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November-December 2016  Volume 110  Number 6

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Disoriented and Immobile: The Experiences of People with Visual Impairments During and After the Christchurch, New Zealand, 2010 and 2011 Earthquakes

Gretchen A. Good, Suzanne Phibbs, and Kerry Williamson

Print edition page number(s) 425-435
Structured abstract: Introduction: On September 4, 2010, at 4.35 a.m., a shallow 7.1 magnitude earthquake struck the South Island of New Zealand, followed by a deadly 6.3 magnitude aftershock on February 22, 2011, centered under the city of Christchurch, which killed 185 people. This research explores the experiences of 12 visually impaired Christchurch residents who lived through more than 12,000 aftershocks throughout 2010 and 2011. The participants shared suggestions about how to be better prepared for such an emergency. Methods: Qualitative research involved 12 face-to-face semi-structured interviews conducted in 2011 prior to the fatal February earthquake. In February 2012, seven of the original participants were reinterviewed about how more than a year of earthquakes had affected their lives. Results: Participants highlighted the importance of communication and technology, personal and agency support, orientation and mobility, health, rebuilding independence, rehabilitation, coping, and resilience. Discussion: Participants demonstrated creative problem-solving abilities, resilience, and community spirit. Findings also indicate that older visually impaired persons are vulnerable in disasters, and that more work needs to be done to prepare communities, agencies, families, and individuals for potential disasters. Implications for practitioners: Participants provided suggestions for disaster preparedness for people who have impairments and for the agencies that provide services to people with disabilities.

On September 4, 2010, at 4:35 a.m., a shallow, nonfatal 7.1-magnitude earthquake struck the South Island of New Zealand near the city of Christchurch. Following that event, 12 visually impaired (that is, those who are blind or have low vision) participants were interviewed about how the seismic activity affected their sense of independence and their mobility.

Immediately following the completion of these interviews, on February 22, 2011, a 6.3-magnitude earthquake occurred at 12:51 p.m. in Christchurch, killing 185 people and injuring a further 7,171 (Potter, Becker, Johnston, & Rossiter, 2015). The February 22nd earthquake resulted in damage to nearly three-quarters of the housing in the Christchurch region; prolonged loss of power, water and sewage; damage to roads; and severe destruction in the central business district, which was wholly or partially cordoned off until June 30, 2013 (Potter et al., 2015).

Christchurch, located in the Canterbury region of the South Island, is New Zealand's second-largest city, with a population of approximately 340,000, which is about 8% of New Zealand's total population (Statistics NZ, 2015). The coastal city is mainly flat, with its southern suburbs located on the Port Hills. The central city, hillside, and coastal eastern suburbs were the most badly damaged, the latter being affected by severe liquefaction (that is, the process by which water-saturated soil is transformed into a substance that behaves like a liquid). Fifty-eight percent of participants lived in suburbs that were severely damaged by the earthquakes. Severe damage in this context included loss of water, sewage, and electricity; damage to roads and bridges; and closure of shopping malls and community and service centers.

Christchurch residents endured more than 12,000 aftershocks throughout 2010-2011, four of which were magnitude 6.0 or greater. In February 2012, seven of the original visually impaired participants were reinterviewed for their perspectives on living in a disaster zone and their ideas for improved preparation and response for those with impairments. Three staff members of the Blind Foundation were also interviewed, in April of 2011. This is the first time that visually impaired people's experience of sequential earthquake activity has been tracked both before and after a catastrophic disaster, and the results of our study provide a rare insight into the impact of disasters on those who are older and living with impaired vision.

Literature review

The International Federation of the Red Cross and Red Crescent Societies (2014) reported that specific groups within a local population are potentially vulnerable in a disaster, including young children, pregnant and nursing women, children on their own, widows, older people, those without family support, and disabled persons. People with disabilities often live on very low incomes (Chou et al., 2005), and those living in poverty are among the most vulnerable during and in the aftermath of a disaster (World Health Organization, 2003). Peek and Stough (2010) identified the fact that adults with disabilities are often excluded from disaster emergency plans.

