By Jane Elliott
Health reporter, BBC News
Too little is being done to help the people of Burma and their health is suffering, an aid expert has warned.
Damage caused by the cyclone is everywhere
Kaz de Jong, head of mental health services for Medecins Sans Frontieres (MSF), said that five weeks after the cyclone there are still remote villages in the Irrawaddy Delta that have received no help.
Other areas, he says, have received just a small amount of aid.
A veteran dealing with natural disasters, Dr de Jong has coordinated services for the Pakistan earthquake and the Asian tsunami, but he says this is the worst response he has ever seen.
More help needed
"I hardly saw any care-giving personnel, which is a big contrast to all other natural disasters, and I have been at most of them within the last 15 years.
"We have been in the area since day two and, despite the fact that we have done large scale distribution, there are still substantial medical needs.
"This needs to be addressed quickly."
Dr de Jong said he was shocked to find that some villages were still cut off.
"These people had been without food and medical care for a month.
"Unfortunately this is not the exception, and that is very worrying."
Focused on survival
He added that the numbers needing help far exceeded MSF's capacity.
"There is a big gap - there are other organisations giving, but it is not enough. It is just not enough.
"The people are extremely resilient and extremely cunning in surviving, but it is extremely difficult."
He said the normal coping mechanisms of the community would be to rally round and support each other, but that in many areas the cyclone had destroyed this caring and supportive network, making people more vulnerable.
Seeing patients in Burma
"The communities are trying to care for each other, but their hands are full.
"How can you care for someone who has lost eight family members, when you have lost five."
Dr de Jong spent two weeks in Burma, also known as Myanmar, and he said the inhabitants were showing signs of mental trauma.
He said if more help were available now, some long term mental health problems could be avoided.
"People are severely affected by what has happened to them, especially in those areas where whole families have been washed away.
"They have watched their whole households be destroyed.
"They question whether they should continue, what is the meaning of life.
"They are not suicidal, but there are moments in life when you question the meaning of it and this is certainly one of those moments," he said.
"One woman came up, her family had been completely wiped out, she was the only survivor.
"She said 'I love you for your food distribution, but you know I don't feel like eating'.
"You can put food in front of people, but they need the motivation to eat it.
Dr de Jong said his teams were seeing signs of mental stress.
"Nearly everybody is plagued by sleeping problems. Their sleep is being disturbed by nightmares, they are also waking up early and not being able to sleep because they are very worried about everything. It is affecting children and adults.
"And if the wind starts blowing they get a sort of feeling they are back in the cyclone.
A map showing where MSF is working in Burma
"Many people have complained about not having any energy," he said.
Dr de Jong said his clinic were also seeing general health problems such high as blood pressure and unspecified aches and pains.
"About 40% of the complaints are difficult to diagnose in the sense that they are unclear - they are not all stress related, but one of the signs of people being under stress is that they have all sorts of unclear physical complaints.
"This all points to people finding life very difficult and being very vulnerable.
"It is this vulnerability that worries us, because the fact that people are vulnerable and also suffering from the signs of stress may affect their functioning and at this stage they need to be fully functional to protect their survival and reconstruct their lives."
He said with help most would recover, but some would need more intensive interventions.
"The majority will recover by themselves after a very tough period. Some need a helping hand in the form of physical and/or mental support.
"But after some months there are a small minority who find it difficult to reconstruct their lives and put energy into their future - they need counselling, psychiatric support and some even medication.
Dr de Jong his teams are already building an infrastructure.
This man lost his wife and only child
"We are not just assessing needs and walking off. We are in the process of training community health workers, and counsellors - people who are locally recruited.
"They are our eyes and ears.
"We also get them to draw attention to people who need help.
"We stay as long as we are needed. What we saw in Pakistan and after the tsunami was that after one year the situation stabilised and the role of MSF as medical emergency organisation became less relevant."