Haiti quake victims face mental struggle

PORT-AU-PRINCE - The battered bodies may be mending, but the minds still struggle.

As many as one in five Haiti earthquake victims have suffered trauma so great with the multiple shock of lost homes, jobs and loved ones that they won't be able to cope without professional help, doctors say.

In a country where mental health services barely existed before the quake, building the required support is a huge challenge.

The symptoms can't be diagnosed by stethoscopes, blood tests and X-rays, and can take time to surface after the initial shock of the disaster.

"It's not about immediate psychological counselling," said Dr Lynne Jones, a senior medical adviser for the International Medical Corps.

"It's about assisting mourning. People cannot recover if their social needs are not met."

Jones, a veteran of natural disasters and wars from Bosnia to Indonesia, is teaching front-line doctors how to identify "disabling fear" and, quite literally, hold people's hands and listen.

Hugo Emmanuel is one of the untold thousands who doctors say have lost the ability to cope.

"Stay away! I don't want you to touch me," he barks at an American nurse who only wants to wash his shattered lower leg.

Emmanuel, 49, is an educated man of spindly limbs but voluble spirit who lies on a mattress on the floor of the kitchenette in the Espoir Hospital in the capital's eastern hills.

He tore the cast off his leg last week. For days after he arrived two weeks ago, he only let the hospital director feed him; he claimed everyone else was trying to poison him.

Emmanuel, who lies in his underwear beneath a white sheet and towel, is at least getting personal attention. Most of those diagnosed with severe trauma are treated as outpatients because there is no room for them in the country's 91 functioning hospitals.

"The doctors in such situations tend only to hand out tranquilisers," Jones said. "We don't want them to do that."

Tranquilisers are hardly sufficient for earthquake victims like Emmanuel, who lost his house, both of his parents and his job.

"I was in a coma-type situation," Emmanuel says in graceful French that reflects his experience as a Quisqueya University researcher. "Every time I think about losing my family, I lose my mind."

He quickly corrects himself. "I'm not crazy. I just think I'm suffering from psychological shock."

The hospital's director, Dr Gusse Darline, said Emmanuel is sporadically amnesiac. But that's only part of his problem.

"He didn't want to come into the hospital for treatment. We had to drag him in," she said.

Darline says she doesn't know what to do with Emmanuel once his leg heals.

Port-au-Prince's only psychiatric hospital is barely functioning. All but 11 of its more than 100 pre-quake patients were removed by relatives who feared the building would collapse in another quake, said Dr Peter Hughes, an Irish psychiatrist who arrived late last week and is studying what to do.

Hospital nurses have refused to accompany Hughes into the building - though it appears structurally sound to him - because "they are absolutely petrified" of another quake, he said.

"There's no electricity and no running water. Some patients are in a barred room. There is a need for mattresses and working toilets."

It is not known how many mental health workers are available to help in Haiti. Pan American Health Organisation (Paho) officials who are co-ordinating medical care among more than 200 aid groups have only just begun to create a database of hospitals, patients, doctors and medical resources.

But it seems clear that Haiti will have to train more of its own personnel to work on the front lines with people suffering from psychological trauma.

"The most urgent need ... is not food and water which is temporary," said Pierre Brunache Jr., an official with the Citizens Network for Foreign Affairs who led a survey of relief workers and victims. "The most urgent need is for psychiatrists."

Paho Dr. Jorge Castilla, lead co-ordinator of the aid groups in Haiti, put out an urgent request Sunday for mental health professionals.

"But this is not easy because they have to be able to adapt to the culture and the language," he said. "I can't have hundreds of volunteers coming here who don't speak the languages."

Castilla said he's looking to the French Caribbean islands of Guadelupe and Martinique as possible sources.

One of the most traumatic experiences for tens of thousands of Haitians is knowing that their relatives have been buried in mass graves, deprived of funerals while their survivors are denied the chance to properly grieve.

Walk into any one of the five public hospitals and 14-odd field hospitals in Port-au-Prince and you see the psychological scars of survivors who have not been able to bury their dead.

Many sit quietly in corners, staring blankly into space. Others cadge handouts or wait in line for tranquilisers.

Palpitations - rapid, fluttering or pounding heartbeats - are rampant among them, doctors say.

At Port-au-Prince's general hospital, Louna Jean-Baptiste waits in line under a punishing sun to be seen. She's had heart palpitations since the quake.

"My heart is racing all the time," said the 34-year-old mother of four. "Sometimes I feel like my heart is in my throat. Other times I can't breathe and feel like I'm going to die."

- AP