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"This was not a war in the classic sense. The targets the army had were homes, churches, schools and hospitals."

 

War Wounds

After visiting war-torn Croatia, a Hopkins nurse discovers editing the book was the easy part.

Asked whether his children-Capozzoli has four daughters and a son-influenced the book, he quickly says, "The short answer is no." But after a moment he adds, "You can't help but reflect on your own children as you're writing this kind of thing."
Joseph Capozzoli's office in CMSC 3 is windowless and tidy, and he keeps a plastic bag of candy on the couch for his small visitors. With his firm handshake and thick, black moustache-the kind favored by police and firemen-Capozzoli seems like a guy who could handle just about anything. As a nurse manager in child and adolescent psychiatry, he often does. His new book, Children and Disasters: A Practical Guide to Healing and Recovery, has just been published by Oxford University Press, and for Capozzoli it's the end of an even longer, tougher journey than most first-time authors travel.

During his 22 years as a nurse at Hopkins, Capozzoli has seen a wide spectrum of human experience, from suffering to love, cruelty to hope. Treating children in Baltimore City-where the homicide rate is one of the highest in the country, where half of male students reported taking a gun to high school-he's witnessed terrible heartbreak, frustration and pain. And then he found himself in Croatia in the middle of a war.

"This was not a war in the classic sense," he says. "The targets were not factories, government buildings and centers of economy. The targets the army had were homes, churches, schools and hospitals."

In Children and Disasters, Capozzoli and co-editor Wendy Zubenko have created a "how-to" manual for people who want to help during and after a disaster. As far as he knows, it's the only book of its kind. The essays by expert contributors cover topics from coping strategies to play therapy and group intervention. And post-September 11, post-anthrax and bioterrorism warnings and serious discussion about "dirty bombs," the book is chillingly relevant. Children are hit hardest by the trauma of disasters, Capozzoli says, whether they are man-made wars or floods, fires or famine. "Kids are what I call moving targets, moving across a developmental continuum. It starts at birth and it's an ongoing change up until the ages of 18 or 20." This makes them especially vulnerable to psychological damage, but also remarkably resilient.

Capozzoli never intended to edit a book called Children and Disasters. In late 1994, an anonymous donor approached the Children's Center with an idea. He would pay to have a child, any child, brought from the Balkans to Baltimore and provide for medical and psychiatric needs. Capozzoli thought it was a noble idea, but he and psychiatrist Paramjit Joshi, then associate professor and director of clinical services in the Division of Child and Adolescent Psychiatry, and director of the Office to Prevent Violence at the Johns Hopkins Children's Center, convinced the man that his money would be better spent sending Hopkins' help to Croatia. "We would go there and work with people already providing aid and psychological relief to these kids," Capozzoli told him. "He'd get more bang for his buck."

With the collapse of communism in 1989-90, Croatia, Slovenia and Bosnia-Herzegovina were engulfed by a wave of nationalism that swept Yugoslavia. By the mid-1990s, the hatred and distrust that had simmered for centuries between Slavic Muslims, Serbs and Croats erupted into wars characterized by rape, rampant crime and the mass murder of civilians known as "ethnic cleansing." During most of the conflict, world response was confused and generally ineffectual. According to some estimates, almost 400,000 people were displaced. Roughly a third were adolescents and children. It was human tragedy on an epic scale. As Capozzoli describes it, he was witnessing an attempt to "obliterate a culture." He remembers churches and homes reduced to rubble and bullet-ridden schools. Joshi recalls visiting a village that had been burned and shelled into a ghost town. "We found an old grandmother with a little grandchild rummaging through the ruins," she says. "They were the only survivors."

As part of a four-person Hopkins team, Capozzoli and Joshi, now chairman of psychiatry at Children's National Medical Center in Washington, D.C., made two trips to Croatia, nine months apart. They held workshops, empowering the aid workers with information about how best to deal with the psychological issues of traumatized children. The team also made field trips into the countryside and visited hotels, schools and army bases that had been turned into refugee camps. What Capozzoli saw left him emotionally shell-shocked. Separated from their parents and siblings, often having witnessed terrible violence, thousands of children were experiencing eating and sleeping disorders, aggression, bed-wetting, severe depression. The children were presenting symptoms of mental illness and developmental problems. "What we tried to do was teach people in the region to discriminate between how you treat mental illness and how you treat people who suffered a tragic loss in the wake of a disaster."

Much of what Capozzoli saw was sadly familiar. "My experience at Hopkins prepared me to do the work that I did in Croatia," he says. "While the disasters we see daily in our work at Hopkins are not widespread, they are nonetheless disasters-broken families, children without supervision or guidance, and children not attached to any family at all."

The main thing to help children recover from emotional trauma, he says, is normalization. "Croatia was a great example of that. You had thousands of kids living in old army camps because that was the only area that could house the number of people fleeing across the border. They made the camps like a big boarding school, a kind of community. People put their gardens outside, kids went to school, there were church groups, there were drama groups, there were sports events."

In a study he discusses in the book, the children were asked to draw pictures before and after they started attending school. The initial drawings were filled with burning homes, falling bombs, family members shot, captured or killed. The second set was dramatically different, featuring images of playing children, families together and "probably most significantly," he writes, "flowers on the graves of those lost in the war."

Capozzoli isn't a poet or a professional philosopher. He's a caring, practical man in the middle of a life dedicated to helping adolescents and children, and the book reflects his problem-solving focus. "Saying there's a whole procedure would be an overstatement, but there's a way to do this to be effective," he says. "You need to be sanctioned by a lead agency, you need to have access to the area. How do you decide what these areas need?"

Writing and editing chapters in Children and Disasters "was another way to debrief from the situation," he says. "Initially when we came back we were asked to do some seminars and some lectures and… I couldn't do it. It was only after I had written and talked to people about it who were close to me that I was able to go out and complete a lecture from beginning to end."

Capozzoli started at Hopkins in 1980 as a new graduate, and he credits the institution with providing the ideal environment to foster his professional growth. He has found his years here rich and very fulfilling, and although publishing a book had long been a personal goal, he's glad it came at a time when he had the skills, support and experience for the project to happen naturally. In addition to the sense of accomplishment publication provides, he says, the work has aided in his own healing and recovery from the horrors of war in the Balkans.

"While the memories are and probably always will be stressful, it can really promote growth in understanding yourself," he says. "It put me back in touch with my values, especially those related to neighborhood and community. Despite the devastation, it was really wonderful and very fulfilling to see people pull together so well for a common cause. With all the diversity in the U.S., it took the events of 9-11 to unite us as a country again."

-Seth Hurwitz


Children and Disasters: A Practical Guide to Healing and Recovery
(Oxford University Press, $16.95) is available on Amazon.com, BN.com, and at major bookstores.

 

 

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