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More than PTSD:
Proactive Responses Among Disaster Survivors

The Australasian Journal of Disaster
and Trauma Studies
Volume : 1998-2


More than PTSD:
Proactive Responses Among Disaster Survivors


Anne Eyre PhD, Centre for Disaster Management, School of The Built Environment, Coventry University, Priory Street, Coventry, CV1 5FB, England. Tel/Fax: +44 1203 838-485; Email: cbx093@cov.ac.uk

Keywords: Post-traumatic stress, qualitative research, survivors, Britain

Anne Eyre PhD

Centre for Disaster Management
School of The Built Environment
Coventry University
Priory Street
Coventry CV1 5FB
England


Abstract

Much of the research on disasters focuses on symptoms and recovery in the weeks and months following the incident with relatively few studies examining the longer term effects. The emphasis is often on pathological responses, such as Post-Traumatic Stress Disorder, rather than proactive forms of adaptation and recovery. This paper describes a small scale study of Disaster Action in Britain using qualitative interviews. The research highlights the importance of examining the broader social, political and legal consequences of disaster in understanding continuing proactive responses by disaster survivors.


More than PTSD:
Proactive Responses Among Disaster Survivors


Introduction

The impetus for the study presented here comes from a group called Disaster Action, a charitable organisation formed by individuals and relatives from various family groups set up after disasters in Britain. Encountering members of this group some years ago left an impression on me both in terms of their personal experiences of disaster and their resolve to actively engage in campaigning and education. It became clear to me that here was a group of individuals who had, over a period of time, accepted and responded to the disasters they had been involved in and were now making a positive and active contribution in informing, campaigning and educating others about disaster management and response. However, these individuals did not fit with the image of disaster survivors (i.e. relatives as well as direct survivors) presented in the research papers I was reading. Much of the emphasis within the literature seemed to be on negative, pathological psychological responses such as Post-Traumatic Stress Disorder and 'unresolved grief'. Indeed, as my interviewees are keen to point out, they are frequently labelled by friends, relatives and others as 'obsessive', 'unhinged' and 'morbid' in continuing to be actively interested in disasters and discussing them nearly ten years on.

Both the academic literature and public perception, then, did not seem to do justice to this phenomenon of long term, proactive response after disaster. I therefore set out to explore the experiences, feelings and opinions of disaster survivors, many of whom approach the tenth anniversary of their disaster. What is it that drives some survivors, albeit a minority, to engage in active response? What can those in disaster management learn from their experiences in the immediate and longer term?


The 1980s: Britain's 'Decade of Disaster'

Disaster Action was formed in 1991 at the end of what had become known in Britain as a 'decade of disasters'. Public and professional interest in disasters was prompted by a spate of socio-technical disasters which occurred within relatively quick succession and received much media coverage and interest. Although the numbers of deaths involved were often, in comparison with other disasters, relatively small, the fact that there was a series of tragic accidents involving ordinary (often young) people doing everyday things - transport accidents, going to a football match, dying at work - heightened the sense of national shock and mourning. The symbolic significance of each tragedy was reinforced by ritualistic visits to the scene by key public figures as well as public expressions of mourning, attendance at official memorial services by senior politicians and members of the royal family, and ongoing media interest in the processes of inquest and public inquiries that ensued.

Significant features of these deaths which increased their effects on the national community were their suddenness, timing and, as befits definitions of disaster, their scale. Furthermore, developments in technology and news styles meant that much of the media coverage included live footage of a scene at the point of or shortly after death has occurred (see, for example, Deppa, 1993). One of the first of these was a fire at a soccer stadium in Bradford in May 1985. Many switched on their televisions on a Saturday afternoon for the weekly match results only to be confronted with scenes of a blazing wooden stadium and individuals, one at least on fire, running from the scene. Other disasters included an aeroplane fire at Manchester Airport during the middle of the holiday season, the sinking of a British ferry off Zeebrugge with substantial loss of life, a fire at Kings Cross (one of the busiest underground stations in London), the blowing up of Pan Am 103 over Lockerbie four days before Christmas, live coverage of fatal crushing at Hillsborough soccer stadium at the FA Cup semi-final (a key feature of the national sporting calendar) and the sinking of the Marchioness pleasure boat on the River Thames during the August bank holiday weekend, 1989.

