Mental illnesses linger long after Haitian earthquake

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PORT-AU-PRINCE, Haiti — In a sweltering annex behind the General Hospital, inner demons stalk in plain view.

In one cramped room, a 58-year-old woman rocks
rhythmically on a folding chair and recites Psalms one after another,
her mouth curled up in a faraway smile. In another, a young man
describes how his heart takes off without warning, thumping like a
runaway train the way it did that terrible afternoon.

Not all the hurts from Haiti’s earthquake can be seen. The Jan. 12
temblor, which the government estimates killed 300,000 people, also
exacted a toll on the psyche of survivors. The damage is still emerging
months after many of the physical wounds were patched up.

An untold number of Port-au-Prince
residents are suffering anxiety or feeling panic at the slightest
movement that suggests the earth is shaking. Others have fallen into
depression. For people who had underlying mental illnesses, the shock
and grief have been severe enough to trigger a variety of disorders,
including schizophrenia and mania, mental health workers say.

The poorest country in the Western Hemisphere was
never an easy place to live. Recent months have poured more stress on
families, many of which are living on the streets with no money,
unsteady supplies of food and a future that on many days appears to be
a fearsome void.

“People were pushed over the threshold,” said Peter Hughes, a London psychiatrist who heads mental health efforts in Haiti for the Los Angeles-based International Medical Corps, which has three psychiatrists working here. “The earthquake changed everything.”

Hughes and his colleagues working at General
Hospital have seen 200 patients referred from the emergency room for a
variety of mental problems. The quake was an aggravating factor in most
of the serious cases and the cause of what Hughes calls “earthquake
anxiety,” a not-unexpected reaction often marked by insomnia, racing
pulse rates and a lingering fear of going indoors.

A 34-year-old woman lying in bed in the main
hospital insists that her legs are paralyzed, though they work fine.
Hughes said the “conversion disorder” stems from stress turned into
physical symptoms.

“We don’t even argue with her about it. She won’t believe us,” Hughes said.

Although medical workers say Haitians have handled
the calamity with remarkable resiliency, the nation was ill-prepared
for a deluge of mental health problems. Its Public Health Ministry
employed only nine psychiatrists, one for every million residents.
There were fewer than 20 psychiatrists in private practice.

The capital’s 50-year-old government-run psychiatric
hospital, Mars and Kline, is a bleak bunker of chipped paint and grimy
tile floors where 60 patients sleep in padlocked enclosures without
beds.

On a recent day, a dozen patients languished behind
bars in a sun-scorched concrete courtyard fouled by human waste. Half
wandered without clothes. On a wall, someone had scrawled “Death Row,”
the name patients gave to a corridor through which many escaped during
the earthquake. The hallway is decorated with faded, childlike drawings
of fruit and Santa Claus.

Louis Marc Jeanny Girard, a psychiatrist who has served as the hospital’s medical director for 10 years, said Haiti
has never treated mental illness with much care. Often, he said, people
suffering psychoses were dismissed as being in the grip of the
“mystical.”

“They never take the mental health issue seriously,”
Girard said. “They take AIDS and things they can see visually and give
them more value. They always put this problem at the end.”

But Girard and other mental health professionals say this may be the perfect moment to fix the inadequacies.

Foreign organizations have begun discussions with
Haitian officials on the outlines of a decentralized mental health
system that would rely on grass-roots diagnosis and care across the
countryside.

Community mental health workers would be trained to
refer patients to local clinics. Those with serious problems would be
referred to psychiatrists. A similar model has been employed for HIV
treatment.

“What we want to have is a system where mental illnesses will be taken care of on the ground,” said Eddy Eustache, a priest and psychologist who works here with Boston-based
Partners in Health. “It is an opportunity to admit that little has been
done for mental health. The government has to do something, and I think
they are on the right track.”

It is too soon to know how many workers would have
to be trained or how much such an approach would cost. It seems clear,
however, that much of the load would continue to be shouldered by
groups such as Partners in Health, which is running a pilot project in Haiti’s central and coastal regions.

Since the quake, the group has trained and hired 17
psychologists and 50 social workers. Partners in Health plans to hire
600 community health workers to bolster a force of 2,000 already
tending to nutrition and child health issues to improve detection of
depression and stress.

International Medical Corps, which provides training
to Haitian psychiatrists and social workers, plans to recruit 75
volunteers to educate people on mental health issues.

The government’s reconstruction plan, presented to international donors in New York
in March, envisions revamping the primary health care system by
building more hospitals and improving access to care in areas far from
the capital. But it makes no specific mention of mental health.

For now, the task at hand is getting people like Jeanne Paul and James Dort through their personal crises. Paul, the woman chanting Psalms nonstop,
had been treated for mental illness and had improved, her sister said.
Since the earthquake, she’s had a relapse.

Dort, 28, says that since Jan. 12, his heart often suddenly pounds furiously.

Hughes and a Haitian psychologist, Kettie Archer,
guide Dort through a series of questions about his life, the
earthquake, his feelings. They demonstrate a breathing exercise that
can help him relax and invite him to a meeting for people with
quake-related anxieties.

Hughes concludes with a diagnosis that is familiar these days.

“There are a lot of people who have their hearts going fast,” he tells Dort. “What you have is not abnormal. You’re not mad.”

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(c) 2010, Los Angeles Times.

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