Meetings with Remarkable Haitians: Dr. Emmanuel Justima
Dr. Emmanuel Justima
I originally met Justima (it’s his last name; as he said, he likes to be called that to distinguish him from “other Emmanuels”) at a “psychosocial cluster” meeting to which Lee-Ann and I had been invited. Perhaps 30 nongovernmental organizations (NGOs) were present. All are working with “psychosocial” issues: the emotional challenges, psychological, and social needs of the close to 2 million people who have lost family members and/or been displaced by the earthquake.
Justima, tall, broad shouldered, slim, in black pants and a crisp checked shirt, entered the room halfway through the meeting and shook hands with the UN coordinators. He stood tall and at ease at the front. When his turn came, he spoke in a voice loud and clear enough that even I– aurally challenged, and still scrambling to recover my French–could understand. And just in case I or anyone else had missed his meticulous instructions on prompt program registration with the Haiti Ministry of Health, he repeated it in flawless English.
Afterwards, Justima began our hour-long private meeting by announcing that PNI (psychoneuroimmunology– the scientific foundation of mind-body medicine), was his “passion as well as [my] professional field of expertise.” For a moment I thought he was putting me on. Another Emmanuel (last name Streel), the psychologist who coordinates the NGO psychosocial programs, had just told me about his own interest in mind-body medicine. “Vraiment?” (“Really?”) I said to Justima in my best, quizzical French.
“Yes,” he replied. “And, of course, we have to teach people to help themselves. There are only 10 psychiatrists in all of Haiti, and not many more psychologists.”
It has long been clear to me, after work with many other traumatized populations, that self-care and mutual help are logical centerpieces of a population-wide mental health program. But how surprising, and how wonderful, that someone so central to the Haitian mental health plan not only welcomes our way of working, but is steeped in the science that supports it.
Justima sits across from me at a narrow table in a prefab corrugated metal UN building, flanked by internationals concerned with similar issues. He takes care of business carefully but briskly, reminding us again of registration requirements, offering to find the most competent translators to put our materials into French and Creole. He carefully repeats phrases I don’t understand.
Around his mouth and in Justima’s eyes, amidst striking efficiency and intelligence, I see the smile of a man who, with all the weight the world has put on him, still enjoys life. I look forward to working with him, and to spending more time with him.
I regret that we didn’t get any pics of Justima. More pics next installment, when we meet Drs. Guiteau & Amedee-Gedeon of the Haitian Red Cross . . .
Meetings with Remarkable Haitians: Pierre Andre DuMas
Haiti is often criticized, even derided for its lack of leadership, or alternately or in addition, for the corruption and cruelty of its leaders. And there is, no question, a long legacy, during and after slavery, of oppression; and of political, social, economic, and spiritual hopes raised and devastatingly betrayed.
On the other hand — and there is definitely another hand — the Haitian people are blessed, at least within the fields I’m coming to know best (medicine, mental health, and public health) by a leadership group that is knowledgeable, thoughtful, and skillful, as deeply committed to the welfare of its people and as open-minded as any I’ve found anywhere in the world. These Haitian leaders seem at this crucial moment in history far less encumbered with the self-importance and pride that afflicts many national and, indeed, professional leaders I have known. Their commitment to the welfare of their people and their compassion trump received truths and narrow professional prerogatives.
Here’s a pic of Haiti streets finally looking a little more alive:
Already you’ve met two of these remarkable people: Alix Lassegue, the physician who directs the University Hospital, and Marlaine Thompson, the nurse who works closely with him. Together, they embrace the flood of people who overwhelm the hospital. They shape the comprehensive services for the complex problems that their patients, overwhelmed by the earthquake as well as the ordinary calamities of Port-au-Prince daily life, bring to them. In the next few blog entries I’ll introduce you to several other of these remarkable men and women, the welcoming leaders and kind teachers with whom we hope to be working closely in the months and years ahead.
Monseigneur Pierre Andre DuMas
There are certain people, who upon entering a room, fill and light it up. Monseigneur Pierre Andre Dumas, bishop of the Diocese Anse-a-veau/Miragoane and president of the Catholic Church’s service arm, Caritas, and Dr. Emmanuel Justima, a psychologist who is a leader in shaping the Haitian national mental health plan (whom you’ll meet next installment) are two.
Pierre Andre DuMas is tall, supple, gray-haired, and dressed in gray vestments. Sitting with him I feel myself warmed by his abundant energy and his generous sweet nature. Though I have never met him before, I somehow feel that I know him. Like my old close friends, we simply share what is most important to us, find ourselves embellishing each others’ narratives, and quickly invite each other into our unfolding lives.
I tell Pierre Andre a little bit about our work and where we have done it, and he smiles with recognition. He invites me to present our way of healing trauma to Haiti’s religious leaders, “as soon as we can arrange it.” It is part of his job, he tells us, to bring together Protestants as well as Catholics, Jews, Muslims and Voudoun practitioners.
He tells us about the thousands who have returned from Port-au-Prince to his rural diocese and the dislocation and suffering they bring with them. On Good Friday, he hiked up a nearby mountain with 6000 people from his diocese. “We sat by a waterfall and breathed deeply, relaxed — Like your work, no? Some of us swam. All of us needed a catharsis.”
