Blog 3 24.2.2010

It is now over a month since the earthquake.  We have just had the three days of mourning here in Port-au-Prince.  The flags have now gone up again throughout Haiti.  There is normality now to daily life.  Walking past and over the rubble, and getting used to the tent life of almost everyone and still an even greater number with no shelter.  The General Hospital has less and less earthquake-related injuries and more everyday gunshot wounds, which were a feature of Haiti life before, unfortunately.  We have had a few recent quakes in the past few days.  Further bits of buildings crumble and fall.

We went to the inpatients at the General Hospital. There are many stuck inside a building and immobile. They were all very scared of further quakes and the roof falling in on them but at the same time were very stoical and gracious.  Just as we were about to start to think of returning to buildings the quakes have held us back.  I have managed to sleep through every quake so far and seem oblivious,  even when everyone else is running out of buildings!  That’s something I’ve got to change!  For anyone who has experienced the earthquake, they seem primed here to feel an intense visceral fear and run out of buildings as fast as they can.  Normality also returns with rubble clearing.  This may well expose more of the corpses.

Local people are trying to salvage anything they can - metal, wood.  What is most alarming is people going into the ruins of a huge market in Port-au-Prince as in the picture. There is a central hall which has multiple floors of pan caked building above it.  Yet these children and adults risk their lives every day going in to see what they can find.

Clinical

We are seeing a lot of patients who have an anxiety and somatisation state.  They are fearful since the earthquake and fear being in any building.  We see many manifestations of this with cases of chest pain, palpitations and headaches.  Today I saw an adult male who clearly had autism, although never diagnosed. The family are on the streets since the earthquake.  With the change of routine and the stress he has started to bite himself severely on his body, causing severe self-inflicted wounds. 

There are a lot of people, women particularly, who have gone mute since the earthquake.  I still can’t work out what this is exactly.   Is it a type of dissociation/shock, depression and anxiety?  Another woman today was screaming and wailing with an abdominal pain.  She has been a frequent attender at the emergency tent.  This is since the earthquake where she lost her parents, brothers, sisters and cousins.

Another case I saw was an aggressive young man in our emergency room.  What was a most difficult task as a UK psychiatrist was having to restrain and tie him to the bed with bandages.  I was impressed with how humanely this was done and helped by his mother.  It is an uncomfortable thing to watch when I compare with UK psychiatry.  Here, there was no option at that time.

Training

We continue to roll out our training to health workers in primary and secondary care.  It is a joy to teach such an appreciative and receptive audience.  I’m beginning to really see how we can make an impact on improving mental health in this region through our training and participation in clinical work.   This is all thanks to the enthusiasm of our Haiti health hosts.

Still in my tent one month on!

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.

11.2.2010 Port-au-Prince, Haiti

I write now just over one week into my stay in Haiti. I left Santo Domingo finally by helicopter with volunteers, almost all from USA with International Medical Corps. They are medical, nursing and other staff who have volunteered for 2 week periods of volunteer work in the main general hospital of Port-au-Prince.

Arriving in Port-au-Prince into a suburban area, and not even an airport, did not reveal the full extent of the earthquake. The effect of the earthquake is so sporadic. Buildings here are intact and then a random, collapsed one.  However there does not seem to be a single street that has not been ravaged by the earthquake. Every building is a tomb for an unknown number of people.Yet walking around Port-au -Prince life goes on as normal. But everywhere people are staying in tents including myself. We don’t know when the next earthquake or aftershock will arrive.

Local people who have been through the earthquake are petrified to be indoors. Gradually I see more and more destruction each day. It is an eerie experience to see building after building reduced to rubble and all the human life that goes with this. Each day I see the tensions on the street as people fight, as distribution of food leads to long queues and frayed tempers. Every day I pass by the market area which was one of the largest in the region. It is unclear how many people perished here. A huge building has collapsed to absolute rubble. Now youths are scrambling up mounds of rubble to loot any items from the market.

What I find most poignant, as I think many of us do, is the school of nursing which is just next to my work base. Here at least a hundred or more nurses perished in the earthquake.  It looks like complete rubble. I pass this every day. One day they were removing some bodies. That is a sight that is quite hard to forget and the smell lingers. Today I saw a load of notebooks nearby on the road that obviously had come from the nursing school. This is my strongest image of the earthquake.

My work is based in the Mars and Kline Psychiatry hospital where they kindly collaborate with us. We are hoping to support their health systems in the main psychiatric hospital and gradually spread out through primary care throughtout the earthquake affected region. This hospital holds 100 patients but the majority left after the earthquake when they were fearful of staying in such a structure. All the staff have been touched by the earthquake, losing family, friends and neighbours. Most of the staff are sleeping on the street still. For example, one of the nurses today showed me all of her mosquito bites as she is still sleeping outside with no shelter. Yet they still manage to come to work and care for the patients.

The inpatients seem to be predominantly suffering from psychosis. The courtyard for the patients is riven with a long gash from the earthquake. The perimeter walls have collapsed. Fortunately no patient was injured in the earthquake. The outpatient service is tent-based outside. The earthquake has exposed patients’ vulnerabilities. I saw one man who had lost a son and his only other offspring, the other son, was paralysed. He had become manic as a result. Other patients were unable to get their medications for their psychosis because of the disruption,  and have had a relapse of their symptoms. There is a lot of anxiety amongst the population, and amongst the mentally ill, particularly in relation to going into buildings. Many people somatise to chest pain. 

The other area of work is the General Hospital, which is tented with many USA and other volunteers supporting the Hospital, which struggles to meet the needs after the earthquake. The majority of the patients are in tents. There are many amputations. Today I spoke to a man who was about to have a below knee amputation. Next to him was a young girl with bilateral below knee amputation. Friday , Saturday and Sunday are a national day of mourning in this tented city for the catastrophic loss of life and livelihood. I now return to my own tent!

2.2.2010 Santo Domingo, The Dominican Republic

As I write, I am currently waiting in Santo Domingo to go by land to Haiti around 2am. Haiti had a massive earthquake on 12 January 2010. Didn’t think too much of this, but a few days later I had a call from the International Medical Corps asking me to be part of a mental health programme, led by Dr Lynn Jones. This aims to strengthen and develop mental health services after the earthquake.

From that point it has been hectic trying to organise my travel and all my arrangements. My employers, South West London and St. George’s Mental Health NHS trust, have supported me fully in this endeavour and have released me from my work for this time.

One of my tasks was to try and organise some medical supplies for Haiti. Support has been incredible. Through fundraising, I raised over £7000 of donations which has gone into buying medication which I can take directly to Haiti. Sticking to the required essential medication list, my three large boxes are packed with haloperidol, procyclidine, amitryptiline, fluoxetine, chlorpromazine to name a few. It is important to have a sustainable medical supply until supplies are re-established. 

My journey to Haiti was made smoother when people found out my destination. Even at Heathrow, I was sped through towards the plane. In Miami, staff literally blessed me on! It was touching and certainly helped me get through transit to Santo Domingo. The flight to the Dominican Republic was full of relief workers; many were church-based and were from the US.

Santo Domingo - the scale of the earthquake really starts to hit me. On international development work scales, this has been the most exhausting, upsetting and personally demanding for those first on site.  The relief effort has been going remarkably well all things considered. The first wave of emergency relief is coming to an end and now is heading towards the stage of future sustainable development.