Helping the Helpers: A Community-based Psychosocial Support Model in China

XINING, Qinghai, China — Five months after a 7.1 magnitude earthquake hit Yushu County, Dr. Zhaxi Lamao left her wounded hometown to attend a training workshop here. Dr. Zhaxi, who works in the county Maternal and Children’s Hospital, was told the training would help release her tension.

Since the April 2010 disaster, Dr. Zhaxi, a victim herself, has worked day and night to help others, and has witnessed the deadly impact of post-traumatic stress.

“I have seen more foetal deaths and stillbirths after the earthquake,” she said. “I can imagine the pregnant women have to deal with enormous stress, but I don’t know how to help them through.”

Social support becoming a post-disaster priority

Global experience shows that psychosocial support is critical for the long-term recovery of earthquake survivors and their communities. As one of the countries most prone to natural disasters, China has started to see psychosocial support as a post-disaster priority. But it has limited experience in this area and needs to develop practical models for providing support.

Qinghai province, 4,000 metres above sea level, is home 360,000 Tibetans including Dr. Zhaxi. Here in the capital city, she attended a conference with 90 other community leaders, women’s organizations, and health and social workers from Yushu and other areas of Qinghai.

Many of them were able, for the first time since the earthquake, to speak out about the stress they face and learn to manage it. They also learned how to assist others facing post-traumatic stress disorder. For most, it was their first chance to have their blood pressure taken since the quake.

The training package was developed after the May 2008 earthquake in Sichuan province, by a team led by Peking University Institute of Mental Health with support from the All-China Women’s Federation and the China National Committee on Ageing. The Ministry of Health of China and UNFPA, the United Nations Population Fund, co-sponsored the innovative project.

Targeting village leaders

Shi Yuan’an inspired the project team back in 2008. As head of Fuxing Village, in one of worst hit areas in Sichuan, he struggled with his own post-traumatic stress while having to deal with the whole community’s problems. “I drove fast, thinking if a car accident happened, it would take some of the stress away,” he said.

Shi regained hope and confidence after meeting Dr. Ma Hong, the Ministry of Health’s psychosocial support team leader in the region after the earthquake. In turn, Shi inspired Dr. Ma to adjust the project approach, telling her, “If you help us, we will be stronger and the community will be stronger. We are leaders, and we are victims too.”

At this suggestion, Dr. Ma’s team trained 835 village heads in six heavily affected counties; they provided support to 1 million villagers over the following year. Training modules and toolkits for similar interventions have also taken shape. Topics covered include: communicating with women, young people and the elderly; common psychological problems; counselling and intervention skills; post-disaster public health education, and self-protection for helpers in post-disaster areas.

Taking culture into consideration

After this year’s earthquake, Dr. Ma and her team organized the training attended by Dr. Zhaxi with further funding from UNFPA. They first conducted a needs assessment visit. Since Tibetan Buddhism prevails in Yushu, the team interviewed monks to gain their insights.

Bu Ri Yang, a monk in Yushu’s main Jiegu Temple for 15 years, explained that Tibetan Buddhism’s concept of sen’ni, meaning sickness inside the heart, is equivalent to mental disorder or emotional stress. “We have special prayers to comfort Tibetans with sen’ni,” he said. “Sometimes we refer them to doctors who have a good reputation.”

The Xining training confirmed that Tibetan Buddhism plays an important role in psychosocial support for the affected communities. Most Tibetan participants cited “praying and visiting temples” as ways to cope with stress after the earthquake.

One participant, Zha Ji, is the wife of a religious figure, a living Buddha in Yushu. She volunteered to work as chair of the Women’s Federation in Zhaxike District. “My husband is busy in his temple. I wanted to keep myself busy too,” she said. “Now I know what to say to the women around me.”

Dr. Ma and her team invited a Tibetan scholar to give the trainers a comprehensive briefing on Tibetan Buddhism and culture. They also had a key psychosocial support reference manual for community leaders translated into the Tibetan language for the first time.

Prospective of sustainability: National level advocacy

The Ministry of Health, which supported publication of the reference manual, has recognized the project’s impact and expressed interest in including this model for psychosocial support in China’s National Emergency Preparedness Plan.

“Responding to people’s actual needs is the key to strengthening communities affected by natural disasters,” said Mariam Khan, UNFPA’s Deputy Representative in China. “This project has found an effective way to do that.” UNFPA hopes that with continued support from national partners, the approach pioneered by Dr. Ma’s team will benefit other disaster-affected Chinese communities in the future.

— Gao Cuiling