The effects of these disasters on those directly bereaved was further exacerbated by the nature, scale and public context of the deaths. Writers in grief and bereavement such as Worden (1991:98) have highlighted how sudden deaths are more difficult to grieve than where there is some prior warning. Learning about or suspecting the sudden death of a loved one in these contexts and through the media was particularly distressing for relatives, especially given the uncertainty surrounding initial unsubstantiated reports and the media intrusion which was a persistent characteristic (Walsh, 1989:121). In the immediate aftermath this included photographers taking close-up pictures of survivors being broken news of personal loss, of distressed relatives arriving at the scene, and of journalists seeking information and interviews with the physically or psychologically injured (Note 1).

Public interest in these disasters has continued in the months and years since, in relation to the processes of public inquiry, inquests and the collection/distribution of disaster funds. A public discourse of shock, sympathy, blame, and accountability tends to be orchestrated through the media and a well-rehearsed narrative is imported which polarises the 'heroes' and the 'villains', regardless of the appropriateness of these constructions. This not only has implications for the emotional healing processes of survivors but means that the issues surrounding these disasters and their consequences persist for the bereaved.


Disaster Action

It was against this backdrop that Disaster Action came to be formed in 1991 (Note 2). The chairperson of one of the family groups invited people affected by disasters to come together and form an umbrella group, independent but supportive of the individual support groups, that might take a broader perspective of the issues surrounding disasters. Functioning both as a mutual support and pressure group, members are bound together by the fact that although each of their personal experiences is different they share some common experiences and misgivings about the causes of disasters, the way in which they as individuals were treated by the authorities in the aftermath and the inadequacy of the wider systems of inquiry and accountability within the British political and legal system. Their aim to use their experiences to the advantage of others is highlighted in their literature:

Our committee is made up of individuals and representatives from all the family groups set up after recent tragedies. As an umbrella group for all these 'grass roots' organisations, we're well aware of the dreadful thread running through these disasters. They weren't Acts of God. They needn't have happened. Preventing future disasters is the main aim of Disaster Action. We don't want anyone else to go through what we've been through.

(Information Booklet. Disaster Action, 1990)

To this end the organisation has been campaigning since its inception for changes in the law to ensure stronger safety cultures within organisations, greater accountability and new legislation on corporate responsibility which would mean that failing to ensure reasonable safety measures becomes a serious criminal offence. They have responded to the Law Commission's Consultative Paper on Involuntary Manslaughter with a view to promoting a bill on corporate manslaughter soon to come before parliament. Members of Disaster Action also give regular presentations to the media and contribute to the training programmes of practitioners such as emergency planners and the emergency services based on their experiences and views. One member reflected thus on the opportunity to learn from experience:

Disaster Action exists because people come together with like experience with the understanding that they know their lives have changed, with the knowledge that emergency planning is not all that it could be and that the human dimension of emergency planning, certainly in the past, has been missing... we try to supply it. And because of the nature of our experience we have credibility.


Methodology: A Qualitative Approach

For this research it was felt that qualitative methods, namely in-depth interviews, were the most appropriate for exploring the experiences, feelings and opinions of the members of Disaster Action. This is in contrast to much of the previous research into the psycho-social effects of disaster which has tended to use quantitative methods and focused on the shorter term impact of disasters, that is to say from the immediate impact phase in the first few months up to the first year or so (e.g. Konkov, 1991; Maida, 1993; Winje & Ulvik, 1995; Hagstrom, 1995). In Britain psychologists such as James Thompson at University College London have carried out a number of studies on psychological reactions to British disasters such as the Kings Cross Fire, the Lockerbie air disaster, the sinking of the Jupiter cruise ship, the Hillsborough soccer stadium disaster and the sinking of the Marchioness (Thompson, 1991; 1995). The main tool for such research is questionnaires designed to measure indicators of psychological distress such as depression, anxiety and Post-Traumatic Stress Disorder. These are distributed and analysed with an emphasis on the immediate impact and the benefits of initial debriefing and short term outreach mental health intervention programmes (Note 3). While such methods are useful for diagnostic purposes and are often used for medico-legal purposes such as compensation claims, they rarely go beyond the first few months or years. By way of contrast, there are very few qualitative studies using ethnographic methods such as in-depth interviewing and participant observation and taking a longer term perspective in examining the effects of disasters. The few exceptions tend to be personal survivor accounts (Campion, 1998), Homewood, 1989), Taylor et al, 1995) and there have also been televised documentaries using interviews with survivors from the disasters at Aberfan (thirty years on) and Hungerford (ten years after the shootings).

