The ongoing challenges in response to the devastating disaster in Haiti continue to occupy front-page news around the world. As I wrote in an earlier blog less than a week after the earthquake hit, weeks must pass before any successful, enduring attempts to help tens of thousands of traumatized Haitians avoid what later could become Post Traumatic Stress Disorder, or PTSD. The window of opportunity remains open for an organized mental health response amidst the overwhelming despair that many of us cannot see.
There are a few seasoned mental health responders on the ground now. For the most part, they are distributing crayons and paper, guiding children and families through the process of naturally coping and comforting citizens as they return to a sense of safety and a new future; however, while these efforts are a salve to bruised psyches, much more needs to be done soon.
According to a close friend and colleague (I'll call her Mary), a member of the U.S. Health and Human Services Disaster Response Unit who was on the ground in Port-Au-Prince within 48 hours after the quake hit, the Emergency Phase I had previously outlined in an earlier blog is still very much the main focus of most relief agencies, NGOs and government aid. The distribution of clean water, nourishing food and appropriate clothing and shelter is, and will remain, priority number one for much longer than was initially expected.
This has not stopped volunteers and "disaster tourists" from flocking to Haiti to lend a hand. Many are befriending children on the streets, comforting families and simply showing genuine compassion. While their intentions are in most cases honorable, the sheer numbers of responders has become a burden to an already overcrowded landscape. It has been estimated that as many as 10,000 caregivers now have a presence in Haiti with no clear direction or organizational structure to prioritize need. More organizations are planning large efforts in the coming months.
In my blog of two weeks ago, I made it clear that our agency and the mental health care teams we organized in past disaster responses in Sri Lanka, Java and Samoa, were not suitably equipped to handle most of the essential needs that other more experienced Emergency Relief groups can. As the second, Recovery Phase begins to emerge in Haiti, we begin to evaluate the level of our own efficacy and the appropriateness of our work. We first considered organizing ways to get our team on the ground within a month or two after the event, but have now concluded that a different need seems to be emerging - one to which we might better respond.
There is one side of what is happening in Haiti now that we are all aware of. The scale of need for help on the part of the population this disaster affected is unprecedented. Already profoundly impoverished and in poor health, Haiti was struck down at a time when she was barely on her knees and on the way to standing on her own. But another side to this story - the very real impact on first responders - raises a critical need for care not unlike that of our veterans who have returned from Iraq, Afghanistan and Viet Nam.
Mary shared her experience with me as one of our own government's first responders. Half of it we have seen on television and read online or in print, but a far less visible impact was evident in her narrative. While she and most others on her team are seasoned first responders who have worked at many a "ground zero" since the bombing of the World Trade Center, nothing before Haiti exposed them to such a massive, concentrated assault on the senses. Trauma effects our five senses first, then the emotions and lastly our physical body.
It is that which we see -- piles of dead bodies, people carrying the injured from collapsed building, people digging through rubble with their bare hands to find survivors -- that bores into our psyche, whether in war or following an earthquake.
What we hear -- the injured in pain, wailing in agony with no relief, a husband and father crying out upon learning that his whole family had perished, a last dying gasp of an infant, a small boy's scream as his leg is severed with a hand saw-- that echoes in our nightmares.
The smell of rotting corpses that causes most to gag and nearly pass out, the taste of mud, dust and soot in the air from debris and the ever present feeling of aftershocks that reverberate like gunshots all re-traumatize our deepest cellular memory.
Behind the story of handing out food and water, comforting the wounded with crushed limbs, and managing the challenges of basic needs, personal safety, security and sleep, every first responder - like every veteran returning from war - has been traumatized, too. First responders need our help if they are to continue to do the good work we all hope continues when another disaster strikes.
The mainstream mental health care answer to victims of trauma is usually a combination of empathic listening, openhearted compassion and where needed, medication. What was once "shell shock" after World War II has been better understood in the chronic diagnoses of PTSD (Post Traumatic Stress Disorder) in the DSM III, the professional diagnostic manual recognized as the final word. Most professionals now accept that the affects of major catastrophes, natural disasters, terrorism and other traumatic events are essentially the same as those seen in veterans of war. The difference lies in our ability to prevent PTSD from forming in the body, as our memory does not become somatic for 90-120 days after the initial trauma. What this means is that we do have time to heal - not only the children in Haiti but also those who bravely responded to this disaster and rushed to offer care while most of us remained at home.
What this also means is that if we don't take care of the caregivers with at least some body-centered methodologies, we will likely see Mary, and others suffer some form of PTSD. It is therefore my intention, and that of my colleagues, to organize a few simple programs that care for the caregivers returning from Haiti now and in the coming weeks.
In an effort to support those who do respond to populations after a disaster, I'd like to share some specific body-centered approaches that we have used very effectively following the 2006 earthquake in Indonesia. There is no doubt that in the right hands, a box of crayons and some blank paper can stimulate a valuable process of opening up and sharing; however, to address the sensing body and not just the emotional memory and cognitive aspects of reintegration, we must also employ physical exercises designed to release fear, grief, and anger that every victim still carries - veterans, first responders and Haitians.
Basic human nature makes it possible for most people to recover from a traumatic event with little or no counseling or support. Every individual knows instinctually how to protect his or her life and acts accordingly; moreover, the sensing and feeling nature inside each child has a remarkable capacity to reorient life after tragic events if given loving support. A very small percentage of children will need more intensive interventions as a result of many factors, i.e. the nature of personal loss, the history of family and social interaction, the degree of personal bodily harm, etc. These special cases, too, can most often be returned to a happy childhood over time.
Normal coping mechanisms are available to children as well as to adults and it is the main role of mental health care professionals to point this out. While there is a reasonable concern for each child's well-being, most kids (and adults) will recover from this event and go on to lead happy, productive lives with no lingering affects. Avoiding symptoms of PTSD from emerging months from now will mean facilitating the expression of the initial shock of the event to the sensing body.
In my next blog, I'll share simple, specific approaches in detail as well as expand on how effective one-day, no-cost workshops could be organized for caregivers who return from the Caribbean. We must begin to consider the possibility that we now have two populations who need our support.