Long-term impact of the New Zealand earthquakes – lessons for Nepal?

Research on the long-term impact of the New Zealand earthquakes has strong potential to help inform responses to the recent earthquake in Nepal. Sarb Johal, from the Joint Centre Disaster Research Centre at Massey University, presented two linked papers that explored the long-term recovery processes for healthcare providers and the communities they serve in the aftermath of the earthquakes that occurred in 2010/11 in Christchurch – New Zealand's second most populous city. The earthquake in February 2011, which measured 6.3 on the Richter Scale followed by a series of significant aftershocks, resulted in 185 fatalities and more than 7,500 serious injuries. Altogether, around 92,000 people were exposed to violent ground shaking. Dr Johal presented data from interviews conducted with doctors and nurses from a range of specialities to explore their personal experiences, and those of their patients, two years following the earthquakes.

The first paper drew on interviews with eight General Practitioners' (GPs) to explore their perceptions of the impact of the earthquakes on primary care clinic patients. Although most survivors were able to adjust over time, some (especially those who failed to receive appropriate support following the earthquake), experienced long-term stress reactions such as loss of control and agency and feelings of anxiety and exhaustion. Many patients presented to seek reassurance that the feelings they were continuing to experience were 'normal'. Secondary stressors, such as insurance and housing issues, also contributed to distress and patients commonly requested social advocacy. Patients also presented symptoms stemming from overcrowding and loss of recreation and green space. Initially community spirit was high, but levels of support tended to dissipate over time (although it was still required). Particular problems were experienced by vulnerable groups such children and elderly people. Dr Johal described the case of one small child who was still too scared to sleep alone two years after the earthquake. Interestingly, people with pre-existing mental health problems generally appeared to cope well. The impact of the earthquakes on GPs themselves was inconsistent. Some experienced a loss of role as their premises had been destroyed, or the population they served had been relocated, while others had a drastically increased workload.

The second paper explored the impact of the earthquakes on the wellbeing of nurses working in different specialities. Dr Johal explained that compassion fatigue, vicarious trauma and burnout were common reactions, particularly in nurses who were living away from home and lacked social support. Many felt unable to sustain the high level of empathy required in their role, but found it difficult to maintain the boundaries necessary to protect themselves against emotional exhaustion. Nurses' workloads and working hours as well as the need for flexibility in role typically increased in response to managing the needs of patients and trying to maintain essential healthcare services.

The earthquakes had a significant impact on the professional and personal lives of GPs and nurses. Many felt pressure from the dual challenges of personal and work demands while delivering essential health services after a major disaster. Sometimes the needs of patients and the community were put before those of family. The high workload meant that many healthcare providers had little opportunity to reflect on their experiences, even though many had been personally affected. Both doctors and nurses typically felt the need to role model successful coping and resilience to their patients. Although counselling was offered, some sought external support as being seen to be failing to cope was stigmatised. In general, doctors were more aware of their personal stress reactions and the need to engage in self-care than nurses.

Important lessons can be learned from this research for helping manage the short and long-term impact of major disasters on survivors and those who care for them. The findings can inform the development of disaster education, preparation and planning resources for healthcare professionals. Particular emphasis should be placed on the need to maintain formal and informal support several years after such events. A key issue that emerged from this research and many other studies is the urgent need to de-stigmatise help seeking by healthcare providers, as well as highlight the importance of effective self care strategies and the need to provide opportunities for reflection at different time points.