult. Old peoples may have difficulties moving around after an earthquake. It's better to have plan that someone helps them evacuate if necessary. They may need special foods or medications.
"What can you do?" Although reacting as mentioned above is normal, we should help victims of earthquake even if their reactions are normal.
least 15 minutes, talk to a mental health worker, take deep breathes to reduce your stress.
First we should prevent survivors from being isolated, because getting away from every one might be less distressing but it slows down healing. Remember that you yourself are the best one who can help you and use the strategies you learned in the past. Tell the story to show your feelings; it makes any unpleasant feeling more tolerable. Be helpful, try to help other survivors. This can speed up your own recovery. Exercise to help your mind to be clear. Force yourself to eat regular, well balanced meals. Cut down consumption of tea, coffee, colas or chocolate and use water, fruit juice and herbal teas instead. Talk to a trusted friend or parent or colleague since talking is the most healing medicine. Allow yourself have private time sometimes. Do things that make you feel good and have realistic expectations for recovery.
"It is better not to do ‌" Don't use legal or illegal substance such as excessive alcohol or drugs to anesthetize the consequences of traumatic events. Don't take sleeping pills without prescription. Don't fight sleeplessness and get up, read, walk, exercise and write down your thoughts instead. Don't fight to flashbacks and images and thoughts, they will decrease over time and become less painful. Avoid giving interviews with the media because it makes you more stressful. Don't think that you are going crazy or you lost something, instead thinks that you are normal and your thoughts are normal too. Don't think about major changes in your life and make decisions for it.
You should use stress relieving activities to control your stress. Walk during a break for at
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"Support someone who has been affected" Be available and accept the response you get. Show your interest to other people, it helps them to feel more confident about you. Listen more than talk and be careful about advises and give practical supports. Sometimes people want to talk about the happening or something they thought happened, so listen to their feelings. Spending time with others is the least you could do for someone until the experts come. Avoid jokes, humor, expressing your own feeling that annoys them. Medical students are one of the helpful people in disasters and situations like earthquake. So it's necessary to know how they can help victims of earthquake. Not only they are helpful themselves, but also they can teach other people how to cope with disaster therefore learning about coping with natural disasters such as earthquakes is an obligation for medical students.
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Fereshteh Tavakoli; Isfahan SCOPH (IFMSA-IRAN) One of the most horrible tragedies in one`s life might be the mare that “one day you wake up and see that all the things you had, have been destroyed due to a natural disaster, called EARTHQUAKE. You will get shocked when you see that you have no home to live in, not even a single room for resting and even worst, you have no more a family to gather together.” But it’s a fact now! The helping group should take out the people who are under the detritus and if they are still alive, save their lives. The most important thing that we have to do at first for people who has encountered such situation is preparing a shelter for them. We must show them that it’s not only their pain but also ours and they are not alone. We should support them mentally as well as physically. It’s necessary to prepare food and water, besides doctors and medications. Another important thing is taking care of the children who have lost their parents. It’s really terrible for a kid to find out how she/he could get used to this new situation. It’s a fact that during just a few minutes all of their hopes have become upside-down. It would be very difficult but we have to make them hopeful again. We should pay attention to the messages of sympathy that will be sent through the baggage. They show that despite the distances on the earth, our hearts are actually close to each other. We should try hard, hand in hand to help them build their houses so strong that at least such a nightmare would never be repeated again for the future kids.
MEHR News Photo by AliHamed Haghdust
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Psychological Recovery of Earthquake Survivors Shiva Fakhari; Isfahan SCOPH (IFMSA-IRAN)
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arthquake affects all aspects of survivors' lives .The psychological aspect is one of the most important aspects that must be noticed. Many studies have shown that the rate of psychological problems among the survivors is high. These psychological problems are stress disorders, depression, insomnia, anxiety and so on. Mental injuries harm survivors more than anything else, because in these situations only physical needs are satisfied and usually the psychological needs are neglected. Due to the fact that women and children are more vulnerable against the disasters, it is important to support them psychologically. Mental problems may badly affect the future life of the children. For example the children who are not helped to cope with the stress disorders may become addicted in adolescence .Furthermore the rate of crimes done by these children will be more than others. So they may become less successful in their future life. Especially orphan children need more attention. The women who have lost their children or husbands are at risk of acute psychological problems. These women usually remember their previous bad memories repeatedly and because of that their mental problems remain for many years after the disaster. Although men are less vulnerable, they are at risk of mental problems too. The sadness following an earthquake may have these reasons. 1) The most important thing that hurt survivors is loss of their families and relatives. Survivors feel that they can no longer continue without them. They may even think of suicide. 2) Destruction of homes and sometimes missing the jobs make survivors hopeless. They think they aren't able to build their lives again. 3) Body injuries especially irreversible ones make survivors depressed.
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Sadness, depression, hopelessness and feeling helpless deeply harm survivors’ quality of life. So mental and psychological support is an important part of the rescue process .These supports are not restricted to only disaster time. They should be continued for a long time and assessed regularly after every certain time. Some of the important activities that must be done to support survivors mentally are empathizing with them, listening to their concerns, trying to change their negative attitudes, solving their problems, satisfying their needs and helping them to repair their homes.
livestock and the destruction of their farms make them frustrated and may lead to feeling infirmity to continue living.
