Occupational therapy in times of disaster.

community has been riveted by news of widespread and damaging disasters, including but not limited to the Indian Ocean tsunami (December 2004), the devastating hurricanes in the Gulf region of the United States (2005), and the earthquake in Pakistan and India (2005). These poignant and powerful images and stories give rise to several potential reactions, including selfreflection on both a personal and professional level. As we watch disaster survivors separated from meaningful environments and daily routines, occupational therapists wish they could provide the type of help and support that would help them regain productivity—we know in our hearts this could be beneficial, yet we don’t know how to proceed. A disaster is a violent and unexpected change resulting in sudden or great misfortune. Although disasters have been with us since the beginning of time, we are becoming increasingly more aware of the effects of calamitous events on persons in faraway lands as well as here at home. The news media captures images of persons struggling to meet environmental challenges that seem insurmountable. We mourn with those who lose loved ones. We may even begin to realize that these things could happen to us, often dealing with our grief and anxiety by wanting to offer our money and professional services. In the past we have tended to make distinctions between disasters attributed to man-made causes such as the Hindenburg airship fire (1937), the Oklahoma City bombing (1995), acts of terrorism in New York, Pennsylvania, and Washington, DC (2001), and petroleum refinery explosions in Texas (1947, 2005) versus those we attribute to natural causes. Recently the distinction between man-made versus natural disasters becomes blurred. Regardless of the cause of the event we want to hold someone or some group responsible. We set up investigations and commissions to see what could have been done to avert the disaster; we blame one another for the misfortune that has occurred. We say things such as, “We should have seen this one coming. ” “We should have had a plan. ” We want to fix the problem; we want to think that the effects of a disaster can be under our control. Who is in control? Who is in the best position to respond? Disasters are contextdependent. They are regional. In fact, we have a term for the place where a disaster occurs. We call it a disaster area. A disastrous event occurs to many persons, but the effects of the event are placeand personspecific. An appropriate response is to put the life of a person as well as the community back in order. Sometimes order means restoring buildings. Other times order means restoring health, daily routines, a job, or relationships with other persons. Those who have skills and knowledge, and who are prepared to respond immediately and effectively, earn our esteem and gratitude; those who cannot do this are perceived as nonessential. Are occupational therapists prepared to respond? Are occupational therapists essential during and in the aftermath of a disaster? Most of us who are occupational therapists rarely stem the flow of blood; but all of us think in terms of “life blood. ” Occupational therapists are specifically trained to address disruptions in daily routines. We are in a position to address needs that are especially salient following a catastrophic event: • Choice making (decisions about how people spend their time and about the nature of daily routines) • Building Connections (access to loved ones and resources) • Exercising Control (over how people utilize resources available to them)