24.2.2010 General Hospital
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.
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