Once again I’m lead to pondering the different ways my situation has affected me, and what might be helpful to mitigate some of the less frequently mentioned aspects of coping in a disaster.
Like many people, I’m still managing with quite limited power, water that is a trickle (not enough pressure to fill a toilet cistern let alone the hot water cylinder!), and the hassles of finding a supermarket and shops that are open, a petrol station before I run out of gas, and ways to dispose of human waste matter safely.
I posted before about the loss of cues that usually help me to maintain my normal routine. With the loss of these cues, and changes to my usual routine, as well as the inevitable anxiety that comes with repeated aftershocks (Is that a truck going by or an aftershock? When will this aftershock stop? Is that crack in my driveway getting bigger? What about the one in my wall?), it’s no wonder that now, 13 days after the quake, I’m feeling fatigued.
Now while some people would argue that I’m somewhat inclined to be over-active (One medical report written about me after my concussion described me as having a ‘frenetic’ level of activity!), I generally like to have a routine. I like to shop in the same place, with a list, on the same day every fortnight. I like to go to the same service station, use the same route to and from the places I go. My daily activity pattern is similar from day to day. I find this helps me maintain a sense of security (no, I’m not obsessive about it!), and it helps reduce the amount of brain power needed to make decisions. This is not what is happening right now! I’m starting to get tired.
And my thoughts turn to the people I work with, people with chronic pain. While some have routines that serve them well, many don’t. Some are too active in parts of the day, slumping into a ‘bust’ period at other parts of the day. Some are quite chaotic and don’t have a regular routine at all. Others are inclined to stop altogether. Many, in response to stressors, find their pain flaring up and have trouble thinking clearly to organise their response to daily demands.
I was handed a leaflet prepared by the NZ College of Clinical Psychologists in response to the Christchurch Earthquake. (Go here for their page for the people of Canterbury) The leaflet reminds people to maintain, amongst other things, routine and says ‘familiarity is comforting’. It’s true.
It also says stay connected (we need each other), save your energy (keep if for important things), lifestyle (balance is healthy), safety (protect yourself in every way).
I totally agree.
What I wonder is whether the people who seek our help, particularly people compromised by chronic pain with its associated fatigue, reduced cognitive capacity, influence on mood and anxiety and sleep, can put this advice in place.
What can we do after an event like this to support people with chronic pain? I see an enormous amount of effort being put in place to support the immediate needs of people around me. While not all the efforts are as coordinated as I’d like (not a portaloo in sight in my street, despite five households of folk in their 80’s, while a colleague who lives in an area with water and power has THREE of the darned things within 100 m of home!) those basic concerns are being addressed. There is a concerted effort by the clinical psychologists to establish an acute stress response service. There is counselling for people. There are resources for people with disabilities who need help with environmental modifications.
BUT – and you knew there would be one – nothing about HOW to maintain routines, how to stay connected, to save your energy, to maintain a healthy balanced lifestyle or to be safe (emotionally and physically). And not a lot for the weeks and months ahead of us all when we’re feeling fatigued, grumpy from poor sleep, dealing with cold and wet weather and poor roading and limited consultation from Powers That Be.
This is a call for occupational therapists, in particular, to begin thinking about ways to proactively engage with vulnerable people in the community to help return some control and routine to lives disrupted by not only disaster, but pain as well. And no, I don’t mean focusing on patients, or people who have already been identified as having disabilities or special needs, or even those who go out and look for help. This is a time to be positive about preventing loss of those things that maintain self efficacy and internal locus of control in people who are vulnerable.
I don’t think GP’s centres are always the best place for this kind of help – after all, people who are vulnerable may not be the same people who seek help. I think of the households of elderly folk down my street – none of them have sought help. We need to move beyond thinking in ‘health = medical’ and into ‘health = living’. People with pain often don’t look for help, hence my PhD.
How could we do this kind of wellbeing work? I think the Welfare Centres that we have established all around Christchurch as part of the response to this quake could do with an occupational therapist who could be available to talk with people about how to retain their routines and habits. Then I wonder if supermarkets and pharmacies and shopping malls might be the next best places to set up shop. Posters perhaps. In libraries, pubs, cafes, and most particularly, takeaway shops. Maybe leaflet drops in neighbourhoods.
What do you think?