03-06-06
Deconstructing Disaster
Molly V. Strzelecki
Summary
Occupational practitioners can play key roles in disaster preparedness and relief.
No one is entirely prepared when a disaster strikes. Granted, there can be some indication that it's time to leave town when the storm tracker starts going off the charts, but even then, no one can ever be ready for the destruction and devastation that follows. Last fall, U.S. citizens saw a number of natural disasters in the form of a string of hurricanes that swept across the southern part of the country, with Hurricanes Katrina, Rita, and Wilma coming in quick succession with almost unimaginable destruction.
What followed was not only loss of life and property, but for many, loss of self and home as they once knew them. The aftermath of the recent hurricanes sent many occupational therapy practitioners into the thick of efforts to help restore order and aid those affected.
Times of disaster and emergency are never easy to cope with, but occupational therapy practitioners can carve out a niche for themselves when they are properly prepared.
The Occupational Therapy Difference
When working with victims of disasters, the main goal of any provider is to make sure survivors are safe and healthy. With an array of rescue workers, from physicians to nurses to social workers to occupational therapy practitioners, it can be hard to decipher what, exactly, a person's training and experience can bring to the efforts.
For those occupational therapy practitioners who were in the first wave of relief volunteers after the hurricanes, the task at hand was making their presence useful in situations where others may not have known how to best use their skills.
"Occupational therapists in disaster/emergency situations are members of a team, just as is typical of our clinical and routine practices," notes Susanne Pickering, MPH, MS, OTR/L, CHES, CAPT, U.S. Public Health Services, Centers for Disease Control and Prevention in Atlanta. "My experience is that there definitely is a role for occupational therapists and other therapists in emergency situations, including evacuation and care of special needs patients from health care facilities and from homes in the community."
Pickering was deployed in the first few years of the Kosovo refugee airlift to Fort Dix, New Jersey, in 1999; to the World Trade Center site in 2001; and to hurricane relief efforts in Florida in 2004. She notes that one of the biggest challenges occupational therapy practitioners face when entering these situations is a lack of resources to address clients' needs.
"For instance, the food served to people on special diets [because of conditions such as diabetes] was often difficult to obtain in shelters. Reaching the bathroom and bathing for people with mobility limitations was a challenge," she notes. Also, Pickering says, shelter residents typically had limited contact with family and friends to let them know they were okay, which added to stress and worry. In the end, Pickering lent her cell phone to anyone who wanted to use it to relieve some of the anxiety.
Any occupational therapy practitioner who has been in this position would agree that practicing in adverse conditions is to be expected during an emergency. But after shop is set up to the best of one's ability, the healing can begin.
"You start helping the person figure out what is important," says Frank Pascarelli, MS, OTR/L, NMSE, CPI, subject matter expert for the Strategic National Stockpile with the Centers for Disease Control and Prevention. "Every day, you work with that person on trying to rebuild their life in a small, incremental way. It puts the control back in their life, and they take control because they're doing it, and they're part of the solution. Talk with them about the piece of china they lost. Talk about their emotion. But at the same time, have a goal or goals in mind that the individual has established with you to help put their life back in order. I think we do that better than any other profession."
"As occupational therapists, we're recognized in two primary roles," says Laura Grogan, OTR, LCDR, U.S. Public Health Service. "We're recognized as mental health and rehabilitation providers. We certainly can bring and implement the skills of both while serving in disaster relief efforts." Grogan adds that, "as occupational therapists we are so versatile that we can see a complete picture. We don many hats and are excellent at evaluation, problem solving, and implementation of plans."
Take Care of Yourself
Taking care of others is not always easy, even if you are running on an adrenaline high that rivals that of a marathon runner. One thing that occupational therapy practitioners need to be conscious of when working in disaster or emergency situations is the toll of this work on themselves.
