Hidden problems

Chen Xuemin, a teacher who provides psychological counseling at Ziyan Primary School in Mianzhu city, which was also hit by the quake, said some students displayed obvious and severe psychological trauma immediately after the event, but that didn't mean that those who showed no symptoms wouldn't experience problems later on.

She described treating a former student who began having a recurring nightmare about seven years after the quake. The girl dreamed she was walking to school with her friends along a road lined with graveyards. However, on the journey home she was always alone.

"After a number of therapy sessions I discovered that she had walked to school with her friends on the day of the earthquake, but she was the only one in the group who survived. The nightmares were triggered by anxiety as she prepared for the national college entrance exam," Chen Xuemin said, adding that the deeper the problems are hidden, the more difficult they are to treat.

Unexpected trigger

According to Du Li, a counselor at Dingxin Xinjian Primary School in Dujiangyan city, many teachers who survived the quake are still experiencing psychological problems, but as a result of unusual circumstances.

"Many parents who lost children in the earthquake decided to have another baby, and now some of the teachers are teaching the younger brothers or sisters of children they knew who died. Trust me, it's not easy for them," she said.

The 50-year-old is fully aware of the importance of psychological counseling because she has also experienced post-traumatic stress disorder, marked by extreme irritability and hallucinations. Professional assistance helped Du overcome her difficulties, and later she trained as a counselor.

Although many aspects of her life have changed in the past 10 years, one thing has remained constant－her cellphone number. "I want all the students who consulted me before to be able to reach me whenever they need to. Recovering psychologically from an earthquake can be a lifelong process," she said.

In the aftermath of the disaster, almost every school in the area affected by the quake established psychological consultation facilities, and many teachers received professional training.

"Psychological consultation was used like a first aid service in the first few years after the quake, and now it's part of the students' healthcare routine," Du said.

Established in 2006, the AIDS Prevention Education Project for Chinese Youth was one of first nonprofit organizations to provide psychological counseling after the quake.

"At the time, psychological problems didn't receive a lot of attention, because most resources were targeted at medical aid, food and water supplies, along with temporary housing," said Zhang Yinjun, the project's director.

A few days after the earthquake, the project organized teams of psychologists to help resolve conflicts between the education department and parents who had either lost children or whose children had been severely injured.

"Nothing can relieve the anguish of losing a child. Some parents had no way of expressing their grief, except by directing their anger at the education department," Zhang said.

However, when the experts arrived in the areas devastated by the quake, they realized that many students and teachers were experiencing severe post-traumatic stress.

In Dujiangyan, safety concerns meant 349 high school students and 329 teachers had to gather at one school, and classes had to resume almost immediately because many of the students were set to take the most important test of their young lives－the gaokao, or national college entrance examination－about a month later.

"Some students and teachers had post-traumatic stress disorders, such as insomnia and depression," Zhang said. "The experts lived with them for about two weeks, and offered assistance whenever they could, which helped many of those affected."