Trauma and Post Traumatic Growth in Young Survivors of a Terrorist Attack: An Experiential Account of Supportive Interventions in a Tertiary Care Hospital in Pakistan

In the winter of 2014, four terrorists attacked a school in Khyber Pakhtunkhwa (KPK), resulting in more than a hundred students' death. Twenty-two survivors (aged 10-18 years) with physical injuries were admitted to a private hospital in Karachi for further surgical and psychological interventions. The aim of this paper is to share a retrospective experiential account of a trauma management plan, based on the bio-psycho-socio-spiritual model for young survivors of terrorism. In biological management, children with hyper-arousal symptoms and sleep disturbances were started on Prazosin and those meeting criteria for Post-Traumatic Stress Disorders were started on Selective serotonin reuptake inhibitors. The Psychosocial interventions included individual therapy, physical therapy, family education, and music groups. Children and their families were also encouraged to draw on their religious support. At the time of discharge, these children were evaluated through clinical interview to assess for improvement. A massive decrease in their hyper-arousal symptoms was seen as evidenced by improvements in their sleeping patterns, mood and behaviour. Moreover, signs of psychosocial development based on the principles of Post Traumatic Growth were visible. Our main limitations were the short period of time and a lack of follow up opportunity. However, this framework provides a basis to establish trauma services at tertiary care hospitals in developing countries like Pakistan where access to overall health care is limited and specifically psychiatric care is lacking in health care institutes.