The Two Faces of Trauma

Thursday, 01 December 2016


From 1900 to 2100

Suttie Conference Room

Emeritus Professor David A Alexander, Robert Gordon University, Principal Advisor Police Scotland

Professor Alexander will give a very personal view developed over the last 30 years of dealing with major trauma, including natural disasters and acts of human malice. Focus will be on personal observations in relation to the oft-quoted assertion that major tragedy brings out the very best and the very worst in folks. David will walk the audience through some of the events in which he has been personally involved, highlighting the best and the worst of what happened.

Notes

·       The President welcomed a large company once again. She reported that the Ashley Mackintosh Golf Trophy for 2016 had been won by Chris Driver and Doug Wardlaw.

·       She was also able to say that the refurbishment work in the Med Chi Hall is almost complete although there is still some way to go with the IT installations; it is hoped we will be able to resume use of the hall by our next meeting.

·       Dr Martin Pucci intimated that he had been invited to join a committee selecting exhibits for the ‘Local Hall of Fame’ museum due to be established in Provost Skene’s House, indicating that the plan is to have a rotation of material on show. (The Society’s Council is due to discuss suggestions for medical nominations for the museum imminently and will report to Dr Pucci thereafter.

·       It has been noted that a number of attending members do not have name badges and anyone in this position was asked to inform the Hon Secretary so this could be remedied.

·       The President then invited Dr Fiona Mair, who had nominated Professor David Alexander, winner of the 2016 President’s Medal, to give a brief summary of his work, affiliations and achievements in Clinical Psychology, and particularly, over almost 30 years working all over the world, in the area of management, planning of and training for psychological truma associated with natural disasters, accidents, war and terrorism. On receiving the medal from the President, Prof Alexander expressed his gratitude to the Society for choosing him as recipient, stressing the point that there is always something particularly special about receiving recognition from one’s ‘ain folk’. He acknowledged his debt to many colleagues and mentors over the years, singling out Dr James Henderson (who was in the audience) for his kindness, support, example and mentorship over the past 45 years.

·       The President finally explained that the original speaker for the meeting, Gavin Francis, had declared himself unavailable at 9 days’ notice, and how grateful she was that Professor David Alexander had stepped in as a replacement speaker. She then invited Professor Alexander to give his talk entitled ‘The Two Faces of Trauma’.

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Professor Alexander’s presentation consisted of his personal view developed over the years of dealing with major trauma including acts of malice and natural disasters. He focussed on his own observations in relation to the assertion that tragedy can bring out the very best and the very worst in people. He illustrated his views by reference to several tragic situations and events across the globe in which he has been professionally involved.

He began – where his particular interest in the psychology of major trauma had begun – with the Piper Alpha disaster in the North Sea in 1988 (the story of which had been revisited at the Society’s heritage event earlier in the year). He described how two things that night had particularly impressed, and stayed with him. One was the calmness and professionalism of Graham Page as the Medic-in Charge; the other was the insistence, while an unknown number of severe casualties was awaited, of nursing colleague Tilly Gibb on talking about the relatively trivial subject of yachting. The former was exemplary, the latter, on some reflection, illustrated the importance of ‘keeping a foot in reality’ to avoid being overwhelmed by disaster. He described a subsequent opportunity to practise this when on a plane when route to advise on the aftermath of the Kenyan bombing, he asked the air hostess to find out the latest score at Murrayfield – resulting in his suffering some minor trauma of his own when the response came back that the Captain was listening to the match on the radio – and Scotland were trailing the New Zealand All Blacks 35 – 5 at half time!

The next extremely harrowing incident referenced involved two trains passing through – and igniting - a field of leaking gas in Russia. There were large numbers of young people on board going to and from holiday camps; many perished in the gas explosion and many others were badly burned and the site had become an extensive barren wasteland. On being called in to help, David was billeted in a large, almost empty ‘hotel’ which turned out to be KGB premises in Chelyabinsk, a large city and centre for the Russian tank building and nuclear industries. There were considerable difficulties in working in such a KGB-regulated environment. Teenagers in the Red Army were given no more than a pair of gloves to work over the incident site gathering charred remains of passengers.

The wisdom was questioned of having taken some young victims of the incident to Aberdeen for treatment to their burns when they had to then return to the harsh austerity of Russia. Follow-up consultations in their own country saw Prof Alexander and a plastic surgery colleague with whom he was visiting, being prevented from jointly examining the vicitims – but having to do so in front of a line-up of stern senior local medics. Carrying out a psychological assessment via an interpreter was hard enough without the regime applying this constraining overlay. Even worse was the prevailing attitude vocalised by a senior medical figure who insisted (or dictated) that “Russian children do not get post-traumatic stress disorder.”

During that association, there were some concerns about the safety of the visitors themselves in what was described as a ‘dishonest nuclear pit’ – black river water, many serious illnesses prevalent, sore throat and stinging eyes – with every expectation that no regard was given to public health and safety by the regime. Reference was made to how international announcement of this horrendous explosion had been delayed for fear it would distract the world from the May Day parades. There was also an ever-present KGB officer watching over all aspects of the visitors’ work – while claiming to be a local councillor interested in their work and pretending to require constant use of an interpreter while actually fluent in English.

