February 7, 2010

Letters from Cap-Haitien: Dr. Ralph Saintfort Describes Psychological Impact of the Earthquake on Survivors

Through personal emails between two colleagues, we get an idea of what conditions are like in Cap-Haitien, our sister city in northern Haiti. The excerpts that follow are written by Dr. Ralph Saintfort, a psychiatrist from Rock Island, Illinois, who has been a clinical volunteer with Konbit Sante since 2003. Dr. Saintfort was born in Haiti and lived there with his family until he was 14. On most visits to Haiti, Dr. Saintfort and his colleague, Dr. Malcolm Rogers of Scarborough, typically teach a variety of psychiatric subjects to medical residents and house staff in Family Medicine and Internal Medicine at Justinian University Hospital in Cap-Haitien. Now the focus has shifted dramatically.

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[January 26, 2010]

Hi Mac. I miss you. It's been hard to e-mail. Both Nate and I are up catching on e-mail (it's about 5:30 a.m.)...service has has not been reliable and staying in touch with people has been difficult. Every staff member here has had a loss or two. They too need some emotional support.

	A large group of people gather outside the gymnasium where they will register as new arrivals to Cap-Haitien, receive food, rations, and be triaged for medical care.

You may have seen my post late last night about working along side two Haitian psychologists (Noesil Elise and Huandy) that I met at the local gymnasium. The gymnasium is two blocks from the Justinian. It has become a processing center triaging displaced people from Port-au-Prince. These people arrive with various needs: shelter, food, medical, and psychosocial. I have set up a makeshift mental health clinic in two areas in the gymnasium; one area for individual therapy/evaluation/acute case management, and another area for group psychotherapy. The group psychotherapy sessions are on a rotating basis for 45 minutes to an hour at each interval. I have better impact doing this, reaching more people at once. They are good patients and get the hang of it very quickly. For people with more pressing issues ie: pre-morbid depression or anxiety, prior hx/o trauma, or suicidality, they get pulled aside for more one to one evaluation or counseling. Also some people are seen first one on one based on what they report on their triage sheet. I have been giving out benadryl as a sleep aid and tylenol for pain relief. I do not have any anxyolitics on hand, but I have written prescriptions for diazepam for those with panic attacks. We now have a system in place that the local civil workers are comfortable with and they are grateful to have this resource on site.

Getting back to Justinian folks. The mood is somber among many staff members. They are overworked. No new interns or residents are coming to Justinian at this time. They were due to report to duty to Justinian in the middle of January. Those rotations have been delayed. I saw Dr. Gena and Dr. Pierre for the first time yesterday. Dr. Gena was at the hospital briefly in the morning, but gone by noon to attend to a wake in the family in Limonade. He has a sister who suffered an open fracture. She is receiving treatment at a hospital outside of PaP. He has family members that are missing, not heard of yet since the earthquake. He is good spirit, however, and very pleased to see me. I am too pleased to see him. We have set up an agenda for the week that includes: local radio program discussing mental health issues related to the earthquake, two separate sessions for group counseling for house staff and administration.

They too need some intervention to process what has taken place. They are dealing with the same issues that I have encountered among those affected by the earthquake.

I do not want to forget this. I have reconnected with Margarette. She is the psychologist we met previously working on the CDC AIDS project. She has joined me along with the two psychologists mentioned above. She too saw patients with me. At the end of the day I did do some didactic with them on PTSD, GAD, PA, and MDD. We touched based on bereavement issues also. I have found some kreyol screening questionnaires for PTSD. I plan to start using that today....more on that later.

Ralph

[Then later on on January 26, 2010, he wrote]

	Dr. Ralph Saintfort (center) and his colleague from Family Medicine, Dr. Gena (left) and host (right), provide education and answer callers' questions during a Cap-Haitien radio program.

Hi Mac. I have been pretty busy, and I am feeling pretty useful. The system I've developed at the local gym is working quite well. The volume of people I have provided services to has increased significantly. I had several young students in a couple of groups today. They are devastated by loss of friends, family members, school, and their teachers. Many of them feel great sense of despair over their future.... no education equals more poverty. They are lost! Schools here in Cap-Haitien are still closed. I still walk daily to the hospital, but I miss the ambience of the morning rituals that you and I had grown accustomed to on prior trips; kids going to school, parents walking their kids to school, the array of colors of the school uniforms representing various schools. I am heart-broken! I walk now toward the hospital with more urgency to get to the emotionally wounded, lost, and confused. My Haiti cherie is badly battered, broken, and its people are in great need of comfort and consoling. My work here is not done.

Edy has been a great resource in helping me negotiate with a local radio station to do a program focusing on the psychological impact of the earthquake. Dr. Gena and Dr. Pierre of Justinien Hospital will collaborate with me on this effort. The local radio station has a large audience that also reaches listeners in PaP. They have agreed to record the program and rebroadcast it a couple of times. This will be a great opportunity to do some psychoeducation on the many issues confronting those affected by the earthquake. We will take questions from the audience during the program. There is more to be done in the days ahead. I will keep you posted.

Best, Ralph