IPI Emeritus Faculty
Saturday came around fast. I had to stand up in front of local Haitian IMC clinic doctors and nurses, and talk for 5 hours about the psychosocial impact of what they and their patients had been through. As I’ve said, public speaking and lectures are not my favorite thing. I spent from 4 to 5 am floating on my air mattress, dealing with my anxiety. Into my mind came the words of Maitress Erzulie Grand Freda, who had told me, as I left Haiti 50 years ago, that I would be successful if I worked hard, that maybe someday I would come back to visit and help her people in Haiti. Thinking of her words and feeling encouraged by my association with the great IMC staff, I took heart, found my courage, and fell back to sleep, until 5:45, when the cock crowed for me.
I had come out to Petite Goave on the southern peninsula to start up our Haitian psychosocial training program here. We drove to the Royal Beach Hotel for my first all day workshop, to be on Mass Trauma, Loss, Grieving, Front Line Mental Health Work, Treatment, Triage, Symptoms, and Major Mental Illness. PTSD, though popular with the press and the world, would be a small part of it, since statistically, surprisingly, it is infrequent in mass disasters, if aid and care are given right. We would cover the needs of patients with pre-existing conditions epilepsy, mania, severe depressive disorder, and chronic schizophrenia who lost their medicine and psychiatric contact because of the quake, and address new first breaks caused by the tremors and the scarcity of outpatient and inpatient psychiatry. We hope to leave a legacy of psychosocially competent front line Haitian family practitioners when we leave in two years.
There were 12 Haitian doctors from our 5 clinics, 19 nurses, and others from Notre Dame hospital, and 5 from Croix Rouge with whom we have liaison. It went fairly well. I even spoke a little Creole to the group when the translator had trouble with my medical English and concepts. I did a group exercise teaching relaxation and imagery techniques to interrupt cycles of anxiety and repetitive thoughts, and then while in the relaxed state, had them visualize where they were when the earthquake struck, helping them recapture and work on their own inner experience so as to increase their emotional availability to each other and their patients. I stressed cost-effective front line stress reduction group sessions that nurses would lead for people they would identify – groups like the one I was modeling.
I had them form pairs and tell each other about what they had been through, and then used their own thoughts and feelings to illustrate the symptoms and expectable phases of recovery for those without psychiatric diagnoses. We talked of acute stress symptoms, and how rare chronic serious post-traumatic stress disorder is, and how early intervention on the front line reduces its occurrence drastically. Without that support in war zones and earthquakes like the one in Haiti, PTSD results from seeing and dealing with dead bodies, and rape, abuse, and violence.
The workers told me that they felt guilty about the long lines ever day and the brevity of their problem-focused encounters with each patient. I reminded them that their Haitian patients are used to waiting for care. And in this case they will get care like they had never had before. Even waiting in the clinic, being near their doctors, and knowing the Clinic is there for them, is helpful. They deliver care in open tents with all watching, and the word gets out that help is there. I said that they should never underestimate the importance of using themselves as a powerful part of the healing. By their presence and their manner of caring, the front-line workers become a transference object of great importance for the camp and village.
I stressed the importance of their presence at the camps and destroyed villages. I reinforced the impact of their caring, their laying on of hands, their quick but careful exams, their mental health first aid, and triage. As front line workers, their work and reassurance gives hope and momentum to recovery for this impoverished, yet strong and resilient Haitian people. I reminded them of resilience, and advised them not to over pathologize what they see. I emphasized the need to see their patients’ (and their own) weird thoughts and feelings as normal responses to abnormal experiences, and to set them in the context of the normal, expectable stages of mass disaster recovery. That’s the way to help their patients not to get stuck and become chronically symptomatic.