Existing disaster research largely focuses on the restoration of communities and is quantitative (Chang, 2010); however, we were able to locate one quantitative study that focused on blind people who experienced earthquakes in Turkey. Duyan and Karatas (2005) interviewed totally blind residents who lived within the 1999 earthquake region of Marmara, Turkey. They found that low self-esteem and consistent anxiety levels were worse for blind people living in earthquake regions, as compared to people who are blind who are not directly affected by earthquakes. They concluded that self-esteem, self-worth, strength, capability, and sense of usefulness need to be enhanced, material losses need to be minimized, and social supports need to be strengthened for people who are blind in the aftermath of a disaster. The participants of Duyan and Karatas' research were relatively young--the mean age of those in that earthquake region was 35 years.

One qualitative study (Stark, 2013) drew on stories of people with disabilities and their vulnerability and adaptation to challenging environments in Haiti after the 2010 earthquake in that country. Stark described one participant as being elderly, although no specific mention was made of the effect on individuals who are blind or older. In the present study, the unique cross section of aging, disability, and disaster is explored.

Methods

After the September 2010 earthquake near Christchurch, a research team was assembled to explore its impact on 12 adults with impaired vision. The research was approved by the Massey University Human Ethics Committee (MUHEC). The Association of Blind Citizens, a consumer organization, agreed to consult with its membership and assisted with recruiting participants. The interviews took place in participants' homes.

Following these interviews, the February 22, 2011, earthquake occurred, centered directly under the city of Christchurch. In the following year, the research team was able to recontact and interview seven of the original 12 research participants. Three staff members of the Blind Foundation also contributed their views on how to prepare for future disasters. Details of the participants can be found in Table 1.

The five participants who were not reinterviewed were all female; four were aged 70 years or over. At the time of the second round of interviews, one had died, two had left the city, one was too traumatized to participate, and one was displaced and could not be located for the follow-up interviews.

Verbatim transcripts were manually coded and analyzed using thematic analysis (Braun & Clarke, 2006). Open coding was used to inductively build themes that represented participant experiences without presuming knowledge (Denzin & Lincoln, 1994). Interview transcripts were then analyzed in relation to literature concerning disability and disaster response.

Results

A number of prevalent themes were identified in the analyses of transcripts that reflected the concerns of participants regarding communication, support, orientation and mobility, safety, health, acts of service, and evacuation centers, as evidenced by the comments Bonnie (a pseudonym) gave on the September earthquake when interviewed in January 2011:

It was a bit nasty eh? I was in bed and then I heard the noise and the noise was horrific and I had no idea what it was and I thought, "What in the world was that?" … [B]y that time [guide dog] was up and he wanted to run out into the living room area and it started to shake … and I flew out of bed. But I couldn't walk anywhere because it kept knocking me over. … I just couldn't move and … I could hear crockery falling and breaking in the living room and in the kitchen and I thought, "I don't know what to do." … I've been told many, many times during an earthquake go and stand under a door jamb but I couldn't even get there.

Themes that were found to be important from the second wave of interviews included resiliency, disbelief, recovery, the need to be with others, erosion of security, and the difficulty of and need to move on. These themes are described in the following sections.

Communication

It became clear that the radio was the most important source of information for research participants, as indicated by Michael (pseudonym), who commented on the September earthquake in January 2011:

Like most people, the first thing you do … when it did stop shaking, I went to flick on my stereo in my bedroom just to turn on the radio to see if I could find out what was happening around Christchurch, how bad it really was, and of course realized the power was out. Flicked the lights, no, that's not working, so I fished out a transistor radio.

