Quake’s Toll on a Young Psyche

A falling chunk of concrete broke Yusuf Khumbar’s arm, which was easy for a doctor to fix this weekend once it was X-rayed. If only it were so simple to see and repair the fractures in a boy’s mind.

The enormity of India’s Jan. 26 earthquake is hard for even an adult to comprehend, as the estimates of the dead and the damage keep rising. Authorities now say that as many as 30,000 people were killed and 600,000 left homeless in the western state of Gujarat.

The number of confirmed deaths reached 16,425 on Sunday, and the federal government says that more than 55,000 people were injured.

Not included in these staggering statistics are the thousands of children who suffered mental wounds that may never heal. In a developing country of more than 1 billion people, still struggling to feed and find shelter for survivors, injured psyches fall far down the long list of emergencies.

When the quake struck and reduced much of this town to rubble in seconds, Yusuf, 13, was one of three boys walking at the front of a schoolkids’ Republic Day parade as it headed along a narrow street.

The buildings crashed down on them from both sides, and a piece of debris pinned Yusuf to the ground. His cousin, Kasim Ismail, 12, pulled the boy free quickly enough to save his life. Their friend, Iqbal Yunnis, 8, was killed.

Behind them, a cascade of broken concrete crushed to death more than 400 schoolmates and 50 of their teachers. Just over a week later, it is hard for a child survivor like Yusuf to know where the memories end and the nightmares begin.

“He’s afraid to sleep alone now,” Yusuf’s aunt, Amena Bai, 35, said through a translator Saturday as he waited for a doctor to set his left arm. “And he refuses to sleep in any closed structure. He wants to sleep only in the open.

“He used to scream at night, and for the first two days would not leave the company of his female relatives,” she added. “But now he’s more dazed than anything else. He doesn’t talk much.”

Once a “fairly active and delightful child,” Yusuf “is more sad now because he’s lost a friend,” said the boy’s mother, Halima Bai, 37. In the middle of a hot day, he was wearing a wool cap, tied tightly under his chin, to fight off chills.

Yusuf’s demeanor contains textbook warning signs of severe trauma, and psychiatrist Sohan Derasari estimates that anywhere from one-third to half of the children who survived the quake are now suffering from “acute stress disorder.”

In many cases, their parents are too traumatized themselves to get them treatment. Sufferers from acute stress disorder look as though they are simply in shock, but the syndrome is worse.

“The person gets really numb, and they are in a daze,” Derasari said from Ahmadabad, Gujarat’s commercial capital. “They cannot remember things properly. They remain a little irritable and angry.”

Some will recover on their own in a couple of weeks, the psychiatrist said, while others risk sinking into the still more serious post-traumatic stress disorder, which can require drugs and long-term care to reverse.

“One of the biggest complications is that they do not seek any help,” Derasari said. “They remain withdrawn for a long period of time. This is primarily because the biochemical changes in the brain do not allow them to process information and other things.”

If parents languish, so will their traumatized children, who “will remain scared and withdrawn for a long period of time, not going to school and not resuming normal activity,” Derasari added.

For many Indians, seeking therapy is akin to announcing to the neighbors that you’re crazy, and Derasari said relief workers who could help ensure that traumatized children get treatment often don’t know how to spot the symptoms.

He is working with a small group of Indian physicians and educators to set up a rehabilitation program for child quake survivors that will include not only counseling but advice to parents and teachers on how to handle traumatized children.

Derasari said he knows of only about 10 psychologists and psychiatrists in Bhuj, the biggest town in the worst-affected area--a region where there are a few million people.

“I don’t know what you can do with 10 persons,” he said. “We are finding it difficult even to get people motivated to get trained.”

If traumatized children don’t get help soon, “they are going to have problems with learning and development,” Derasari said.

Indian Prime Minister Atal Behari Vajpayee admitted last week that his government had failed to get a coordinated rescue and relief effort going soon enough after the quake.

Private groups such as charities and political parties have delivered food, clothing and emergency aid to many villages where residents say they are still waiting for government help.

But even as they shiver under thin blankets next to small fires each night, or run barefoot along dirt tracks to catch a scrap of used clothing or a bag of water tossed off aid trucks, many of the homeless children still laugh as if it were all great fun.

In reality, the children are probably so overwhelmed by what’s happened that they are trying to switch it off, like a scary movie, said Mamata Pandya, project coordinator for the government-funded Center for Environment Education. The center is leading local efforts to provide treatment for child quake survivors.

“What we are afraid [of] is that this trauma is going to be so deep that it’s going to leave lifelong scars,” she said. “We really have to do a lot of learning ourselves to start working with traumatized children.”

The Nehru Foundation for Development’s compound, a green oasis of calm where Pandya’s center is based in Ahmadabad, has become a home for 30 people who can’t--or in most cases are simply too afraid to--return to their homes in the city.

“Right now, it’s a big holiday for the children,” Pandya said. “There’s no school, they’re all together running around and playing. They’re not manifesting their anxieties, but we are sure those anxieties are very deeply ingrained.”

In a Red Cross field hospital 150 miles to the west in Anjar, Vanay Chauhan, 14, lay with his bandaged left hand tied to a pole to keep it upright and draining. The top halves of the fingers were crushed under concrete rubble, and when Vanay’s father brought a knife to cut him free, the boy yanked his hand hard enough to sever the fingers himself.

Vanay isn’t afraid anymore, only a little unsettled by the wailing and moaning of injured patients all around him, said his father, Himat Chauhan, 45.

In the wrecked city of Bhachau, meanwhile, Dr. Bharad Gadia, an orthopedic surgeon, is trying to move 5-year-old Puri Nagar from a cot in a tent clinic to his hospital more than a 200-mile drive away in Bhavanagar, so he can treat her fractured and dislocated left shoulder. But Puri refuses to go.

A tiny medallion of the minor Hindu god Ramdev hangs on Puri’s forehead from a chain that her mother strung through the child’s braids in hopes that the talisman would protect her.

The child’s arm was in a gauze sling Saturday, wrapped tightly against her chest. She was crying, as she has constantly since the ground shook and reduced her family’s house to rubble in the village of Kakarva.

Puri hasn’t stopped repeating one thing, the doctor said, and she said it again as he stood at her bedside: “I want to go home.”