On 12 January, the Republic of Haiti was struck by a devastating earthquake that left many thousands of civilians dead or injured, and over a million homeless.
Beyond the visible destruction of infrastructure, natural disasters on this scale have a large impact on people's mental health. Many are left traumatised, while those with pre-existing mental illness are placed at high risk of relapse due to increased stress and the breakdown of support systems.
Dr. Peter Hughes, a consultant psychiatrist at Springfield Hospital, left Tooting to join the International Medical Corps' Mental Health Programme in Haiti, which aims to strengthen and develop local mental health services in the aftermath of the earthquake.
The following extracts from his online blog, published by the Royal College of Psychiatrists, reveal the challenges that the country continues to face nearly two months on from the earthquake:
It has been hectic trying to organise my travel and all my arrangements. My employers, South West London and St. George’s Mental Health NHS trust, have supported me fully in this endeavour and have released me from my work for this time.
One of my tasks was to try to organise some medical supplies for Haiti. Support has been incredible. Through fundraising, I raised over £7000 of donations, which has gone into buying medication which I can take directly to Haiti. Sticking to the required essential medication list, my three large boxes are packed with haloperidol, procyclidine, amitryptiline, fluoxetine and chlorpromazine, just to name a few. It is important to have a sustainable medical supply until supplies are re-established.
Arriving in Santo Domingo - the scale of the earthquake really starts to hit me. On international development work scales, this has been most exhausting, upsetting and personally demanding for those first on site. The relief effort has been going remarkably well all things considered. The first wave of emergency relief is coming to an end and is now heading towards the stage of future sustainable development.
I write now just over one week into my stay in Haiti. I left Santo Domingo for Port-au-Prince by helicopter with volunteers, almost all from USA with International Medical Corps.
The effects of the earthquake are so sporadic. Buildings here seem intact and then a random, collapsed one. However there does not seem to be a single street that has not been ravaged by the earthquake. Every building is a tomb for an unknown number of people. Everywhere people are staying in tents including myself. We don’t know when the next earthquake or aftershock will arrive.
Local people who have been through the earthquake are petrified to be indoors. Gradually, I see more and more destruction each day. It is an eerie experience to see building after building reduced to rubble and all the loss of human life that goes with this. Each day I see tension on the street as people fight, as distribution of food leads to long queues and frayed tempers.
What I find most poignant, as I think many of us do, is the school of nursing just next to my work base—here at least a hundred or more nurses perished in the earthquake. I pass this every day. One day they were removing some bodies. That is a sight quite hard to forget and the smell lingers. Today I saw a load of notebooks nearby on the road that obviously had come from the nursing school. This is my strongest image of the earthquake.
My work is based in the Mars and Kline Psychiatry hospital where they kindly collaborate with us. This hospital holds 100 patients, but the majority left after the earthquake when they were fearful of staying inside a structure. Most of the staff sleep on the street still. For example, one of the nurses today showed me all of her mosquito bites as she is still sleeping outside with no shelter. Yet they still manage to come to work to care for the patients.
The earthquake has exposed patients’ vulnerabilities. I saw one man who had lost a son and his only other offspring was paralysed. He had become manic as a result. Other patients were unable to get their medications for their psychosis because of the disruption, and have had a relapse of their symptoms.
It is now over a month since the earthquake. There is normality now to daily life. The General Hospital has less and less earthquake-related injuries and more everyday gunshot wounds, which were a feature of Haiti life before, unfortunately.
We are seeing a lot of patients who have an anxiety and somatisation state. They are fearful since the earthquake and are anxious about being in any building. We see many manifestations of this with cases of chest pain, palpitations and headaches. Today I saw an adult male who clearly had autism, although never diagnosed. With the change of routine and the stress he has started to bite himself severely on his body, causing severe self-inflicted wounds.
We continue to roll out our training to health workers in primary and secondary care. It is a joy to teach such an appreciative and receptive audience. I’m beginning to really see how we can make an impact on improving mental health in this region through our training and participation in clinical work. This is all thanks to the enthusiasm of our Haiti health hosts.
Still in my tent one month on!
To follow Dr Hughes' blog, visit www.rcpsych.ac.uk