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 from Haiti.

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.

24.3.2010: The earthquake which had turned Haiti upside down by Fern Georges, Haitian Environmental Journalist. Port-au-Prince, Haiti  

Like hundreds of Haitian entrepreneurs, I was greatly affected by 12 January’s very deadly earthquake.  Listening to a Haitian evangelical radio station, waiting for two visitors while taking a nap in my cosy little office at the Haitian Environmental Reporters Network (REHPE), I heard some weird noise and felt some strong vibration which lasted about thirty seconds.  In fact, I thought that my office building was collapsing from exhaustion because it was very old - some 120 years old.  It usually shook up whenever a big car or truck passed by.  All of a sudden, I had an idea firmly rooted in my mind to exit my place by jumping out of the first storey, with my bare feet, which I did!  Being on the first floor, I was questioning my business colleagues about what happened. They told me that it was an earthquake.  

Everybody was shouting, especially women not being able to control their emotions.  A wide mass of dust filled in the air. People became dirty. They looked ugly with grey powder finely spread over their faces, heads and bodies.  It was a big disaster. Several houses, schools and state buildings in my area were destroyed.  With a lot of caution, a few minutes later, I had decided to re-enter my still-standing work place to rescue some important materials such as electronic items, office supplies, files etc…  Fortunately, I was by myself in my office. All my employees had already left. So I could feel guilty if one of them had to die or be hurt because of me.  

On my way back home, I was just counting corpses, running people, demolished residences and broken vehicles. My soul was quite invaded by dismay, anguish, anxiety and fear. Unlike my office building, my house was not affected by the quake because it was built on the rock – in the mountain.

Losing my agency, my job, some close friends - and feeling sorry for many people, I had to cope anyway with my new living condition.  Luckily, I had joined as an interpreter, guide and assistant in the Mental Health Department of the International Medical Corps (IMC), a well-known organisation which came to Haiti for the International Disaster Relief Team / Haiti Emergency 2010 program.  Hence, I  met Dr Peter Hughes, one of my supervisors, an Irish psychiatrist based in London who had  politely asked me to write this article for his blog.   Meanwhile, I have been looking for assistance to re-establish my business organisation – which is just a pain in the neck!  

Finally, as an Environmental journalist, it is obvious that the 12 January natural disaster had completely turned Haiti upside down.  The thinking and acting way of the Haitian people along with their international good friends and sponsors must change by developing a new sense of responsibility in future.  

The quake had publicly unveiled the nudity of Haitians and their foreign partners.  Nothing really important has been done in Haiti for the last 206 years such as a lack of a good infrastructure system, no project had been implemented with a long-lasting development and management goal and so on...

Of course, Haitians cannot help themselves.  Billions of dollars have been spent in Haiti. Nevertheless, for decades, the islanders have been splashing around an awful misery under the monitoring and/or with the agreement of their international fellows.  Let’s say that on the one hand, Haiti has always been located in a very troublesome ecological region. Thus, the earthquake was just a fact – not an event!  Awareness was raised and warnings were given by many specialists from different skylines.   

Since last year, the Haitian Environmental Reporters Network (REHPE) has been carrying out an Environmental Education Campaign throughout the country for which it has gotten no support of any kind!   On the other hand, we can only count the days we are living on the island. So wisdom is a must – what about common sense?

Fern Georges, Haitian Environmental Journalist

See also 'A Plea for Haiti'  by Sienna Miller, Global Ambassador, International Medical Corps                                  

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.

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.

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!

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.