By Masako Otera, Tohoku University
The paper discusses required knowledge in preparation for a disaster relief. The author shares her experience of the Great East Japan Earthquake and reviews how she went through the post-disaster phase as a music therapist. The author has made three suggestions for change in music therapy as a disaster relief. First, specific topics on disaster relief should be included in music therapy educational courses. This should cover general information regarding natural and human-made disasters and disaster relief. Second, making connections with related organizations, both the individual and national level is also suggested. Third, the further accumulation of studies on music therapy as a disaster relief service is needed.
The Great East Japan Earthquake struck on March 11 2011 at 14:46(JST). The power of this quake was estimated Magnitude 9.0, which was the most powerful earthquake in a recent history of Japan. The earthquake generated a tsunami which caused serious damage to the Pacific coast of eastern Japan and also triggered equipment failures and radiation leaks at the Fukushima Daiichi Nuclear Power Plant (Takano, 2011). The most devastated area was Tohoku region, which is the northeastern part of Honshu (the main island). This disaster consisted of the earthquake, tsunami, and nuclear accident. While many regions have experienced earthquakes, tsunamis, and /or nuclear disasters, a compounded disaster like this one had not been experienced in recent human history. The Japanese prime minister at that time announced that this earthquake was “the most severe crisis in the 65 years since the end of the Second World War” (Prime Minister of Japan and His Cabinet, 2011).” As of February 2012, the number of killed or missing persons is over 19,000, the number of injured persons is more than 6000, and the number of fully- and half destroyed buildings is approximately 372,000 (National Police Agency, 2012).The financial damage is estimated 16.9 trillion yen (216 billion US dollars) (Government of Japan, 2011).
The author experienced the disaster in Sendai city which is the largest city in Tohoku region. Ms. Otera still lives there and works both as faculty and music therapist at the medical school of Tohoku University. In this paper, the author would like to share thoughts and ideas regarding music therapy as a disaster relief service. Especially, the author emphasizes what music therapists need to know when the disaster strikes by reviewing what she experienced from the earthquake.
The next section is written in first person to more personally describe the author’s experiences.
On March 11, I was in my office at the Building 1 of Tohoku University School of Medicine which is on the 7th floor. When I started to feel some quakes, I did not pay too much attention to them because I had experienced similar ones from few days prior, with no complications. However, I gradually started sensing that this quake was clearly unusual. I found myself not being able to stand on my feet and all I could do was hide myself under the desk. The quake continued for about two minutes, and I could only watch things falling around me. Interestingly, I now remember hearing barely any sounds, which should have been present during that moment.
When the quake stopped, I came out under the desk and found a first-class mess in my office. My boss was out of town and no one was there except me. I realized that I had to make decisions for myself. Because there were still frequent short quakes afterwards, I decided to go outside in order to get out of the danger. People were gathering in front of the building and just stood outside. At that time, we did not know that this earthquake would end up being the worst disaster since World War II.
I was standing outside for a while and then decided to go to the palliative care unit in the university hospital, which is next to the medical school. I work there and was concerned that they may have needed help. When I arrived, I was informed that no one was injured on the unit. Hospital lights were still working because of the emergency power system and the unit seemed to be settled down. The chief doctor suggested I stay on the unit until the situation was more stabilized, so I accepted his offer and stayed there for a while. I tried to gather information about the earthquake. Via a portable television I heard a news reporting saying between 200-300 bodies were found on the coastal area in Sendai city and also saw the view of tsunami washing out the Sendai airport. I was gradually realizing that we may have been experiencing an event that would result in a great loss and misfortune. It was a very cold day and stormed with snowfall sporadically. I was just watching the storm without any thoughts coming up in my mind.
From that day, the city of Sendai was in an emergency state for about a month. People had to live without essential utilities including electricity, gas, water, and phone, and experienced severe shortages of everything. Situations differed among the areas and our circumstances in the city area were much better than those in coastal areas. However, the crisis was compounded with the nuclear accident as it exhausted all of us physically and mentally. Our fatigue was physical as we lived in the unaccustomed post-disaster environment and emotional as we had to deal with uncertain rumors about the nuclear pollution while not knowing the prospectus for the recovery.
I was experiencing light insomnia due to frequent aftershocks. I was also at a hyper aroused state, which commonly occurs after a stressful event. In addition, it was difficult for me to deal with feelings of helplessness and restlessness; I felt anxious during the day and restless in the evening. I was unable to focus for longer periods of time, and symptoms of anxiety such as irritability, sleeplessness, and heightened emotions were frequent.
