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Tacloban, Philippines (AFP) Nov 25, 2013
Rodico Basilides visits a forlorn cross that stands as a memorial to his family who died in the catastrophic Philippine typhoon, one of countless survivors who are being forced to grieve without professional counselling.
"This is for my wife, Gladys, and four children. They were swept away by the waves," Basilides, 42, said as he stood alongside the cross made of two sticks tied together with green string on the floor of what used to be his seaside home.
As Basilides, a mini-bus driver, left the rain-soaked ruins, he met Jovelyn Taniega, a friend who lost her husband and six children when Super Typhoon Haiyan smashed the central Philippines with unprecedented ferocity on November 8.
Taniega, 39, still looking to be in a state of shock, had also returned to the spot where her family was swept away in giant storm surges, trying to find some solace by being close to where she last touched them.
"I'm alone now. It's very painful, I miss my family a lot," she said, shielding herself from the rain with an umbrella. "I feel like I'm going crazy."
As the rescue and emergency phase of helping the survivors winds down, medical and social workers are appealing for trauma experts to counsel typhoon survivors such as Taniega and Basilides.
But like all other aspects of the response to the disaster, the scale of the psychological needs is overwhelming.
More than 5,200 people have been confirmed killed and another 1,600 are missing after Haiyan tore across some of the country's poorest islands, generating tsunami-like waves that left dozens of towns in ruins.
About four million people have been left homeless and 10 million affected, according to the government.
Too few experts for giant task
Amid such widespread mental trauma, the Department of Health has been able to deploy just 21 psychiatrists and psychologists, according to Bernardo Vicente, director of the government's National Center for Mental Health.
"Definitely, we don't," Vicente told AFP when asked if there were enough professional counsellors available to treat traumatised survivors in the disaster zones.
Vicente pointed out there were just 600 registered psychiatrists nationwide, most of whom worked in large city hospitals and unable to abandon their duties to help the typhoon survivors.
He said the health department's counsellors had worked only in Tacloban, a city of more than 220,000 people that was among the worst hit and where 1,727 people have been confirmed killed.
Health workers in Tacloban say that support is not nearly enough, and the needs will likely grow as the focus of survivors shifts from putting up makeshift shelters and looking for food.
"Yes, we need psychiatrists to come and help," said Marife Garfin, chief nurse of the Bethany Hospital in Tacloban.
"At the moment they (survivors) are not able yet to process the whole experience. We are still in the process of being able to fend for ourselves and survive, get some food, get some treatment.
"But probably after a week or two, everything will sink in, everything will come to mind -- the loss, the separation from loved ones."
Not all traumatised people require intensive psychological counselling, Vicente emphasised.
"There are things you can do which do not require highly trained individuals," he said.
"Simply providing hope is enough for the community... simply providing food, lifting them up and asking: 'how are you?' or giving them a pack of noodles, is already psychological first aid."
Vicente also said counselling need not just be one-to-one, and trauma experts would be able to work with big groups of people.
In the long run, Vicente said between one and five percent of survivors would likely develop post-traumatic stress disorder, which required specialised treatment from experts.
Mathijs Hoogstad, a psychologist with humanitarian group Medecins Sans Frontieres (MSF, or Doctors Without Borders) in Tacloban, also said survivors would be able to get important support from within their communities.
Speaking with family, friends and church figures would help survivors overcome their traumatic experiences, Hoogstad said.
'I see them in my dreams'
For people such as Basilides and Taniega, who live on the outskirts of Tacloban, family and community support are indeed proving vital in helping them cope with their tragedies.
Basilides is living with a local official who has taken in him and his survivor son, nine-year-old Jack Ross. The son had been found clinging to a piece of wood and brought to an evacuation centre.
Basilides said mixing with people helped him forget the pain, and praying offered some comfort.
But he said that, in his moments of solitude, the gripping scenes of how the strong current ripped two of his children from his arms, and the sight of his wife and other children being carried off, kept replaying in his mind.
Taniega, who now lives with her father and a brother, also said speaking with friends allowed her to momentarily escape the torment.
She is also taking pills to help her sleep, but it was in those times of rest that she most clearly saw her lost husband and children.
"That's my only connection to them. I see in my dreams our happy times," she said.
"Sometimes my husband shows himself to me in a dream and I tell him: 'Oh you're still alive.' He'll call me by my nickname and my children will call me: 'Mamma.' They are laughing as they hug me."
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