I’m delighted–NBC Washington online just posted a wonderful profile of our work in Haiti. Read about our program and the many people it is helping here.
I’m not quite sure when or even how it happened but Haiti is starting to feel like home. Not in the sense that I have my family with me, or know where to do grocery shopping, or can lay my hands on the books I love most.
It’s something else, an ease with people, a sense of words and actions contributing to something really good – right now and for the future — a welcome, even an embrace that keeps expanding. It swells from the team around me, and from the 120 people — doctors, psychologists, nurses, midwives, teachers, priests and nuns and voudoun healers — who come to our training with great fidelity and teach the techniques they are learning from us to friends, family, and patients as soon as it is humanly possible. “In order to keep the training inside me always, I have to share it with others,” one young teacher announced this morning.
In the days after Yehlie’s first communion we complete the training we began in December. My ‘small group’ of participants, gathered together again, begins as always with a few minutes of soft belly meditation – slow deep breathing, in through the nose, out through the mouth, with the belly soft and relaxed — quieting our nervous systems, our minds and bodies. And then we “check in”, tell each other what has happened since we last saw each other and share what we are feeling “right now.” Already it is becoming a commonplace for us, a way to regularly connect with those around us, outside as well as within the training. “Check in,” laughs one priest, “is almost now a second religion.”
There are still major problems and issues – almost half of our group is still not living in their homes, and there is abiding sadness for those who have died, but there is more energy for understanding and meeting current challenges.
We discuss the short term memory loss that bedevils several people and makes them apprehensive, even in their thirties or forties, about Alzheimer’s disease. I say it is highly unlikely, that trauma has long been known to obscure memory. And one of the other doctors in the group assures us that her memory – devastated amidst the loss of her brother and her husband — has begun slowly to return: “Sharing my emotions, accepting help from others, permitting my own tears – it as if the memory flows back with them.”
This doctor’s face is no longer constricted in pain as on our last visit, but open, changeable, easy with laughter as well as tears. Many of the faces I see are equally changed. James, who is head of psychology for the National Police, scrupulously kind, but painfully thin and equally serious in December, is ten pounds heavier, relaxed, expansive. And the woman I think of as “the Teacher,” as immobile and expressionless as mahogany in devastated grief at the loss of husband and home two months ago, is now a river of feeling and words.
One participant says, “The earthquake brought us so much pain, but also we are seeing it brings good things to the people who survive. Psychology [i.e. traditional therapy] was useless to me and my community – no one could go because it meant you were crazy. Now with CMBM approach I am helping myself and others too.”
Says another, “On January 12th, the anniversary, when everyone in my church was so tense, I taught them the breathing. And as I relaxed I let myself cry, and found my strength, and then we cried together, my children and my friends. And then I sang a song – I have never led a song any time – and I asked everyone to sing with me and praise god. And we did, three songs, and then we all felt more calm.”
It is so encouraging to see the positive changes in our trainees, and to hear that our participants are taking the techniques back to their homes, churches, workplaces. Giving the people of Haiti practical tools for their own emotional healing, and empowering them to teach these tools to everyone they meet, will, we hope, help the Haitian people heal themselves.
I am honored to be at Linda’s daughter Yehlie’s first communion – surprised at first, quickly engaged, and soon moved.
The church turns out to be a metal shed, spacious, vaulted, open on one side, doing duty on other days as classroom, auditorium and gymnasium. There are permanent concrete bleachers against the long wall, and for today worn wooden pews imported, in stately rows facing the altar and lectern that are even now being carried in. The communicants’ chairs are arranged in several rows of nested crescents. Yellow flowers overflow the basketball hoops at either end of the floor.
Parents, siblings and friends fill the pews and bleachers, smiles breaking out in greetings, cameras at hand. Sweet music pours from surprisingly faithful speakers. Nine and ten year old girls in strawberry jumpers sit opposite me, close to the altar – the choir – looking expectantly toward where the younger children will enter as they take their place in the church and with their God. Such gentle order in the midst of Haiti’s general chaos.