This survival mode continued for approximately two weeks. During this time I was able to work toward recovering my life by making contacts with my family and friends, organizing my apartment and office, and searching for food and supplies. I decided to go back to my clinical work after the two weeks as I was requested from one of my clinical work places. Gasoline was unavailable throughout the region; I could not buy gasoline for my car and had to commute by bicycle. Biking to work, leading some groups, singing with full voice, and going home was not easy. It was energy consuming, but helped me to improve my mood by focusing on physical work. Doing what I did prior to the disaster helped me to recover emotionally as well.
While my daily life had been coming back, I started being able to take care of others and think of what I could do as a music therapist. However, I first could not come up with any ideas for a disaster relief. There were so many people who were still in need for basic supplies such as food and water even after a month. I was not sure if it was time for music yet. I started collecting information about local shelters and ongoing volunteer projects via the internet and television.
Many volunteer projects were sending relief supplies such as food, clothes, and daily necessities. I joined one of them and went to a coastal area to deliver supplies. I also found musicians or entertainers had started going to shelters to provide concerts and music events. Some local music therapists also started their own disaster relief projects, but I did not have connections with these people. I started sending music CDs to local radio stations which were newly opened after the disaster as local resource media. I called them to ask what kind of CDs they needed. They requested some music for nighttime to assist listeners’ sleep. I sent requested CDs including a music box sound and easy listening music.
I did not have any ideas about an operating system of disaster relief projects and basic information such as what kind of organizations are involved and who runs shelters and temporary housings. This was crucial information, which I had to learn before starting my disaster relief project.
Many professional organizations provided various resources for trauma care and crisis intervention. I read these materials and books, but still could not come up with what I would do next. Seminars and meetings regarding disaster relief had been offered by various organizations. When I attended one of these seminars, I heard someone saying, “There are people who need intensive care by clinical professionals. On the other hand, most people can recover by helping each other and building and confirming relationships within families, friends, and their communities. What care providers can do for them is to offer spaces and opportunities in order to promote people’s gathering.”
This comment made me realized that I tended to adhere to fixed ideas such as providing crisis intervention and counseling through music activities. I thought that simply providing opportunities for people’s gathering may be what I could do as a music therapist by using my group leading and management skills. Also, I realized that entertainments and mental health care provided in shelters were not necessarily based on people’s individual needs. There were people who enjoyed concerts and entertainments provided by popular musicians. Some people may have been helped by counseling. However, following a traumatic event, there are frequently individuals who are not able, ready, or appropriate to begin counseling, and also those who may not see the value of entertainment. Because the disaster had created complex situations, people’s needs varied and had been changing day by day. For example, the number of people staying in shelters quickly changed and it was difficult to predict who needed what kind of services. Creating people’s gathering based on service recipients’ needs through music activities seemed to have a potential which was unique to music therapy. I was getting some ideas about my disaster relief project and continued searching opportunities for music therapy.
Two months later, I came to know a chair person of a Non-profit Organization (NPO) which was planning to start a new support program for residents of temporary facilities as a public service entrusted from the city of Sendai. The chair-person of the NPO was interested in a music activity for enhancing social interaction among residents. We started a discussion about holding a music activity in one of temporary facilities served by the NPO.
Due to the widespread damage throughout the eastern Japan, disaster recovery projects tended to be delayed and construction of temporary facilities was not an exception. Therefore, it was almost three months later when people started to move into temporary facilities. While waiting for resident’s living conditions to settle down, I tried to figure out some possibilities that I could do for residents and their new community. There was an increasing social attention to prevention of residents’ social isolation because some solitary deaths incidents in temporary facilities were reported from an experience of the Kobe earthquake in 1995. I had some opportunities to visit the temporary housing and talked with residents. I also joined an activity offered by a volunteer group in order to obtain some ideas regarding which activities would be appropriate in that environment. I eventually made a plan of a singing group for the residents. This was based on identified needs which I had seen and heard at the temporary housing. I continued discussions with the NPO and finally I was able to start the singing group at the end of August, which was five months after the disaster struck.
The singing group was planned for enhancing social interaction among residents. This group was open to all of residents so that the group is highly participative for them. It was also easy for me to handle as a continuous project. The purpose of the singing group was not specifically designed for sharing thoughts and feelings experienced by the disaster, although any topics that may come up during the session were discussed. I provided residents a song book which consisted of 35-50 Japanese popular songs. The song selection was based on the age range of participants. Participants chose a song they wished to sing during the session and we sang together with my keyboard accompaniment. One volunteer person helped me with the group handling and the preparation of the tea break held after the session. The singing group still continues on a monthly basis.
As I review these months after the earthquake, I surely can reflect on myself being unprepared for the disaster. There are three points that I would like to make reference.
