Father Eddy Eustache is a priest and psychologist who serves as director of mental health and psychosocial services for Partners in Health in Haiti. He responded to the NewsHour's questions by e-mail, from Port-au-Prince.
What are the most common mental health challenges you are seeing in Haiti at this point?
Almost four months after the earthquake we are seeing people having various kinds of emotional distress responses. These include difficulty sleeping, heart palpitations, somatic complaints, and significant sadness, worry and anxiety. Some of these can be seen as normal reactions to a highly abnormal situation. However, the level of distress for many is severe. We also see people who have developed psychotic reactions, and other more acute mental health problems, since the earthquake.
One major challenge [to addressing mental health needs] is a general lack of services in Haiti to address significant mental health problems. Haiti had few mental health professionals, and limited organized mental health services prior to the earthquake. There was not a clear understanding of the prevalence of mental health problems in Haiti prior to the earthquake, but we can expect that the mental health dimensions of the earthquake, overlaid on the pre-existing issue of poverty, will have significant ramifications for mental health. Our hope is to further develop the services needed to assist with such problems, in a culturally appropriate way, for the long-term.
Can you give examples of some of the cases you are seeing?
There are people walking and lying in the streets who are hallucinating, disoriented and frightened, some likely unwell prior to the earthquake, but some also exacerbated by the current circumstance.
We have had one instance of children jumping out of school windows when a truck passed by, startled by the rumbling of the ground, and requiring medical attention for their injuries. When we have visited schools we have met many children who were living in Port-au-Prince, now living in rural areas, who have been very unsettled both by experiencing the earthquake itself, but also by the loss of family members, displacement and the general level of uncertainty in their lives.
In our clinics we have seen many people presenting with physical symptoms that most likely represent emotional distress, but are also associated with medical illness, lack of water, food, shelter, and sense of safety. Everyone has been profoundly affected by the earthquake, the loss is incomprehensible, and people are coping as well as they can in the current situation.
How are mental health workers trying to address the needs?
Interventions are needed that respect people’s capacity to recover from such an event, that do not pathologize normative responses to such a terrible circumstance, that do not risk harm to individuals, that have some evidence for their efficacy, and that are appropriate to the Haitian context.
At Zanmi Lasante [Partners in Health] we have expanded our team to 17 psychologists from three prior to the earthquake, and to more than 50 staff focused exclusively on mental health and psychosocial services. We have been working … to provide communal opportunities for mourning, to develop community-based supportive interventions in collaboration with schools and churches, and we have expanded basic clinical services.
This has included training of doctors and nurses in management of acute mental health problems, and planning for expansion of the system of care to include community health workers attuned to mental health, and development of effective referral networks to providers.
How much attention is mental health receiving from NGOs and the government?
Haiti has an important opportunity to develop community mental health services, and the Haitian Ministry of Health has expressed a strong interest in developing such services. Mental health is one significant issue among many. Basic needs must be met, and these include shelter, nutrition, and health. The government and NGO’s are working to meet these, and there has also been general agreement that working to meet mental health needs is a high priority.
For a disaster on this scale, what can we expect in terms of mental health challenges six months from the earthquake, and down the road a year or two?
We have never dealt with a natural disaster of this scale in Haiti… we can expect many people, once their basic needs are met, to recover from the losses involved. But we can also expect that current events may be unprecedented in terms of promoting emotional difficulties in the population. The slower the reconstruction effort, particularly with regard to addressing basic needs, the higher the risk is and will be for the development of mental health problems.