In preparation for emergencies, it can be crucial for people with impaired vision to acquire and keep transistor radios in working order and with a good supply of batteries. However, participants told us the quality of the information they received from radio broadcasts was poor. Participants spoke of misinformation being circulated and the challenge of finding the best radio station that could be relied upon to have up-to-date facts. Participants noted that accessible information that helped rather than frightened was hard to come by in the aftermaths of the earthquakes. Getting information proved to be especially complex for those who are deafblind. Participants spoke about the use of cellular telephones and Global Positioning System (GPS), noting that in a disaster, texts sent by cellular telephones may get through even when calls cannot be made, so for older people and those with impaired vision it is worthwhile to access appropriate technology and to learn to use text messages for communication. GPS is increasingly being relied on for those who are visually impaired to navigate walking routes and public transportation routes. GPS proved to be unreliable in the aftermath of the quakes, however, when terrain was dramatically changed and roadways and footpaths were damaged or blocked by debris and liquefaction. Participants discussed the frustrating lack of information about the conditions of local walkways and disruption to bus routes for many months following the earthquakes.

Support

Personal support

Every participant noted that personal contact with someone in the week following the earthquake was essential, since little agency support was offered.

… [I]t's been our own personal networks rather than institutions [that have been offering support], … friends and colleagues. (Michael, January 2011)

I think somebody should have checked on disabled people … some official, if you follow my point. (Bonnie, January 2011)

Those with minimal established social supports reported feeling isolated and panic-stricken, and would have valued the opportunity to share their stories with someone who would listen. Those with larger social support networks reported that recovery from trauma was quicker than was reported by those who were more isolated.

Agency support

Support from agencies, civil defence, or other authorities did not figure into the recollections of the participants in the aftermath of the earthquakes. Although Blind Foundation staff members reported that every registered member was contacted, none of the participants recalled this contact. Some participants recalled that the New Zealand Earthquake Commission did make contact regarding damage to their homes and properties, but this took up to several months. Participants suggested that a database of vulnerable people, including those who are older, who live alone, or who are visually impaired, be developed, so that those unable to check their homes for safety could be reassured or evacuated. However, lessons learned from the Great Eastern Japan Earthquake in 2011 indicated that this kind of initiative is not considered to be best practice, since it builds in dependency and will not ensure a greater level of security or safety in a major disaster (Ranghieri & Ishiwatari, 2014). Instead, emphasis needs to be placed on the importance of both individual and community preparedness, as well as on the development of robust personal networks.

Orientation and mobility

Familiar landmarks disappeared in the aftermath of the large earthquakes, creating navigational nightmares for the participants in this study. Altered bus routes, barriers on sidewalks, toxic liquefaction, difficulties crossing the road due to detours, and an inability to find or activate traffic signals--all created a great deal of stress.

There's places in town that aren't easily accessible, like I haven't been on a bus to go into town because the bus routes were all changed, there were places that they couldn't go, and if you go on a foreign bus route and you get off and you don't know where the hell you are. … If you use a dog guide, people seem to have the impression that they are magicians and they can put you off at the wrong bus stop if they've gone past your stop and your dog's magically going to know where it is. Well, it doesn't work that way, they have to have worked that route with the guide dog trainer, they have to have learned everywhere they go, so if you got put off at a different place we'd all be lost because the dog doesn't know either. (Gillian, January 2011)

It [the earthquakes] devastated my bus routes, which I rely on 99% of the time. … I was isolated … [un]able to get back to my old haunts. (Donna, February 2012)

Participants reported that, later, lack of standards for the erection of temporary building barriers, scaffolding, and security fences created major navigational difficulties, which decreased independence and increased their vulnerability. Cane and dog guide users encountered dangerous obstacles, not only in earthquake-damaged areas, but in the areas local authorities created to solve problems. Temporary roadways and bus routes disrupted important routines such as getting to doctors' appointments, the pharmacy, the supermarket, and the homes of friends and family.

Dog guide users discovered that their dogs had to be comforted, retrained, and assessed as to their abilities to cope as working dogs after the earthquakes. The Blind Foundation provided additional specialist training for the dog guide teams to support dogs that were traumatized. As one participant commented, for example:

Oh the dog, the poor dog … he was shivering, he shook until about 10 o'clock the next morning, he just shook. I gave him his breakfast and he couldn't eat all his breakfast, what he did eat, he brought up, so he was really in a bad way. (Bonnie, January 2011)

Safety

Participants reported an erosion of their sense of mastery and independence over time, since the unpredictable aftershocks went on for many months.

