In August, Haiti’s health care system registered a major victory: the first COVID-19 patient to survive intubation and mechanical ventilation returned home to his family after 29 days at the University Hospital of Mirebalais, the state-of-the-art facility that has served as a lifeline for patients from across the country.
Yet even a hospital as well-equipped as Mirebalais can do little to alleviate the psychological effects of crises—from COVID-19 to the devastating 2010 earthquake—that have laid bare systemic inequities and compounded the hardships of daily life.
And as researchers with Partners In Health (PIH) found in a recent study, young people in Haiti are made especially vulnerable by their chronic exposure to stressful life events.
“We are exposed all the time to different types of trauma,” says Father Eddy Eustache, an ordained Catholic priest and the director of mental health with PIH’s Haitian sister organization, Zanmi Lasante (ZL). “Mental illness in Haiti exists on a large scale, and because of the worsening situation, that need for care continues to grow. So, we think the services we provide should be scaled up at the national level.”
Expanding Mental Health Services
Those services began in earnest in the weeks after the earthquake, when “Père Eddy,” as he’s known to friends and colleagues, met with Dr. Giuseppe “Bepi” Raviola, PIH’s director of mental health, to plan a coordinated mental health response.
In addition to the post-traumatic stress disorder (PTSD) it exacerbated, the earthquake revealed just how significant the burden of mental health conditions already was, with high levels of depression, anxiety, and stress have developed over decades of unemployment, violence, and political instability—or what Père Eddy has described as the “poverty package.”
It also exposed the severe lack of mental health care at that time—just a pair of psychiatrists for a country of 10 million people—and spurred the government and partners to act.
In the decade since the earthquake, ZL has expanded its mental health team to include 15 psychologists and social workers, who work in 12 clinics across the country. They’ve also trained 156 community health workers to address depression, anxiety, bipolar disorder, epilepsy, and schizophrenia. ZL has also published research around its long-term mental health response to the earthquake, as it built up a comprehensive, sustained mental health system to serve 1.5 million people.
Still, says Père Eddy, they’re fighting an uphill battle and not least because of the persistent stigma associated with mental health conditions. “There’s a lot of fear and shame,” he says. “And as a result, there isn’t the political will to address it.”
The Burden of PTSD Among Youth
That led to Père Eddy and colleagues to study the effects of the earthquake on the mental health of Haiti’s youth. In the study, published in 2018 in the Journal of Psychiatric Research, Père Eddy and colleagues analyzed data collected about 4 years after the earthquake from a mental health assessment conducted at a secondary school in Haiti’s Central Plateau.
Although the earthquake had centered in Leogane, a city on the southern outskirts of Haiti’s capital, Port-au-Prince, some 90,000 internally displaced persons migrated to the Central Plateau, including many of those who had been injured.
What the study found was concerning. The mental health assessment had included a Stressful Life Events Checklist—a 13-item questionnaire documenting exposure to a broad range of stressful life events, including sexual abuse, armed conflict, and separation from family.
Of the 120 students who had filled out the assessment, all reported at least one stressful life event; nearly three-quarters reported witnessing others being physically mistreated, and 42.5 percent said they had experienced physical mistreatment themselves. Additionally, just over 58 percent reported that there was a time when they felt that their life was in danger, and nearly 57 percent had experienced the death of a loved one.
To the surprise of the researchers, the study found that exposure to an earthquake or other disaster was not significantly associated with having PTSD. Nonetheless, it offered further evidence of the immense burden of PTSD among youth in Haiti.
“The earthquake did not bring mental illness to Haiti,” says Père Eddy, “but it did present to us an opportunity to raise awareness about the urgent need for quality care—to say to the world, ‘Something has to be done.’”
‘Unity of the Body and Mind’
In January, just as the first reports of the novel coronavirus were surfacing in China, Haitians commemorated the 10th anniversary of the earthquake and its more than 300,000 victims.
Reflecting on the legacy of the earthquake, Père Eddy says policymakers must understand the importance of mental health—what he calls “the unity of the body and the mind.” Ignoring mental health, he says, will only exacerbate poverty, feeding a cycle that is sure to continue in the absence of quality care.
“Dr. Farmer described the earthquake as ‘an acute and chronic crisis’ that compounded what was already a very difficult situation,” says Père Eddy. “And as our study shows, that’s true of mental health too. The exposure to stress was not a one-time event; it’s a product of the violence and poverty people live every day.”
Still, he remains hopeful: “We’re taking this opportunity, in the tenth year since the earthquake, to say to all: ‘We want these programs to continue and to grow so that more Haitians can have access to mental health care.’”