"It is easy to predict that you'll be working very long days. A 12-hour day is going to be normal," explains Grogan. "Anticipate that there will be mental, physical, and spiritual challenges each day. You're working with people who just lost everything and are now in an unfamiliar setting with new faces." Grogan points to a day when, feeling full of energy, she decided to take a tour of nearby Waveland, Mississippi. Having been through Biloxi and Gulfport, mainly business communities, Grogan was unprepared for the destruction that had hit the housing community of Waveland. "All of a sudden you'd see a set of concrete stairs that lead to nothing, or just the steel frame of what is left of a house. It was hard to process that, and then resume work with the individuals who went through that. My empathy level increased two times, leaving me mentally, physically, and spiritually exhausted. And not having time to take care of myself only added to the complexity."
Grogan suggests remembering that occupational therapy practitioners can help each other, which makes a huge difference.
"[If you see] a fellow team member in distress, as an occupational therapist you can help augment their needs, and if they need services beyond your capacity you can facilitate getting services for them," she says. "Being involved in a disaster affects people very differently. For some people it may bring back issues that need to be addressed on the spot."
Realizing Roles & Goals
It's tricky, diving into the chaos that destruction brings, and making a positive difference. It takes training, know-how, and finesse to be effective.
Pascarelli was deployed to Pascagoula, Mississippi, in October 2005, just one stop in a tour of relief work, and concurs that preplanning for disaster response is essential.
"As a nationally recognized professional organization, we really need to have a response team," he says. "When you go in ones and twos, it's hard because you don't know where to go or how to begin. But if you're part of an agency, you already have those relationships established. These organizations are part of a larger response plan."
After the Florida hurricanes of 2004, the American Occupational Therapy Association Commission on Practice asked for an official document on what role occupational therapy can play in disaster relief. The concept paper, authored by Marjorie Scaffa, PhD, OTR/L, FAOTA; Steven Gerardi, MS, OTR/L, CHT; Georgiana Herzberg, PhD, OTR/L; and Mary Ann McColl, PhD, details how occupation can be used to help people get their lives back on track after a disaster.
"We looked at how occupational therapists might be involved in planning prior to disasters; for example, how shelters might be set up to help occupational performance," explains Scaffa. "Also, [we explored] issues related to people with disabilities during disaster and how to appropriately evacuate them and provide for their needs in shelters. The paper looks at how we might get involved in the planning stages up front, to make sure that there are environmental adaptations that were appropriate, [and] special equipment that might be needed for people with disabilities."
The paper next explores the immediate response after disaster hits and describes several roles for occupational therapy practitioners. "We can be managers of special needs shelters. We can train volunteers to provide services in shelters," Scaffa says. In the long-term the big push is the mental health aspect.
Fewer and fewer occupational therapy practitioners have been practicing in mental health, but in disaster response it is the area most in need, Scaffa explains. The challenge, she contends, is that occupational therapists are not listed in many states as mental health providers, and often agencies such as the Red Cross or local relief organizations do not know how to use occupational therapists in that capacity or do not believe that occupational therapists are qualified to address mental health issues. Scaffa adds that the occupational therapy industry should address the need for more mental health-focused and well-trained occupational therapy practitioners.
With recent disasters weighing on minds and media across the country, and occupational therapy practitioners playing a key role in relief efforts, Scaffa says that the authors have high hopes for the influence of the paper, which was approved by the Representative Assembly at its online meeting in October.
"I hope that it encourages occupational therapy practitioners, prior to disasters, to get involved with their local agencies that respond to disasters, making those contacts, letting them know who we are and what we're capable of doing during disasters," Scaffa explains. "If we have contacts up front, it will be easier for us to get involved and provide services when a disaster occurs."
Occupational therapy practitioners' roles in disasters also include addressing physical challenges.
"When we're talking about occupational therapy's role, there is a point that needs to be made about the body's physical reaction to stress," says AOTA Vice President Charles Christiansen, EdD, OTR, OT(C), FAOTA. "Research indicates that if we normalize routines and lifestyles, we can, in fact, have a measurable positive impact on reducing the negative consequences of stressors [on the body]. Because the immune system is involved, this positive benefit serves a preventative role in helping the person to resist infection and chronic disease that occurs with the wear and tear of stressful situations on tissues and organs." Christiansen notes that emphasizing this preventative physiological benefit places occupational therapy services squarely within the realms of health promotion and prevention in public health. "Not only are practitioners helping people directly after the event, coping with the emotional distress of the moment, but through normalizing daily routines they minimize the ongoing cost to the body over time, since emotional signals to the brain release the stress hormone that, when called on to excess, leads to the damage of the body," he says.
