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

Shock, depression, anxiety

 Typical scene

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.



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.


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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Re: Shock, depression, anxiety
Dear Peter

Your fortitude and focus are truly inspirational; it is heartwarming to hear that you are making a difference to so many lives. Your efforts are clearly invaluable and you are a credit to Psychiatry.

Best wishes

Greg Smith
Re: Shock, depression, anxiety
Dear Peter,

Thank you for keeping us up to date with Hati- it's no longer on the news in the UK so your Blog is important.
It's interesting to see how much good can be done with mimimal resources and no atypicls. Perhaps your trip also serves as a reminder that most things can be helped even without the latest medication.
Keep up the Excellent work, and best wishes,
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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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Dec Haiti Earthquake Appeal


Dec Haiti Earthquake appeal