This segment ended with a touching counterpoint occasioned by a gift of a toy received from an orphan girl. While visiting a mental hospital, the visitors were told that the significant number of children there were orphans and there was no more appropriate provision. The child was sufficiently impressed that there were visiting helpers to give prof Alexander a substantial proportion of her total worldly possessions – a memento which he still treasures.

The account then moved briefly to the Balkans and the attendant reminder of the aphorism ‘soldiers fight, civilians suffer’ supported by the statistic that 90% of the large numbers killed there were innocent bystanders, substantially women and children. The visitors were in Croatia to help both soldiers and refugees; a picture of refugee camp consisting of tents standing in a field of muddy puddles was testament to the desperate situations that may be faced. Two disturbing reflections were the graveyard where Serbian fighters had launched a heavy mortar attack on families burying their dead, and the perversity of UN troops arriving in Zagreb, living in fancy hotels and being over-exuberantly wined and dined – in front of the civilian casualties of the war, living in squalor and misery.

Next stop – the aftermath of the sinking of an Estonian ferry in very deep water with a loss of some 800 lives. A political undertaking to retrieve the bodies meant that deep-sea divers required psychological briefing before the added stresses of encountering hundreds of drowned passengers while working in extreme conditions. Another reference to the risks to the volunteers was Professor Alexander’s harrowing account of getting from a semi-submersible platform to a boat 80 feet below in a 20 foot swell!

Then to Kenya where we heard about the terrorist bombings in Nairobi in which 1 ton of semtex had been detonated in a built-up area. A picture showed a high-rise building with no windows intact – and the accompanying tale of huge numbers of people working there who had suffered glass injuries. There was also the terrible tale of a news team in a helicopter filming – but doing nothing to help - as a woman blinded by glass injuries walked over the edge of a flat roof. The misguided thinking of sending in a riot squad armed with machine guns was pointed out. And then another example of communities pulling together and helping in the face of tragedy was the story of how the feral children – who lived independently in storm drains and scavenged bins for scraps – worked to help with scraping up blood from hospital floors after the event. An additional reference to the hazards for visitors came with an account of a trip outside the hotel, against orders, which saw a sudden and concerted attack by a large family of beggars.

After that the narrative moved to Sri Lanka after the major tsunami which caused death and destruction along much of the south and east coast. Several pictures illustrated the enormity of the damage. A large number of children had been killed and one of the roles Prof Alexander was involved in was preparing bereaved parents for the awful ordeal of trying to identify their own child’s body among so many flood victims. He also expressed his revulsion on finding amongst such destruction, operatives trying to recruit lost, orphaned and traumatised children for sex trafficking. On a much lighter note, he recounted his interaction with a Colour sergeant in the local military who advised him that he must be dehydrated since according to the colour chart, his “pee was crap!”.

Next to the Middle East – and an insight into the cultural difficulties of a visiting group, teaching a class of Iraqi midwives. Failure in the course would result in the woman being beaten and even evicted on return home. The need for military minders when in Kuwait was described. Much evidence had been seen of the US Forces’ predilection for protecting oil pipelines rather than civilians during the conflict there. Charity feeding stations were chaotic, as ever favouring the strong over the weak. Unexploded ordnance was extremely risky for children. Puddles of sewage lay around in towns extremely high temperatures, there was fly-tipping anywhere and even the spoils of injecting drug users were in evidence – all proving highly dangerous in terms of public health. Sadly, the immunity of the Red Cross symbol had deteriorated to that of target and the US Forces apparently had a policy of bombing the nearest village in retaliation for any insurgent activity!

The final stop was in Pakistan following major earthquakes when within moments landscapes had been permanently altered and villages obliterated. An incident was described where the screams of a woman, apparently being beaten, were heard coming from a tent in a refugee camp. The local guide advised against any intervention – something quite unnatural to a Westerner who had gone there to help – as it could not do any good against the way things were done there, and indeed would result in even greater consequences for the victim; that was another lesson in the importance of understanding local culture and custom when flying into a war or disaster zone. The Red Crescent camps, run by Turkish forces, were applauded – and particularly their principle in limiting passive dependency by facilitating cooking within refugee communities they were supporting.

In the question and answer session which followed the lecture, Professor Alexander highlighted the importance of peer support in times of tragedy, commented on the futility of would-be do-gooders parachuting in uninvited (and determined on applying their standards to the situation of others) and emphasised the importance of preparatory homework. In response to the last question of whether his work experiences had affected his overall view of humanity, Professor Alexander suggested that it had ‘sharpened both ends of the pole’ with instances of unbelievably cruel and callous behaviour being perhaps more than compensated for by the many examples of how people in-situ and with next to nothing, are so often willing to make sacrifices in order to help their fellows.

 

The President thanked Professor Alexander for his excellent, thought-provoking talk particularly at such short notice, and observed that those present would have been given an opportunity to understand why he was considered to be an extremely deserving recipient of the President’s Medal.

The meeting closed with a reminder that the next meeting will be on the 2nd Thursday in January when Dr Andrew Fraser, Director of Public health Science, NHS Scotland, will talk to the title ‘Politics is Nothing Else but Medicine on a Large Scale’.

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