Tuesday, March 16, 2010

Mental Health in Haiti

(Miami Herald, March 15, 2010)
For anguished Haitians, earthquake takes a mental toll
The Jan. 12 earthquake struck a psychological blow to Haitians, some of whom have begun treatment.


PORT-AU-PRINCE -- On a recent Friday morning, Marie Kettie Geolnarol-Archer, between appointments in the Champ de Mars neighborhood, stopped people in the street and on the sidewalk, gently squeezing shoulders and patting backs until they looked her in the eye.

``You are not crazy,'' she told them. ``Everything will be OK.''

Geolnarol-Archer is a psychologist, and while her sidewalk ``treatments'' may have been casual and unorthodox, the most unusual thing about them was the responses.

Most people, after pregnant pauses and awkward foot-shuffling, began to share with her complaints about everything from headaches to depression.

Before the Jan. 12 earthquake that killed more than 200,000 people, Geolnarol-Archer wouldn't have offered random psychological counsel because she would have been rebuffed, she says, due to Haiti's cultural practice of frowning on mental health problems and people who acknowledge them in themselves or others.

But the quake has done something that 200-plus years of turmoil had not accomplished.

``It has changed the way people think about mental healthcare,'' Geolnarol-Archer said. ``Or should I say it is changing the way they think. . . . Something happened with this particular disaster that snapped in some people's minds. Until now it has always been considered a shame -- this is a matter of Haitian culture, cultural beliefs -- to speak aloud about your mental health.''

Shamed families might have abandoned mentally ill relatives before the quake, or may have dumped them in asylums, Geolnarol-Archer said.

No more.

Adults are not the only ones targeted to receive help. First lady Elisabeth Preval is pushing for mental health services to be part of a reenvisioned education system. A just-completed assessment report on the quake's damage estimates that Haiti will need $11.5 billion to rebuild, including its education system and hospitals.

Geolnarol-Archer says her biggest concern is that the more than 1.3 million residents of Port-au-Prince under the age 30 will self-medicate their emotional stresses by binge drinking.

``Alcoholism is a serious problem with our young people,'' she said, adding that as many as 200,000 Port-au-Prince residents could be in need of immediate mental healthcare. ``I do worry that they may turn to it when the reality of our situation fully sets in.''

Rene Sadre, 21, agrees that Geolnarol-Archer's fear is legitimate.

He says that if he hadn't met Geolnarol-Archer, he probably would have tried to drink away his quake-related sorrows.

``It changed me,'' he says from his bed in a hallway at General Hospital.

Sadre's family hogtied him and dropped him off at the hospital after he became incoherent and violent. And while they alluded to his emotional problems, their pretense for checking him in was a possible stomach injury, said Dr. Peter Hughes, a Cambridge, England-based psychiatrist for International Medical Corps, who has teamed up with Geolnarol-Archer to treat her new influx of patients.

``That's the way it started with many people,'' Hughes says, while examining Sadre. ``A lightbulb has gone off and people recognize that they don't feel right -- mentally, emotionally. But they still don't know how to address it. So they began coming to the hospital in droves and asking, `Can you take a look at this injury on my leg?' And then they casually slip in `By the way, I'm also experiencing panic attacks and heart palpitations'.''

Panic attacks and heart palpitations are the symptoms most frequently presented by Haitians seeking treatment these days, Hughes says, adding that both are understandable considering the frequency of tremors and aftershocks.

``The slightest rumbles that in the past they would have paid no attention to -- a large truck passing by, a plane overhead -- can now send people into a near frenzy,'' he said.

The Pan American Health Organization has been trying to help mental health experts in Haiti establish a care network in the aftermath of the quake, said Dan Epstein, an organization spokesman.

``We're encouraged by the outreach care providers have been able to engage in with the people who need it most,'' Epstein said. ``Our concern over the past six weeks or so has been to establish before the spirit of camaraderie and neighborhood teamwork wears thin, as people think more about the long road ahead. That's when serious mental health problems can surface.''

Joseph Frantzdy, 25, says his family was so comforted to know they weren't alone in their emotional stress, that it made them comfortable to commit his 41-year-old mother to General Hospital a day after the quake, when she became catatonic and mute -- a condition in which she remains.

In the past, Frantzdy said, they may have hidden his mother out of shame, but not anymore, because ``it is not the right attitude. She is my mother. Even if you cannot see her injuries, she is not well.''

Claude Dougé, 49, is less subtle about his feelings on changing attitudes toward mental healthcare.

Since the quake, he and five family members have been camping in the rubble of his partially collapsed home.

``I believe I feel relief, perhaps joy. This is something we have needed for so long, considering what this country has been through over a great many years,'' said Dougé, a teacher and former United Nations social worker.

Over the past four years, Dougé has lost a brother to suicide, his father to cancer, his wife to divorce, and now his home to the quake.

What's kept him stable, he said, is his long habit of seeing a psychologist for periodic counseling.

``I have been telling people . . . that it is no shame to talk about your mental state if you have problems,'' he said. ``This earthquake has been terrible. But if it is opening people up that is good.''

More evidence that attitudes toward mental healthcare are ``opening up'' is the number of people who've flocked to the Mars Kline Psychiatric Centre.

``Look around you,'' Hughes says, upon entering Haiti's largest psychiatric hospital.

``Before the earthquake, the only people you'd see here were patients who were considered violent, dangerously violent. No one came here voluntarily, just for help.''

The front lawn at Mars Kline is now covered by tents and blue tarps.

According to Geolnarol-Archer, ``these people could have taken their families anywhere, but they came here for access to the hospital's staff. They know that this is not a place to get their bodies treated, but rather their minds.''

Jean Philipe, a former Haitian soldier, went to Mars Kline for counseling after the earthquake.

Philipe was later deemed a danger to himself or others and committed to Mars Kline, a move that angers him, since he insists ``I am sane,'' but also a move he admits could stabilize him in the long run.

``I don't care who sees me here,'' Philipe said. ``I am here. Hopefully these people can fix my mind.''

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