It is a slide shares for disaster mental health care in Myanmar which was really based on the post Nagis cyclone impacts in delta, Myanmar. It is presented for the final project of Understanding the brain; Neurobiology in Everyday life by Professor Peggy Mason, University of Chicago on Course a.

1. Disaster Mental Health in Myanmar;
Everyday life with PTSD
San San Oo
Student of Course a Class ; Understanding the Brain:
Neurobiology in everyday life by Professor Peggy Mason,
University of Chicago

2. PTSD; Understanding the Brain ,Neurobiology in everyday life by
Professor Peggy Mason, University of Chicago on Course a
• Problem with Overwhelming and Debilitating state where triggered
Emotional memories of traumatic event are working in re exposure
to the sensory environment with details in reminders
• Highly charged situations of much imp actual to life are stored in
memory bank because emotion facilitates memory formation
• Body and Brain work best together in the response; Aroused/
exercised Body responses to fright, flight and react and emotional
type of memories
• It can be helped out via Beta blockers ; sympathetic suppression
settled down the body through which new memory is consolidated
– non emotional experience- and less evocative of emotional
reactions are formed

3. PTSD; Understanding the Brain ,Neurobiology in everyday life i
by Professor Peggy Mason, University of Chicago on Course a
• It can be helped out via Beta blockers ; sympathetic
suppression settled down the body through which new
memory is consolidated – non emotional experience- and
less evocative of emotional reactions are formed
• Can recall the event without much emotions
• Promise for a lot of people for helping them from PTSD
• Unfortunately A lot of Trauma in the world

4. Traumatic Stress effects Brain and Nervous
System
• Bremner JD Departments of Diagnostic Radiology and
Psychiatry, Yale University School of Medicine, Yale Psychiatric
Institute, Yale/VA PET Center, New Haven, CT 06520, USA.
Seminars in Clinical Neuropsychiatry [1999, 4(4):249-255];
Two brain areas that have been consistently implicated in PTSD
include the hippocampus and prefrontal cortex.
The Effect of PTSD on the Brain;The Size of the Hippocampus
Differs Between People With and Without PTSD
By Matthew Tull, PhDUpdated May 30, 2014

5. The neuroscience of PTSD/ The brain and PTSD
• how memory processing and the brain matters in relation to trauma and
post traumatic stress disorder. Fight, flight, freeze and shutdown:
http://www.youtube.com/user/Integrati... With trauma and PTSD
specialist Dr Shoshana Garfield, based in Brighton UK:
http://shoshanagarfield.com/
• Scientists Reveal Brain Circuitry Involved in Post Traumatic Stress and
Related Disorders;
psychiatry.yale.edu/research/programs/clinical.../ptsd.asp...Yale
University,10/14/2012
• PTSD Documentary; http://youtu.be/JBUjLXtedfc
•

6. Scientists Reveal Brain Circuitry Involved in Post Traumatic Stress and
Related Disorders;
• psychiatry.yale.edu/research/programs/clinical.../ptsd.asp...Yale
University,10/14/2012;
Other recent findings discussed show: How exposure to stress
causes molecular changes that weaken the ability of the prefrontal
cortex to regulate behavior, thought, and emotion, while
strengthening more primitive brain circuits (Amy Arnsten, PhD,
abstract 310, see attached speaker summary).
• “New methods for looking deep into the brain are revealing a
dynamic landscape that changes as it must to cope with
trauma,” said press conference moderator Sheena Josselyn, PhD,
from the Hospital for Sick Children in Toronto,
Ontario, an expert on the neural basis of brain function. “The more
we learn about those changes, and how
experiences remodel the brain, the more tools we will acquire for
treating disorders that affect millions of people.”

7. Post Traumatic Stress Disorder
• Posttraumatic stress disorder (PTSD) can occur
after someone goes through a traumatic event
like combat, assault, or disaster. Most people
have some stress reactions after a trauma. If
the reactions don't go away over time or
disrupt your life, you may have PTSD.
National Center for PTSD

8. Complications of Untreated PTSD
• Psychiatric disorder caused by exposure to
preceding Traumatic Event
Destructive to self THOUGHT,ACTION AND
BEHAVIOR – violence, aggression, arguments and
also to family – uncomfortable to life threatening
• Relationship problems, Jobless,
• Anxiety and depression
• Alcohol and drug abuse
• Can not cope with daily life/function well.

9. PTSD CONTD’
• Can affect Anyone no matter the age, sex ,or
age of a person
• Common Traumas – Military combat
experiences, Natural Disaster, Violence,
Physical Abuse, Rape, Unexpected Accidents,
Witnessing a death, Childhood neglect
experiences, Traumatic event on a job.
• (http://ptsdtreatment help.com)

10. Disasters and Mental Health Care in
Myanmar
• Natural Disaster – Earth Quakes, Landslides,
Floods, Tsunami, Cyclones ( In 2008, on 2nd May
Cyclone Nagis killed 14,0000 people ),etc.
• Manmade Disasters – Wars on minorities over 50
years, Massacre, Violence and Crimes, RTA, HIV
etc.
• Post Disaster mental health care – 1 year plan
after Nagis Cyclone on 2nd May, 2008 :Delivery of
psycho social services after Disaster

11. The report BY John Hopkins Bloomberg Public Health School
Center for Public Health and Human Rights
• The response to Cyclone Nargis on the part of Burma’s ruling
junta, the State Peace and Development Council (SPDC), was
profoundly affected by the junta’s policies, its practices
toward its citizens generally, and by the political imperatives
of the junta’s referendum priorities.
• , After the Storm: Voices from the Delta, reveals systematic
obstruction of relief aid, willful acts of theft and sale of relief
supplies, forced relocation, and the use of forced labor for
reconstruction projects, including forced child labor. The slow
distribution of aid, the push to hold the referendum vote, and
the early refusal to accept foreign assistance are evidence of
the junta’s primary concerns for regime survival and political
control over the well-being of the Burmese people.

