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The Human Toll

Post-tramatic stress often ignored


January 8, 2008
By Karen Dallimore

Topics

The official line from the government after the 2001 foot and mouth
disease outbreak in the U.K. was that, “Foot and Mouth doesn’t cause a
problem in humans.”

10The official line from the government after the 2001 foot and mouth disease outbreak in the U.K. was that, “Foot and Mouth doesn’t cause a problem in humans.”

Try to tell that to people who lived through the disaster. Tell that to the farmers who watched their animals die at a collective rate of 18,000 per day at the height of the slaughter, a culling that went on for nine months. Tell that to the children who lost their pets and show animals, the breeders who lost generations of bloodlines, and the families who listened to the eerie silence of the barns, yards and fields that so suddenly became uncomfortably empty.
As one farmer put it, “To see your life’s work lying dead in your yards and fields is something no one can imagine until you see it for yourself.”

Whether it’s Foot and Mouth Disease or Avian Influenza or another similar disease, or even a disaster such as Hurricane Katrina, the human toll is still the same. Although the dollar amounts can quantitatively reflect the financial losses of such disasters, how can we sum up and deal with the human toll: the emotional cost of quickly seeing normal changed so drastically?

Post mortem on Britain’s tragedy
Dr. Maggie Mort is the director of postgraduate research at the Institute for Health Research at Lancaster University. She has recently completed a 28-month study on the psycho-social implications of the 2001 Foot and Mouth disease outbreak in the U.K.

She focused her data collection in the Cumbria area of Britain, the most affected area in the U.K. The farms there are typically small, marginal, and rich with history.

It is there that the Watchtree Stone marks the graves of 448,508 sheep, 12,085 cattle and 5,719 pigs that were buried there during the outbreak, representing only half of what was killed. At one point 14 pyres surrounded the village.

While government and agricultural agencies were able to implement en-quiries to address the physical and
logistical aspects of a disease, as a sociologist Mort was looking more for the psychological effect of the disaster on the rural communities. She interviewed the farmers, their families, front-line workers including the slaughter teams, related agricultural workers such as truckers and auctioneers, local retail and tourism small business operators and members of the community at large such as teachers, clergy, veterinarians and health professionals.

Mort defines a traumatic experience as a blow to the psyche that suddenly breaks through one’s defenses. People are stressed by being unable to fight or flee or take control of the situation. Recurrent thoughts and flashbacks are common. All of this she described as normal reactions to abnormal events. “It’s the event that’s crazy, not the person.”

Through a series of group discussions, diaries and interviews, Mort most frequently found the personal effects of the disease outbreak to be described in apocalyptic terms, similar to images of war. Many people were experiencing post-traumatic stress. For many it was a bit like returning from the front lines of battle and not being able to talk about it.

Workers on the slaughter teams, who were often recruited out of the ‘dole queues’ or unemployment lines, were classed as “dirty”. They disappeared after the outbreak, taking their emotional scars and their experience with them.
 
At the first group meeting the farmers didn’t want to go home. They just sat around for hours, telling stories. Mort had never seen so many grown men cry. There was no normality left. Many began to hate the farming they’d once loved. The distress stretched way beyond the farms and it was only the feeling of solidarity that helped many to cope.

The problem is that such a human toll is invisible to formal health services if it is not medicalized, therefore it doesn’t attract the resources necessary to deal with it.

Mort says that the majority of people don’t need counselling but communities do need a support network and front line workers need de-briefing. Her study also uncovered a widespread fear of another outbreak, in itself creating uncertainty, while the locals reflected a need for authorities to draw upon local experience in the event of another such disaster in order to establish and maintain trust.

Lessons Learned in B.C.

While we have no official studies on the psychological effects of the avian influenza outbreak in British Columbia in 2004 we can still learn lessons from the experience of those involved in the crisis.

Dr. Victoria Bowes is an avian pathologist with the British Columbia Ministry of Agriculture and Lands. She was a key player in the Fraser Valley avian influenza outbreak: because she did not have a defined official role when the outbreak occurred she found herself everywhere, providing provincial support wher-ever needed for the Canadian Food Inspection Agency response.

The outbreak affected 410 commercial farms, representing 90 per cent of the farms in the Fraser Valley, as well as involving 18,000 birds in 553 backyard flocks.

Bowes recognized that the effects of the outbreak went way beyond the destruction of commercial flocks. When you block off a road, people without chickens are impacted. Aviaries and backyards flocks are affected. All of the allied trades are affected:  the truckers, employees, feed suppliers, local businesses and hatcheries.

The pressure was on the politicians as well: as the third largest Canadian poultry producer, British Columbia knew it had to play to the international audience.

“It was exhausting to be in response mode for three months,” said Bowes. The industry was down for 50 days and for Bowes, “it took four weeks to realize it wasn’t going away”.

The prevailing wisdom in the case of an animal disease outbreak is to find it and get rid of it quickly: the disease cannot be allowed to become endemic, explained Bowes. The impact on international trade is the key driver of this response, but you have to balance aggressive disease control with animal welfare concerns surrounding humane destruction as well as the negative health impact of disease mitigation strategies such as confining waterfowl.

On the commercial farms CO2 gassing was used for euthanasia, a process that had never before been done on such a scale. CO2 gas quickly became short of supply. Workers drew down the lights and worked slowly and quietly around the birds, which were not used to people, in order to make sure the birds just lay down instead of piling up and scratching. Workers were not prepared for the disposal volume: 1.3 million birds were deemed biohazardous and had to be incinerated, landfilled or composted.

To Bowes, it was not only the animal welfare and health issues surrounding euthanasia and disposal that were felt by the human community. While a broader emotional scope of the AI disaster is difficult to summarize, Bowes personally reflected on the bond between animals and their human caregivers in both commercial and non-commercial situations: “That was what was most truly affected.”

In many cases it was the backyard flocks that took the emotional toll the hardest. Community grieving circles started to form at local coffee shops. Bird owners would spend two minutes on the microphone, talking about their loss. “It was really profound,” recalled Bowes. A Backyard Farmers’ Association was formed, although it soon disbanded due to dissimilar philosophies. Three years later Bowes still choked back tears as she mourned the personal loss of her own pet ducks, Romeo and Juliet.

At one point there were eight CFIA teams just to find the backyard flocks. There was a lot of resistance to enforcement: although a lot of people wanted to do the right thing, there was also a sentiment that the “big nasty commercial barns” were causing the problem. The experience brought home that we need to handle the backyard flock differently, said Bowes, perhaps considering the option to quarantine.

As the crisis wore on, Bowes watched the official version of the outbreak stray from reality as the government attempted to put an optimistic spin on the situation for the sake of international trade, while she reflected from the trenches that 42 positive-testing farms in 90 days is not positive.

To her, the only positive thing to come out of the outbreak is that we are now so much more prepared.

Bowes continues to work on the recovery phase of the AI outbreak, doing risk analysis and providing outreach to backyard flock owners. She would like to ensure that the post-traumatic stress is fed into the review process. It’s also one of her concerns that naïve volunteers will not be so easy to find if there is another crisis. In Canada, “Nobody’s asking the questions that Maggie Mort has asked.”

It’s the experience of people like Bowes and of those in the U.K. that must be shared. The human toll of disease outbreaks and disasters is slowly being recognized and acknowledged as an issue that must be addressed in order for communities to recover and for authorities to prepare for the future.

For more information on Maggie Mort’s study, visit www.footandmouthstudy.org.U.K. n