Mental Health in Haiti: A Resident's Perspective

Abstract

In March, I stepped off a chartered plane onto the sweltering tarmac in Port-au-Prince to volunteer at the University of Miami Hospital in Haiti. The field hospital was created by Project Medishare and the University of Miami Miller School of Medicine’s Global Institute on January 21, 2010, just 11 days after the devastating earthquake destroyed much of the country’s infrastructure and injured and killed hundreds of thousands of Haitians (1). The hospital was a four tent facility with 240 beds located at the Port-au-Prince airport. It was arguably the most comprehensive hospital in Haiti after the earthquake, with four operating rooms, medical, pediatric and neonatal intensive care units, a pediatric ward, a medical/surgical ward, an emergency room, triage, and wound care and orthopedic clinics for follow-up care. The field hospital moved to a permanent building at the Bernard Mevs Hospital in Portau-Prince in June of 2010. It is run primarily by the University of Miami and other volunteers from around the United States who work tirelessly for 8-day stints. Project Medishare, which was founded by Barth Green, M.D., Professor and Chairman of the Department of Neurosurgery, and Arthur Fournier, M.D., Professor of Family Medicine and Associate Dean for Community Health Affairs, at the University of Miami’s Miller School of Medicine, has been working to provide sustainable health care in Haiti since 1994. As a medical student, I previously had the opportunity to volunteer in Haiti with Project Medishare on two separate occasions to provide primary care in rural villages. As a second postgraduate year (PGY-2) resident in the Department of Psychiatry and Behavioral Sciences at the University of Miami, I was eager to return to Haiti following the earthquake to provide care in any capacity needed. My faculty mentors in psychiatry warned me to avoid pathologizing patients’ normal responses to such extraordinary trauma. Haiti has suffered more than its share of disasters, but the January 12 earthquake was one of the worst natural disasters in history, with over 230,000 deaths and 1.3 million left homeless. Although I was there 8 weeks after the earthquake occurred, most Haitians affected by the catastrophe still did not have adequate access to food, water, health care, shelter, or security. Until these basic needs were met, mental health problems were, by necessity, considered secondary. I volunteered to work with the internal medicine team, partly because I had completed my intern year in internal medicine and felt comfortable ordering antibiotics and pain medications for postoperative patients. However, once my identity as a psychiatric resident was revealed, I provided much needed mental health care to Haitians as well as to some health care volunteers who were overwhelmed by the experience. The resilience and pride of the Haitian people is deeprooted. Haiti was the world’s first independent black republic, the first independent state of Latin America, and the only nation to be formed from a successful slave rebellion. Prior to its independence in 1804, Haiti was the richest French colony in the New World. Haiti’s economy was crippled when France required the small nation to pay a hefty indemnity in order to be recognized as an independent nation. Haiti has since been plagued with corrupt leadership, military uprisings, foreign occupation, and environmental devastation. Eighty percent of the population lives in poverty, half in extreme poverty. It is the least developed country in the Americas. According to the United Nation’s Human Development Index, Haiti ranks 149 of 182 countries (2). Haiti lacks a coordinated mental heath care system. There are two psychiatric hospitals in the country. Defile de Beudet in Croix-des-Bouquets is the sole hospital for the chronically mentally ill. Mars and Kline Psychiatric Center in Port-Au-Prince is the only hospital for acute mental illness. It is a 52-year-old dilapidated facility, which is severely understaffed and under-resourced (3). Received June 20, 2010; revised August 11 and September 11, 2010; accepted September 15, 2010. Dr. McShane is affiliated with the Department of Psychiatry at the University of Miami Miller School of Medicine in Miami, Florida. Address correspondence to Kathleen Molly McShane, University of Miami, Department of Psychiatry (D-29), 1695 NW 9 Ave. #3100, Miami, FL 33136; KMcShane@med.miami.edu (e-mail). Copyright © 2011 Academic Psychiatry