12. Disaster mental health care after Nagis cyclone
• .Withintheexistingsocio-politicalcon-straints, . The disaster hada
severe impact on more than 2.4 million people, mostly in the Delta
region (Post-Nargis Recovery and Preparedness Plan,2008).
• Post-Nargis Recovery and Prepa-redness Plan (PONREPP, 2008),
report that 23% of the respondents had a family mem-ber with
psychological problems associatedwith the Nargis cyclone. Of these,
only 11%reported having received treatment.
• PONREP reports that 7% of the householdsreported at least one
deceased family mem-ber. Save the Children also reported
thatteachers and children had di⁄culties toconcentrating since the
cyclone. (IRIN,2008). Other NGOs, such as Me¤dicines
SansFrontie'res, highlighted the need for psycho-logical assistance
in Burma/Myanmar
• (Me¤dicines Sans Frontie'res (MSF), 200

13. Mental Health problems after Nagis cyclone
• Acute severe Stress
Reactions to Trauma
• Anxiety, Fears
• Depression
• PTSD
• Chronic Stress
• Alcohol problems
• Hopelessness, Insomnia
• Poverty

14. Post Disaster Mental Health Care
Coverage under the regieme
• 1 year plan
• Loaded tasks in Basic health staffs
as affected communities / limited
mental health infrastructure and
limited formal mental health
training
• Scarce mental health
professionals/ Resources
• Details screening in mental health
problems not done
• Large population affected in large
area.
• Long run follow up not done.
• Limited research
• No access in far areas

15. Research in Disaster Mental Health
with Burmese people
• Very Limited
• 50% Survivors affected
from severe
Psychosocial Distress ;
2008, 6 months after
Nagis studied among
more than 4200
survivors( Post
Disaster Mental Health Care
project - Myanmar)

16. Research in Disaster Mental Health on PTSD
• 20% - 30% Population of severely
affected areas ( Bogalay, Labutta)
suffered PTSD, 5 Years after Nagis in
2013 ( Psychological sufferings of
Nagis cyclone survivors – Khin Myo
Htut and San San Oo at al, Paper
No;0608, ICEPS2014, Taipei)
• In severely affected area ( Labutta)
8.5 % survivors suffered severe
depression 5 Years after Nagis in
2013 ( Complex Trauma and PTSD
among Nagis survivors - Khin Myo
Htut and San San Oo at al, Paper
No;0608, ICEPS2014, Taipei)
• Mental health care received – not
established
• More than 50% reduction in daily
income as poverty

17. Research in Disaster Mental Health-POST TRAUMATIC STRESS-
with Burmese people
• Pilot randomized controlled trial of Common Element
Treatments Treatment Approach ( 150 Treatment group /126
wait control group) amounts adults from Burma living in the
Thailand found high level of Post traumatic symptoms and
depressive symptoms, with CETA significantly reducing the
symptoms of both in treatment group.
(Cite: A Common Elements Treatment Approach for Adult
Mental Health Problems in Low – and Middle Income
Countries – John Hopkins Bloomberg School of Public Health)

18. Challenging Dilemma
• Resiliency as thought of
main stream
• Survivors suffered much
in their diversities
• Trauma is seriously and
severely enough
• ?PTSD is the case in
Myanmar
• ? PTSD is common

19. Lessons learnt
• Disaster Mental Health
Care and Traumatic
Stress study has been
still underway as
contemporary issue
• Mental Health Care
outreach in affected
communities is needed
• . Mental health policy
should favor disaster
mental health care

20. Thoughts on Trauma/PTSD
• Dr Terry Keane, Director in Behavior Science Division, National Center for PTSD,
U.S – ‘Long poverty after disaster could account for Complex PTSD’
• Ex -Professor and Ex - Post Disaster Mental Health Project Manager ( Myanmar,
2008)- ‘ Resiliency is the key factor in the individual to affect the mental health’.
• Saw Thet Htun, Deputy Chief Counselor( John Hop kin University) and ex political
prisoner – ‘We live in trauma society’, ‘ I lost my one own eye in prison. I thought
traumatic Stress was needed to study well’.
• Daw Aye Than ,65, a cyclone Nagis survivor from Bogalay, Delta, Myanmar – ‘Next
time if Cyclone comes, I’ll wear the stalking, so that I would not stay naked, and
chilled for 2 days ( she showed a pair of second hand - trousers she bought street
side), I have been feeling still shocked’.
• The woman survivor, 45, said’ I never forget how I met that killing cyclone. I felt
very bad and frightened just after I noticed I survived as being naked, starved,
thirsty among the widespread dead bodies around, I covered my lower part with a
plastic piece I found nearby and walked past across the deserted land’

21. Voices on Trauma and PTSD
’’ I felt very painful and shocked and tried to avoid that memories but I have
been with intrusions all time, I cannot concentrate well on anniversary
funeral and daily routines, Life is very painful and no more happiness in
this farm here’; the survivor, 54,said 5 years aftermath.
. 5 years aftermath the Nagis survivor, the wife of a local fisherman said in
her tears and sobbing during her sales on her dried fish;’ I wish to find out
my younger brother, he left away in the days of deliberate suffers from our
both parents and siblings loss in Nagis, I have been left alone here busy all
day for food but I want to find out where he has been and see him’.
‘ I found my 1 year old boy survived and still breathed but he looked pale and
chilled and thirsty and I was trying to find out water but no one and water
was around there, I embraced him tight and walked around and gradually
he stopped breathing.’ the survivor, 25,recalled painfully 5 years after
math.

22. To the Better understanding of others
and life
THANK
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