Scaffa says she hopes the paper will encourage practitioners to get more training in disaster response. "It's a specialized area and does require some additional knowledge. There is a whole skill set that we don't have in terms of crisis intervention that I would like to see practitioners pursue to become more proficient in that."
One way to get additional knowledge, Pascarelli notes, is through Web sites like www.fema.gov, which can help occupational therapy practitioners be better prepared to volunteer.
"There are things found on the FEMA Web site, like just learning terminology or the common language of [incident command system]," Pascarelli says. "You have to know what that means-if you as a volunteer fit that system."
Molly V. Strzelecki is the associate editor of OT Practice.
When Roles Are Reversed
Occupational therapy practitioners are doing their part to get involved in relief efforts, but what about those practitioners who were directly affected by the hurricanes?
Eve Taylor, PhD, LOTR, program director for occupational therapy at the Louisiana State University Health Science Center in New Orleans, lost her house and most of her possessions to Hurricane Katrina. Her husband lost his job, and her daughter lost her school. It's not an uncommon story, Taylor says, noting that the population of nearby Baton Rouge has nearly doubled from about 250,000 residents to 500,000 since Katrina hit. The hurricane left 80% of the houses in New Orleans flooded, with few places available to rent or even in livable condition.
As an occupational therapist, however, Taylor is using her background to help herself and her fellow victims through the tough times ahead.
"I know one of the things suggested to individuals for disaster relief, or trauma recovery, is to maintain life routines as much as possible," Taylor says. "That's one of the key points with occupational therapy, trying to obtain or maintain routine. But when you've lost your house and your neighborhood and your job all in one clean sweep, [and] you're staying with friends or family in temporary situations, it's very difficult to establish a routine, much less stay with it."
Taylor says a common phrase she hears is, "I can't imagine what it is like to experience what you're experiencing," to which she responds that she can't really imagine it, either. "I think about it in chunks-getting my daughter settled in a new school, my husband's search for another job, or our house and how we will deal with that-and take one day at a time. But I can't see the totality of it. It's too overwhelming."
Taylor notes that she tends to take a holistic approach to how she views life, because of to her training as an occupational therapist.
"I zoom out and take a macro view, looking at the whole picture, and how this event will affect us nationally and internationally from the perspective of what we have in common with the earthquake victims in Pakistan," Taylor explains. "And then I can zoom in and look at it as self-care, what I need to do to take care of myself, my family members, my colleagues."
Taylor adds that having a job to go back to is considered very lucky by fellow victims, and has added a great sense of normalcy, purpose, and meaning for her since everything else has been tossed up in the air.
"Having a job is lucky. You have a job, you have people that you can depend on and who depend on you," Taylor says.
-M.S.
For More Information
Federal Emergency Management System
www.fema.gov
World Federation of Occupational Therapists
www.wfot.org
The Role of Occupational Therapy in Disaster Preparedness, Response, and Recovery: A Concept Paper, Draft V, 2005. By the American Occupational Therapy Association. Bethesda, MD: Author. Retrieved December 12, 2005, from http://www.aota.org/members/area6/2005-fallra/DisasterPrep.pdf.
Surviving 9/11: Impact and Experiences of Occupational Therapy Practitioners
Edited by Pat Precin, 2003. Binghamton, NY: Haworth Press. (To order, call toll free 877-404-AOTA or shop online at www.aota.org. $24.95 for Members, $35.50 for Nonmembers. Order #1398-MI)
Reference Information:
Strzelecki, M. V. (2006). Deconstructing disaster. [Electronic Version]. OT Practice, 11(4), 14-17.
©Copyright 2006. The American Occupational Therapy Association. All rights reserved.
