 It
takes a special kind of doctor to sign up for the tsunami
relief operation. Indeed, someone with a special kind
of resilience, willing to risk life and limb in the face
of such misery and devastation, all in the service of
helping others. Yet, as Kingston-based psychiatrist and
post traumatic stress disorder (PTSD) expert Dr Robert
Oxlade points out, it should also be someone who has the
foresight to "take care of [his/her] own needs for physical
and psychological preservation... even if all around are
dying and starving."
Dr Oxlade's work with Canadian
peacekeeping forces from harrowing missions like Rwanda
has taught him the value of a healthy dose of normality
in these situations. "There has to be support for a
normal balance here," he says. "Some people can be excessively
or competitively altruistic and can neglect their own
needs, and can then wear out or make mistakes that can
be costly, or damage their health irretrievably."
'HEAL
THYSELF' SECONDARY
While doctors will acknowledge the reality of PTSD,
in a crisis situation like the tsunami relief effort,
self preservation isn't always top priority. "Doctors
are notoriously lax about their health," says Dr Anthony
Feinstein, a professor of psychiatry at the University
of Toronto who has also worked extensively with PTSD
sufferers. Dr Oxlade agrees, having recognized this
behaviour over and over again with relief operations
in doctors' attitude toward sleep. "In some instances,
sleep has been perceived as an 'expendable luxury.'
Doing without sleep is seen as macho."
Emergency physician Dr Daryl Leiski,
from St Josephs Hospital in Comox, BC, has just returned
from a tour of duty in tsunami-ravaged Indonesia with
the Canadian Relief Foundation. He wouldn't necessarily
describe his own sleep deprivation as macho, but he
does realize the importance of self preservation.
During a two week clinic in Drien
Rampak, near Meuloboh, the six-person team he was part
of ensured that they kept a ready supply of Canadian
army rations, power bars and fresh water on hand. In
addition, while close to 200 patients passed through
the clinic each day and despite a 14-15 hour workday,
the team made time to socialize with the locals, play
soccer and tour the devastated region.
'NORMAL'
AMONG THE RUINS
Still, trying to achieve 'normal' when you're a 16-hour
flight from home and surrounded by ruin can be a pretty
daunting challenge. Dr Leiski and his team say they
were lucky in their Indonesian experience to be able
to take cues from the local people, whose fortitude
was incredible. "When we first arrived, people were
walking around shocked, stunned," says Dr Leiski. "But
by the time we left, they were beginning to re-build
their communities."
"We were fortunate in that the
'emergency response' portion of this mission had all
but ended by the time we arrived," explains another
member of the team, paramedic and medical coordinator
Bill Coltart. "This meant that those we were treating
had injuries that were relatively minor in nature. This
coupled with a strict religion that demands prayer three
times a day meant that we were able to take breaks."
Dr Oxlade applauds the good sense
of this downtime. "Taking proper breaks for rest and
relaxation is an imperative rule," he says. "Self survival
also requires strong spiritual support — whether
this be music, poetry, literature, religious involvement,
prayer, meditation."
CAREFUL
SELECTION
Non-government organizations like the Red Cross are
well aware of the balancing act that doctors and other
emergency workers must perform during a relief operation.
That's why the selection process for volunteers is very
rigorous, says Ginette Archambault, an International
Services Officer with the Canadian Red Cross. "We want
to see if the doctor has a personality well-equipped
to deal with high stress. Many have an idealistic view,
so we ask their reasons for wanting to do it. We want
to know that they aren't running away from a failed
relationship, because once they are on an operation
these problems will only become magnified."
Once selected, basic training for
doctors includes workshops on security, health and PTSD.
"The person who suffers from PTSD is not necessarily
the person who's had a gun to the head. Usually, it's
caused by being exposed to a high level of misery, dead
bodies, suffering children on a daily basis," says Mrs
Archambault. "Even if you are a very strong person,
it is normal to react to a crisis situation, because
the situation itself is not normal."
Dr Oxlade invites physicians interested
in PTSD to get in touch: [email protected]
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