Typing this final blog post, I am already back stateside, at my favorite neighborhood restaurant, about to enjoy a good, hot meal and a cold beer. It's a luxury that I will try to never again take for granted. As I look back at our experience in Haiti, at the goals we hoped to accomplish, I am both proud that we were able to do some significant good, and frustrated that so much more is needed and left undone. The healthcare needs of the Haitian people have been and are being grossly undermet. Now, after a devastating catastophe which has claimed over 200,000 lives, the world's moral focus has been directed upon Haiti, and there has been a tremendous amount of humanitarian and financial support. But the question I struggle with is, "What does the disaster psychiatrist do when, prior to the designated event, the mental health care system was disastrous? In Haiti, the healthcare system as a whole was in such gross disarray before the earthquake, that disaster-specific responses fall woefully short of addressing the needs of the people. After a few months, after a few years even, what then?
Of course, those really are questions for governments to answer. But even a perfunctory review of Haitian history will suggest that such answers are unlikely to obtained. Prior to the January 12th earthquake, physician presence in the Leogane region was nearly non-existent. After the January 12th earthquake, and after the Disaster Psychiatry Outreach response, psychiatry presence in the region will be...nonexistent. There will be absolutely no psychiatrists in a region serving greater than 300,000 people.
This is why it is so critical to train the FSIL nursing students the basic tenets of psychiatry...in my opinion, expanding beyond even trauma-related issues. As of right now, the main physician presence in the region is volunteer-based. And though all of the doctors have some psychiatric training, certain issues amplified in importance with psychiatry...language, culture, rapport...are poorly met by a foreign volunteer staff. It is critical that we train the nurses who, as they were before the earthquake, may soon be the lone providers of both mental and physical health care to the people of Leogane.
So the questions arise again. What constitutes a disaster? What if the disaster spans two centuries? What strategies, systems, responses need to be employed? Certainly, an attempt to respond to such needs is well beyond the scope of what we can hope to achieve as disaster psychiatrists...(as I cut into my perfectly prepared, medium-rare steak) Right?