100 or 120 little girls in white dresses with wide fluttering skirts and white crowns of linen flowers enter -walking, skipping a little, so pleased and proud. During the course of the morning’s service I notice that each one has a different hairstyle, curls and braids, straight and natural, falling in cascades or caught up in geysers, billowing toward every point of Nature’s compass, saying, I imagine: “This is how I like it” or “This is how my mom and I like it”. Some are obvious leaders, engaged from moment one, with the girls in the next chairs, or eyes bright with ones across the way. Others are more internal, sitting with some poise or fidgeting for a comfortable place.
I count only a few boys, heads shaved, in white dress shirts and grey pants, bow ties like red blossoms under their chins.
Linda’s family and friends make sure I am comfortable, out of direct sunlight, able to follow the service. I am bathed in their kindness, the little girls’ pleasure and anticipation, the sweet yearning of the choir’s voices and the words of the hymns calling, crooning, praising: “Ton amour nous appelle” (Your love calls us); “Merci mon dieu pour ton amour, pour le don de la vie.” (Thank you god for your love, for the gift of life.”) My heart cracks and I cry with appreciation for these girls and their parents and the priest, and the joy and hope they – and now I – feel.
When it is time for the “kiss of peace” everyone is thrilled to share and receive the love. I am too.
“You have planted a seed,” he tells us, before we all go off to bed. “Other ways, like medication and just talking, weren’t working or were too difficult, or even if good, like prayer, were not enough. But this seed is now becoming a tree and it is bearing fruit.”
We are in Port-au-Prince this week doing an Advanced Training in Mind-Body Medicine with 120 Haitian health, mental health and education professionals and caregivers. Please look for more posts in the days to come. More info on our Global Trauma Relief program in Haiti can be found here.
Because our training in Mind-Body Medicine was interrupted by election riots in December, we scheduled half day workshops for our December trainees on January 11th, 2011. It was a place for us to share feelings just before the anniversary of the earthquake, a refresher course, a time for questions and guidance, the opportunity to gather and sit and eat together in our new CMBM Port-au-Prince office. What a treat to have space for people to come- 60 or 80 at a time if we need it – windows that shed light, and a kitchen to cook in.
At the end of our time together we sit silently for a few minutes, morning and afternoon, remembering losses, allowing tears to wet our cheeks and spot our clothes. And then we hear about the help that these men and women are already offering others — in hospitals, schools, churches and tent camps. We make plans for how we will work together with Haitian people everywhere, and the ways we will continue to share ourselves and what we are learning.
Sometimes, on this first anniversary of the earthquake, it feels like very large, steady hands are needed to pull together the two sides of the gaping wound that is Haiti, hands that Michelangelo might fashion for this purpose.
I find myself looking around as we circulate through tent camps with little food and water, no health care or education or employment for the tens of thousands of people I see, for the hundreds of thousands who still live like this all across the region. “How can this be?” I shout – but only inside my head – how can we, Americans, the world community, all of us, let this continue? Our hearts were touched a year ago. Politicians said the right things, famous people answered phones on television and lent their shine to the pleas for help. Billions of dollars were pledged. Where are they? Why is there scant organization, no plan, so little mercy and fellow feeling?
It worries me, as much for ourselves–the privileged, literate, and apparently protected– as for those who live exposed to heat and rain and hurt.
In one of our workshops on January 11, 2011, the day before the anniversary, two men – a priest who tends a devastated parish and an accountant who has left his paying job to bring whatever order he can to two tent camps– share their drawings. (Read more about CMBM’s drawing exercise in this earlier Haiti entry.)
The accountant, a large serious man, sees himself planted in the midst of a quilted crop of families, cooking fires and plastic sheeting; the priest’s drawing of his slim black-clad figure is bright with God’s light refracted through a mirror framed in rainbow colors. The drawings of their “biggest problems” are, with no other guidance, no consultation, virtually identical. One side of the pages shows effort – to salvage and succor, hands reaching out, shovels in the earth – and a row of disconnected figures: “the ones who could help but don’t” “the rich and powerful who do not care.” They are barely sketched, drained of color. On the other side of the page, the people in the camps are suffering, but they do have bodies and expressions.
We need to offer them help, ourselves, in order to be human; and we need this at least as much as they need our help. That is the key to a happier future anniversary.
