By Avishai Levkovitz
My name is Avishai Levkovitz and I am a social worker. I have been volunteering with United Hatzalah as part of the Psychotrauma and Crisis Response Unit (PCRU) for a short time now and I was asked to participate in the organization’s recent relief mission to Puerto Rico following the devastation left by Hurricane Fiona.
One of the first things we discovered in Puerto Rico was how many people were suffering severe emotional trauma as a result of the destruction caused by the hurricane. This was the second major hurricane in Puerto Rico in five years, and many old wounds caused by Hurricane Maria were reopened by Hurricane Fiona. We were helped a lot by the local Chabad community and its leaders Rabbi Mendel Zarchi and his wife Rachel.
In one house that we went to in the municipality of Anasco, a town that hadn’t yet received any outside help from other aid organizations, I met a young boy named Jack, (false name) who was severely traumatized. His mother told me that Jack had trouble sleeping, wasn’t connecting to others, and was even refusing to make eye contact. I expressed empathy to the mother and emphasized that this was a very natural reaction to an extreme situation.
After talking with the mother in order to show Jack that I meant no harm, I turned to him and asked him if he wanted to sit with me. At first, he was fearful, but I put a stool in the middle of the room for Jack to use and told him that I am here for him whenever he would like to talk. To my surprise, he immediately sat on the stool. I sat on the floor and began a psychotrauma intervention, using a technique called bilateral stimulation, which involves tapping on the body in a “drumming” fashion. Throughout this whole time, my partner Gabi was describing the entire treatment to Jack’s mother so that she would know what was going on and likewise know what we were doing to help and why.
After asking for his permission, I started tapping on Jack’s knees for the rest of the conversation. I explained to him that the hurricane is now over and that he is now safe. To understand what the trigger of his trauma was, I asked him what had scarred him the most about the hurricane. He told me that being in the dark, due to the electrical outage, while hearing the sound of the hurricane, had been a terrifying experience.
Progressively, as we continued to speak while “tapping” on his knees, Jack opened up and started sharing his feelings with me. From talking about the hurricane, he slowly switched to telling me about more positive aspects of his everyday life. He talked about his cat and his dog, whom he loves very much, and about his school. He told me about the video games he likes and his favorite superhero. His level of distress, which was categorized as very high on our scale when we entered the house, had now gone down significantly.
It was incredible to witness how the body language and the topics he talked about reflected his progressive change of mood. By the end of our conversation, Jack was looking calm and confident. I thanked him for opening up to me and wished him luck. As I turned and prepared to bid farewell in order to visit another family, Jack jumped vivaciously off the stool, with a big smile on his face. Gabi and I spoke to Jack’s mom for a few minutes and explained to her how to use the techniques that I had administered in order that she could use them if Jack relapsed into his previous state, or use them on others she noticed who were suffering from similar sensations of emotional distress or trauma. Part of the goal of our mission is to treat the people we find, another part is to give people in the communities here the tools we know how to use so that they can use them as well and thus help others and become a force multiplier.
Another incident that left a strong impression on me is when I sat down with some of the police officers who were accompanying us in Anasco that day. During our trip, I saw that the police officers themselves were suffering from emotional overload. They were exhausted and seemed emotionally drained after having been active for many hours working with the local populace. I asked the commander if we could sit and talk with the entire team and she acquiesced.
We went into a large room where we could all sit together without being overheard. I told them that this was a place where each could express what they were feeling and that we would discuss together how as a team they can help one another cope. The officers began to describe what they had undergone over the past few days since the storm. We spoke about how to help one another lower tension and stress even when responding to high-stress situations such as natural disasters and hurricanes, or more minor incidents such as car accidents.
The commander was overjoyed that the officers were opening up, and we all shared a bit in a round-robin style of discussion. Each of the officers found that they all shared similar worries and stresses. Many of them had been working 12 hours shifts or longer every day since the hurricane and hadn’t had time to spend with their families. They were all exhausted, but they had to be the strong ones in order to help out their communities. It was taking a toll on them and it was important for each of them to recognize that they were not alone and that they already have a support network in each other. Their fellow officers and colleagues were people with whom they could share their frustrations and worries while helping each other to share the emotional burdens that they carry.
I worked with them on breathing techniques teaching them how to breathe in order to lower their own stress levels, but I also taught them how to instruct breathing techniques so that they could use them out in the field when they came across others in distress. We also talked about how the sensation of helplessness is one of the main causes of emotional stress and I gave them some tools on how to help one another and avoid feeling helpless, even in the face of disasters such as this one.
Another incident that was inspirational for me took place at the college for paramedics in San Juan where we got to work with the students who were training to become the first responders of the future. They were very interested in what we were doing and in the various techniques that use to provide PFA to those suffering from emotional or psychological stress. Together with the other members of our team, I showed them some of the techniques that we use to stabilize patients in the field and taught them how to do it themselves. A lot of them picked up very quickly the techniques and excelled at their implementation. As they will be the staff out in the field in the near future, empowering them means that we are empowering many others who will benefit from their learning how to recognize who is in need of psychological first aid and how to provide psychological first aid in the field.
For me, this entire trip was an incredibly emotional one. It wasn’t easy to leave my home and my family behind for the High Holidays, but I felt that working here to empower those suffering in the wake of Hurricane Fiona is something that is incredibly important and worth the sacrifice. These people have lost so much, I am happy to have had the opportunity to give them tools to rebuild their own resiliency and the resiliency of others.
Avishai Levkovitz lives in Petach Tikvah, Israel, and is married with three children. He is a practicing psychotherapist and is the vice principal of a school dealing with psychiatric care in Tel Aviv.
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