26.4.2010: Port-au-Prince, Haiti
It is three months since the
earthquake hit Haiti. The Palace, which is the national symbol of
Haiti, is being demolished. Nevertheless, people are slowly
beginning to clear the rubble and start rebuilding their homes.
At the general hospital in
Port-au-Prince, the patients are being moved into buildings as the
ward tents come down. However those same patients are still
terrified of earthquakes and fear a concrete 'hospital grave'.
We'll work with the patients and try and calm their fears.
Thankfully we’ve moved out of the tents
ourselves at International Medical Corps Haiti. This was a great
relief to me but the tents are never far away for us in case
we stop trusting the buildings. Our mental health work
continues to make good progress. We're embedded in several primary
care clinics in Port-au-Prince and the surrounding earthquake
affected areas, intensively training staff and supervising the
mental health clinics.
The clinics are mainly still based in
tents. It’s an uncomfortable, hot environment for the staff who
work day in, day out. We still see a great variety of patients -
mainly those suffering palpitations and anxiety. Many had these
symptoms at the beginning of the earthquake and they have
intensified because they fear another earthquake will happen.
We don’t see post-traumatic stress
disorder. I have only seen one case which was a girl kidnapped and
badly assaulted two years prior to the earthquake. There, however,
remains a universal earthquake anxiety.
Everyone has a fear of being indoors are ready
to escape at short notice. Often people don’t know what to
do. When I asked a child at the clinic, he replied that he
would cry then pray; he didn’t think of safety.
There is a surge of cases of SGBV or sexual
and gender-based violence. At my clinic yesterday I saw a 13 year
old girl with her parents after her rape. She said she was fine but
she looked incredibly sad and is afraid of any man coming near her.
She has to start school now and try and get back to normal. The
parents have explained the situation to the school but
the girl has decided not to tell her friends.
Another casualty of the earthquake is a young
girl of 12 who keeps running after women in the street who look
like her mother. Her mother died in the earthquake and this
girl did not get to go to the funeral. She doesn’t believe she is
dead - another casualty of the earthquake.
Today a man arrived and asked us to take care
of his daughter. She is 4 years old. She may have been abused when
he left her with neighbours. He took the child away when he
realised this. However, he can’t work and support the child at the
same time. The mother is mentally ill and unable to care for her.
He begged us to take care of the child. This is just one of a
number of cases of people asking us to take their children as they
can’t support them any more.
There are countless stories of loss of
children, wives and husbands every day in the mental health clinic
and at the hospital. On the other hand we are reaching people with
mental health problems who would never have had treatment without
the earthquake. What we have done is provide
treatment to those who were previously marginalised and
stigmatised. Illness has been aggravated by the earthquake. Indeed
life in every way is prisimed through the earthquake.
We conduct lively training programmes for the
primary care health staff. A recent talk by Father Pierre Eustache
was particularly well received. He described how Haitians can
symbolically have a formalised mourning ritual for those that are
lost, including those whose bodies have never been recovered. This
training had a strong resonance with the staff. I realised then how
many had been directly affected by the earthquake, with loss of
loved ones, home and jobs.
I am coming to the time when I originally
planned to return to UK. I can’t deny counting the days if not the
hours of my return. On reflection, I have enjoyed the work although
it has been hard and frustrating. At times I have been burned out
and totally exhausted. I have probably cracked up on many
occasions. However, there is a sense that there is a long standing
benefit from our presence in terms of mental health; certain people
have received treatments who wouldn’t have done otherwise. There
are definately Haitian health professionals I know who now carry
knowledge of mental health treatment with them, and can make a
difference to those with mental health problems in the
future. I have been proud to be part of this work.
So instead of leaving Haiti for good, I will
return after a brief break in UK and continue for a while longer on
this programme with International Medical Corps in Haiti. The scale
of the destruction, lack of an existing mental health system in the
country and the dire poverty of Haiti means there is a lot of work
ahead for the future for all those who come here from overseas and
LA Times piece on our mental health programs in Haiti
Personal blog written by Dr. Peter Hughes, Psychiatrist
working at International Medical Corps
Based at Southwest London and St. George’s
mental health NHS trust.
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