One of the problems with tragic earthquake that took place in East Azerbaijan – Iran is that the earthquake occurred in the valleys and rural areas were mostly affected. Due to the fact that there is strong relations and dependency among people living in such areas, loss of family members is very difficult for them. Furthermore in these areas, homes are made of less resistant materials .Therefore many homes are damaged and becoming homeless make the mental condition even worse. Another problem is that the most people living in earthquake-stricken areas were farmers and the death of their
Some of the popular athletes showed their empathy to the survivors by going to earthquake-stricken areas, donating their Olympic medals to them and helping them financially. The survivors felt that they are not alone and helpless.
According to IRNA (Islamic Republic News Agency) a team of psychologists have been sent to earthquake-stricken areas to support the survivors .Furthermore for the first time a crisis Committee for Women and Children has been formed in East Azerbaijan .This committee will support women and children against social and emotional injuries .It also helps widow and pregnant women with their probable problems.
All Iranian people are empathizing with the survivors by helping them financially to accelerate reconstructing their homes and donating blood to injured survivors.
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Post-traumatic stress disorder (PTSD)
Naeimehossadat Hosseini; Vice of Isfahan LPO (IFMSA-IRAN)
Post-traumatic stress disorder, which was once called shell shock or battle fatigue syndrome, is a type of anxiety disorder. It can occur after a person has experienced or witnessed a traumatic or terrifying event which involved the threat of injury, serious physical harm or death. Causes, incidence, and risk factors PTSD can occur at any age. It can follow a natural disaster such as a flood or fire, or events such as: assault, domestic abuse, prison stay, rape, terrorism and war. For example, the earthquake in Azarbayjan may have caused PTSD in some people who were involved, and those who lost their relatives and friends The cause of PTSD is unknown. Psychological, genetic, physical, and social factors are involved. PTSD changes the body's response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters).
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It is not known why traumatic events cause PTSD in some people but not others. Having a history of trauma may increase your risk for getting PTSD after a recent traumatic event. Some reactions such as shock, anger, anxiety, fear and guilt are common, many people would go through these reactions and they will eventually fade away as time goes by. However, in a person with PTSD these feeling will linger and they become so strong that interferes with normal life. The symptoms will remain longer than one month based on DSM IV criteria (Diagnostic and Statistical Manual of Mental Disorders) and the symptoms must lead to "clinically significant distress or impairment" of major aspects of life activity, such as social relations, occupational activities and so on.
Symptoms
Symptoms of PTSD fall into three main categories: 1. "Reliving" the event, re-experiencing the original trauma through flashback episodes (event seem to happen again and again) or repeated nightmares and strong reactions to situations reminding the victim of the event.
2. Avoidance which is emotional “numbing� as if one doesn’t care about anything, avoidance of people who remind the distressing memories of the event, inability to recall the major aspects of the trauma, losing interest in daily activities, and feeling that one`s future will never be normal like other people. 3. Arousal which is having difficulty concentrating, startling easily, difficulty falling or staying asleep, feeling more aware (hypervigilance) showing outbursts of anger and irritability. One might feel guilt about the event such as survivor guilt, some symptoms like agitation, excitability, dizziness, fainting, palpitations and headache are typical of anxiety, stress and tension and mught be experienced. The diagnosis is based on clinical evidences. No tests can be performed to diagnose if one is going through PTSD.
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Treatment
Why PTSD is important and prompt actions must be taken after a trauma like earthquake? Early treatment is better. PTSD symptoms can change family life. PTSD can be related to other health problems Treatment can help prevent PTSD from developing after a trauma. Good social support is an inevitable part of treatment especially in natural disasters such as earthquake and can help protect against PTSD. Psychotherapeutic interventions such as cognitive and cognitive behavioral therapies are considered as first line therapy. In CBT, individuals learn to identify thoughts that make them feel afraid or upset and replace them with less distressing thoughts. Another form of treatment called “desensitization” might also be used in which one learns to remember traumatic event and express his/her feeling about it. This helps the memories of event to become less frightening over time. There are also support groups where people with similar experiences gather together, talk about their feelings and help each other in breezing through the traumatic event. A variety of medications has shown benefit in reducing PTSD symptoms but "there is no clear drug treatment for PTSD”. To help reduce anxiety, antidepressants including selective serotonin reuptake inhibitors (SSRIs) and sleep medications can be of help. Beware of complications such as alcohol or substance abuse, depression and panic attacks.
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AM2012 India After all the problems happened to the IFMSA-IRAN delegates at AM2012, this is a good time to say congratulation to IRAN SCORPians. By the way this is not the first time our SCORP friends are presenting a project at GA but this is our first time having a chance to appreciate their great job. Best orange wishes from Isfahan SCOPHians for them with one IsfSCOPH Respect Badge. Here is the abstract of IRAN SCORP project which was presented at AM2012 project fair.
Psychodrama for Those Suffering from Down syndrome and Performing Street Play by them Art is a medium for non-verbal communication; on the other hand, speaking disorder and delayed expression are among the most obvious problems of the children suffering from Down syndrome. 13 persons suffering from Down syndrome underwent Psychodrama for a period of 8 months (128 hours) until this play reached the step of a street performance. The play was performed on 28th-29th April 2012 at Tehran University of Medical Sciences. This resulted in improvement of communication between such patients and the society, enhancement of expression and so on. This project shows the effects of Psychodrama on those suffering from some kind of mental-physical disorder.
FARS News Cartoon by Shahin Kalantari
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Happy Doctors Day to all Iranian physicians and also to Iran
future
physicians.
Avicenna's
birthday
is
commemorated as the national doctor's day which is August 23 (Shahrivar 1st in Persian calendar). This will be a good time to say thanks to all Iranian physicians and wish them the best.
Isfahan SCOPHians also give their great blessing and best wishes to Iran young future doctors.