The research methods for this study include participant observation (in particular attendance at AGMs and at presentations given by Disaster Action) and a review of literature and other documentary material (including publicity material, information leaflets and reports produced by Disaster Action, as well as official reports into disasters). The main research tool is in-depth interviews with members of Disaster Action, particularly those on the Executive Committee. Interviewees were invited to talk about life just before the disaster, their experiences and feelings relating to the disaster itself, and key events and issues for them following the disaster. Although the number of interviews is small (six so far with a further ten being planned), the fact that the interviews are long (ranging from one and a half to three hours), and relatively unstructured, has elicited rich data from which key themes are being selected.

Depth of understanding is given a higher premium in this study than attempts to generalise the experiences and effects of disaster, especially given the fact that, even with the same disaster, each individual's experience and interpretation is subject to difference and variation. A further reason for not generalising in this case is that the people being interviewed for this study are exceptional in the fact that they are the minority who remain organised. Of all those affected by disaster they have become most publicly active, not only as members of the family groups set up after respective disasters, but also as members of Disaster Action, the umbrella group. Thus although the sample is clearly not representative of all people affected by disasters, some interesting similarities have emerged among their experiences and outlook after the disaster.

An emerging theme is the significance of the social, legal and political context of death through disaster for the processes of constructing an account of death, grieving and longer term psycho-social rehabilitation. This arises from the fact that disasters involve 'complicated' forms of death.


Disasters as 'Complicated' Deaths

Worden (1991:68-70) states that the psychological and social make-up of individuals can increase the likelihood of complicated grief reactions. It is suggested here that the form and circumstances of death too can be more or less complicated. Disasters involve complicated deaths in the sense that it is not always straightforward to establish the nature, cause and moment of death. This is important because these are questions which survivors want answers to and which can cause added anxiety in the personal, political and legal aftermath of disaster. Survivors are often left with inconsistent, incomplete or conflicting accounts of how, when and where their loved ones died. Consequently in situations of mass tragic death the increased need to blame someone, as a feature of grief through sudden death (Worden 1991:99), often becomes legitimately focused on the responding authorities and the way in which they conduct their affairs.

The fact that the British disasters in the 1980s were attributed to human/socio-technical causes has resulted in a series of inquests, inquiries and investigations, many of which are ongoing and complicate the psychological and social processes of grief. A feature of the British judicial system is long, drawn out and bureaucratic procedures. Although these are needed in order to conduct a thorough and comprehensive review of the evidence, the time-frame and bureaucratic manner in which they are conducted can also contribute to and prolong the emotional trauma of relatives and survivors. Worden states that such legal interruptions can delay the grieving process, but suggests that when cases are closed, this can help put some closure on grief (1991:99). Worden is focusing on situations involving a trial. However few public inquiries into disasters in Britain have lead to prosecution and with many of the disasters in the 1980s there are outstanding calls for full and open inquiries until which there cannot be a sense of closure. Added to this, the ups and downs of ongoing legal battles have left survivors feeling victimised by, and as angry at the systems of inquest and inquiry, as they are at the fact of the deaths themselves.

This last point is particularly significant. For campaigners within Disaster Action an outstanding issue is not simply the fact of loss and the mode of death but also the way in which the bodies were dealt with after death and the way in which relatives have been treated in the immediate aftermath and since. They are often presented with conflicting accounts of death which themselves become the subject of inquiry and speculation. Some relatives feel that the events after the deaths were at least as devastating as the fact of the death itself; in other words for them death is only the beginning of the disaster. These events in the aftermath are important because they are part of the process by which relatives and other survivors make sense of the death. The process of constructing an account of death is often far from straightforward after disaster; in fact it is often quite a lengthy and disordered process in contrast to what would be the normal and expected order of events.


