Tuesday, April 27, 2010

Team #2 Haiti Post-Earthquake

Team #2 Haiti Post-Earthquake: Day 2 and 3
Rachelle Rene, PhD, BCB, Heather Muhr DO, MPH, Angela Smyth MD

Monday and Tuesday, April 26 and 27

Heather Muhr blogs: On Monday morning, we met 16 fourth year nursing students from FSIL. On Tuesday morning, we met 14 third year nursing students. In our Creole and French introductions, we emphasized, as a psychologist and two psychiatrists, that we were clinicians for both the students and the Hospital Saint Croix clinic patients. We also focused on our roles as teachers and discussed the psychosocial effects and impact of stress after a disaster such as the January 12 earthquake.

After the students separated into three groups (each group with one clinician), they shared with us their personal experiences of what patients have been telling them since the earthquake. This organically led into an interactive, dynamic sharing of their emotional, physical and spiritual experiences post-earthquake. Descriptions included: “vide(emptiness)”, “le denil(denial)”, “tristesse(sadness)” ,“le deuil(grief)” and not wanting to make connections with their friends. The feelings connected to loss, stress and grief are tangible. There was a deep sense of community and shared humanity amidst all of our connections with the students.

The students made specific requests for skills or tools ( i.e. psychoeducation) that could help them with their stress and the stress of their community, including patients. We began with a discussion of the normal response to stress. We did an interactive exercise on self-care and a guided visualization and grounding exercise. As teachers and clinicians, we are focused on offering the nursing students a set of hands-on therapeutic techniques and self-care approaches to address their stress and that of their patients.

Angela Smyth blogs: Clinic started Tuesday morning. Although our space is a long way from the primary care clinic, we have networked with the other hospital providers and made them aware of our location and availability. We saw the first six patients today. All of the patients have their medical problems ruled out before they come to see us in our clinic.

Today most of the patients presented with somatic signs and symptoms related to the trauma of the earthquake. One young woman was convinced that she had a cancerous growth in her abdomen and was unable to eat/swallow. There was another older woman with pain all down the left side. Most of the patients have trouble sleeping. Angie also had a therapy session with a patient, first seen by Kobie, who is grieving the loss her 2 year old daughter.

At moments, it can seem overwhelming to provide education to Haitians about mental health. Even the educated people have very fixed ideas about psychiatry. If we can pass on the value of mental health to a few nurses, we can make a difference for patients, their families and the community. We hope to include some outreach to key stakeholders who are interested in providing counseling and support in the community. As an example, we plan to meet with pastors who provide pastoral counseling to their parishioners. In Leogane, the church and their pastors provide significant support for the local community.

Rachelle Rene blogs: Despite the daunting task of educating people here about basic psychiatry and psychology, the nursing students have been extremely eager and receptive to learning from us. They asked a lot of questions and are grateful for any and all information we provide. The nervous laughter they exhibit when we begin to teach them some simple relaxation techniques quickly gives way to enthusiasm and openness.

Everything here has to be customized within the context of the Haitian culture. Simple visualization techniques have to incorporate Haitian idioms and imagery. The response is greatest if the students are able to come up with the examples themselves. In helping them to recall what they have done to cope with stress prior to the earthquake helps to set a foundation for what tools they can engage in again and hopefully teach their patients. We emphasize that self-care cannot be understated.

There is a lot of need here in Leogane, on all levels. We want to make the best out of our time here and hopefully leave a lasting impact; one that can be sustained by the people who will remain here to continue the work. That being said our presence among the locals here, the children especially seem to have an impact already. They are a resilient bunch these children; always smiling and happy to see us when we walk by. You would never know that they have no home, no bed to sleep in or that the sandals on their feet are torn. It really drives home how much we can sometimes take for granted.

Heather Muhr blogs: Moments of gratitude are abundant. A few examples follow.
1-When sharing with her classmates about stress, a nursing student with a distant, flat affect states that she does not wish to connect with the world or talk to anybody about feelings related to her stress. After the self-care exercise in which the same nursing student identified dance as a place of celebration, I see her dancing alone in the back of the classroom with a big smile on her face.
2- Another nursing student recognizes that ‘denial’ is how she is coping, she admits to the group and to me that she wants to talk about “it” (“it” is the denial and/ or her stress response to the earthquake).

3-Ah-ha moments: A young woman I saw in the clinic lost her sister in the earthquake. We talk about grief, and discuss ways to seek support for her grief. She smiles brightly(”ah-ha”), and pulls out a book from her purse in French. The title of the book is loosely translated as, “Working with the problems of young adults in marriage and the Christian family”. She carries this book with her in her purse wherever she goes. She admits to finding a lot of support for her grief from this self-help book. This book also reminds her of the support available to her in her church community.

4- Resilience. Every day a group of young Haitian boys and girls from the tent city outside our front door join us in a run to the beach. As they run, fast, with their almost bare feet for five miles, they recount in Creole or French their loss and losses from the ‘evenement’ (earthquake). There is loss of their parents, the loss of their siblings, the loss of their family members, the loss of their home, and the loss of their limbs. The resilience of the Haitian children is not lost.

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