24.2.2010 General Hospital
It is now over a month since the earthquake. We have just had
the three days of mourning here in Port-au-Prince. The flags have
now gone up again throughout Haiti. There is normality now to daily
life. Walking past and over the rubble, and getting used to the
tent life of almost everyone and still an even greater number with
no shelter. 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 have had a
few recent quakes in the past few days. Further bits of buildings
crumble and fall.
We went to the inpatients at the General Hospital. There are
many stuck inside a building and immobile. They were all very
scared of further quakes and the roof falling in on them but at the
same time were very stoical and gracious. Just as we were about to
start to think of returning to buildings the quakes have held us
back. I have managed to sleep through every quake so far and seem
oblivious, even when everyone else is running out of buildings!
That’s something I’ve got to change! For anyone who has experienced
the earthquake, they seem primed here to feel an intense visceral
fear and run out of buildings as fast as they can. Normality also
returns with rubble clearing. This may well expose more of the
Local people are trying to salvage anything they can - metal,
wood. What is most alarming is people going into the ruins of a
huge market in Port-au-Prince as in the picture. There is a central
hall which has multiple floors of pan caked building above it. Yet
these children and adults risk their lives every day going in to
see what they can find.
We are seeing a lot of patients who have an anxiety and
somatisation state. They are fearful since the earthquake and fear
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. The family are on the streets since the earthquake. With
the change of routine and the stress he has started to bite himself
severely on his body, causing severe self-inflicted wounds.
There are a lot of people, women
particularly, who have gone mute since the earthquake. I still
can’t work out what this is exactly. Is it a type of
dissociation/shock, depression and anxiety? Another woman today was
screaming and wailing with an abdominal pain. She has been a
frequent attender at the emergency tent. This is since the
earthquake where she lost her parents, brothers, sisters and
Another case I saw was an aggressive young man in our emergency
room. What was a most difficult task as a UK psychiatrist was
having to restrain and tie him to the bed with bandages. I was
impressed with how humanely this was done and helped by his mother.
It is an uncomfortable thing to watch when I compare with UK
psychiatry. Here, there was no option at that time.
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!
Personal blog written by Dr. Peter Hughes, Psychiatrist working
at International Medical Corps
Based at Southwest London and St. George’s mental health NHS
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