For survivors of Cyclone Nargis, the start of the monsoon rains is yet another reminder of last year's tragic events.
"Single storms and heavy rains in the past few weeks have triggered severe anxiety attacks among the survivors," Sylvia Wamser, a psychologist with Médecins Sans Frontières (MSF), who has spent much of the past year counselling survivors in the Bogale area, in the heart of Myanmar's badly affected Ayeyarwady Delta, told IRIN.
"Before Nargis, I had a happy family and enough income," one 27-year-old patient told MSF in Bogale. "My family and all my possessions were all destroyed in a single night," he said.
Another tried to escape with his family in a boat, which could not withstand the strong waves and winds.
"All my family fell into the water. My children were crying and shouting for help. I can still hear them now," he said. He lost his wife and four children that night - only one son survived.
Long road to recovery
While much of the delta is beginning to return to normal, for millions of survivors, life can never be the same again. Memories of Nargis, which left 140,000 people dead or missing, and affected 2.4 million more, has left many reliving that night, while others live in fear of ghosts, a profound influence in this deeply superstitious nation of more than 48 million inhabitants.
The ghosts of the dead and the missing usually come when there is no moon and when the wind picks up, Wamser explained. "They can hear them walking along the rice terraces and along the riverbanks," she said.
"Some of them cry out: they sound sad, and others are angry," Maung Maung, an elderly farmer whose village, deep in the delta, was washed away, told MSF. He lost most of his family, apart from his wife and two grandsons. "We are all frightened when they wail."
Overcoming these deeply held fears of ghosts has been a major challenge for counsellors such as Wamser.
"It was important to help them understand that nightmares are normal after such a terrible incident, and that their loved ones are not restless souls," she said.
Post-traumatic stress - a hidden problem
One year on, many aid workers say the hidden or silent scars of the cyclone are much harder to heal than providing food and shelter - particularly among children.
"It's easy to help the villagers rebuild their livelihoods - to buy tools, fertilisers, livestock, fishing nets and boats - but it's much harder to help them repair their minds so that they can rebuild their lives," said Kaz de Jong, a psychology expert with MSF, who visited the delta in the first few weeks after the cyclone.
The signs of post-traumatic stress are only too evident, according to aid workers.
People suffer from nightmares, limited attention spans, listlessness, problems concentrating and loss of appetite. They also complained of a host of physical symptoms - back problems, headaches and other pains - all psychosomatic and the result of trauma.
Nearly all children who experienced Nargis initially displayed signs of psychological shock or stress, said Makiba Yamano, World Vision's chief child protection officer in Myanmar, including being emotional, fearful, having difficulties concentrating or becoming withdrawn.
"Everyone was saying how resilient the people of Myanmar are," said Brian Agland, country director for the aid agency CARE. "While that is true, there are still people who haven't gone through the process of fully grieving and understanding what happened," he said.
According to the Post-Nargis Recovery and Preparedness Plan (PONREPP), a three-year recovery plan released in February by the UN, the Association of South East Asian Nations (ASEAN) and the government of Myanmar, almost a quarter of households in the cyclone zone have reported signs of deep psycho-social distress, but only 11 percent have received help.
The International Federation of Red Cross and Red Crescent Societies (IFRC) has trained more than 600 volunteers who make regular home visits in about 600 villages to help survivors cope with their loss.
MSF was one of the first aid agencies in Myanmar to recognise the significant mental health problems Nargis had created and has been running counselling sessions in the delta from the beginning of the massive relief effort.
In the past year the agency has managed to provide counselling for nearly 60,000 people, with 3,000 receiving intensive therapy.
"The basis of our success with the work we have been doing is to teach patients relaxation techniques and to encourage them to open up and talk about their feelings," said Wamser.
Disclaimer:This material comes to you via IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States.
Photo: Copyright IRIN