For me, pictures showing the levels of destruction in the south of the country immediately recall the earthquake of January 12 2010.
This has also been the observation of many of my colleagues – psychologists, social workers, humanitarians and professors at the State University of Haiti – who have visited the ruined cities of the South, Grand’Anse and Nippes regions. Aerial pictures show the cities of Jérémie, Dame Marie, Les Cayes, Port Salut and others in a state of total devastation.
Hurricane Matthew has once again exhibited the vulnerability of the modern world’s first black republic to natural disasters.
Natural disasters don’t just have physical consequences. When people have been directly exposed to an event in which others have died, and in which they were afraid for their own lives, we can expect them to develop severe post-traumatic stress and symptoms of depression.
In survivors, we also observe recurrent nightmares, psychological distress, trouble concentrating or making decisions, learning difficulties, depressive and anxiety symptoms, and social dysfunction. Research into the earthquake of 2010 showed all of these traumatic consequences.
Survivors of natural disasters also report physical symptoms such as nausea, headaches and chest pain.
Studies in the aftermath of the January 2010 earthquake found that two years later, more than a third of children, adolescents, and adults showed severe symptoms of post-traumatic stress disorder. Almost half of the children and adolescents and more than a quarter of the adults also showed severe symptoms of depression.
We know that time cannot heal injuries associated with traumatic events, and psychological support programs must be created to support survivors. Mental health professionals can work to build therapeutic resilience among survivors without forcing people to talk about the event.
Lessons from 2010
Since the 2010 earthquake, international NGOs have invested heavily in providing psychological support to survivors. But our studies show that these programmes have not been effective, and were often actually culturally inappropriate.
The programmes began at a time when survivors were not necessarily ready to talk about the event because there was no physical, social and cultural infrastructure in the country. Everything had collapsed.
In circumstances like these, we must first recreate an acceptable living environment. As psychologist Alessandra Pigni has written, “You can’t give people peace of mind if they don’t have a home.”
Only after rebuilding can people express their pain and make sense of what has happened to them. This also explains why after natural disasters, few people go to see psychologists installed by NGOs in relief camps, and why the results of emergency social support might not be totally effective.
Long-term studies among populations affected by natural disasters, and the testimonies we have received on the ground in Haiti, have shown that people most need psychological support two years after the event, when normal life has resumed. Sadly, by then NGOs and psychologists are far, far away.
So how can make sure that we do not repeat the same mistakes of 2010 this time around? There are some key lessons to guide us.
Starting with schools
Schools, with all the important people they contain – teachers, student peers and support staff – can be excellent points of first aid. In Haiti, there are fewer than 200 graduate psychologists and 30 psychiatrists, for a population of more than ten million people. So it is essential to support existing help systems, such as families and schools.
Training teachers to support children when they go back to school is crucial. Teachers should be given the tools to identify the pain of children, help them with breathing and relaxation exercises, and guide them to relevant services.
Recovery programmes should ensure that all children go back to school, and give special consideration to orphans. The Haitian school is a complex space where humour, sharing, solidarity, generosity, altruism and empathy can come together as what psychologists call “multifactorial factors of resilience” in the face of traumatic events.
In the long term, art programmes should be implemented in the school curriculum, as artistic creation has been shown to be a protective factor for psychological resilience.
Facilitate the grieving process
One of the greatest disasters following the 2010 earthquake was the way the dead were dealt with. Funeral rituals were not respected and the grieving process was not properly facilitated. Almost seven years later, there is still no official list of the deceased.
One of the most important things the government of Haiti should ensure is to have a complete list of the dead and missing. With this list, each city could build a monument to victims, inscribed with all of their names.
In the absence of a personal tomb, this monument will serve as a cemetery where families can come to remember lost ones when the need arises. Considering the role and the importance of the dead in Haitian culture, this will facilitate the grieving process for survivors.
Long-term counselling centres
After rebuilding, a time will come when survivors need psychological support for their traumatic experiences resulting from Hurricane Matthew. For now, counselling units should be set up for those who have lost family members. These cannot be short-term centres; it is crucial to implement long-term programmes that last at least two years.
If ongoing field missions are not feasible, temporary, recurrent counselling missions that last several weeks could be set up periodically in the worst-affected areas. Haiti should consider setting up mobile humanitarian psychiatry clinics staffed by Haitian professionals.
Where local care is not possible, survivors with special needs should be followed up via long-distance phone calls on a regular basis. These programs must be implemented by Haitian Creole-speaking professionals who are knowledgeable of Haitian culture.
Planning for the future
The recovery process from the severe psychological injuries caused by Hurricane Matthew must accompany the physical reconstruction of devastated cities. The Haitian government must immediately take measures to deal with the deaths – this is a part of proper care for survivors.
In the short term, psychological support should rely on existing social structures such as schools and churches.
For the long term, psychological counselling centres should be set up, and they should be appropriate to Haitian culture.
We should never forget one key recommendationfrom Johns Hopkins University’s emergency mental health guide: “community-based mental health care is the best solution”. The aftermath of Hurricane Matthew may be tragically similar to that of the 2010 earthquake, but our response doesn’t have to be.