Andrew J. McLean

Mitigating flood exposure

Introduction. In 2011, following heavy winter snowfall, two cities bordering two rivers in North Dakota, USA faced major flood threats. Flooding was foreseeable and predictable although the extent of risk was uncertain. One community, Fargo, situated in a shallow river basin, successfully mitigated and prevented flooding. For the other community, Minot, located in a deep river valley, prevention was not possible and downtown businesses and one-quarter of the homes were inundated, in the city’s worst flood on record. We aimed at contrasting the respective hazards, vulnerabilities, stressors, psychological risk factors, psychosocial consequences, and disaster risk reduction strategies under conditions where flood prevention was, and was not, possible. Methods. We applied the “trauma signature analysis” (TSIG) approach to compare the hazard profiles, identify salient disaster stressors, document the key components of disaster risk reduction response, and examine indicators of community resilience. Results. Two demographically-comparable communities, Fargo and Minot, faced challenging river flood threats and exhibited effective coordination across community sectors. We examined the implementation of disaster risk reduction strategies in situations where coordinated citizen action was able to prevent disaster impact (hazard avoidance) compared to the more common scenario when unpreventable disaster strikes, causing destruction, harm, and distress. Across a range of indicators, it is clear that successful mitigation diminishes both physical and psychological impact, thereby reducing the trauma signature of the event. Conclusion. In contrast to experience of historic flooding in Minot, the city of Fargo succeeded in reducing the trauma signature by way of reducing risk through mitigation.

Trauma Signature Analysis of the Great East Japan Disaster: Guidance for Psychological Consequences

OBJECTIVES On March 11, 2011, Japan experienced the largest earthquake in its history. The undersea earthquake launched a tsunami that inundated much of Japans eastern coastline and damaged nuclear power plants, precipitating multiple reactor meltdowns. We examined open-source disaster situation reports, news accounts, and disaster-monitoring websites to gather event-specific data to conduct a trauma signature analysis of the event. METHODS The trauma signature analysis included a review of disaster situation reports; the construction of a hazard profile for the earthquake, tsunami, and radiation threats; enumeration of disaster stressors by disaster phase; identification of salient evidence-based psychological risk factors; summation of the trauma signature based on exposure to hazards, loss, and change; and review of the mental health and psychosocial support responses in relation to the analysis. RESULTS Exposure to this triple-hazard event resulted in extensive damage, significant loss of life, and massive population displacement. Many citizens were exposed to multiple hazards. The extremity of these exposures was partially mitigated by Japans timely, expert-coordinated, and unified activation of an evidence-based mental health response. CONCLUSIONS The eastern Japan disaster was notable for its unique constellation of compounding exposures. Examination of the trauma signature of this event provided insights and guidance regarding optimal mental health and psychosocial responses. Japan orchestrated a model response that reinforced community resilience.

Disaster risk reduction and sustainable development for small island developing states

ABSTRACT In contrast to continental nations, the worlds 52 small island developing states (SIDS) are recognized as a collective of countries that experience disproportionate challenges for sustainable development related to their geography, small size, and physical isolation. These same states also face elevated risks for disaster incidence and consequences particularly in the realms of climate change, sea level rise, natural disasters (tropical cyclones, earthquakes, tsunamis, volcanoes), and marine hazardous materials spills. Cyclone Winstons direct impact on Fiji in 2016 and Cyclone Pams landfall over Vanuatu in 2015 provide case examples illustrating the special vulnerabilities of the SIDS.

Fear-related behaviors in situations of mass threat

ABSTRACT This Disaster Health Briefing focuses on the work of an expanding team of researchers that is exploring the dynamics of fear-related behaviors in situations of mass threat. Fear-related behaviors are individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. Importantly, fear-related behaviors modulate the future risk of harm. Disaster case scenarios are presented to illustrate how fear-related behaviors operate when a potentially traumatic event threatens or endangers the physical and/or psychological health, wellbeing, and integrity of a population. Fear-related behaviors may exacerbate harm, leading to severe and sometimes deadly consequences as exemplified by the Ebola pandemic in West Africa. Alternatively, fear-related behaviors may be channeled in a constructive and life-saving manner to motivate protective behaviors that mitigate or prevent harm, depending upon the nature of the threat scenario that is confronting the population. The interaction between fear-related behaviors and a mass threat is related to the type, magnitude, and consequences of the population encounter with the threat or hazard. The expression of FRBs, ranging from risk exacerbation to risk reduction, is also influenced by such properties of the threat as predictability, familiarity, controllability, preventability, and intentionality.

