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The Royal College of Psychiatrists Improving the lives of people with mental illness

Every building is a tomb

Haiti after the earthquake Nursing school in 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.

Mars and Kline Psychiatry Hospital, Haiti


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 throughout 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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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
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 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
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,

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
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
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
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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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