Our Man in Haiti, Parts I and II

By Kent Ravenscroft MD

IPI Emeritus Faculty

Part 1

Haiti is an amazing country. It is devastated by yet another disaster, yet the strength and spirit of Haitians is stunning.   I know it well.  I spent time there as a young man learning Creole and writing my thesis on possession and its link to dissociation.  Now I’m in Paris living at the other end of the spectrum.  I hear firsthand from friends who still live and work in Haiti that the devastation is ghastly.  They say that International Medical Corps (IMC) is co-ordinating support efforts well, and that as a child psychiatrist I could be useful to distressed families there and to people suffering from post-traumatic stress disorder and psychiatric sequelae of physical trauma.  I am powerfully drawn to help, and with my wife’s blessing, I decide to leave Paris for Haiti.  She tells me that her sister, a nurse, heard from her colleague on the American hospital ship Comfort off the shore of Haiti, that they’ve been swamped with the worst cases.  No-one in Haiti has seen ANYTHING like this.  No war zone compares.  I am about to leave when my wife tells me this, and asks me if I know what I am getting myself into.  My anxiety shoots up and I make her stop telling me.  It is time to go.

With $300 worth of overweight medical supplies and equipment, I fly to Haiti from Paris.  On the flight I meet a team of water-purification and rescue workers and a top manager from WHO.  Within two weeks of the earthquake the man from WHO was co-ordinating 240 humanitarian groups, medical and otherwise.  Now there are more, but some are pulling out now as the acute phase ends.

In the air I feel a sadness, the return of the repressed, depressed feeling of missing the Haiti I had known 50 years ago as an idealistic, enthusiastic young man, because of the destruction and loss on the ground, resonating with the stage I am at in my life, and  because my last summer there had been a hard one.

We are one of the first commercial flights to land in Haiti, and I am one of the first child psychiatrists to arrive.  The airport is as chaotic as ever, entrepreneurial Haitians hawking baggage trolleys for $2 dollars (American), and several eager cabbies grabbing me and my stuff.  At last, Matthew, the International Medical Corp driver, finds me and the other new doctor, Zurob, who is from Russia, Georgia actually, and we set off for the Plaza Hotel.

Matthew drives Zurob and me through streets lined by collapsed houses and rubbles, teeming with busy or displaced Haitians, past huge tent cities.  Lighting is spotty, and the destruction massive but strangely spotty.  The gaily painted buses and vans move at a snail’s place, with traffic jams everywhere.  Images slide by: A nursing school with 200 young souls, crushed to eternity; the once gleaming, white Palace, of Papa Doc fame during my years there, now lop-sided and caved in, too scary for President Preval to work in.   Matthew and I jabber away in Creole and French, while Zurob pores over his tropical medical manual as we jounce over an incredibly pock marked road, now strewn with rubble.

When I arrive at the Plaza Hotel, I find the main rooms filled with cots and mattresses, eager, excited, exhausted young physicians from all over the world, coming back from a day’s work in one of the remaining hospitals or outlying clinics.   Everyone is talking about life and death, the resilience of the Haitians, the malingerers, and those wanting a doctor for old ailments. Triage, compassion, and breathtaking work is in the air.  I feel anxious and out of place, no one at first receiving or orienting me.  Then it is time to eat – at a surprisingly sumptuous buffet.  The other volunteers begin to clue me in about how wonderful the effort and how great the support from the leadership of the IMC is.  Other volunteers show me where to find a spot to sleep, and tell me about cornflakes for breakfast, about lights out at 10, lights on at 6, bus leaving at 7 for the hospital, AND, where to find the WiFi, which is good, and where to exercise.  I eye the pool eagerly.  Security is good in the compound, not as good on the streets, the staff being like mother hens for us chicks.  My fear of losing 40 pounds as I had done that first summer has evaporated.  I have landed in comfort.