Constructing an Account of Death in Disasters

With an 'ordinary' case of death, such as death by natural causes, the process of constructing an account of the 'hows' and 'whys' of death is usually fairly straightforward. A relative learns about the approximate or precise time and circumstance of death; they may later choose to view the body, there may be a post-mortem and inquest (should a coroner deem one appropriate), and there will be a funeral. This all takes place within a relatively short space of time (a matter of days) and is recognised as part of the process of making sense of the reality of the death, as part of the mourning process. With extraordinary deaths such as in disasters, however, the order and process of constructing an account of death can be both far from straightforward and take much more time, extending into months and even years. One may learn about the disasters through friends or the media before knowing for sure that a relative may be or is involved. The death might only be affirmed hours or possibly days later and this may not yet involve formal confirmation of death through the existence of an identified body. Given the complexity of establishing the circumstances of death, coroners often open inquests shortly after a disaster and postpone further proceedings until much later. Funerals may thus go ahead before the full details of the causes and circumstances of death are known. Access to post-mortem reports and to seeing the body may be circumscribed or delayed and the procedures of inquest, inquiry and criminal trial (where these occur) can be drawn out over several years, often to the dissatisfaction of the bereaved. This disordered and dissatisfactory process is illustrated by the following two examples.

On Friday March 1987 the Townsend Thoresen ferry The Herald of Free Enterprise capsized just outside Zeebrugge harbour after sailing with its bow doors open. In the first few days conflicting estimates were given of the number on board and the number of fatalities. The bodies of some on board were only recovered after the ferry was righted five weeks after the disaster. One family of a member of the crew on board was twice told that he had survived. On the first occasion the man's brother was told that he was fine and was walking and that he could go and meet him off a returning ferry. Twelve hours later the family were told a different story, that the man had been pulled out on to the hull of the ship and taken to hospital in Belgium, ill but alive. Thirty six hours later the family were told to expect the worst. They then had to wait for five weeks before the body of their loved one was brought home.

Although the inquiry into the disaster clearly identified the company as being 'infected from top to bottom with the disease of sloppiness' and the 192 victims were found by the inquest jury to have been unlawfully killed, attempts at private prosecution of P&O European ferries for manslaughter by some of the families failed. Now, over ten years later, the family's frustration is compounded by the fact that although the design of Ro-Ro ferries has long been acknowledged as being fundamentally flawed, the International Maritime Organisation and ferry companies have resisted and postponed implementing changes which would greatly reduce the vulnerability of ferries. It was the chairman of the Herald Families Association who spearheaded the foundation of Disaster Action which, on the basis of this and other cases of unsuccessful prosecution attempts following disasters, continues to campaign on the issue of corporate responsibility and accountability.

The second example relates to the Marchioness Disaster. On the evening of Saturday 20 August 1989 the Marchioness riverboat sank on the River Thames after being struck by a dredger. Fifty one people were killed. Over the following week bodies were recovered and the missing were eventually confirmed as dead. However relatives were denied access to view the deceased and formally identify their loved ones. Bodies were returned to them in sealed coffins with instructions from the coroner that they should not be allowed to view. The funerals went ahead. One mother was finally granted permission to see photographs of her dead son three months later. This was only after she applied and gained access to the photos. In the process she turned the page and came across a post-mortem report, an experience she described as like being 'punched in the stomach'. No one had informed her that this had even taken place.

The inquest was opened within the first few days and adjourned. It was resumed in April 1990 and adjourned again. Nearly two years later the coroner admitted that the hands of some of the deceased had been removed but no explanation was given as to why. The coroner refused to resume the inquest at this stage. Eventually, after continued campaigning by the relatives and survivors, a new inquest was granted in April 1995 - six years after the sinking. A verdict of unlawful killing was brought by the jury, but fifteen months later the Crown Prosecution Service ruled that there was insufficient evidence to take further action.

The Marchioness Action Group only heard a full account of the events on the River Thames at the second inquest in 1995 when a police statement was read out in full. Given that this was six years after the disaster, relatives and survivors were angry that they were denied an opportunity to hear such information sooner and in fact had to fight to learn about the events that night and what went wrong. The evidence at the second inquest was not new, simply evidence that had not been called for the previous inquest. On the basis of this and dissatisfaction with inquest procedures following other disasters, members of Disaster Action have raised questions about the politics of inquests and the role, training and authority of coroners.