It made me feel terrible, useless is the word, because if I had to run, I couldn't; if I had to see, I couldn't; if I had to do anything, I'd have to rely on [husband] to do it for me, and I think the older you get you lose your independence, the thing you rely on just goes, and when you get those shakes … I'm just terrified. (Margaret, January 2011)

I must admit I was more frightened [in the magnitude 6.4] in June [2011] than I was in February [2011]. … In February … whilst it was obviously a bad shake, I didn't know until I got outside and started to hear what people were telling me, that I realized people had likely died. … In June, we all knew what earthquakes really could do … and what the consequences could be, and that was the one that really frightened me. (Michael, February 2012)

Health

Three participants identified themselves as having significant multiple impairments. They were able to manage, but needed assistance to access medications, placing their health at risk during the shutdown of the central business district. Two demonstrated a need for counseling several months after the initial earthquake, and referrals were made.

A lot of people [had] to get taxis to get to medical appointments. … [T]hey are older people, so they need to get their [prescriptions] filled, so they've got to get to the doctor, they've got to get to the pharmacy, and they've got to get their shopping. … [T]ake the assistance that's offered, be prepared to ask and also take financial assistance, and just keep in touch with your neighbors, and agencies, … [and] those that are there to support you anyway. … Kiwis are too proud sometimes to ask for assistance, but these are the times that you have to be prepared and it may be that some of the strengths they have they can take a lead role in their community. … (Blind Foundation staff member, April 2011)

Other health concerns included hygiene issues related to toxic liquefaction; using homemade, chemical, or public toilets for extended periods of time; accessibility of showers; and coping with the cold weather when without electricity or utilities. Every participant was older or was caring for an older person, making safety a significant issue.

Evacuation centers

Some of the participants may have benefitted from leaving Christchurch for a short period of time. However, almost every participant's main concern about evacuating related to the safety of their homes and possessions. Other concerns were the need for assistance with reading and writing, orientation and mobility, the safety of dog guides, general cleanliness and hygiene issues related to using large public facilities, and the potential loss of independence a visually impaired person could experience in an evacuation center.

They look after people, they look after dogs, they look after children, they look after people in wheelchairs … but what do they do for people who are visually impaired? Have they got somebody sort of assigned to that particular aspect? … [Y]ou would need to have somebody to … do any reading or writing for you. … [I]f you need something, you have to put down your name and all sorts of things. And … when I go out anywhere, I always have to ask people, "Where is the toilet?" and they sort of have to show which is the ladies. (Kay, January 2011)

Issues specific to the second wave of interviews

The seven people whom we reinterviewed learned about emergency preparedness through trial and error, and they ultimately managing to cope and maintain their independence through four major earthquakes. Participants told their stories and shared their expertise on how to cope in a disaster.

When I look back at our clients here in Christchurch, some of them have passed away over the last short while and I don't know why. … [I]t could be due to distress. … [S]ome have left, some are not well in themselves, and it is going to take quite a bit of time for them to sort of feel OK about themselves … and make sense of the world around them, because it's topsy turvy. … [M]y role is to get them together. I've got another meeting this week to try and pull as many as I can together just to share the[ir] stories. (Blind Foundation staff member, April 2011)

Participants who took part in a second interview spoke of their own resilience for having survived with what felt to them like war. Participants were reticent about giving advice about how to cope with a natural disaster, saying that it was a matter of doing the best they could at the time with the resources that they had.

Analysis and interpretation of data highlighted themes from the second phase of interviews, including disbelief, loss, and resiliency.

… God, how could that happen to us, how can that happen? (Michael, February 2012)

Everything that you knew and loved is gone … just gone and when you go into it [the central city] and actually see it for yourself, … you just can't believe what's happened and … nothing had prepared you. (Francis, February 2012)

Participants spoke of the need to be with others. In the September earthquake, participants stayed in their homes after the earthquake; however, in the February quake the need to flee or escape their home and be in the company of others was a theme participants spoke about.

