Emergency Trauma Healing and Recovery Program

Introduction

Nepal has gone through a decade of arm conflict between the government and the rebellion; consequently, more than sixteen thousand people were killed. Simultaneously after the peace settlement, the monarchy was diminished and a political instability rose which still exists today. Unfortunately, the aftermath of the April 2015 earthquake was devastating and more than eight thousand people lost their lives. The blockade in the south boarder also has had a massive impact for Nepalese lives. Many of the youth populations are bound to settle abroad and a massive majority are compelled to go to gulf countries because they hold the cheapest labor.  Additionally, women and girls are living in the most vulnerable conditions in the country. As the dominated of the patriarchal hierarchy system, women have no access and control over the resources and the majority of them do not have access to primary education. The oppressive traditions of Nepal: 'Dowry System', 'Polygamy', 'Witchcraft', 'Chhaupadi' etc. have had huge negative effects for the majority of rural Nepalese women. The Severely traumatized women are giving birth to babies in the streets or they are locked up or even chained up which happens in their own homes, in the outskirts of the villages and the forest. All of these devastating issues have negative consequences of severe psychological trauma. This vicious circle of violence leads to immediate or delayed psychological trauma. 

From its very beginning, KOSHISH has tried to promote wellbeing by endorsing 'prevention is better than a cure', promoting awareness and community-based psychosocial support. However, from becoming aware of the slogan of Sustainable Development Goal (SDG) 'No one left behind'; we have started caring for those who have been severely and psychologically traumatized. This is achieved by providing community awareness, emergency short-term residential care and tracing back to their own family and community. KOSHISH has not and will not compromise with any more institutions because there is no substitute for community based intervention. 

 

Psychological Trauma as a Cross-cutting Issue

Gender Based violence and Psychological Trauma 

For a woman, life in Nepal is very hard as they have to face more challenges than men. Women are the most vulnerable group affected and are suffering from domestic violence, sexual assault and cultural malpractices. These different forms of violence often manifests into severe mental distress. The majority of communities in Nepal are patriarchal which means a women’s life is controlled by her father, husband and son. Women with severe mental distress in Nepal are chained, tied and locked up at homes or are abandoned in the streets.  Women lose their humanity in the eyes of the community because of mental health problems.  It is imperative to provide services to the people in need who have been neglected and are in a vulnerable state. The greatest barrier for these women who have suffered pain and stigma due to mental health problems is community acceptance; we must help them achieve this. The SAATHI and Asia Foundation 1997 study showed that 93% of women had been exposed to emotional and mental torture, 82% of these women were physically abused, 30% had been raped and 28% had been forced into prostitution. Sexual violence makes up 15.3% of the violence experienced by women in Nepal and around 75% the perpetrators of this violence were intimate partners. Rape against children and women was the most reported crime against women in 2015/16. The most targeted group was underage girls (Himalayan Times, 2017). KOSHISH has been providing its untiring support to these women and until today, 37% of psychologically traumatized women has received service from KOSHISH. To help these women, KOSHISH has showed them support, empathy and love. Koshish practices that every human being has the right to live a full and healthy life of mental well-being.

Balkumari was manipulated and sexually abused by a man as a young teenager. She became pregnant whilst the man was already married and settled with his family. After having two children from this man, she became a victim of severe domestic violence. As a result, she left home and was living in the streets. Even in this critical time, severely mentally and physically traumatized, she was raped again and delivered a baby girl in the street. While KOSHISH rescued her and provided support for her recovery.. Nowadays, her baby girl has been grown up and started school whilst Balkumari goes to work. The mother and girl are now living independently in rented accommodation. Balkumari says, "KOSHISH is like my parent who has never given up on me"  

 

April 2015 Earthquake and Psychological Trauma 

In 2015, over 8,800 people lost their lives and 22,304 were left injured when the country was struck by a devastating earthquake (Government of Nepal statistics). This incident had a large impact on human lives. It caused unimaginable trauma resulting in an increase in cases of mental health problems. The large segments of the population faced major social and emotional challenges in coping with the events and with an uncertain future. KOSHISH has been providing its services to protect and enhance psychosocial well-being and/or work to prevent and treat severe mental disorders. 

Forty-year-old Shyam, a native of Dolakha, had been suffering from Schizophrenia for the past 18 years. Because of his condition, his wife abandoned him. After the earthquake, his condition worsened as he began to display aggressive behavior and set the neighboring cowsheds on fire. To rein in his aggressive behavior, his family imprisoned him inside a cage His case was brought to KOSHISH’s notice after it was published in a national daily. Subsequently, the team of KOSHISH freed him on February 16, 2016. In the care home, proper medication and psychosocial counseling, Ram showed drastic improvement and had a quick recovery. Ram was reintegrated to his family and helps them with the agricultural work.

 

Conflict and Psychological Trauma 

Nepal, in 2006 emerged from a decade-long armed conflict in which over 16,000 people lost their lives while many more were subjected to torture and inhumane treatment (Nepal Conflict Report). The Nepalese Conflict Report states that during this civil war, many Nepalese people experienced: torture, forced disappearances, sexual violence, arbitrary arrests and unlawful killings. This armed conflict and violence disrupted social support structures and exposed people to high levels of stress.

Tarapati was a diligent officer serving in the Armed Police Force (APF), when during the internal insurgency, he was captured by the Maoist rebels and subjected to months of torture. When he was released he was also dismissed from his duties. Subsequently, his mental health deteriorated and he began displaying aggressive behavior. He showed no signs of improvement so his family locked him in a cage for over a year. KOSHISH rescued him on March 5, 2016 and provided him with emergency psychosocial support in a short-term residential home. Five months later, he made a full recovery and he was reintegrated back with his family.