The Need for a Longer Term Perspective

The time factor is important to note with these examples. The events and decisions made in the first few weeks remain part of the process of constructing an account of death in the years that follow. The experiences of other members of Disaster Action show that there are similarities between these examples and other disasters mentioned earlier, both in terms of the process of accounting for death and the persistence of unresolved issues in the longer term.

In order to understand the psychological and social consequences of disaster for relatives and survivors, it would therefore seem to be more useful to adopt a concept of disaster as an extended ongoing process rather than as a single event. This is in line with contemporary analyses within crisis literature as highlighted by Forgues and Roux-Dufort (1998) who refer to an increasing consensus on the appropriateness of considering crises as cumulative processes over an extended span of time and space. Furthermore, the concepts of rehabilitation and recovery in the latter stages of the disaster cycle need to be operationalised in a way that looks further beyond the first few months and years than has tended to be the case in previous studies. In these latter phases of disaster it is also important to address the social, legal and political systems and structures in place to respond to disasters since they will determine the nature and effectiveness of lessons learned as well as processes of accountability and responsibility.


Acting on Disasters: Looking to the future

The aftermath of the disasters in Britain in the 1980s highlights the importance of looking both longer term and at the broader social, political, legal and organisational context of disasters in order to fully understand their psycho-social consequences as well as their causes. Others have highlighted that an organisational focus helps us to understand why lessons are frequently not learned after socio-technical disasters (Turner & Pidgeon, 1997; Weir, 1998). Combining such a focus with the experiences and testimony of relatives and survivors also explains why they remain frustrated and angry at the longitudinal processes of disaster and helps us to understand the sustained motivation driving pressure groups such as Disaster Action. As one member explained:

We have to get people to understand that unless the inquiries are conducted properly, unless there are conclusions drawn, the families will not rest... (others) sometimes find it hard to understand why people continue to want answers to questions many years down the line... you continue to want justice but that message can sometimes be a little hard to get across.

At the same time, their experiences motivate and inspire continued campaigning initiatives in the area of corporate responsibility and public inquiries and provide a legitimate and valuable platform for educating those within disaster management who may learn from them and respond better in future incidents (see, for example, Dix, 1997).

Recent examples illustrate this continuing role at a national level. Disaster Action have contributed to guidelines produced by the Emergency Planning Society (May, 1998) focusing on good practice in addressing the human aspects of disaster. They have also been invited to comment on a Home Office working party report investigating and seeking to improve the role of inquiries and inquests following disasters (HMSO, 1997). Finally Disaster Action have commissioned a report which will highlight the defects of the criminal justice system in investigating and prosecuting companies responsible for accidents and disasters. This document, which in principle has the support of various action groups, trades unions and others. will be a vehicle for lobbying parliament to introduce new legislation on corporate responsibility.

These examples and this study highlight a familiar theme, namely that there is an opportunity to learn from the past with respect to responding to the human dimensions of disaster. In addition to this, the qualitative approach used here also highlights the importance of adopting a perspective which looks to the longer term and which includes the views and experiences of those directly involved in the aftermath of disaster. Indeed, some disaster survivors may be uniquely placed and motivated by their experiences to complement the views of practitioners by contributing to the development of disaster plans, participating in emergency exercises and commenting on policy-making at local and national level, as well as providing networks of mutual support for those affected by future tragedies.


References

Allen, R. D. (Ed) (1993) Handbook of Post-Disaster Interventions (Special Issue) Journal of Social Behaviour and Personality ,8, No.5.

Campion, M. (Ed) (1998 forthcoming) Jupiter's Children. Liverpool: Liverpool University Press.

Deppa, J. (1993) The Media and Disasters: Pan Am 103. London: David Fulton Publishers.

Dix, P. (1997) Corporate Responsibility - The Victim's Perspective. The Safety and Health Practitioner, June 1997.

Emergency Planning Society (1998) Responding to Disaster: The human aspects. Emergency Planning Society.

Forgues, B. and Roux-Dufort, C. (1998) Crises: Events or Processes? Paper presented at a conference on Hazards and Sustainability: Contemporary Issues in Risk Management, Durham University Business School, Durham May 1998

Hagstrom, R. (1995) The Acute Psychological Impact on Survivors following a Train Accident. Journal of Traumatic Stress, 8 (3), 391 - 402.

HMSO (1997) The Report of the Disasters Inquests Working Group the Home Office. London: Her Majesty Stationery Office.

