Staff Perspective: Nepal Will Rise Again
On April 25, 2015, a 7.8 magnitude earthquake occurred nearly 80 kilometers northwest of Kathmandu, Nepal. I received the news update on my phone and understood that more pictures and video would soon tell more of the overwhelming story. For a moment, I remembered how terrified I was back in 2006, when Oahu experienced a 6.7M earthquake. According to the United States Geological Survey, Nepal’s 7.8M earthquake was 12.589 times bigger than and 44.668 times stronger than what Oahu experienced. Questions troubled me about this disaster: What did the families and communities of Nepal experience? How would they recover in the upcoming months? What more would we as behavioral health providers learn about the impact of trauma? More importantly, what could we as a discipline contribute to their suffering?
At the time, Nepal seemed so far away and intangible. I did not know that several months later, I would be much closer and have the opportunity to connect with a team of behavioral health providers and officers from the Nepalese Army. In September, I was invited to participate in the Post Disaster Behavioral Health Medical Subject Matter Expert Exchange (SMEE) at the Nepalese Army Institute of Health Sciences in Kathmandu, Nepal for four days of discussions focused on disaster response, recovery, and ways to enhance behavioral health operational readiness. More questions arose about the devastation and suffering I would witness.
There was a wide range of eye-opening topics over the week. Some of the most memorable for me were the conversations over breaks and lunches, when we could be more personal and candid in our discussions. There were many parallels in how we operate as professionals and I found an instant connection with the women officers. We discussed our passions for work, cooking, travel, and parenting. We even discussed our roles as working women and how we balance our strengths at work and home. Nepalese Army Psychiatrist, LTC Namrata Mahara Rawal described the gender differences, “Nepal is a male dominated society and there is always a gender issues in terms of job specification, postings, leadership positions and so on. But as in any other developed country the proportion of women leadership positions have definitely grown. I have experienced and observed at many instances during my career that women have shown lesser motivation as compared to male co-workers and mainly because of social pressure to fulfill dual role as a housewife and as a worker. In our society, most of the housework and child care has to be done by females and men will work only at their work place and not at home. But if I have to talk about myself and few other officers too, we are lucky that it is not the same, trends are changing. I see not much difference in terms of power motivation to leadership and I can contribute equally as any other male officers.” I am not sure if this was a topic that was fresh in their minds since our visit happened to coincide with the Teej Festival, a celebration of women and sisterhood.
LTC Rawal described the effects of the earthquake on the public’s optimistic view of mental health as, “The Earthquake impact in behavioral health has changed vision of most of the people. People have realized mental health importance after seeing its consequences and its need during time of disaster. Six months on, Nepalese are getting back to their regular business. No doubt the earthquake left behind much damages and ruins but Nepalese are optimistic that it is also an opportunity to rebuild better.” In addition, the positive sentiments were also evident among staff members, Nepalese Armed Forces Psychiatrist, Dr. Nishita Pathak reported, “After (the) earthquake (in) general people also seem to be much comfortable if they are referred to a psychiatrist. Unlike my regular days in the past, The Armed Police Force staff also visits my Out Patient Department without hesitation. I am not saying the stigma has changed but after the earthquake the concept regarding mental health has been changed.”
After hearing throughout the week the impact of the recent earthquake and the increased demand on behavioral health practitioners, my hope was to make a connection beyond implementation of evidence-based practices, provider burnout prevention and a practical application of self-care. I questioned how I would deliver information about mindfulness for self-care when spiritualism seemed to be engrained in their everyday culture and meditation was common practice. We discussed the Sanskrit word, sukha, as a similar meaning to demonstrate mindfulness. Dr. Pathak’s eloquent description “Sukha, the word which (we) use almost every day, now I have new way of seeing the same things. I realize that after earthquake I was under a significant stress for my family and the duty I have to do as a doctor. It’s our resilience and a strong family support I could really swing back to (almost) my life. Developing self-care strategies assist me with managing my everyday stressors and adversities of post disaster, thus creating efficiency and competency and creating greater sense of wellbeing.” The Nepalese team intuitively identified with the meaning. And when coupled with chocolates (we were being nonjudgmental, but it was Ferrero Rocher, an international and apparently local favorite), much like the eating a raisin mindfulness exercise, we were able to join in the practice of suspending judgment and employing all five senses to be in that very moment. A profound experience for me was hearing Dr. Pathak comment on the exercise, “I remember the mindfulness (practice) which I experienced with the chocolate you gave, it really tasted different and I think it was a first time I enjoyed the taste of chocolate. To be in the moment and even while washing my hand can be relaxing and preparing me in a fresh way.” It was quite humbling to be able to offer them an approach that they already were very familiar and congruent with who they were as a culture, yet offer a fresh perspective. I recall the room filled with a shared experience which moved beyond a self-care approach into an overwhelming sense of interconnectedness.
