Lessons from the 2015 earthquake(s) in Nepal: implication for rehabilitation.

PURPOSE: There has been an increase in the number of natural disasters in recent history, and the rate of disability is increasing among survivors. The most recent major natural disaster was the earthquake(s) that occurred in Nepal on 25 April 2015 and 12 May 2015. In total, more than 8500 people were killed and over 18,500 people were left injured. This article aims to demonstrate the role of rehabilitation professionals in post-disaster relief and beyond in Nepal. METHOD: This is an experiential account of physiotherapists present during the earthquake and participating in the post-disaster relief. RESULTS: Rehabilitation professionals played an important role in the acute phase post-disaster by providing essential services and equipment. However, discharge planning emerged as an important role for rehabilitation providers in the early days of post-disaster and signaled a relatively new and innovative function that facilitated the heavy imbalance between little supply and tremendous demand for care. In the coming years, rehabilitation will need to support local initiatives that focus on minimizing the long-term effects among people with a newly acquired disability. CONCLUSIONS: Rehabilitation serves an important role across the continuum in post-disaster relief from the initial stages to the months and years following an event. IMPLICATIONS FOR REHABILITATION: Driven by medical advances in acute field medicine, the relative proportion of casualties following natural disasters is decreasing, while relative rates of disability are rising among survivors. In post-disaster settings, the growing number of people with newly acquired disabilities will be added to the existing proportion of the population who lived with disabilities, creating a significant growth in the total number of people with disabilities (PWDs) in communities that are often ill prepared to provide necessary services. Rehabilitation interventions in the initial stages of emergency humanitarian response can minimize the long-term effects among people with newly acquired disabilities through early activation and prevention of secondary effects. Rehabilitation providers thus appear to have an important mediating effect on outcomes of disabilities in the early stages, but must also be strong partners with PWDs to advocate for social and political change in the long term.

Virgin Territory: Theology, Purity, and the Rise of the Global Sex Trade

Sex sells. A lot. But who exactly is on the market?

What kinds of bodies are calibrated for traffic and consumption, and how exactly do they get there? When it comes to “sex” trafficking—which comprises a minority percentage of human trafficking, yet dominates the moral imagination as an “especially heinous” crime—the rise in predominantly white, evangelical Christian American interest in the trafficked subject galvanizes an ethical outrage that rarely observes critiques of race, ethnicity, sexuality or class as conditions of possibility. Though a nuanced mandate to fight trafficking is all but cemented in the contemporary American political and moral conscience, Virgin Territory accounts for the ways Christian ideas of purity annex both gender and sexuality inside the legacies of racialized colonial encounter, and foreground the market expansion of the global sex trade as it exists today.

In Part I, I argue that the narratives of virginity tied to Mary’s body simultaneously foregrounded the gendered, sexed Other as sparked disdain for the religious Other, for the Jewish body and for Mary’s Jewish identity. Through this analysis I explore the connections of racial identity to the Christian theological elision of Jewish election. I demonstrate how the questions of sexual ethics materialized at the site of the Virgin Mary, and align the moral attachments of sex and purity in the production of whiteness. These machinations, tied to the emerging European identity of empire, irrupt horrifically into the narrative ontology of dark flesh in Africa, Asia, and the Americas.

In Part II, I highlight the function of these narratives inside of the moments of colonial encounter, demonstrating how the logics of purity and virginity were directly applied to manage dark female flesh. I map the visual iconography of the Black Madonna first through a Dutch painting entitled The Rape of the Negress. I read this image through the social theological imagination instantiating the idea of the reprobate body and white imperial gaze. This analysis foregrounds a theological reading of Sarah Baartman, the “Hottentot Venus,” as the center of a complex sex trafficking investigation, outlining the genealogy of race, as well as the ideologies of the racial, ethnic and national Other, as mitigating factors in the conditions of possibility of a global sex trade. By restoring these narratives and their theological undertones, I reiterate the ways Christian thought is imbricated in the global sex trade, and propose theological strategies for rethinking humanitarian responses to sex trafficking.

Documenting the Contextualization and Implementation of mhGAP-HIG in Post-earthquake Nepal

Background: The burden of mental health is increased in humanitarian settings, and needs to be addressed in emergency situations. The World Health Organization has recently released the mental health Global Action Programme Humanitarian Intervention Guide (mhGAP-HIG) in order to scale up mental health service delivery in humanitarian settings through task-shifting. This study aims to evaluate, contextualize and identify possible barriers and challenges to mhGAP-HIG manual content, training and implementation in post-earthquake Nepal.

Methods: This qualitative study was conducted in Kathmandu, Nepal. Key informant interviews were conducted with fourteen psychiatrists involved in a mhGAP-HIG Training of Trainers and Supervisors (ToTS) in order to assess the mhGAP-HIG, ToTS training, and the potential challenges and barriers to mhGAP-HIG implementation. Themes identified by informants were supplemented by process notes taken by the researcher during observed training sessions and meetings.

Results: Key themes emerging from key informant interviews include the need to take three factors into account in manual contextualization: culture, health systems and the humanitarian setting. This includes translation of the manual into the local language, adding or expanding upon conditions prevalent in Nepal, and more consideration to improving feasibility of manual use by non-specialists.

Conclusion: The mhGAP-HIG must be tailored to specific humanitarian settings for effective implementation. This study shows the importance of conducting a manual contextualization workshop prior to training in order to maximize the feasibility and success in training health care workers in mhGAP.