Five things I've learned

My sister in law, Melissa was just visiting for a week from Canada.  Melissa works as a psychiatric nurse with children and adolescents, she spent the mornings educating our clinic staff and treating patients.  In the afternoons she was teaching nursing students in Dr Rodney's medical school. Here are her reflections on her time in Haiti...

After a week of working at Bethesda Medical Center, teaching staff, seeing patients, and lecturing in the nursing school, I want to share 5 things that I learned:

It is wrong to assume that healthcare professionals in Haiti know nothing of mental health.

In my teaching at the nursing school, I came with the assumption that they would know very little. I was surprised to hear that they had a psychiatry component in their curriculum and the national registration exam includes psychiatry. They covered schizophrenia, Alzheimer’s, depression, and anxiety. I had the general impression that their psychiatric practice was not current, and this might be because of a lack of current teaching materials and textbooks.  Because so few professionals are doing psychiatric practice, the students would have limited exposure to adequate clinical placements.

As always, it is better to understand what people know, and partner with them to fill in the gaps. I talked with the academic director and adjusted some of my presentations to match with information she thought relevant. I provided the newest version of the DSM 5 (the diagnostic manual of mental illnesses) in French for use at the nursing school and the clinic. I hope that access to diagnostic information will help the assessment of many patients. I also gave my slides and talks to Julie to find someone to translate. I would love to be able to provide more resources in French that would be helpful for the students and staff.

Where mental health treatment is not available, people suffer.

Because of the limited psychiatric care in the north of Haiti and wide-spread poverty, most people with mental illness do not have access to treatment.

We saw a young man who had struggled with symptoms of bipolar disorder for about 10 years. He became aggressive at home when experiencing mania. The family’s way of dealing with his behavior was to tie him up. He came to our office with his hands tied together behind his back. We were able to prescribe a medication that should help regulate his mood and treat his psychotic symptoms. We told the family that they should not be tying him up (especially when he was not experiencing mania), and that with effective treatment the manic episodes should be reduced if not eliminated.

People are resilient.

Dr. Rodney Baptiste and I saw a woman who had been struggling with symptoms of bipolar disorder. She would have days of not sleeping, as well as psychotic symptoms, such as feeling like Satan coming after her and hearing voices. Many people had prayed with her with no change in her symptoms. She had seven children and was managing to bring one of her daughters on a regular basis to see Julie for Physiotherapy. I cannot imagine how difficult it would be for someone to be as consistent in caring for her children as this woman. Dr. Rodney will be talking to his medication provider to see if he can get some Quetiapine (a mood stabilizing drug that is also an antipsychotic) at the clinic, as this woman would not be able to afford the medication otherwise. This woman was functioning much better than I would have expected.

Another patient we saw was a man suffering from HIV. He had lost some of his family because of his diagnosis and he also lost his job. His life was very difficult. As I was assessing symptoms of depression, I was surprised at how well he was coping and how much fight he had to continue to battle poverty and hunger.  He was very resilient man.  He continues to be supported at Bethesda for HIV treatment and social work.

Having someone understand your symptoms is validating.

Dr. Rodney and I saw a young woman suffering from panic attacks. As I was asking some diagnostic questions about this experience, I could tell that she knew that we understood her experience.  She started to cry.  I was able to give her some relaxation and breathing strategies to help her cope with her panic attacks.

At Bill and Julie’s home, I met with one of Julie’s friends. Her husband was murdered 2 years ago, and she has 4 kids. She has been working to support her family.  She has periods of time where she feels really heavy and sad.  These feelings are totally normal for someone that has gone through such a traumatic experience! The grief feelings have become less over time and were not getting in the way of working or caring for her family. In my opinion, was processing the grief and trauma well. Her strength has allowed her to be a good example for her children and for the rest of the family. I think sometimes it is helpful just to have someone tell you that what you are experiencing is normal.

Hope comes from the people.

There is no psychiatric hospital in northern Haiti. The psychiatrists that I learned about were ones that lived in Port au Prince, and traveled to see some patients in the north. There is a real lack of psychiatric services in the Cap Haitian area. 

I was really impressed by the curiosity and desire to learn of the nursing students and staff, including Dr. Rodney. I really think that they want to do the best they can for the patients that they see. I believe that with more knowledge and resources, that they could be a leading resource in northern Haiti.

Finally, I want to thank Julie Edler (my lovely sister-in-law) for asking me to come to Haiti, and Dr. Rodney Baptiste for translating for me, putting things into cultural context and for seeing patients with me. It was a great (and exhausting) week.