Once they felt comfortable with me in discussing the needs of their patients, several nurses and doctors shared their personal experiences of losing family members, seeing their houses destroyed, and living in tents outside their houses. About a third of them had been affected. When the topic of tents came up, I noticed two nurses looking down and huddling privately. I finally asked if they could share what was going on. With some embarrassment but plucky honesty, one of them confessed she didn’t even have a tent yet and was living outside with family members in one of the camps, grateful the rains hadn’t come yet, and proud she made it to the clinic every day to work, somehow looking clean and kempt. The clinic was clearly a beacon of hope, care and support for her. And her own experience gave depth and meaning to her work. It raises the question: “Who takes care of the care takers?”
One young doctor came up to me afterward, doubtful about the purpose and usefulness of the group exercise. When I explained that it had to do with taking care of yourself as well as your patients in times of trauma, his eyes rimmed with tears and he told me about pulling children, some dead, some gravely injured, from under crumbled concrete slabs in the house next to his after he and his kids got out safely, before both houses collapsed. I’ll be working with him in one of my weekly clinic rotations. I was deeply moved by my experience wit him and with the group in general. The workshop certainly broke the ice for me, and I hope for them. Now I am poised to go out and work alongside them.
It seems tents are now in short supply in Haiti and there is still great need. We have enough tents in our privileged IMC ‘camp’. We are well taken care of, mostly. So I have a tent that I am not going to be using. My extra tent was a gift from a friend who sent me off with a lot of camping stuff, urging me to give it away when I left, bless his soul. So I plan to give it quietly to this nurse when I go to her clinic, secretly so as not to stir up envy, or a perception of favoritism by IMC. But that other nurse huddling with her may be in the same plight. So I have sought a more systematic solution. I asked Stephanie, my NGO administrator if she can get tents for our clinic workers in need. I don’t want to wait on bureaucracy, but Stephanie seems to make mountains melt for her people. She’s my kind of NGO person!
My only complaint about Stephanie is that she wouldn’t like me to visit my old field site because of security concerns over the increasing risk of abduction. She said that one abduction can cost an NGO $30,000 to $50,000, and she emphasized that this would mean that hundreds of refugees would have to go without food and care because of the wasted funds. There was something strange about how she tightened up and how guilty she sounded, and how she used the image of starving refugees to persuade me not to go. I learned that she had been abducted for 25 terrifying days in Darfur, before negotiators got them to release her. But all she seems to feel about that, besides wanting to protect us, is terribly guilty about how much she cost IMC for her ransom, and the loss of money for care of the people in Darfur. She has a lovely amulet she wears every day, given to her in gratitude by her people in Darfur. I find myself tearing up again as I write this: I have such admiration for this woman. Stephanie said she felt she could probably get some tents for my nurses in the next week.
Speaking of Stephanie and tents, just the day before my workshop I had visited a clinic called Beatrice, at the top of a high hill, with a tent city surrounding a small village. We also visited Petit Guinee, a destitute and now ruined seasoned village, and Trois Soeur, a tent city around a monastery. Later that day a huge wind came up, and when I got back to the staff residence, I discovered that the big tent covering the Beatrice Clinic had blown down, with everyone in it. Stephanie was frazzled because she had been called, as usual, to rescue the situation, and had spent the afternoon putting the tent back up with the staff.
After my workshop, I treated myself to a Haitian lobster dinner at the Royal, and two Barbancourt rum and cokes. I enjoyed the ‘Strict Badou,’ a jazzy, professional Haitian group, with appropriately strong island flavors. I slept well last night. Even the roosters failed to rouse me. Today is a day of rest, and a chance to write. I made an omelette for me and Stephanie, and gave my novel to Peter who was complaining about nothing to read. So that’s it for now, except for preparing my materials for my first clinic tomorrow. I look forward to beginning my clinical teaching and training, though I’ve already begun to worry a little about my lecture in Port-au-Prince at the Mars et Klein Psychiatric Hospital next Saturday, possibly on Adolescence. I’m all prepared for an Eating Disorder lecture, with slides, but somehow that doesn’t feel quite right for down here. Anyway, type A is interfering with my day off. Talk to you later.
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