PBS NewsHour recently interviewed Father Eddy Eustache, a priest and psychologist who serves as Director of Mental Health and Psychosocial Services for Zanmi Lasante, PIH's sister organization in Haiti. Below is an excerpt from the interview. Read the full piece at the link below:
Q: What are the most common mental health challenges you are seeing in Haiti at this point?
A: Almost four months after the earthquake we are seeing people having various kinds of emotional distress responses. These include difficulty sleeping, heart palpitations, somatic complaints, and significant sadness, worry and anxiety. Some of these can be seen as normal reactions to a highly abnormal situation. However, the level of distress for many is severe. We also see people who have developed psychotic reactions, and other more acute mental health problems, since the earthquake.
One major challenge is a general lack of services in Haiti to address significant mental health problems. Haiti had few mental health professionals, and limited organized mental health services prior to the earthquake. There was not a clear understanding of the prevalence of mental health problems in Haiti prior to the earthquake, but we can expect that the mental health dimensions of the earthquake, overlaid on the pre-existing issue of poverty, will have significant ramifications for mental health. Our hope is to further develop the services needed to assist with such problems, in a culturally appropriate way, for the long-term.
Q: How are mental health workers trying to address the needs?
A: Interventions are needed that respect people's capacity to recover from such an event, that do not pathologize normative responses to such a terrible circumstance, that do not risk harm to individuals, that have some evidence for their efficacy, and that are appropriate to the Haitian context.
At Zanmi Lasante [Partners in Health] we have expanded our team to 17 psychologists from three prior to the earthquake, and to more than 50 staff focused exclusively on mental health and psychosocial services. We have been working ... to provide communal opportunities for mourning, to develop community-based supportive interventions in collaboration with schools and churches, and we have expanded basic clinical services.
This has included training of doctors and nurses in management of acute mental health problems, and planning for expansion of the system of care to include community health workers attuned to mental health, and development of effective referral networks to providers.
Read the full interview at the link below:
In response to the devastation following the 7.0 magnitude earthquake that ravaged Haiti on January 12, 2010, Partners In Health (PIH) and its sister organization, Zanmi Lasante (ZL), with 4,403 local staff and a large network of public hospitals and health centers, immediately began delivering treatment and care to earthquake survivors in Port-au-Prince and across the Central and Artibonite Departments.
The long-term ramifications of this disaster will be significant and far-reaching. To address them, PIH/ZL has taken on relief, recovery, and rebuilding activities in three core areas: clinical services, social and economic support services, and health systems strengthening. This report outlines PIH/ZL’s activities in these program areas from January 12 through April 12, 2010. Highlights include:
• In the first month after the earthquake, PIH/ZL emergency medical efforts treated 4,961 critically injured patients through facility-based interventions, set up, stocked, and staffed 25 operating rooms, identified roughly 1,000 additional patients and referred them to collaborating medical relief organizations, and evacuated 140 patients to the USNS Comfort and hospitals abroad.
• PIH/ZL established clinics in four settlement sites to serve the basic healthcare needs of 88,000 displaced people in Port-au-Prince. Since January 25, these four clinics have treated more than 50,000 patients.
• During the first three months, PIH/ZL hired 358 additional local staff, shipped more than 422 tons of medicines, supplies and equipment, and deployed 516 clinical and technical volunteers.
• PIH/ZL has already supported more than 10,000 people and their families with social or economic support in the form of cash, food, agriculture assistance, educational support, jobs, or other services over the course of the past three months.
• Bolstered capacity at our 12 clinical sites in the Central Plateau and Artibonite to meet the needs of both thousands of injured survivors and tens of thousands of displaced people, who are in need of basic health services.
PIH/ZL approaches “building back better” in Haiti with the same values and principles that have guided our work for many years, namely: partnership with the Government of Haiti to achieve sustainable, long-term improvements to the country’s public health system; pragmatic solidarity with the Haitian people to address their basic needs; and a comprehensive approach to help lift communities out of poverty.
Please open the attached PDF for the full report.
The long-term ramifications of the earthquake in Haiti, already the poorest country in the western hemisphere by a wide margin, are staggering. One month following the devastation, PIH began to move beyond the acute phase of response in order to formulate and execute medium and long-term plans for the rebuilding of lives and livelihoods, communities, and the public health system. Though we are sure our plans will continue to develop as the needs on the ground evolve, on February 12, 2010, PIH launched a Fund for Building Back Better in Haiti to support a three-year recovery and rebuilding plan with an initial budget of $125 million.
Below we have outlined the current projected activities and efforts that the Fund will support with the knowledge that the scope of our interventions, and therefore the size of the Fund, may grow in the months to come.
Medium-Term Activities (1-6 months)
1. Continue urgent medical and surgical care operations for earthquake survivors.
PIH/ZL will sustain our expanded volunteer deployment, logistics, warehousing and distribution system in support of the increased demand for medicines, medical and surgical supplies and equipment and the need for specialized surgical and medical teams to reinforce and help train our existing staff. These efforts will continue to serve patients in Port-au-Prince at the University Hospital (HUEH) and at PIH/ZL facilities in the Central Plateau and Artibonite Departments.
2. Sustain community-based care and mobile clinic outreach within Port-au-Prince.
PIH will operate mobile clinics serving between 80,000 and 100,000 displaced people within five or six communities in Port-au-Prince to provide comprehensive primary health care, reproductive health services, treatment of pediatric malnutrition, HIV testing and referrals, and disease treatment and prevention.
3. Provide assistance to displaced people and affected households in PIH/ZL's catchment area.
In collaboration with partner organizations and through our existing community-based social and economic support initiatives, PIH/ZL will help strengthen food & agriculture, housing, safe water, education, and income generation programs for the most vulnerable people in the areas we serve.
