November 28, 2005

Epidemic survivors stress need for mental care

By Tan Ee Lyn

HONG KONG (Reuters) - Joey Lee began suffering severe mood
swings, depression and would sob every day for no apparent
reason soon after she survived a SARS infection while working
as a nurse in a public hospital in Hong Kong in 2003.

Lee and her 8-year-old son, who was not infected, have been
seeing a psychologist since. "He would cry all the time and at
night, he is terrified that my husband and I will die," she

Lee and her friends who are coping with the after effects
of SARS shudder to think what will happen when a feared bird
flu pandemic actually strikes, a catastrophe that will make the
SARS epidemic of 2003 seem like a drop in the ocean.

Health experts have warned for months that the H5N1 bird
flu virus might trigger this disaster if it mutates and becomes
easily transmissible among people. Millions could die.

It was in Hong Kong that H5N1 made its first known jump to
humans in 1997, infecting 18 people and killing six of them.
About 1.5 million chickens were culled to end the outbreak.

The virus flared anew in Asia in late 2003 and since then
67 people have died. The disease is already spreading quickly
in poultry in neighbouring China, where two people have
recently died of bird flu.

The Asian Development Bank says a year-long pandemic could
cost Asian economies $283 billion. Countries are already
stocking up on drugs and experts are calling for thorough
preparation, including counselling for victims and families who
will suffer grief on a scale they probably have not seen in
their lifetime.

Although a contingency plan is in place in Hong Kong, which
officials say would help the city cope with the crisis, Lee and
her friends are not so sure.

"There is no way they can handle a pandemic. Our wards are
too overcrowded and the risk of cross-infection is very high.
Like SARS, they won't know how to handle the survivors and
won't know how to rehabilitate them," said Kelly Lo, a nurse at
Caritas Medical Center who became infected early in 2003 while
tending to patients admitted for fever, a classic symptom of

"I really fear getting infected. I'd rather die than be
admitted to hospital again."


Suffering from bone and spine degeneration because of the
strong steroids she was given when she was admitted to hospital
for SARS in 2003, Lee, now 34, has not been able to return to
work and is terrified of crowded places.

Her son was never infected, but he is still traumatized by
the long separation from his mother when she was in hospital.

SARS, which is believed to have first showed up in southern
China in late 2002, began spreading around the world in 2003.
In Hong Kong, 1,755 people were infected and 299 of them died.
Of those infected, 386 were healthcare workers, six of whom

Many of Lee's colleagues who survived SARS suffer similar
mental and physical disabilities. But doctors here do not seem
to understand that victims of epidemics can be left struggling
with debilitating psychological trauma and depression.

"I was crying everyday and the doctors just said it was all
in my mind...they did not even refer me to any psychologist
until I asked (at the end of 2003)," said Lee, who became
infected while working at Hong Kong's Princess Margaret


A group of experts at the Chinese University is studying
the psychological impact left by SARS. In their interviews with
about 150 survivors so far, the importance of healthcare
support is a consistent theme in feedback.

"In general they agreed they received appropriate care, but
it was not exactly satisfactory," said psychology assistant
professor Winnie Mak. The study will be completed in August

Rita Chiu, who has not been able to return to her work as a
nurse at the Caritas Medical Center and is too weak even to
care for her toddler, said: "Doctors here are only reactive,
not proactive. When you complain (of psychological problems)
they will try to ignore you."

The stigma attached to SARS survivors adds to their
hardship. Many victims cannot find jobs.

Cheung Shuk-man, who quit her attendant job at the Prince
of Wales Hospital after she recovered, said: "When I tell
prospective employers I recovered from SARS, they look at me
like I am a freak. They would go silent and say 'this is all,
please go home and wait for our call'."

In other ways, life is not the same for some survivors.

"I can't even buy insurance. Insurers say they don't know
what other complications I may suffer," said Lo, a former
athlete who now suffers premature bone degeneration.

Psychologist Mak stressed the importance of public
education to inform people about the looming pandemic and to
dispel myths.

"Not knowing what's going on can intensify peoples' fears.
Now that we can prepare, what we tell the public is very
important so as to reduce fears. When people don't know what's
going on, they tend to blame and avoid the victims and
discriminate against them," Mak said.