Life goes on, but psychological wounds will linger (Feature)

By Anindita Ramaswamy Jan 24, 2010, 2:32 GMT

Port-au-Prince, Haiti - The mind doesn't always believe what the eyes and ears cannot escape in Haiti.

Homes, schools and offices are shattered beyond repair; innumerable, anonymous dead discarded at street corners or collected in garbage trucks and dumped in mass graves; countless injured being treated in makeshift hospitals, bleeding and screaming in agony without anesthesia; and mourners grieving inconsolably for lost loved ones.

The suffering is so massive that numbed Haitians cannot express it in words.

Health experts say the full extent of psychological trauma will only surface several months later, as the aftershock of what survivors have witnessed and experienced sets in.

The present and future horrors on the long and painful road to recovery in Haiti have sparked serious concerns about providing psychological support for thousands of survivors who have lost everything that helped them make sense of their world.

But local doctors say that there is no structure to deliver mental health care in Haiti.

'Mental health care is a new concept for us. It's a blank domain,' said paediatrician Hans Thomas at St Francois De Sales Hospital in Port-au-Prince. 'There are a few psychiatric clinics in Haiti, but no one knows about them. It's alien to us.'

Haitians say there is no culture of seeking help for mental problems in their impoverished Caribbean country, which has endured more than its share of political upheavals, violence and natural disasters. When troubled, people pray, go to traditional healers or fall back on voodoo, which grew out of traditional religions that were brought to the Caribbean by African slaves and is still practised across Haiti.

'People don't know that there is professional help available if they are feeling depressed, angry, anxious, dazed,' said Thomas. 'They just tell themselves that this is life, and move on. The culture of coping is very different here. But this can be detrimental in the long term and lead to serious psychological problems.'

With their faith sorely tested, Haitians flock each night to the ruins of churches - where usually the only structure standing is the crucifix - to hold hands, sing and pray by candlelight. The chaplain of a US medical team was coordinating community healing strategies with local pastors in some areas of Port-au-Prince.

'You see the whole spectrum of trauma here: people who have not reacted, people who don't want to talk and people who have moved on,' said David Lipin of the Disaster Medical Assistance Team from California. 'They are starting to move beyond asking for food and water, from the basics. That's a good sign. They're talking about sanitation and personal hygiene.'

If there was any system of psycho-social counselling in Haiti, it came as a result of the AIDS epidemic, local doctors say. Haiti has the most severe epidemic in the Caribbean, with an estimated 120,000 people living with HIV.

'When HIV programming was being conceptualized for Haiti, a key aspect was the introduction of counselling, and a system was set up for dealing with AIDS involving social workers, counsellors and psychologists,' said Thomas. 'But this doesn't exist in the general population.'

It is possible to create health care systems where no infrastructure existed, as has been demonstrated by Partners in Health, which has been working in Haiti for more than two decades. The group developed a pioneering HIV treatment programme that successfully delivered anti-retroviral treatment in one of the world's poorest countries.

'The path-breaking work done by those in HIV has shown that we can organize a system for psychological support for the general population. Now, after the earthquake, it's a must,' Thomas said.

Meanwhile, Boy Scouts have fanned out across the Haitian capital, and one of their tasks is to try to alleviate the suffering of the survivors. It's a difficult job because they are also earthquake survivors and have narrowly escaped death themselves. But it keeps them invested in their communities and gives the youths a sense of purpose.

Petit Jean Denis noting that he and his follow scouts had actually received some limited training in psycho-social counselling before the earthquake.

'This catastrophe has overcome our country, and as scouts we are here to help,' he said. 'We are all victims, but we have made our 'promise' as scouts.'

For now, Haitians are devising their own coping strategies.

Some hold loved ones and weep. Many remain in the present and focus on daily activities: finding a safe place to sleep at night or procuring fuel for their cars.

A few seek the comfort of strangers - stopping people on the road just to say they have lost a son or mother, but are out on the streets looking for food, because life must go on.