Front page New York Times, March 20: In Haiti, Mental Health System in Collapse. This journalistic portrait of an already destitute psychiatric hospital now in complete collapse also includes a few column inches demonstrating the challenges of trying to provide mental health care in a disaster zone — even at the rather quotidian level of a bad interpretation:
There were some cultural and linguistic barriers. After Dr. Samuel said of Mr. Francillon, “The truth is what he’s talking about is not serious. It’s a reality that goes along with being Haitian,” Dr. Hughes tried another approach. He explained the theory of the bodily fire alarm and told Mr. Francillon, “You’re not mad,” which the Creole interpreter delivered as, “You’re not angry.”
The article features veteran disaster mental health specialist Lynne Jones, psychiatrist with the International Medical Corps. Dr. Jones has worked in Bosnia and Chad (with Darfur refugees) among other places, and has developed in her practice what several of us who do research on conflict zones have developed in theory: a multi-modal mental health approach that focuses on psychiatric first aid for most and specialist caretaking for those with pre-existing psychiatric conditions — all with an emphasis on educating local practitioners.
Many with less severe issues are seeking help at the medical clinics in the big tent cities, like the one in Pétionville, where Dr. Jones and a psychiatric colleague, Peter Hughes, ran a mental health clinic one day last week while simultaneously training a Haitian internist.
“Remember, these are not our patients, these are your patients,” Dr. Jones said to Dr. Charles Samuel, the internist. “We are going to teach you so that you can carry on.”
With only 13 psychiatrists in Haiti prior to the earthquake, clearly education and development need to be priorities now.
Fritz Francois of NYU Medical Center, head of NYU’s Haitian Effort and Relief Team (HEART), has similar tales from Haiti, but from the surgical perspective. Dr. Francois’ blog, well worth a read from start to finish, is here.