First, I could have learned what would happen in general when the disaster strikes. For example, I definitely did not have enough basic information on how to handle emergency situations such as where to evacuate, how to make emergency contacts, what could happen when all utilities and power resources shut down. It was also important to know some physical and psychological reactions typically occurring in people during the crisis. If I had better knowledge about them, it would have been easier for me to go through the post-disaster process.
Second, I also could have had more knowledge about crisis intervention and disaster relief. I only had one seminar regarding trauma care and had not taken other classes or lectures. Also, I realized that I had a lack of knowledge about a social welfare system within my society and how disaster relief projects are conducted during the post-disaster phase. Because of this problem, I did not know which organizations to contact and who I needed to talk in order to start my activities.
Third, prior to the disaster, I could have built more connections between local agencies including music therapists, related organizations including welfare and social security organizations, NPOs, and volunteer groups. It was not easy to start making connections with those people after the disaster struck because of the disruption of communication means and the chaotic situation.
As reviewed above, it is very important for music therapists to have general information and basic knowledge about disasters. Also, the knowledge about how disaster relief services are delivered within the local social welfare system is crucial as this was the most needed information for the author to start her disaster relief project. The author suggests including these specific topics as a part of music therapy educational courses because this information is essential for a music therapist whether or not if s/he becomes a first responder. Some courses may have already included clinical topics such as trauma care and crisis intervention. The author maintains this clinical knowledge and techniques can be useful after music therapists successfully plan their projects and find opportunities to deliver their services.
Following a disaster, the immediate priority is to address critical issues such as lack of food, water and shelter caused by the disaster as quickly and smoothly as possible and is not to acknowledge what professionals are willing to do. All of first responders and even survivors need to do whatever they can do for their survival regardless of his/her profession or job, especially during the acute phase. While participating in the disaster relief project, the author heard about many conflictions among professionals and volunteer groups who demonstrated egocentric professionalism and claimed their unique significance. These conflictions resulted in exhaustion of local coordinators. There are many ways music therapists can participate as human-aid professionals. Those things may not relate to music therapy or music activities, but they may identify some needs for music therapy services and may find the way to deliver their services through participating non-musical activities.
Most of the time, it is hard to predict an occurrence of a disaster. It is not easy to learn necessary knowledge after the disaster strikes because of the chaotic situation and lack of learning resources due to lack of power and damages to buildings (For example, local libraries and other reference sources are most likely closed for several months). Music therapists need to know what may happen and what they can do after the disaster so that they can act appropriately, smoothly, and with calm judgment. Because situations and needs in affected areas change constantly, having prior knowledge and information is helpful in order to later execute proper analysis for ongoing situations, to take thoughtful actions, and to minimize ineffective activities. Music therapy is not included as a typical service for a disaster relief. Therefore, music therapists need to know where to contact or people to speak with regarding knowledge about the social welfare system in the local area. Otherwise, music therapists will lose the opportunity to join disaster relief projects, even if music therapists are knowledgeable about post-traumatic clinical techniques.
As Whitehead-Pleaux (2005) suggested, it is also necessary to build connections between music therapy associations and related organizations. Local music therapy agencies may have their own connections, but these may not work efficiently in the case of a large-scaled disaster; these local agencies are likely to be damaged and even those in surrounding areas may be the same situation. Therefore, making connections and building alliances with related local and national organizations during a non-emergency time are critical issues to be resolved prior to catastrophe to support local disaster relief activities.
There is a tremendous need for more case reports and activity records during the post-disaster process. Music therapists who have not been involved in disaster relief projects can even contribute to this by reviewing related topics such as disaster relief projects other than music therapy or a social welfare system directly related to the disaster relief. Discussion regarding administrative issues such as operative methods of disaster relief projects and fund raising are also needed. The author found that a report of Whitehead-Pleaux was very helpful because it discussed various administrative and financial issues. Case reports and papers dealing with such topics are very important because those issues can arise at any point of a disaster relief project.
The purpose of accumulating studies on music therapy and a disaster relief is to provide music therapists information so that each of them can start their professional work efficiently and quickly after the disaster strikes. No case identical to the Great East Japan Earthquake and disaster can be found regardless the number of studies compiled because each disaster creates unique situations. However, music therapists would be provided opportunities for thinking of what music therapy can do after the crisis by reading and learning from case reports and records. This would enhance research and discussion on this topic and lead to efficient public promotion of music therapy as a disaster relief service.
The three suggestions the author has made above may not be very new. The enrichment of an educational program, building connections with organizations and people, and accumulation of studies are already identified needs for the development of music therapy as a whole. The author had to fully realize these needs through the direct disaster experience. Because anyone may be struck by a disaster, it is important to be prepared both as a professional and an ordinary citizen before it strikes.
The author would like to express her appreciation to Ms. Penny Roberts, MM, MT-BC for her advice and suggestions for this paper.
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