Every building is a tomb

Haiti after the earthquake Nursing school in Haiti Mars and Kline Psychiatry Hospital, Haiti

 

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!

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Comments

Re: Every building is a tomb
Thanks so much for agreeing to write this blog - it makes compelling reading. We all really appreciate that you are finding the time to do this. Do take care.
Re: Every building is a tomb
I must admit that while I had been thinking about the future psychological problems that would arise from the devastation, I hadn't thought about the people already experiencing mental illness. Thank you for writing this blog which really brings home the impact.
Re: Every building is a tomb
Thanks for taking the time to write the blog, Haiti has disappeared from the news but obviously there is so much to be done to help these people. You are doing a really worthwhile thing. Look after yourself.
Re: Every building is a tomb
Your excellent work is much appreciated. It is reassuring for me to know that even a psychiatrist could be of that much help in such a devastation!
Re: Every building is a tomb
No doubt your doing great work over there. will follow the blog ,sounds quite hectic there.Stay safe and best of luck.
Re: Every building is a tomb
The media kept us updated of what is going on. Living it and describing it, is with more impact. It must be very hard. Take care
Re: Every building is a tomb
Many thanks for writing this blog and for giving us an opportunity to share in the experience of going into a disaster zone as a psychiatrist. The first hand account makes a strong impact. It would be good to think how members of the College can respond to similar situations in the future and there are other ongoing needs such as those of the returning Afghanistan veterans where voluntary support could help to cover the shortfall in NHS /military care.
Re: Every building is a tomb
Thank you Peter. This blog needs to continue if only to alert all of us to the reality of things in third world countries after natural disasters. It is a humbling lesson in counting our blessings. Peter will have much to tell of developments on the ground as people begin to emerge from the initial phase of shock into rage!
Re: Every building is a tomb
I was most impresed by the dramatic account of the work you are doing for the victims of the earthquake. It represents the role of psychiatry in a very valuable way.
Re: Every building is a tomb
Dear Peter,

May you, and all those associated with you, be strengthened with the courage and grace you need.
Re: Every building is a tomb
Peter, your account is very moving, and it's heartening that a colleague will have the initiative and courage to go to a country that is suffering such devastation. We're v proud of you back in SW17.
Re: Every building is a tomb
Dear Peter, this blog is so timely, as the media back home seem to have already moved on and we mustn't forget the ongoing plight of so many. It is all very humbling - but difficult to know what we can do back here that will do most good?
Re: progress
I admire your fortitude out there Peter. As your friend, I wish you well. As a psychiatrist, you're doing our profession a great service.
Re: Every building is a tomb
Dear Dr Hughes,
You are an inspiration for a junior trainee in psychiatry with strong interest in the work you're doing. Thank you for the the vivid images that come across from your writing and good luck and strength for the days to come.
Re: Every building is a tomb
Thank you for bringing the psychiatric perspective to us from Haiti. Keep up the good work.
Re: Every building is a tomb
Thank you for sharing your experience with us. It is both tragic, heart breaking and heart warming to read, I wish you well.
Re: Every building is a tomb
I find your account very moving.The particular issue of people with mental illness in such an awful situation is something I hadn't really thought about. I hope perhaps you might write something for a newspaper when you return. l'll also let others know about DEC appeal. All the best out there.

Re: Every building is a tomb
Dear Peter
You are a great man.
Re: Every building is a tomb
Dear Peter

I am impressed you are able to write with such eloquence after witnessing such devastation. Your story about the nurse coming to work, even though she was homless, really puts things in perspecive. Keep safe.
Re: Every building is a tomb
Dear peter, great idea to make a blog of your experience, both as reassurance to us and in keeping us informed and updated of this worthy cause. well done.
Re: Every building is a tomb
Dear Peter
Reading about your experiences on the blog really shows how important your international work is and what a real difference you're making to help others in distress. Stay safe - your team in Tooting is thinking of you.
Re: Every building is a tomb
Dear Peter, thank you for reminding us of the humanity caught up in this devastation. We miss you in Tooting though we admire your work!
Re: Every building is a tomb
Your noble contribution to help relief the sufferings of Haiti people is an example for all of us to do as much as one can to help relief the human suffering.
Re: Every building is a tomb
Dear Peter,
Thank you for your vivid, sad and moving narration of this stupendous calamity struk at Haiti population. In these circumstances usually mental health take a back seat as people are more concerned about acute conditions. Thank you bringig it in the forefront.
Hopefully College could have a database of a volunteer force to help in future natural calamities.
Re: Every building is a tomb
Thankyou for supporting the people of Haiti. Reading your blog has really brought home the fact that we as psychiatrists can also help during the aftermath of a disaster and it's not just about general medics and surgeons. It was also good to hear that you are supported by your trust in your charitable endeavours. Keep up the good work and enlightening blog, we need more people like you in this world....
Re: Every building is a tomb
Dear Peter
Excellent work! It's a time to reflect on those affected by such disaster.
Keep safe.
Tehmine
Re: Every building is a tomb
Dear Peter,
I am helping arrange a charity event to raise money for the victims of the earthquake. Do you know of any charitable organisations we could speak to?
Estelle
Re: Every building is a tomb
Like several other comments posted here, I followed the unfolding tragedy with a sense of helplessness - what use is a psychiatrist in a disaster zone? Or so I thought. Thank you for showing me how wrong I was. I echo the calls for the College to take a more active role in promoting this essential work. I'm sure that if more people knew how to offer practical help, then we would.