Matthieu Ricard, a French scientist-turned Buddhist monk, living in the mountains of Nepal wrote in his book, Happiness: A Guide to Developing Life’s Most Important Skills, about the Sanskrit word Sukha, “Sukha is the state of lasting well-being that manifests itself when we have freed ourselves of mental blindness and afflictive emotions. It is also the wisdom that allows us to see the world as it is, without veils or distortions. It is, finally, the joy of moving toward inner freedom and the loving-kindness that radiates toward others (p.25).” The experience in Nepal gave me more than answers to my questions about this disaster. I was surprised to witness hope and pride rather than devastation and suffering. I found that the Nepalese people inherently drew their resilience on strategies that their culture has practiced for centuries, yet found new meaning. It also gave me a sense of connection to the people whose lives were ultimately changed and they continue to draw on their resilience in the journey toward recovery and to realize the Nepal Will Rise Again movement.
To add a final note, I wish to express my heartfelt gratitude to the Uniformed Services University of the Health Sciences Center for Disaster and Humanitarian Assistance Medicine (CDHAM) who provided their generous support so that I may participate in the SMEE. CDHAM’s mission is “To provide support to Department of Defense agencies, through education and training, consultation, direct support and scholarly activities, regarding the role of military health care in response to disasters and humanitarian assistance missions.” Thank you for the opportunity to gain a first-hand experience of exactly that.
Dr. Namrata Mahara Rawal is a Lieutenant Colonel, neuro psychiatrist and Head of the Psychiatry Department for the Nepalese Army at Shree Birendra Military Hospital. She is also an assistant professor at the Nepalese Army Institute of Health Science.
Dr. Nishita Pathak is a psychiatrist for the Nepal Armed Police Force (APF). She initiated the psychiatry and psychological services for the APF in 2011 and provides treatment to the APF staff, their family members, and civilians.
Richard, M. (2003). Happiness: A Guide to Developing Life’s Most Important Skill. New York: Hachette Book Group.
Dr. Laura Cho-Stutler is a clinical psychologist and Evidence-Based Psychotherapy Champion Consultant with the Center for Deployment Psychology.
Laura Cho-Stutler, Psy.D. is the Evidence-Based Psychotherapy (EBP) Champion-Consultant with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
On April 25, 2015, a 7.8 magnitude earthquake occurred nearly 80 kilometers northwest of Kathmandu, Nepal. I received the news update on my phone and understood that more pictures and video would soon tell more of the overwhelming story. For a moment, I remembered how terrified I was back in 2006, when Oahu experienced a 6.7M earthquake. According to the United States Geological Survey, Nepal’s 7.8M earthquake was 12.589 times bigger than and 44.668 times stronger than what Oahu experienced. Questions troubled me about this disaster: What did the families and communities of Nepal experience? How would they recover in the upcoming months? What more would we as behavioral health providers learn about the impact of trauma? More importantly, what could we as a discipline contribute to their suffering?
At the time, Nepal seemed so far away and intangible. I did not know that several months later, I would be much closer and have the opportunity to connect with a team of behavioral health providers and officers from the Nepalese Army. In September, I was invited to participate in the Post Disaster Behavioral Health Medical Subject Matter Expert Exchange (SMEE) at the Nepalese Army Institute of Health Sciences in Kathmandu, Nepal for four days of discussions focused on disaster response, recovery, and ways to enhance behavioral health operational readiness. More questions arose about the devastation and suffering I would witness.
There was a wide range of eye-opening topics over the week. Some of the most memorable for me were the conversations over breaks and lunches, when we could be more personal and candid in our discussions. There were many parallels in how we operate as professionals and I found an instant connection with the women officers. We discussed our passions for work, cooking, travel, and parenting. We even discussed our roles as working women and how we balance our strengths at work and home. Nepalese Army Psychiatrist, LTC Namrata Mahara Rawal described the gender differences, “Nepal is a male dominated society and there is always a gender issues in terms of job specification, postings, leadership positions and so on. But as in any other developed country the proportion of women leadership positions have definitely grown. I have experienced and observed at many instances during my career that women have shown lesser motivation as compared to male co-workers and mainly because of social pressure to fulfill dual role as a housewife and as a worker. In our society, most of the housework and child care has to be done by females and men will work only at their work place and not at home. But if I have to talk about myself and few other officers too, we are lucky that it is not the same, trends are changing. I see not much difference in terms of power motivation to leadership and I can contribute equally as any other male officers.” I am not sure if this was a topic that was fresh in their minds since our visit happened to coincide with the Teej Festival, a celebration of women and sisterhood.
