Many people were unable to realize what happened soon after the earthquake. This period is sometimes known as the ''6-hour vacuum''. When the earthquake struck, I was unable to realize that it was an earthquake. I thought that it was some kind of an explosion under my house. Also, it took a long time for many people in Kobe to realize that the epicentre of the earthquake was close to the city. Nobody expected an earthquake in the Kobe area. Many victims in the Kobe area could realize the magnitude of the event only after watching on television the scene of the nearby Nagata district on fire. It is important to know that the population affected by a disaster is sometimes the least informed on the magnitude and nature of the event .
HEALTH PROBLEMS IN THE ACUTE PHASE Immediately after the Earthquake
At Kobe University Medical School, a considerable number of victims brought to emergency services were found to be DOA (dead on arrival). Many other cases were referred to orthopedic surgery. Several cases of crush syndrome were also reported. The forensic department was extremely busy for administrative autopsies and certifications of death .
Soon after the earthquake, most of the victims experienced emotional numbness. A friend of mine who lost his parents said that he felt out of touch with reality. He said that he could not feel sadness. I experienced a sort of depersonalization (possibly, a psychological protection from the disaster).
Two or three days after the earthquake, the majority of the victims became talkative and joyful. Some people even became hypomanic and showed signs of psychomotor excitement. These symptoms might be caused by the biological joy of survival. Major psychiatric problems in this early stage were recurrences of mental disorders and epileptic seizures due to the interruption of habitual medication. Loss of memory and disorientation were reported, particularly among the elderly. In general, manic-depressive patients turned manic .
During the first week, everybody was anxious to secure food, water, and information. A kind of a battlefield friendship existed for a certain period. This resulted in mental excitement and friendship among victims. However, fear of after-shock and general anxiety were experienced at the same time. Survivor's guilt was strong for those who lost family members.
I experienced an abnormal sense of time: I felt one day was eternal, but I could not remember the events of the previous day.
After 1 week, the focus of health care was shifted from emergency medical care to care for chronic patients, including those with hypertension, diabetes mellitus, and mental disorders [4,5]. Care for demented elderly and mentally handicapped people in shelters posed difficult problems. Insomnia was common at crowded shelters. Acute stress responses and nightmares were reported. Psychiatric emergency care was established at some shelters. The Hyogo Prefectural Mental Health Center played a key role in coordinating mental health care to victims.
Volunteers, including physicians, psychologists and psychiatrists, flocked to Kobe and damaged areas. It is reported that almost 1.5 million volunteers from all over Japan, and some from abroad, came to the Hanshin area to assist after the earthquake.
After 10 days, the life in shelters became very stressful for many victims. An increase of acute stress responses, including serious stress peptic ulcer, was reported. The Department of Internal Medicine of Kobe University Medical School was busy with the treatment of many cases of extremely serious bleeding ulcers. Anxiety reactions and sleep disorders were common . An increased occurrence of pneumonia and bronchitis was reported among the elderly (the earthquake took place in January, which was wintertime in Japan).
After 2 weeks, victims started facing reality and the loss of family members, housing and jobs. Depression became manifest among victims. A few suicide cases were reported. Acute symptoms of post-traumatic stress (ASD), such as flashbacks, continued among victims.
After 1 month, a considerable number of the aged people became unable to cope with the continuing stress. Among elderly victims, dementia, disorientation and incontinence were often reported. The consumption of alcohol increased among victims, which led to an epidemic of alcohol-related problems in some shelters. Alcohol-related violence was sometimes reported. Some children showed regression. Burnout syndrome among volunteers became commonplace.
At one time, more than 320,000 people lived in shelters such as schools and public buildings. The government started the building of temporary houses which were similar to military barracks. In total, 47,000 temporary houses were built by public funding and almost 80,000 people lived in temporary housing.
Many victims lost their jobs and faced economic difficulties. In the process of rehabilitation and relocation, many victims faced degradation in social status which, in turn, caused depression.
Among the victims, the most disadvantaged population groups included the elderly who lost kin, families comprising a mother and children, the physically and mentally disadvantaged, and foreigners from developing countries.
After 2 years, victims moved gradually from temporary housing to condominiums built by the local government. Victims left their temporary houses one by one and by 1999 almost all temporary housing units became vacant .
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