That's the one night that I left my house. I said, "I just want to sit in a chair in a house with somebody else in it. … I just need to be where there's someone for the night. …" So I just sat in an armchair. I took my sleeping bag, and I just sat in the clothes I was in. I said, "I'm not getting undressed, I just want to be where there's someone," and that's what I did, and I came home in the morning. (Francis, February 2012)

With the continuing aftershocks, participants showed resilience with their coping skills and in the management of their home environment.

… I tend to try and take it with a pinch of salt each time, really, and not assume that the roof is going to fall down. It's just gonna rumble, and it's going to continue to rumble, and little things might fall off, but you do what you can to avoid it. So, every time we had an earthquake or a shake, the dog's here, the cats there … , they're both next to me and I say, "Oh, come on girls, shimey shimey shake," and by the time you've finished talking to [them], it's gone, and if you keep calm yourself, they keep calm. (Gillian, February 2012)

Blind Foundation staff members commented on the aftermath of the first, nonfatal earthquake that made Christchurch like a "tourist attraction" initially, but then vulnerabilities began to show in those with disabilities, or who had previously experienced trauma. The erosion of personal safety became apparent after several weeks. After the potentially more traumatizing, deadly earthquake, any remaining stoicism dwindled; older, visually impaired individuals admitted vulnerability, accepted help, and acknowledged loneliness.

People are actually saying, "Yes, I do need help." Very specific … "I don't need this, don't need that," but actually, "I could probably do with a bit of help here." (Blind Foundation staff member, April 2011)

The sharing of stories and offering service to others was a theme throughout the interviews, a means to alleviate feelings of isolation and to provide meaning and purpose in the offering of emotional support to others. This pattern of responses was identified in the second wave of interviews, with an acknowledgement that some felt more resourceful and prepared at the time of the February earthquakes. Lessons had been learned about the best way to access information, to utilize community networks, and to cope. Often, the way to cope was to tell your story and to help others. Of course, needs were different for each person, depending on personality type, extent of disability, and the geographic area of the city in which they lived. With the magnitude and level of devastation of the February earthquake, a vast majority of the population of Christchurch were affected, with many more this time needing to leave the safety of their own homes for longer periods of time than with the first earthquake. For those with impaired vision, this displacement created compounding difficulties with orientation and mobility.

Discussion

In this study, older visually impaired participants shared their experiences of the significant earthquakes in 2010. They spoke of the challenges they experienced with the practicalities and inconveniences of disrupted schedules, changed landmarks and terrain, and damaged homes that may have been unsafe. After the fatal earthquake of 2011, participants' stories had a more serious, introspective tone, and they spoke of resilience, survival, and coping. Previous studies have demonstrated that older people are more likely to experience post-traumatic stress disorders after a disaster than are younger people (Jia et al., 2010). Although age-group comparisons were not made in the present study, there was evidence of trauma that affected the daily functioning of the older visually impaired participants in this study. Lie (2012) noted that older people who appear to be coping well within a community may rapidly deteriorate in times of disaster. This effect was seen in this cohort of older visually impaired participants, not all of whom survived the year of aftershocks, or had to move from independent living or to a different region of the country to be with family members. Research related to blindness and disasters supports the findings of this study, which showed that self-esteem, self-worth, capability, usefulness, and social support need to be strengthened for visually impaired disaster survivors (Duyan & Karatas, 2005).

Limitations to this study relate to the small sample size and the possible bias of those who volunteered to be interviewed in each phase of the study. Despite these limitations, older people who have impaired vision and those who provide services to them, their families, and communities, could learn from the experiences of those who have shared their stories and could improve preparation for and response to disasters for people who may be more vulnerable in a disaster.

Implications for practice

Research participants offered advice in respect to the themes of communication, support, orientation and mobility, and health and safety.