On the anniversary of their earthquake, Haitian men, women, and children are more likely to tremble anew with fear and contend with reawakened physical, emotional and behavioral symptoms. Chronic headaches and stomachaches that had subsided over months are now returning with renewed force in those living in their own homes as well as in the more than a million demoralized tent dwellers. Sleep, increasingly restless, is more often riven with nightmares of family members buried in the rubble. Children whose beds were dry are once again wetting them. The free-floating anger that had ebbed in many is rising, increasingly visible in family quarrels, child abuse, and street conflicts.
These phenomena, occurring at the same time as the original trauma, a year later (or indeed 5 or 10 years later) are called “anniversary reactions”. They were observed by Freud in 1895 and have been the subject of case reports ever since.
Sometimes a quite conscious understanding and anticipatory dread of the anniversary appear to set the stage: Winston Churchill dying at the same age, and on the exact same day as his father; Elvis Presley, who had announced that “my life is ended,” after his mother died at 42 in August 1958, himself dying early in August 1977, also at 42.
Often, however, the person suffering the anniversary reaction seems to be unaware of the connection. There is ample documentation of people who are surprised to learn that their unexpected anxiety attacks, nightmares, blood clotting disorders, chest pain, or heart attacks have occurred a day or two before the date a family member had died.
Some investigators have hypothesized that ”incomplete mourning” makes one more vulnerable to anniversary reactions, but it’s hard to say, especially in a situation of catastrophic loss and ongoing horrific hardship, like Haiti’s, what ‘complete mourning’ might be. Others see the reactions primarily as conditioned responses triggered by preparation for a memorial, for example, or an awareness of the coming of the season of loss, producing a variety of psychophysiological reactions.
Whatever the mechanisms, it is clear that these anniversary reactions take place on a population wide as well as an individual level. Many New Yorkers report a growing apprehension on clear days in early September that precede each 9/11, and since Hurricane Katrina, New Orleanians’ level of distress increases precipitously each August . Scientific observations confirm these reports. A study of Gulf War veterans published in the American Journal of Psychiatry in 1999 revealed a significant increase in symptoms of posttraumatic stress disorder (agitation, reliving of the traumatic experience, emotional withdrawal) in the same month that the original trauma occurred. And a 2007 study in Stress and Health, showed that a gradual decline in physical and psychological symptomatology in the months after a flood in Thailand, was followed by a marked increase in symptoms as the one-year anniversary drew near.
It is certainly possible to mitigate these anniversary reactions and indeed transform them into opportunities for mastery. The commemorative services that religious and civic groups, and governments organize often combine mourning with a shared experience of gratitude for what survivors do have. The work The Center for Mind-Body Medicine is doing in Haiti and elsewhere unites this approach to practical instruction in self-care techniques like deep breathing; self-expression in words, drawings and movement; and small group support.
Still, the usefulness of commemorations and therapeutic instruction depends in part on the circumstances in which people find themselves. In Thailand, those who were still living in tents had the most severe anniversary reactions. I have observed that it is far easier for children going to rebuilt schools in postwar, independent Kosovo to move through reawakened pain than for those in Gaza, who continue to attend overcrowded, still damaged schools in a besieged and isolated territory.
Today on Haiti’s earthquake anniversary the situation is far more desperate and discouraging for many than it was in the first months after the earthquake. Some are of course putting their lives back together – kids going to school, adults back at work, many selflessly teaching and helping others. Well over 1 million, however, are still living in tent encampments and the conditions are, if anything, less supportive than they were six or 10 months ago. Supplies of food and water are less reliable; robbery and rape seem to be more frequent. The government is in disarray and is, after the recent postelection rioting, fearful rather than welcoming of public gatherings like the helpful and cathartic day of mourning it organized on February 12, 2010.
After the earthquake, there was an enormous, spontaneous outpouring of goodwill toward Haiti, particularly from the United States – and commitments of funds to match. Since then, the Haitian government and local and international nongovernmental organizations have done much good work, but it has often been poorly coordinated by a still devastated bureaucracy;, and only a small portion of committed funds have actually arrived.
The Anniversary brings up memories of the extraordinary pain that the entire Haitian population has suffered, that old symptoms of demoralization and despair as well as renewing emotional and physical distress. We are working, along with the Ministry of Health, Partners in Health, and other organizations to address these symptoms and mobilize the Haitian people’s resiliency and hope. Our efforts, however, depend significantly on whether the international donors and the American people will fulfill the commitment to rebuild we made a year ago –a commitment that can help transform this anniversary crisis into an opportunity for the Haitian people to recover their wholeness and celebrate their surviving community.