Disaster averted: Community resilience in the face of a catastrophic flood

ABSTRACT In the spring of 2009, the Fargo, North Dakota, metropolitan area had 5 days to lay millions of sandbags to avoid devastation from record flooding of the Red River of the North. The community was able to successfully mitigate the flooding and escape potentially catastrophic economic, physical, and mental health consequences. We hypothesized that Fargo flood protection efforts reflected the community resilience factors proposed by Norris, Stevens, Pfefferbaum, et al. (2008): citizen involvement in mitigation efforts, effective organizational linkages, ongoing psychosocial support, and strong civic leadership in the face of rapidly changing circumstances. This community case report utilizes an extensive review of available sources, including news reports, government documents, research articles, and personal communication. Results demonstrate that Fargos response to the threat of catastrophic flooding was consistent with Norris et al.s (2008) factors of community resilience. Furthermore, success in 2009 carried over into future flood prevention and response efforts, as well as a structured approach to building psychological resilience. This case study contributes to the literature on community resilience by describing a communitys successful efforts to avert a potentially catastrophic disaster.

Existence (or, Our Patient with Superpowers)

“Good morning, Iris,” I said. She replied, “How do you know my name?” Her unstated question actually was, “WHY do you know my name?” Not from a stance of vigilance, But rather, a lack of belief that there would be acknowledgement of her value, of her being, of her presence on this earth. An early life of trauma and thereafter, serious mental illness with frequent visits over decades to our clinic. Her gray clothing allowing her to blend in to the waiting room furniture; Eyes downcast, features non-clinically catatonic, Undiscoverable. Magically able to rematerialize at the designated time to see her case manager, her peers or my psychiatrist colleague. “Of course I know your name,” I grinned. She smiled back. Artist’s Statement Empathy refers to the capacity to understand another’s experience (thoughts/feelings/attitude) from their perspective. As providers, we often forget what that experience is like. This poem about a clinic patient is a gentle reminder.

What Is It About This Substance

What is it about this substance That causes me to abandon everything? To suffer existential myopia; To reduce salience to the size and weight Of a singularity As family and friends orbit Like desperate moons, Avoiding the event horizon That is my addiction. What is it about me, and not My friends or siblings that Allows for this condition? Bad luck? Step on a crack? Piss off the Devil (or God)? This drug affects my life By month, week, day; By second. It is not in my true nature To behave this way-to talk This way. Compassion gives way to sociopathy, Eloquence to profanity. I stumble in the shadowy jungle Addiction Where the wild beast Substance Has grabbed me by the throat And won’t let go. Artist’s Statement This poem is a reminder of the individual’s experience in addiction, the acknowledgment of pain to self and others, the wish to change, and the powerlessness that can occur. Substance use disorders are ubiquitous in our field, and the reader may see a patient, a friend, a family member, or themselves in this poem. Our community recently lost a medical practitioner who, while in recovery, developed a chemical dependency treatment program which significantly helped educate our medical students and residents. This poem is dedicated to him.

The Human Condition

Human beings are described by many spiritual traditions as ‘blind’ or ‘asleep’ or ‘in a dream.’ These terms refers to the limited attenuated state of consciousness of most human beings caught up in patterns of conditioned thought, feeling and perception, which prevent the development of our latent, higher spiritual possibilities. In the words of Idries Shah: “Man, like a sleepwalker who suddenly ‘comes to’ on some lonely road has in general no correct idea as to his origins or his destiny.” In some religious traditions, such as Christianity and Islam, the myth of the ‘Fall from the Garden of Eden’ symbolizes the loss of the primordial state through the veiling of higher consciousness. Other traditions use similar metaphors to describe the spiritual condition of humanity:

I Remain in Awe of You, My Patient

I remain in awe of you, my patientIn spite of your voices telling you To stay away, you return to this clinic Often. You pace In the crowded waiting room. It is not the pace Of a lithe great cat Nor of emotional anxiety. (Though certainly you have shared Your fears with me.) It is like the back and forth discomfort Of a child having to wait for the bathroomWe both know, however it is The restlessness from side-effects of medication Supposedly meant to help; Which I prescribe, and you willingly take Because you trust me. What have I done to earn this trust? I remain in awe of you, my patientYou awoke early, rode three buses To get here, Not yet having eaten. (I complained this morning because After a hearty breakfast, I had to Scrape the ice off my car Before driving to work.) Somehow, you feel the effort To return to this “treatment” Is worth it. I remain in awe of you, my patientI will try to better understand you. I will try to do you more good than harm And I will be here.