Bob, a 48-year-old resident of Port-au-Prince, WhatsApp’d a series of texts, photos and videos to his friends abroad in one thread. The first video, in early July, featured a report of gang killings near his home. One week later, he texted, “It’s sad news,” attached to an article about President Jovenel Moïse’s assassination.
Soon after, Bob sent six photos documenting a standoff with police in the capital and, then, a video of foot-deep blackish rainwater, strewn with garbage, rushing through the nearby streets.
Bob, who asked that his full name not be used for safety reasons, ended his thread with the early morning news of the Aug. 14 earthquake on the other side of the country. For the six-weeks of commentary, he summarized, “In Haiti, today, there’s no life. We just survive.”
Bob’s summary speaks to a long-standing view about Haitian resilience — the capacity to bounce back and develop in a positive way following traumatic events and adversities. Various nonprofit leaders and organizations, including Paul Farmer of Partners in Health, UNICEF and watermission.org, have used the word over the years.
Both popular writers and scholars have described the Haitian people during the last decade as resilient. In 2018, BJ Psych International published the paper, “Resilience in Haiti: is it culturally pathological?” The paper concluded, after several post-disaster studies, “The resilience levels of survivors in Haiti were superior to those of other countries with experience of similar natural disasters such as China, Armenia, Japan, Italy and Taiwan.”
Lately, however, many groups and experts have begun to balance the view of Haitian resilience by advocating for and providing mental health support in responding to recent disasters, including the August earthquake.
“Everybody always praises the Haitian resilience … and some patients wear it as a badge of honor, but it’s not really,” said Renate Schneider, founder of Haitian Connection in Jeremie. “Haiti shouldn’t be able to just survive, it should thrive.”
“There’s a limit to anyone’s resilience,” Thebaud said. “Some people might be somewhat resilient because they’ve been exposed to things before,” he said. “But the end result — you’re going to break. It’s human.”
When infrastructure and resources are lacking, people gravitate around whatever they can, particularly someone who gives hope. Pastors, for example, have played a significant role in the whole societal functioning of countries like Haiti.
“When you remove people from the environment where the stresses are significantly affecting them and place them in a protected environment with food, rest, and a break from the stress,” Dr Thebeaud said, “many of them will stabilize — but it’s not long term.”
Providing formal mental health care
Few options are available in Haiti for formal mental health support, such as psychological counseling sessions. One of the few is through Haitian Connection, which began as a wide-reaching program to serve women and children in Jeremie. Over time, the group focused more on mental health services for the area’s residents, offering a community-based approach to bring about healing.
Haitian Connection’s Schneider, who holds master’s degrees in both clinical psychology and pastoral studies, recognizes that Haitians often resort to prayer and that some people look to Vodou priests for help. These bôkôs, “have an amazing knowledge of how people function,” she said, “and often give good counsel.”
“Every single day in Haiti is a struggle to get enough food … to find a job. These kinds of trauma are underlying,” Schneider said.
To help, Haitian Connection trained 25 community mental-health workers in trauma and grief intervention who have worked with almost 6,000 clients. If a worker learns that someone’s brother died and asks how they felt, the answer might be unclear as many Haitians describe their feelings in physiological terms — a headache, tiredness, dizziness.
The staff listens and provides tools to clients that they, themselves, can apply — tools such as deep breathing, listening to sounds in nature and praying. The workers encourage use of somatosensory processes to locate pain in the body and relaxation exercises to minimize their pain. Staffers also play a lot of games — always well received — and work mostly in groups.
“The staff are trained,” Schneider said, “to know when they need to refer a person to Port-au-Prince to a psychiatric facility.”
Soon after the earthquake, Schneider recalled, a priest — one of their mental health workers — asked people to come forward and recount their experiences during a mass. Everyone in the congregation could relate. People cried together. They even laughed together. One hour extended into three.
“I’m very grateful,” said Schneider, “that this mental health program works so well.”
Another formal mental-health program is run by Capracare. Located outside Les Cayes in Fonfrede, the nonprofit organization develops sustainable health and education programs in rural communities. Co-founder Jean Pierre-Louis of Brooklyn, New York, a master’s in public health diplomate, recognizes, “There is no health without mental health.”
Capracare’s staff of seven trained in 2010 with Dr. Joshua Miller, a professor at Smith College, who teaches and writes about psychosocial responses to disasters. The staff helped scores of people who returned to Fonfrede after the 2010 earthquake.
Similarly, two days after the Aug. 14 earthquake in Les Cayes, Capracare’s team delivered its mental health services under its “Psychological First Aid” program. One on one, “they listened actively to their patients, who explained their experience, showed compassion and acknowledged they were not the only people going through this,” said Pierre-Louis, who has a passion to improve health care in developing countries.
Team members encouraged patients to remember good times in the past and moved them into a positive mental space. Within three weeks of the earthquake, they had served more than 400 community members.
Capracare’s approach to health also entails mental health education, yoga and trauma-based acupuncture sessions. “In Haiti, it’s always tense,” Pierre-Louis said. “Those 20 minutes make a huge difference.”
Need to make mental health care a mainstay
Bob, the Port-au-Prince resident on WhatsApp, sounded stressed to his friends who received his messages. They urged him to find a place to give his mind a rest and he scheduled himself to leave with his pastor and 10 others on a week-long retreat outside of Port-au-Prince. Their departure came one day after the earthquake.
Bob enjoyed his retreat and, to his friends, he was much improved. He had risen early and gone to bed late. He prayed, played soccer, danced and jogged. He had eaten breakfast, lunch and dinner, sang every night and made new friends.
“I was the champion of the day,” he said excitedly, a week later, “three times in American dominoes!”
One month after his return from the retreat, Bob texted to his friends, “I started feeling the same badness.” He talked about finding a new place away from the 17 other people with whom he lives.
His friends suggested he take a different approach toward his home and housemates by considering ways that he could engage them in some positive activity. It would not be a long-term solution, but it could help Bob’s mindset for the time being.
“Teaching them to sing songs would be difficult,” he said. Then, he remembered, “We have many Domino players around — good idea!”