I wish you all the best, and will continue to follow your progress.
Re: Every building is a tomb
Dear Peter,

Thank you for providing us with a snapshot of the excellent work that you are doing. Often psychological and humane side of such devastating catastrophs is forgotten amongst the need for provision of what is seen as more basic needs. Your admirable work highlights the importance of recognising and meeting psychological needs. We are proud of you here at St George's!
With all the best wishes
Niruj
Re: Every building is a tomb
Dear Peter,

Good to hear from you, have been wondering how you are getting on! It is great to know that psychiatrists can be helpful practically in such a horrible situation, and I agree with others - very inspiring for juniors. Hope you are staying safe and see you back at SWLSTG soon!
Re: Every building is a tomb
Dear Peter

I am so moved by your selfless and compassionate act of going to Haiti.
I hope you are also looking after yourself.
I am thinking about you having to face such devastation and pain and sending you and all the other carers all my good wishes to keep you safe and help you cope with all that you see.
You are an inspiration to all of us at home.
I was struck by the article that Richard Villars so bravely wrote on the BMJ and we have communicated by email. He has sent me some of his photos and kindly given me permission to quote him in one of my training sessions on promoting compassionate care in medical environments. My argument being is that if he can recognise the importance of relationships and instillation of hope whilst setting up the field hospital immediately after the earthquake then we can do so in our fully equiped, expertly staffed and safe NHS.
Keep safe
All the very best
Alys
Re: Every building is a tomb
I strongly agree with the comment above. Sometimes it can feel as if psychiatrists may not be as helpful in times of disaster, at times this has deterred me from the profession. Waiting to treat the inevitable cases of PTSD seems the wrong way to do it. However, you have shown the crucial role we can play to existing psychiatric patients undergoing trauma. This is a truly inspiring blog and I look forward to keeping up with your progress. I wish you a safe and successful trip.
Re: Every building is a tomb
Good luck Peter
You are doing a valuable thing
Sadly the aftershock is well-named from what you say
Take care
David
Re: Every building is a tomb
Thank you for sharing with us this very moving experience. Your efforts to contribute to the eliviation of suffering for sch a large poluation are very inspirational.
Re: Every building is a tomb
Dear Peter, thanks, the description of the sight, and smell, of the school of nursing was very moving. Thanks for the work, and for the blog. Take care of yourself. Thinking of you and the people of Haiti, even down here in Cornwall! Jane BernalJane Bernal
Re: Every building is a tomb
Thank you for sharing some of your thoughts with us. Your experiences are an inspiration and will inform my own thinking about the many people we come across in the UK who have also suffered acts of devestation and/or violence.
Re: Every building is a tomb
I must admit that while I had been thinking about the future psychological problems that would arise from the devastation, I hadn't thought about the people already experiencing mental illness. Thank you for writing this blog which really brings home the impact.
Re: Every building is a tomb
Peter, thank you for keeping us in touch and conveying such a vivid and heart rending account of the devastation from the earthquake and it's emotional impact. Best Wishes from Tooting.
Re: Every building is a tomb
Thank you for your work and for bringing the fraility of our own lives into perpective. Mental health services in Haiti will benefit form your input and thank you on behalf of the trainee psychiatrists in London- you are an inspiration to us.
Re: Every building is a tomb
Dear Peter
Thanks so much for taking time to write a blog. This is a perfect way to get across the ways in which we can really make a difference as psychiatrists in disaster torn areas. I hope your writing will inspire some more people to come and join you.
Sheila
Re: Every building is a tomb
Dear Peter,