As the anniversary of Haiti’s catastrophic January 12, 2010, earthquake approaches, physical and emotional symptoms that were ebbing or had disappeared, are rising. We hear it everywhere as we– Linda Metayer, our Haiti program director, and I–move through a day of visits and talks with staff at the General Hospital and the Ministry of Health, as well as with kids and adults in tent camps in Petionville, a suburb of Port-au-Prince that is a city of half a million.
Headaches have intensified, and sleep is ever more disturbed by sudden awakenings and half remembered nightmares. Irritability and anger sweep people away in rage at children, who are themselves agitated by neighbors who are too close and too ever-present, too troubled and helpless, too painfully mirroring their own suffering.
Everyone knows in their bodies, as well as from the calendar, that the anniversary is coming, but there is little plan for public ceremony that might make remembrance and mourning easier, and bring hope for a happier future. The program that Linda Metayer and Rene Domercant (a Ministry of Health official who attended our first training in December) have organized at the General Hospital is a happy exception.
After an introduction by Dr Jocelyn Pierre-Louis, one of the Ministry of Health’s leaders and a strong supporter of CMBM’s program, Linda, Rene and I speak. Our talks are nicely paired: Linda and I discuss the extent of psychological trauma and the practical steps people can take to heal themselves and their communities psychologically, and I teach slow, relaxing soft belly breathing and get everyone to move their body. A number of these professionals appreciate the immediate effectiveness and ease of the techniques – “I feel so calm,” says one; “So calm I went to sleep,” adds another, and everyone laughs, recognizing the tension that keeps them awake and the need for rest. “I felt tears come,” another woman adds – all the emotion that needs to be released, I suggest, and she nods.
Afterwards Rene, who is an engineer as well as a psychologist, shows slides from a manual for safe rebuilding: foundations propped and buttressed so they are no longer unbalanced and unstable, second stories supported by first floors that have sustaining walls. Each slide is paired a “Don’t” in red which can lead to collapse in a future earthquake, a “Do” in green – the safe way to sustain a dwelling and save lives. These slides will be shown everywhere in Haiti and distributed in booklets, Rene tells us.
What a pleasantly surprising symmetry and pairing: principles and building blocks for new safe houses, and for emotional and physical self-care–a hopeful beginning for the new year.
To be continued tomorrow–the anniversary of the Haiti earthquake . . .
Fire on the Streets, Peace in Our Circle
CMBM Training, Day Five
25 participants come today, making their way to the hotel around barricades and tire fires in the streets avoiding the demonstrators armed more and more now with guns as well as machetes. Just outside the hotel several men, apparently from one political party, have opened fire on others. Three are dead.
The tent camp on the Champ de Mars is uneasy. People are moving away from the street, ahead of rumors of revenge for political sympathies that some feel are unacceptable. Inside the hotel, its gates locked, its security guards on alert, we feel pretty safe. We’re sitting in a large circle answering questions, sharing what we have learned and are learning. “Is it helpful?” a psychologist asks, “to talk about what makes us afraid? Shouldn’t we use images to make it go away?”
“We cannot force away our fear,” I say. “It doesn’t seem to work. The fear will return.” Heads nod in agreement.
“But isn’t it possible to relax with your fears?” a teacher asks.
“Yes,” I respond, happy at an apt pupil, “that is exactly what we teach.”
“Well,” grinning now, he says, “Let me tell you about yesterday. I was at my school and there was shooting outside between political parties and everyone was upset and very scared. I said, ‘I’ve been in a training and I’ve learned a technique for relaxing even in such difficult situations.’ So, I taught them the safe place images. We sat for ten minutes or so, and afterwards the shooting was still going, but we were smiling and talking with each other, and even singing together.”
And so it goes for the rest of the day, stories of finding a little calm in the chaos, our participants’ eagerness to take what they are learning into their homes, classrooms and clinics.
“My bishop,” a priest tells me, “wants everyone in the parish to learn what you are teaching.” The dean of the midwifery school says she will begin tomorrow to bring our work into the delivery room, to all “sage femmes” who will attend the births of the next generation.