  • have a transistor radio and batteries at hand
  • learn to communicate by text message, and keep your cellular telephone charged
  • have at least two people organized to contact you following a disaster
  • establish good relationships with neighbors and be willing to be a contact for others
  • register with local disability organizations and make sure you regularly update your information, but do not count on agencies to be available to act on your behalf in a disaster
  • keep your shoes under your bed, keep a flashlight on the doorknob, and have spare white canes available
  • remember that GPS may not be helpful after an earthquake
  • expect transport lines to be disrupted: online information about bus routes may not be reliable, and you may need to telephone to confirm current bus routes
  • arrange to travel with a friend until obstacles are clear and routes are re-established
  • dog guide users should keep cane skills sharpened: in a disaster, your dog may become lost, injured, or traumatized, and may not be able to assist you
  • store food, medications, and water to last for 72 hours, for you and your dog
  • secure furniture in your home
  • prepare a first-aid kit
  • keep copies of insurance information, medical records, and details of medication in an easily accessible, sealed plastic bag and e-mail an electronic copy to yourself
  • secure assistance for a thorough inspection of the safety of your home and neighbourhood
  • learn how to rig up a home portable toilet using plastic bags in the toilet bowl and keep bags of cat litter handy (to remove odors)
  • tell your story and listen to others

References

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.

Chang, S. (2010). Urban disaster recovery: A measurement framework and its application to the 1995 Kobe earthquake. Disasters, 34(2), 303−327.

Chou, Y., Huang, N., Lee, C., Tsai, S., Chen, L., & Chang, H. (2004). Who is at risk of death in an earthquake? American Journal of Epidemiology, 169(7), 688-695.

Denzin, N., & Lincoln, Y. (1994). Handbook of qualitative research. Thousand Oaks, CA: Sage.

Duyan, V., & Karatas, K. (2005). Effects of the 1999 earthquake on the completely blind living in and outside Marmara, Turkey. International Social Work, 48(5), 609-619.

International Federation of the Red Cross and Red Crescent Societies. (2014). What is a disaster? Geneva, Switzerland: Author. Retrieved from http://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/what-is-a-disaster

Jia, Z., Tian, W., Liu, W., Cao, Y., Yan, J., & Shun, Z. (2010). Are the elderly more vulnerable to psychological impact of natural disaster? A population-based survey of adult survivors of the 2008 Sichuan earthquake. BMC Public Health, 10, 172-182.

Lie, D. (2012). The care of older people during and after disasters: A review of the recent experiences in Queensland, Australia, and Christchurch, New Zealand. Australasian Journal on Ageing, 3, 69-71.

Peek, L., & Stough, L. M. (2010). Children with disabilities in the context of disaster: A social vulnerability perspective. Child Development, 81, 1260-1270.

Potter, S., Becker, J., Johnston, D., & Rossiter, K. (2015). An overview of the impacts of the 2010-2011 Canterbury earthquakes. International Journal of Disaster Risk Reduction. 14(1), 6-14.

Ranghieri, F., & Ishiwatari, M. (2014). Learning from megadisasters: Lessons from the Great East Japan Earthquake. Washington, DC: The World Bank.

Stark, S. (2013). Stories from the field: Reflections on occupational therapy experiences in Haiti following the earthquake. WFOT Bulletin, 6820-6825.

Statistics NZ. (2015). 2013 Census QuickStats: Canterbury region. Retrieved from http://www.stats.govt.nz/Census/2013-census/ profile-and-summary-reports/ quickstats-about-a-place.aspx? request_value=14703&tabname=

World Health Organization. (2003). Social determinants of health: The solid facts (2nd ed.). Copenhagen: Author.


Gretchen A. Good, Ph.D., COMS, CVRT, senior lecturer in rehabilitation, School of Public Health, Massey University, Private Bag 11222, Palmerston North, New Zealand; e-mail: <g.a.good@massey.ac.nz>. Suzanne Phibbs, Ph.D., senior lecturer in sociology, School of Public Health, Massey University, Palmerston North, New Zealand; e-mail: <s.r.phibbs@massey.ac.nz>. Kerry Williamson, M.A., research assistant, Ministry of Justice, 3/19 Aitken Street, Wellington, New Zealand; e-mail: <kerry.williamson@justice.govt.nz>.


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