4. Build capacity for acute trauma counseling and overall mental health services within our sites.
With key partners, PIH/ZL is conducting an initial needs assessment at our sites and in the spontaneous camps. The assessment is particularly focused on identifying consultation psychiatry needs, developing a training plan for staff and community health workers, outlining additional medicine requirements, and defining key psychosocial support activities.
5. Support the social and economic needs of Zanmi Lasante's more than 4,000 staff.
Almost all our Haitian staff have lost family members in the earthquake and are taking in relatives who have nowhere to go. To ensure these front-line workers, the majority of whom are medical personnel and community health workers, can continue to perform their jobs over the long-term, PIH/ZL is distributing financial assistance to staff to help them with basics during this very difficult time.
Long-Term Initiatives (2-3 years)
1. Expand capacity for specialty clinical services needed to care for earthquake survivors.
PIH/ZL will develop new facility and community-based capacity for post-operative care, rehabilitation and physical therapy, and mental health services by forging strategic partnerships, recruiting additional expertise, and conducting extensive training. Surgical care will be greatly strengthened at all of our facilities in the Central Plateau and Artibonite, with higher-level surgery available at five hospitals and capacity for emergency obstetrical care available at all sites.
2. Strengthen our clinical operations and the public health system.
In partnership with the Haitian Ministry of Health, PIH/ZL will strengthen our network of community health workers as well as the clinical operations at 12-15 hospitals and health centers that provide comprehensive health care to our catchment area in the Central Plateau and Artibonite Departments, which together may grow from 1.2 million to 1.7 million people.
3. Build and renovate public health infrastructure.
Construction and renovation projects, in the form of new hospitals, training centers, pharmacy/warehousing buildings, surgical suites, outpatient clinics, and inpatient wards, will take place at six sites already identified.
4. Strengthen the public medical and nursing education system in Haiti.
A new hospital and teaching center will be constructed in the town of Mirebalais, which is estimated to serve roughly 450 patients per day. The Mirebalais facility will serve as one of Haiti's national teaching hospitals, with PIH/MSPP facilities in the Central Plateau and Artibonite serving as satellite teaching sites.
5. Expand PIH/ZL's programs for social support, community development, and poverty alleviation.
Roughly 2,000 additional community health workers will be hired and trained to work in tandem with mobile clinics, health centers, and hospitals to expand the reach of services.
On February 11, 2010, Dr. Paul Farmer articulated his view on the crisis and need in Haiti: "We are in uncharted territory here, and a certain humility about diagnoses, prescription, and prognosis is surely warranted...So what is to be done? ... Might addressing the acute needs of the displaced and injured afford us a chance to address the underlying chronic condition?" After some reflection, he summarized, "So the diagnosis is: natural disaster in a setting of great and longstanding privation... Haiti needs to build back better and stronger than before. This, then, should be the treatment plan."
While PIH/ZL's role in building back better is only a small piece of Haiti's overall plan, our vision of accompanying Haiti has resounding effects in the small country and beyond. As of February 12, 2010, we have raised roughly $57 million toward our $125 million plan to build back better. Our expectation is that $15 million will be spent before July 1, 2010, and an estimated $110 million in the two to three years that follow. We welcome and encourage both longstanding and new partners to contribute to the STAND WITH HAITI Fund as a way to engage in sustained, long-term recovery to rebuild lives, livelihoods, and communities.
With thousands of survivors needing amputations to save their lives following the January 12 earthquake, the PIH/Zanmi Lasante team has been increasingly concerned with how to help amputee patients literally get back on their feet.
A partnership with Hôpital Albert Schweitzer (HAS) is starting to fit these patients with prosthetic devices. With a well-stocked factory in partnership with prosthetics manufacturer Hanger, HAS has already begun accepting patients referred by PIH/ZL from the Central Plateau and Artibonite regions.
In early March, the PIH/ZL team brought three patients with lower extremity amputations to HAS for their prosthetic fitting. Staff noted the immediate change in the women as soon as they received their new legs--they were each able to stand up and walk with the aid of parallel bars, and quickly left behind their fears, prejudices, and doubts with each determined step. PIH/ZL staff also report that the three women are now able to walk as well as kick soccer balls - and next up on their agenda is dancing.
These three women are just a few of the patients who have undergone procedures at our hospitals and will be receiving prosthetic care through this partnership. Thank you for enabling this work!
PIH had more than 100 doctors, 600 nurses, and a total of 4,000 Haitian employees on the ground in Haiti working from 12 existing PIH medical facilities in Haiti before the earthquake struck on January 12th.
• PIH quickly established field hospitals in Port-au-Prince, helping set up 20 operating rooms, 12 of which were able to function around the clock.
• PIH established a comprehensive triage and relief transfer system to move patients back and forth from Port-au-Prince to PIH sites in the Central Plateau and Lower Artibonite Valley.
• PIH is evacuating patients in critical condition to hospitals in the United States and Dominican Republic as well as to the U.S.N.S. Comfort.
• PIH has sent 66 plane loads with more than 235 medical volunteers – orthopedic surgeons, anesthesiologists, surgical nurses and other medical professionals – and roughly 100,000 lbs of medical supplies to support the large network of PIH’s local health care providers already working in Haiti.
• The long-term ramifications in Haiti are going to be significant and far-reaching with a new, large group of vulnerable and displaced people. PIH has the experience and commitment to Stand With Haiti for many years to come.
Looking ahead, PIH’s efforts will be spent in three core areas:
1) supporting the public sector’s ability to provide health care;
2) mobilizing people at the grassroots level to participate in the health care system; and
3) addressing the mid- and long-term health, social, and economic ramifications of the resettlement of tens of thousands of people from Port-au-Prince to areas where PIH works.
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