Health workers in the hardest-hit areas of Ecuador have felt the impact of the recent earthquake particularly deeply; they not only have to deal with the emotional impact on their patients, but also the consequences for themselves and for their families.

Like so many people in Ecuador, health professionals lost their homes, their projects and even their loved ones in the earthquake. The double burden of caring for people at the same time as coping with personal stress can mean that health workers need additional support.

Brazilian MSF psychologist Ionara Rabelo, has been in the northern Manabi province supporting earthquake victims and providing training to health workers, lecturers, social workers, community leaders and fellow psychologists. The team that she was working with has provided psychological care and training to more than 1,280 people.

What is the current situation in the north of Manabi province?

The cities most affected by the earthquake have received support from the government and NGOs, mainly through the official shelters, however, in a number of smaller unofficial camps people’s basic needs are still not being met.

In cities like Jama, San Vicente and Bahía, to the north of the country, the earthquake has left the mental health network in a very fragile state; there were few existing mental health services and the need for them has now grown. In three months’ time an even bigger need for psychological services may emerge as people struggle to deal with the situation and start to develop chronic mental health problems. 

What is MSF doing in Manabi province?

MSF has provided training to help health professionals deal with the personal consequences of the earthquake, and to help their patients and colleagues to do the same. This has included providing training in counselling techniques and developing psychosocial programmes within health services.

MSF has also trained community leaders and people working in temporary shelters in how to spot the signs of a more serious mental health problem. Our teams trained more than 60 lecturers who can now run their own training to help members of their community to spot these signs. This training includes explaining the importance of coping strategies, the expected mental health reactions following a natural disaster and the importance of early diagnosis.

MSF staff have also trained primary school teachers in group activities that can help children and families to cope following the earthquake.

What are the main needs of the population in this region?

Before effective mental health support can be provided, people’s basic needs for shelter, food and protection need to be met. This gives people the platform that they need in order to start rebuilding their lives. For the moment, it is people who are living outside of the official shelters - sleeping in parks, schools or open areas close to their destroyed homes - who are most in need of this support.

Three weeks after the earthquake we started to hear about men using alcohol to cope with the situation. An increased dependence on alcohol or drugs could become a challenge for the country in the coming months. We also met people who had lost their homes and were struggling with losing their independence.

People sometimes wrongly assume that psychology professionals are always strong but they too can need support and care from their families, friends and colleagues.

A psychologist I was working with told me that she had lost the home she had lived in for more than 40 years. She had hoped that she would pass her house onto her children but it was severely damaged and is now uninhabitable. Two floors of the hospital where she works were also damaged and what is left of her office has now been moved to another location.

Many changes had taken place that were out of her control. She had symptoms of stress and was suffering a great deal. Her colleagues also wanted to talk to her but she felt that she did not have enough time to talk to them as well as to her patients.

We worked with her to see that she could regain control within the emergency situation, for example by taking a day off to spend with her family or, at work, by setting up group, psycho-educational and training plans for the people working at her hospital who needed support.

What is mental health work like in emergency situations?

Any emergency requires different strategies and tools in order to deliver mental health support and time is often of the essence. In this response, MSF has focused on providing counselling and building capacity amongst professionals to allow them to deliver psychological first aid.

Unlike long-term projects where patients often have a period of time to process the situation they are in, feelings and emotions can run high during an emergency. When working on psychological first aid we try to ensure that patients are able to identify their feelings, recognise their emotions and reorganise themselves internally, to try to make sure that they do not go on to develop a chronic disorder.