The U.S. Navy is usually among the first organizations worldwide to respond to devastating natural disasters, providing supplies and medical care. But often the victims need more than the basic necessities of life. They may need help healing their hearts and their minds as they struggle to comprehend the enormity of their losses and rebuild their lives.

The Navy played out this scenario recently with an exercise that simulated severe flooding in Asia. During Pacific Partnership 2017, hosted by Malaysia, activities included humanitarian assistance and disaster response preparedness exercises, such as mock rescue medical triage. During the exercise, the Navy led medical exchanges, nutrition and cardiopulmonary resuscitation classes, civil engineering projects and community engagement events.

Experts also focused on ways to prepare for and handle the emotional shocks and psychological strains that follow a disaster, not only for potential victims, but also first responders, according to Lt. Stacey Uzueta.

Uzueta, who worked with Malaysian health care professionals throughout the exercise, is an expert in stress and trauma from Naval Hospital Bremerton, Washington. She received a direct commission as a lieutenant after years of civilian social work, first in child protective services, then in a foster care agency and finally as a clinical therapist.

Social work is a narrow career field in the Navy, with only about 80 billets, but an important one, Uzueta said, explaining assignments are either in clinical mental health or case management, which is her current role at Bremerton.

I became a social worker because I enjoy working with people, helping people to help themselves and because mental health is very interesting to me. I joined the Navy to serve my country and serve others as a social worker. It's pretty cool to be able to do both at the same time." - Lt. Stacey Uzueta

During her time in Malaysia, Uzueta spent one week in the capital of Kuala Lumpur and two weeks in the coastal city of Kuching on the island of Borneo, engaging in community health outreach and participating in subject matter expert exchanges and field training exercises. She also talked about self-care, coping mechanisms, resiliency and stress reduction with local Malaysians.

"Some of the techniques included types of coping strategies, general classifications of coping mechanisms, reactive versus proactive coping ... positive coping mechanisms versus negative coping mechanisms, evidence-based interventions and resiliency. Generally, I urged them to make self-care a priority," she said, admitting this was a challenge because Malaysians "do not naturally see self-care as a priority, mostly due to their lack of resources. ... Most people do not focus on self-care, but rather caring for children and elderly and meeting basic needs."

Self-care, Uzueta continued, involves not only ways to relax or attain emotional well-being, but also the activities of daily living, from hygiene to eating to sleeping.

"People all have different goals for self-care," she said, "but in general, the goals of self-care are to find a state of good mental and physical health, reduce stress, meet emotional needs, maintain relationships and find a balance between one's personal and professional or academic life."

During the simulated flooding exercise, Uzueta also assisted victims in accessing resources and provided psychological first aid.

"Social workers are not typically first responders," she noted, "but any mental health provider/clinician would provide psychological first aid in a disaster response situation. ... Psychological first aid is a lay intervention that includes support from non-mental health providers, although individuals do receive some training; seminar/group style skills including active listening; awareness of resources for referrals and other similar skills. Dos: Promote safety, calm, connectedness, self-efficacy and help."

While conducting this intervention, responders typically listen to people who want to share their stories, assist victims in finding their loved ones and help people learn to help themselves. Above all, Uzueta said, it should be utilized to promote safety and help victims find basic necessities.

Support from family and friends can aid in recovery as well, as can stress reduction techniques such as meditation, deep breathing techniques, exercise, prayer, even something as simple as talking.

These practices can, Uzueta said, mitigate the effects of trauma and stress, and help prevent more serious problems from developing, which can include difficulty sleeping, flashbacks, re-experiencing, difficulty concentrating, intrusive memories and anxiety. They're helpful for both victims and for first responders, who can become overwhelmed and depressed after confronting tragedy and loss over and over again.
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Back in the States, if a trauma response were to linger and develop into something more serious, such as post-traumatic stress disorder, anxiety or depression, Uzueta would refer her patients for prolonged exposure therapy (PE) or cognitive processing therapy (CPT). They're evidence-based, she said, and research shows they're effective. (She's trained in the therapies, but doesn't conduct them in her current role.)

According to the Department of Veterans Affairs, PE teaches patients to gradually approach trauma-related memories, feelings, and situations. By talking about the details of the trauma and by confronting safe situations they have been avoiding, patients can decrease symptoms; minimize emotions like fear, anger and sadness; reduce unwanted memories and regain more control of their lives.

Cognitive processing therapy, on the other hand, typically consists of 12 sessions of psychotherapy that teach patients to evaluate and change the upsetting thoughts they have had since trauma occurred. By changing their thoughts, according to the VA, patients can change how they feel. For example, patients may believe they are to blame for traumatic events, or that the world is a dangerous place. Providers help them think about the trauma in new ways and try to reverse those thoughts through talk therapy, writing and worksheets.

Of course, this may not be practical or even possible in a disaster-ravaged developing nation. Even under the best of circumstances, Uzueta said, access to health care is a challenge in Malaysia's remote villages. In fact, during Pacific Partnership, many Malaysians received basic medical treatments that wouldn't be available to them otherwise. Mental health care is almost nonexistent. Instead, she said, families and neighbors support each other financially, emotionally and logistically.

Following a traumatic event, families and communities might pool their resources and help each other in recovery and re-establishing communities. ... I understood more clearly than ever the basic human instinct for survival and how resilient most humans are in the face of trauma." - Lt. Stacey Uzueta

"I also took away how very important it is for people to have support from others and how that aids in their recovery from traumatic events," she said.

The experience of not only helping the Malaysian people, but also the opportunity to deploy and work with Malaysian health care experts and service members, was the highlight of Uzueta's two years in the Navy.

"It was an honor to be a part of this," she said. "It was particularly special because it was my very first deployment and mission away from the command. It really was a great experience for me. ... It was so cool to meet the people of Malaysia, learn about their culture, their challenges, the differences and similarities among us, and just to be a part of the helping process."

Pacific Partnership is the largest annual multilateral humanitarian assistance and disaster relief preparedness mission conducted in the Indo-Asia-Pacific theater. Its goal is to enhance regional coordination and preparedness for manmade and natural disasters.

Malaysians have first-hand experience with the massive natural disaster that prompted Pacific Partnership: the Dec. 26, 2004 9.3 earthquake off the northwestern coast of Sumatra, Indonesia, that caused a devastating tsunami. More than 100,000 people were killed, with thousands missing and some 700,000 displaced. On Penang Island, Malaysia, alone, tsunami waves of 25 to 35 feet slammed ashore, resulting in 68 fatalities, six missing and 8,000 displaced residents.