Hodgkinson, P. and Stewart, M. (1991) Coping with Catastrophe: A Handbook of Disaster Management. London: Routledge.

Homewood, S. (1989) Zeebrugge: A Hero's Story. London: Bloomsbury.

Konkov, F. (1991) Primary Psychological Intervention with Families of Earthquake Survivors in Armenia. The American Journal of Family Therapy, 19 (l), 54 - 59.

Maida, C. (1993) Child and Parent Reactions to the Los Angeles Area Whittier Narrows Earthquake. In Allen R D (Ed) (1993) Handbook of Post-Disaster Interventions' (Special Issue) Journal of Social Behaviour and Personality, 8 (5), 421-436.

Parkes, C. M. (1995) Guidelines for Conducting Ethical Bereavement Research in Death Studies, 19, 171-181.

Taylor, R., Ward, A. and Newburn, T. (eds) (1995) The Day of the Hillsborough Disaster: A narrative account. Liverpool: Liverpool University Press.

Thompson. J. (1991) Theoretical Issues in Responses to Disasters. Journal of the Royal Society of Medicine, 84, (January), 19-22.

Thompson, J. (1995) Psychological Effects of the Marchioness Disaster on Survivors and Relatives. European Journal of Psychiatry, 9, (4), l97-208.

Turner, B. and Pidgeon, N. (1997) Man Made Disasters. Oxford: Butterworth-Heinemann

Walsh, M. (1989) Disasters: Current Planning and Recent Experience. London: Edward Arnold

Weir, D. (1998) Man Made Disasters Revisited. Paper presented at a conference on Hazards and Sustainability: Contemporary Issues in Risk Management. Durham University Business School, Durham May 1998

Winje, D. and Ulvik, A. (1995) Confrontations with Reality: Crisis Intervention Services for Traumatised Families after a School Bus Accident in Norway. Journal of Traumatic Stress, 8, (3), 429-444.

Worden, W. (1991) Grief Counselling and Grief Theory. London: Routledge.


Notes

Note 1
The portrayal of photographs and video footage in this context is understandably distressing to relatives and survivors in the first few days. What is also significant, however, is that once such material exists it is available to be reused months or years after the event whenever a news story occurs either directly or indirectly connected to the event. Particular photographs or film footage often become symbols of a particular disaster and are reused on an anniversary or when a similar tragedy occurs. The sudden appearance of these images can be distressing. As found by other researchers (Hodgkinson & Stewart, 1991), interviewees in this study referred to such 'triggers' and their disturbing impact.

Note 2.
Disaster Action includes members of family groups and survivors associated with the following disasters:

DateLocationIncidentNo. of Fatalities
11/5/85BradfordFootball stadium fire56
22/8/85ManchesterAeroplane fire54
6/3/87ZeebruggeFerry sinks192
8/11/87EnniskillenTerrorist bomb11
18/11/87Kings CrossUnderground fire31
6/7/88Piper AlphaOil rig explosion167
21/10/88GreeceCruise ship sinks4
12/12/88ClaphamTrain collision36
21/12/88LockerbieAir crash270
8/1/89KegworthAir crash47
15/4/89HillsboroughOvercrowded stadium96
20/8/89MarchionessRiverboat sinks51

Note 3.
One might question the ethical appropriateness of exploiting the opportunity to distribute questionnaires to vulnerable individuals in the first few hours or days given that they are likely to be in shock and may not be emotionally prepared to fully exercise their right to informed consent. One such study was carried out by a psychologist studying trauma who distributed questionnaires to 83 people on the very day their homes and neighbourhood had been destroyed by fire (Kurt Kieiner - New Scientist 28 June 1997:6). This research has paid close attention to Colin Murray Parkes' guidelines (Parkes, 1995) for conducting ethical bereavement research which highlight the great care that should be taken in approaching, conducting and using research carried out with potentially vulnerable people.


Copyright

Anne Eyre PhD © 1998. The author assign to the Australasian Journal of Disaster and Trauma Studies at Massey University a non-exclusive licence to use this document for personal use and in courses of instruction provided that the article is used in full and this copyright statement is reproduced. The authors also grant a non-exclusive licence to Massey University to publish this document in full on the World Wide Web and for the document to be published on mirrors on the World Wide Web. Any other usage is prohibited without the express permission of the author.


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