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

Homeward bound


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.
Dr Peter Hughes in Haiti

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.
Tents in Haiti after the earthquake
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.


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Re: Homeward bound
well done Peter for sticking it out to ensure you leave a lasting legacy.
I'm sure it must have been almost unbearable at times and so easy to get on an early flight home.
Your trip has also done lots to educate us back home about what we can do to help those less fortunate than ourselves.
we owe you a debt of gratitude.
Thank you.
Safe journey home.
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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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