Reading your blog made me realise how important and invaluable we psychiatrists can be in a disaster zone as Haiti.We all appreciate the work that you have done in Malawi and currently in Haiti.
You are a brave man and you do instill courage and inspiration to all of us so that we also can do things out of the way to help people in distress
Re: Every building is a tomb
Thank you for sharing this with us Peter. You are an inspiration to us all.
Re: Every building is a tomb
Hi Peter. The blog is a great idea as i often think about how you're getting on. Have you come across Habitat for Humanity - they are starting to distribute emergency building kits and built 'transitional homes' (temporary structure of a solid foundation that can be used to build a permenant house on later). Would be interested to hear what that's like on the ground. Look after yourself and keep us posted...let us know if there's anything we can do?
Re: Every building is a tomb
Hi Peter. The blog is a great idea as i often think about how you're getting on. Have you come across Habitat for Humanity - they are starting to distribute emergency building kits and built 'transitional homes' (temporary structure of a solid foundation that can be used to build a permenant house on later). Would be interested to hear what that's like on the ground. Look after yourself and keep us posted...let us know if there's anything we can do?
Re: Every building is a tomb
Hi Peter
Your writing shows how life for people in Haiti remains at a standstill and yet the press coverage appears to have reduced signicantly. It is so poignant how people continue to live in fear of further earthquakes / after shocks and are living out on the street. And then you tell us how the nursing staff are living out in the street and then coming into work to help others.

One can't even begin to imagine what life is like for those who have survived
and the health problems with which they have been left with.

Your international work is truly inspirational and you have touched the lives of many.

Those of us in Tooting and Balham are thinking of you and sending you lots of love and support.

Keep yourself safe.
Re: Every building is a tomb
Peter,thanks for the blog.Sounds like harrowing work over there.It must be wonderful for the people of Haiti to have your experience to hand.Take care and keep up the good work
Adrian
Re: Every building is a tomb
Dear Peter,
Thank you for proving us with a behind-the-scenes insight into what life is really like in Haiti. Unfortunately the media back home (UK) seem to have lost interest as soon as last survivor was pulled from the rubble when we know it's after the rescue that the really hard work towards recovery starts.

Unsurprisingly for me you continue to selflessly work for others and be a shining- no I mean a radiant light to us all juniors and not so juniors alike. Maybe one day even I will find the courage to follow in your footsteps!

I would like to thank Vanessa (Cameron) for acknowledging your blog/work and ask if the Royal College (with it's expanding international reputation and activities)ought to now consider a College Award for Excellence in International Work aimed at advancing the mental health (care provision) of other nations?
Do take care and Best Wishes.
Alex
Re: Every building is a tomb
Dear Peter, your work and dedication are incredible. You have shown me new light how anyone can be so altruistic. I am glad to know you.
Re: Every building is a tomb
I think your first hand account is really helpful to help us understand the full extent of the disaster and to grasp the magnitude of the task of restoring an infrstructure in the months ahead. I admire what you are doing. Michele Hampson
Re: Every building is a tomb
Hi Peter,
Thank you for keeping the disaster fresh in our minds. The worlds media has already moved on and we must not forget what these poor people are experiencing.
What you are doing over there is very important and WILL make a difference.
Take care of yourself, we need our Deputy RA back.
Re: Every building is a tomb
Dear Peter,
Your words paint a personal and vivid picture of the devastation in Haiti and brought me close to tears. Your actions are a fabulous inspiration to us all. I too am greatly heartened to realise that even humble psychiatrists can play a significant role for survivors of disasters such as Haiti has just experienced.
Well done for your efforts there! I wish you all the very best.
Natasha
Re: Every building is a tomb
Very Inspiring indeed.
Re: Every building is a tomb
Dear Peter,
your blog gives us a very vivid picture of the events in Haiti and brings to the forefront psychological needs of the people stuck with natural disasters. Very moving indeed.
Re: Every building is a tomb
Haiti needs help to help itself. Most people should be helping by giving money. E.g. to medecins sans frontieres. People, who post here could easily give a months wage to the cause. That's what I would call help. They have enough psych staff over there, what they need is help to feed and shelter those staff to allow them to do their jobs.

There do not seem to be any critical posts here, so I guess only flag wavers are let in... Please tell me this is not so!
Re: Every building is a tomb
A very touching and inspitational blog. Thank you
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About this blog

Dr Peter Hughes - consultant psychiatrist

Dr Peter Hughes is a consultant psychiatrist based at Springfield University Hospital, London. He has an interest in international psychiatry and has been travelling to Africa over the last five years doing short-term assignments in mental health. He has recently flown to Haiti to work on a mental health programme.

 

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