This was not to be for long. I meet Nick, a British psychiatrist, the next morning, with our driver, a Haitian electrical technician with a generator, and a translator, a great guy, but oddly for one in his profession, he stutters.  We sit on morning rounds which last all day, with no food at all.  We go to WHO’s PROMES facility, a huge warehouse complex, to get psychiatric meds for a Psychiatric hospital we are to visit beyond the airport.  We run into red tape for three hours, and then the traffic is incredibly bad, but we finally reach an alley behind caved in buildings and banana stands, bumping over cess-filled ditches, which will finally get washed out now the rainy season is beginning, and that will be good until the mud slides began.  This reminds the electrician that, though the stench of bodies decaying and of rats has abated through dessication, the rains might stir things up again.  The electrician is stoic until we pass a collapsed building where a dear friend was buried.  All the while, Nick is leading us onward, and briefing me about our teaching mission for young Haitian professionals and support and consultation in the hospital and the outlying beach-head clinics.  He is wonderfully British, very warm and supportive, wise and caring, and inspiring hope and confidence in me as I try to imagine myself once again working on the front lines in the trenches under such difficult and compassionate circumstances.

Finally we reach a nondescript gate opened by a shotgun-toting guard to reveal a huge open space ringed by caved-in one-storey buildings and walls, a collapsed primitive kitchen, a tent city, a patient with an American flag bandana screaming and gesticulating, two women frozen in bizarre positions, men marching her and there, half naked women leaping around the grounds, goats feeding and prancing about.  Nick is walking with the psychiatrist, doing a needs assessment as I trail behind, saying hello to all the curious patients.  I meet one who speaks English.  He has just won a Port-au-Prince award for his wonderful drawings, and he wants to give me a portrait for helping them.

We deliver the huge supply of meds, my friend the electrician installs the generator for their water supply, and the heavens begin to rain on us.  Some patients tell me they fear that their gleaming white canvas tents from Russia are old stock and might leak.  Two excited patients insist that they have their picture taken — I oblige.

When I get back to the hotel I am told to pack up to come to the residence where the staff of IMC live, to get to know them better.  I would be oriented to clinics the next day, today, in preparation for assuming leadership next Thursday in one of the outlying clinics in Petite Goave.  The last tremor, the Translator told me, in between stutters, happened a week ago, with a huge, cracking, snapping deep groan, and a slight convulsive shake.  Nick tells me that when one of the earlier major aftershocks happened two weeks earlier, everyone moved outside to sleep from then on.  Some of the surgeons and nurses got freaked out and insisted on leaving immediately; others now sleep inside at the residence; and I now sleep in an assigned tent outside.

Today I head in with Nick to work in the Hospital Psych Clinic where I will begin warming up my skills – medical, psychiatric, and linguistic.  I am inspired, daunted, challenged, and glad I am here among impressive groups and dedicated younger people.  I’ll try hard as I put my ancient oar in these troubled waters.  May the good Lord and my ancient friends, the Voodoo gods, look kindly on our efforts.

Part 2

Yesterday, I went with Nick to see the IMC facility at the Haitian University Hospital, mostly under Haitian control.  The IMC triage, outpatient, ICU, and medical units are in tents.  First we visited the ICU to see a 30-something woman with symptoms of periodic rectal bleeding, and paralyzed left arm and both legs.  The paralysis distribution didn’t make sense, nor did the bleeding pattern. She looked good, showing la belle indifference, which came on more recently, after the quake, and this fit with the diagnosis of hysterical conversion reaction.  Thinking more about the intermittent bleeding pattern, I concluded that she might be faking or feigning her symptoms, which fit the diagnosis of Munchhausen Syndrome. She was a nurse and would know what to do to generate these symptoms.  I just didn’t know how.  In cases like this, I always wonder if I might be making a mistake and I fear that I am missing something serious.  We told the nurse and doctor our thoughts, and advised that she should be transferred to the step-down medical unit because she was taking up valuable urgent care space.  Shortly after we left she had a significant bowel movement with bright red blood, though her colonoscopy was negative.  When we came back this morning, we found out that they didn’t transfer her.  They gave her an indwelling venous catheter to give her blood if urgently needed.   I suggested the next time it happened they should compare her own blood type to the blood in the bowel movement.  I was fairly certain it would not be hers, though I could be wrong.  She still had her paralysis.  While she thought that we weren’t looking, we noticed normal hand gestures in the paralyzed hand while she was talking to her sister.  We were encouraged that she would recover.