LTC Rawal described the effects of the earthquake on the public’s optimistic view of mental health as, “The Earthquake impact in behavioral health has changed vision of most of the people. People have realized mental health importance after seeing its consequences and its need during time of disaster. Six months on, Nepalese are getting back to their regular business. No doubt the earthquake left behind much damages and ruins but Nepalese are optimistic that it is also an opportunity to rebuild better.” In addition, the positive sentiments were also evident among staff members, Nepalese Armed Forces Psychiatrist, Dr. Nishita Pathak reported, “After (the) earthquake (in) general people also seem to be much comfortable if they are referred to a psychiatrist. Unlike my regular days in the past, The Armed Police Force staff also visits my Out Patient Department without hesitation. I am not saying the stigma has changed but after the earthquake the concept regarding mental health has been changed.”
After hearing throughout the week the impact of the recent earthquake and the increased demand on behavioral health practitioners, my hope was to make a connection beyond implementation of evidence-based practices, provider burnout prevention and a practical application of self-care. I questioned how I would deliver information about mindfulness for self-care when spiritualism seemed to be engrained in their everyday culture and meditation was common practice. We discussed the Sanskrit word, sukha, as a similar meaning to demonstrate mindfulness. Dr. Pathak’s eloquent description “Sukha, the word which (we) use almost every day, now I have new way of seeing the same things. I realize that after earthquake I was under a significant stress for my family and the duty I have to do as a doctor. It’s our resilience and a strong family support I could really swing back to (almost) my life. Developing self-care strategies assist me with managing my everyday stressors and adversities of post disaster, thus creating efficiency and competency and creating greater sense of wellbeing.” The Nepalese team intuitively identified with the meaning. And when coupled with chocolates (we were being nonjudgmental, but it was Ferrero Rocher, an international and apparently local favorite), much like the eating a raisin mindfulness exercise, we were able to join in the practice of suspending judgment and employing all five senses to be in that very moment. A profound experience for me was hearing Dr. Pathak comment on the exercise, “I remember the mindfulness (practice) which I experienced with the chocolate you gave, it really tasted different and I think it was a first time I enjoyed the taste of chocolate. To be in the moment and even while washing my hand can be relaxing and preparing me in a fresh way.” It was quite humbling to be able to offer them an approach that they already were very familiar and congruent with who they were as a culture, yet offer a fresh perspective. I recall the room filled with a shared experience which moved beyond a self-care approach into an overwhelming sense of interconnectedness.
Matthieu Ricard, a French scientist-turned Buddhist monk, living in the mountains of Nepal wrote in his book, Happiness: A Guide to Developing Life’s Most Important Skills, about the Sanskrit word Sukha, “Sukha is the state of lasting well-being that manifests itself when we have freed ourselves of mental blindness and afflictive emotions. It is also the wisdom that allows us to see the world as it is, without veils or distortions. It is, finally, the joy of moving toward inner freedom and the loving-kindness that radiates toward others (p.25).” The experience in Nepal gave me more than answers to my questions about this disaster. I was surprised to witness hope and pride rather than devastation and suffering. I found that the Nepalese people inherently drew their resilience on strategies that their culture has practiced for centuries, yet found new meaning. It also gave me a sense of connection to the people whose lives were ultimately changed and they continue to draw on their resilience in the journey toward recovery and to realize the Nepal Will Rise Again movement.
To add a final note, I wish to express my heartfelt gratitude to the Uniformed Services University of the Health Sciences Center for Disaster and Humanitarian Assistance Medicine (CDHAM) who provided their generous support so that I may participate in the SMEE. CDHAM’s mission is “To provide support to Department of Defense agencies, through education and training, consultation, direct support and scholarly activities, regarding the role of military health care in response to disasters and humanitarian assistance missions.” Thank you for the opportunity to gain a first-hand experience of exactly that.
Dr. Namrata Mahara Rawal is a Lieutenant Colonel, neuro psychiatrist and Head of the Psychiatry Department for the Nepalese Army at Shree Birendra Military Hospital. She is also an assistant professor at the Nepalese Army Institute of Health Science.
Dr. Nishita Pathak is a psychiatrist for the Nepal Armed Police Force (APF). She initiated the psychiatry and psychological services for the APF in 2011 and provides treatment to the APF staff, their family members, and civilians.
Richard, M. (2003). Happiness: A Guide to Developing Life’s Most Important Skill. New York: Hachette Book Group.
Dr. Laura Cho-Stutler is a clinical psychologist and Evidence-Based Psychotherapy Champion Consultant with the Center for Deployment Psychology.
Laura Cho-Stutler, Psy.D. is the Evidence-Based Psychotherapy (EBP) Champion-Consultant with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.