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Holding on or moving forward? More than two years and 13,000 aftershocks later, Christchurch inhabitants sometimes still struggle to cope with the effects of the earthquakes.

Many Christchurch people sense an unspoken expectation that the city and its people should have "moved on" by now. For those of us still living and working in Christchurch, there is no escaping the legacy of the earthquakes: continuing road works with unscheduled detours, delays and traffic jams--who would have thought Auckland traffic would look appealing? It is now possible to take a wrong turn driving on the same route to work you have driven for years, because familiar landmarks are missing. It is not possible to escape the lingering hypersensitivity to potential danger--living on high levels of adrenaline wreaks havoc with cortisol production and use, and leaves many irritable, exhausted and quick to anger.

Of greater concern is the constant battle of everyday life in a quake-affected city. Still waiting to hear if your house has been condemned? Never mind--keep living there and hope for the best, or face the difficulties of moving out, paying rent on "temporary" accommodation and remembering why you are paying a mortgage on a wrecked house and useless piece of land. Looking forward to the children finally leaving home? So long as they don't plan on flatting or working in Christchurch--no problem. Yes, we are getting a bit jaded, the cynicism is starting to show through. Many nurses still have children at home, elderly parents to support and mortgages to pay. The reality is their children are facing upheaval through school closures and mergers, many of their elderly relatives have lost their homes and are struggling to find affordable accommodation, and the equity they thought safe in property may no longer provide that nest egg for the future.

Health care workers are becoming emotionally exhausted--as if the normal stresses associated with nursing were not enough, we are having to cope with significant and continuing disruption to our personal lives. Living in these conditions is tiring, many are nearing exhaustion and it is now, rather than in the immediate aftermath of the disaster, we are likely to face significant health issues in our workforce. People lack the energy to keep fighting issues with their insurance companies, builders, EQC and local government. When you meet someone new, or someone you haven't seen for a while, the fall-back conversation topic remains the earthquakes.

Monitoring secondary impacts

For those of us travelling outside Christchurch, it feels the rest of New Zealand has, indeed, moved on. But for many in our city, it is becoming "too hard" and, perhaps, we should be more closely monitoring the secondary impacts that may indicate communities are close to breaking point. Anecdotal reports tell of growing incidents of "road rage", incivility in the workplace and "compassion fatigue". There is a need for continuing research into the effects of the earthquake - suicide rates, self harm, and depression would seem an obvious starting point. What about the presentations to primary health and the emergency department by builders, contractors and workmen with more minor injuries--not only a result of their work but also the risk of less focused attention related to sleep disturbances, stress and exposure to potentially toxic conditions in "red zone" properties and others? Should we follow up those workers involved in rescue, retrieval and subsequent safety clearance of buildings where asbestos and other substances were exposed?

This is not to suggest there are no positives - just a recognition we have moved past the "honeymoon phase" of disaster response, where we could all feel good about pulling together and making a difference. It now feels, at times, as if we are unable to make a difference at any level--whether personally with our families, as they face the struggle of re-defining their work roles and contribution to the community, or professionally, as we recognise the financial implications of the disaster and its meaning for future developments in health care.

Nurses are nothing if not resilient, but even that remarkable attribute needs to be nurtured and supported. One of the key elements of developing and maintaining a resilient workforce is fostering a support network of colleagues, family and friends. This does not mean asking or expecting a quick fix; it is about mutually valuing our experiences, what we have learned, the emotional journey we are on. It is important to know that what we do as nurses makes a difference, to have confidence the experiences of the past two years have meaning and can form a new foundation for nursing development.

Given the disruption Canterbury has faced and the damage to hospitals, it would have been enough to have continued providing high standards of care. But we have done more; we have shown innovation and flexibility in the workplace, coped with ongoing change and looked for more ways to respond to our communities' needs. Because of this, many thousands of people, particularly the elderly, who before the earthquakes, would have been admitted to hospital, have been cared for, and cared for very well, in the community.

There are many more positive developments but there are also many more challenges and frustrations. For these, we seek continued understanding and a level of acceptance--that sometimes we still want to talk about "our" disaster, that it's ok to have days when we don't want to talk at all or get angry for little reason. The recognition there is no single "right" way to recover or react is vital. As one colleague said, "we just want people to be considerate"--to consider our situation, to keep that context in mind, even as time passes. We want to move on, and sometimes we feel we have, but not everyone and not always. What gives value to our experiences is that others learn and incorporate that knowledge into personal and professional disaster planning, life skills and resilience. And to recognise we are neither victims not heroes; those stereotypes are too simplistic. We are more than this--we are nurses and we have considerable strength, resilience and the continuing support of our colleagues. *

Sandra Richardson, RN, BA, DipHlthSci, DipTchng, PhD, is a nurse researcher in the emergency department at Christchurch Hospital.
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Title Annotation:viewpoint
Author:Richardson, Sandra
Publication:Kai Tiaki: Nursing New Zealand
Article Type:Viewpoint essay
Geographic Code:8NEWZ
Date:Apr 1, 2013
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