The next patient had lost his leg below the knee and was recovering from shock and speechlessness.  Next was a woman with a manic reaction, speaking fragmented English and singing American songs at us, demanding to be let out.  This state of mind had been precipitated by seeing her house collapsing in front of her. Next was a woman who had been hearing the voice of a god inside her head beseeching her to be more faithful, and she was getting better on a mild sedative and so that suggested a diagnosis of temporary confusion, not psychosis.  We saw a quietly sad woman with paranoid delusions, who was homeless and had been found walking naked.  She was pulling herself together.  Another woman who had seen her house collapse had been thought to be psychotic.  Today we got a better history from her and diagnosed psychomotor epilepsy complicated by severe anemia. The two Haitian nurses rounding with us, giving the psychiatric meds, and doing the follow-up supportive therapy, were bright, gracious and serious.  I found my Creole wanting in these situations, and had to turn to them and to the translator.  The translator was a great guy, very bright and helpful, but he stuttered.  What is going on here?

We were late to get over to what I mistakenly heard called Calvin Klein hospital where Nick delivered a great lecture to a roomful of fully participating Haitian nurses and doctors, with the hope that we would be able to influence the situation sooner or later.  (How will I do???) The grounds were covered with tents for the displaced, and all during the lecture there was a horrific metallic banging.  I found out it came from the inmates in isolation cells.

At breakfast this morning I am very sleepy, kept up by very disoriented and disturbed roosters who cried out randomly all night.  I got to know their individual cries, their personal signature calls, and I knew where they lived.  I dealt with my irritation by thinking of purchasing them for dinner.

The head of the outreach team, a young woman who has worked in Afghanistan and Iraq, and was one of the first into Haiti, has arrived.  She asks each of why we are here.  She has in mind a triangle of categories and wants to figure out where we fall in it – careerist, adventurer, or tree hugger?  I am moved by each personal response.  I appreciate the IT specialist objecting that tree hugger isn’t fair for idealists who should be respected as people of balance and realism too.  He tells us his own terms:  Mercenaries, missionaries and misfits.  Just as I am feeling more at home, someone comes in to announce that two women from Medicins sans Frontiers have been abducted last night and that the Haitian NGO community is waiting for the ransom requests.  I am now taking security warnings much more seriously.

I just found out from the Director what I will be doing here in Haiti for the next four weeks. She has designed a mental health clinic, to be attached to a small Haitian general hospital now partly run by IMC in the outlying town of Petit Goave, a little way out on the southern peninsula.  This is a new clinic, not yet functioning, with a Haitian social nurse and a translater.  I will be creating and running the clinic, which will treat outpatient referrals from the hospital’s follow-up, OPD, and family practice clinic.  Haitian family practice doctors in three nearby outlying family practice clinics will rotate one day a week into my clinic to see our patients and be supervised by me, or see mental health patients with me, to train the family doctors to incorporate mental health interview and intervention skills into their frontline work. On another day I will rotate through 4 ‘boat’ clinic outposts to do the same thing.  On two out of my four Saturdays, beginning this Saturday, all the clinic Haitian Health Care workers will come in to have an all-day Saturday mental health workshop.  Hearing all this makes me feel a little anxious and overwhelmed, especially since the trainees are all Haitian. So the workshop will be in Haitian Creole. Not that I have to do it in Creole, since I will have a translator.  But, never the less it makes me anxious.  Even in English, preparing and giving lectures is not my favorite thing to do.

I will be moving out to Petite Goave Thursday to do the first Saturday workshop and start the clinic on Monday.  I will have Wifi out there, so I am told.  I will have Sundays off, and Fridays for paperwork and lecture prep.  But even sooo!

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