 

Migration and Psychological Trauma 

In the last few decades there has been an alarming increase in the number of conflicts, civil disorders, natural disasters etc. in Nepal. These situations have led to mass migration and the break up of families and communities. Many of the youth populations are bound to settle abroad and the majority are compelled to go to gulf countries because they hold the cheapest labor.  Sadly, everyday several dead bodies arrive from abroad at the Kathmandu airport. This results in a overall vulnerability for both physical and mental health problems. Migrant experiences typically involve multiple traumatic events and sometimes torture. A (2006) report says that almost all migrant workers are working in vulnerable situations and do not have any legal protection by the receiving countries government' nor the Nepalese government. The report also shows the prevalent issues include: physical and sexual assault for female migrants, exploitation, insufficient payment, violation of women's rights and human rights, discrimination as well as the unlawful and lawful imprisoning of workers. 

Maya was raised up with her parents in south India. Maya married a security guard and unfortunately they were both in an accident. Maya's husband had to get a limb amputated and could not continue to work. Her husband pushed her into prostitution to earn a living and she soon developed symptoms of mental illness. When the situation deteriorated, she left home and started living in the streets where she was extremely vulnerable. She was sexually abused by men, fell pregnant and gave birth in the streets. After years of homelessness with a new born baby in her arms, she was finally rescued by KOSHISH. At the transit home, she and her baby were provided with love, care and medicine. Upon recovery, Maya and the baby were reintegrated to Maya's maternal home. Now, Maya is able to household work and gets a pension from her husband's company. Maya quotes, "Even in my worst dreams, I cannot imagine going back to those years of living in the streets. Today, thanks to KOSHISH, I am in good health and my daughter is also growing up fine".

 

Trafficking and Psychological Trauma

Cross-border trafficking from Nepal to India is one of the most common slave and forced prostitution routes in the world. It is estimated that there are between 5,000 and 10,000 Nepali girls and women trafficked in India alone every year. Of those trafficked to India, 20% are under the age of 16 years. Human trafficking has devastating and long-lasting effects on mental health. Post-Traumatic Stress Disorder, anxiety, depression and drug addiction are often consequences from the prolonged abuse that trafficking victim's experience. Apart from the sex trade, people are usually trafficked to become servants as well as agricultural or construction workers. Car washes and nail salons are also often staffed by trafficking victims.

Story of KAMALA in her own words:
"I was 4 years of age when my family sold me for RS 30,000 to women traffickers. I was very young at that time. I did not know anything about female trafficking but I did not like them at all so I ran away from those people. Since I was very young I did not remember my family so I could not reach back to them and anyways they did not want me as they sold me to traffickers. I grew up in streets. When one of the missionaries schools put me in their school in Jhapa. I stayed there for 8 years but I failed my SLC. I was back in the streets and became a tourist guide. Tourists meant food for me. If there were tourists, there was money, there was food; if no tourist, no food. Once, I was carrying a bag for one of the tourist but unfortunately it had narcotics and fake US dollars in it. Police caught me and claimed that the bag was mine. Police arrested me and put me to jail for 10 years. I was in Kathmandu Central jail for 10 years. When I came out from the jail, I took a small job but I could not cope up with the pressure of the job since in the jail I had developed mental illness. 10 years of jail time had given me depression, schizophrenia, post-traumatic stress, anxiety and nervousness. When office people realized that I was suffering from mental illness, they stigmatized me and they did not want me in the office, claiming that mental disease is contagious. I had to leave the job and with that I had to also leave the salary. I had no money on me and my mental health was deteriorating very fast. I could not pay rent for my room and I landed in the streets again. But, this time my mental health was bad. I did nothing in the streets except I sat all alone in an absolutely dazed condition. KOSHISH rescued me from the streets, gave me encouragement and medicine, both of which gave me a hope to revive myself. After one year of treatment, today I am a different person with much more confidence and now I am the part of the KOSHISH team, helping others just as I was helped."   

 

HIV and AIDS and Psychological Trauma 

In 2015, UNAIDS estimated that there were 39,000 people living with HIV in Nepal. The UNGASS (2007) report claims labor migrants make up to 41% of those infected with HIV in Nepal, sex workers make up 15.5% and injecting drug users make up 10.2% of this population.  Having a serious illness, like HIV, can be another source of major stress. It is found that living with HIV negatively effects a person's well-being and exacerbates existing mental health conditions. At times, some people might feel trapped, hopeless, or might wonder what they have to live for. The prevalence of mental illnesses in HIV-infected individuals is substantially higher than in the general population since they become a highly vulnerable, marginalized and stigmatized population.

 

Conclusion

In Nepal, people have been going through various forms of violence in their lives which results in severe psychological trauma. All the social issues and trauma people go through develops with adverse effects on people's mental well-being. There has been a rapid growth in a need for treatment and support for the psychosocially traumatized people. Currently, there has been some provision of psychosocial support for the people undergoing mild and moderate stages of psychosocial trauma. However there are no support mechanisms from the government or from the civil societies for people who are severely psychological distressed and are in severe and profound conditions. 

From its very beginning, KOSHISH has focused on providing a practical and humanitarian support. Through emergency care and facilitating rehabilitation, these people may be able to go back to their community and may live with dignity. From our practical experience, there is no alternative for their homes and families. Everyone in any condition should be able to live independently and be included in their own family and community. We are able to find the root causes of violence that lead to any physical and psychological severe distress. Our initiatives urge us to focus on causes of the problems and provide practical support for the most vulnerable groups.   

The table and graph below shows the number of beneficiaries who are undergoing severe and profound psychological trauma that KOSHISH has provided specialized care and support for. (November 2017)