When I give him a copy of my book Unstuck, I assure him that he will enjoy it even though he’s not depressed. “I know that you know that I am not,” he says. “If you are still alive,” he adds, opening his hands, “you have to stand up and give hope.”
Next installment, meet Emmanuel Justima, a psychologist working on Haiti’s National Mental Health Plan
Celebrating Hope and Healing in Haiti–Day 2
In Haiti three days of “memorializing the dead,” of prayer and fasting have begun.
thousands gather to memorialize the dead
Haitians gather for sermons
the cathedral in ruins
great faith and hope for the future
Haiti Day 1, Pt. 2 of2–Visit to the Tent city
Shortly after we arrived yesterday afternoon, Star and I crossed the street and walked down the ragged line of incongruously bright new tents that front the road. An open space gives us entry, and we wander through the maze of living and cooking spaces, a large, older white man, a small, younger black woman whose “bonsoirs” are often returned with smiles.
We reach one boundary of the encampment formed by a four-story concrete building which has been crushed like a paper hat. A young woman with an infant greets us. The baby is a little thin, a little dour, a little jumpy. Her name is Miranda, and she is two months old. Miranda’s mother shows me a place on her head where the nearby building had quite literally fallen on her. It hurts still, a month after the earthquake, and so do her neck and back. I go into her tent to take a look. There is great tension and tenderness at the site of her injuries. I do some gentle manipulation, and she smiles with relief. I reassure her that in time the symptoms will subside and remind myself to bring acupuncture needles next time.
Others have not been as fortunate as Miranda and her mother. One woman’s two children have been seriously injured and are still at the hospital. Another’s aunt has died. A third is missing her husband. A fourth has lost the sight in one eye. The pain from injuries received in the earthquake persist. Memories of loss and unspeakable terror seem to have attached to and continually restimulate the pain—the ever-present physical replaying of the catastrophe, the physical manifestation of psychological trauma and ongoing distress. Some “cannot remember the simplest thing,” or “make any decision.” The blind woman fears that she will not receive medicine without money to pay for it. No one sleeps well. All are fearful of further loss or injury, or—they are not quite sure what.
And, indeed, the situation is enormously stressful. The tents, which look so good, just arrived yesterday, brought by the French Red Cross. . For a month, these people have been sleeping in the open. “We have a committee,” says Wilson, Miranda’s father, “to organize ourselves.” And they are indeed cooking communally. “But we do not have toilets, or other necessary sanitation.” There are no doctors readily available to them, or medicine, or replacements for needed glasses lost, or hope for more adequate or permanent housing, or indeed, much communication with the world beyond the tent city. As we are leaving, Wilson invites us to share the rice that half a dozen families are beginning to eat.
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More in days to come.
Jim
Bringing Psychological Healing and Hope to Haiti; Day 1, Part 1 of 2–Arrival
Day 1, part 1 of 2–Arrival
There is a weight to the air; we begin to feel it at the border where we enter from the Dominical Republic. We can smell it, too, in the swirl of dust that forces some to wear masks, in the acrid edge of burned and burning building materials. It grows heavier as we bump around flanks of rubble on the outskirts of Port-au-Prince. In the city, it roughens our voices and presses tears from our eyes.
Happily, surprisingly, we have a place to stay—in the Coconut Villa, a hotel near the airport that is an undisturbed island amidst collapsed houses. Across the street, several thousand Haitians live in tents.
Rosemary Murrain, Star Myrtil, and I are here to see if our approach can help bring psychological relief to the people of Haiti—and to see if we can work with and find support from the large international agencies that are funded to bring food, housing, schools, and emergency medical care to the people. Our approach, which combines such mind-body techniques as meditation, guided imagery, biofeedback, and yoga, self-expression in words, drawings, and movement, and small group support, has made sense to and worked remarkably well with war- and disaster-traumatized populations in Kosovo, Macedonia, Israel and Gaza, in post-Katrina New Orleans, and with US military returning from Iraq and Afghanistan. It’s practical, easy to learn, and feels right to people who are trying to gain control over the thoughts, feelings, and memories that overwhelm them in the wake of catastrophe. We’ve published the only randomized controlled trial (RCT) of any invention of any intervention for war-traumatized kids. It showed an 80% decrease in symptoms of posttraumatic stress disorder in Kosovo high school students, an improvement that was maintained at three months’ follow-up. More recent studies on 1,000 children and adults in Gaza show similar sustained gains in spite of the ongoing constraints and tragedy of life there. Altogether, the several thousand clinicians, teachers, and community leaders’ we’ve trained have made our CMBM model available to hundreds of thousands of children and adults around the world.
Rosemary is CMBM’s new Director of Finance and Administration. Immensely capable, unflappable, fluent in French, she’s an MBA student who has helped to create and lead educational programs throughout Africa. She’s in charge of the logistics that brought us on our journey here, and she will help create necessary partnerships. She’s also, I say with pride, my goddaughter. Star is her friend, a Haitian living in Florida, leading women’s programs there and fluent in Creole as well as French; a human bridge for us to Haiti and to its people.
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I’ll post more this afternoon, about our visit to the tent city outside our hotel and the people we met there.
Jim
Day 7: The Gaza Training Ends
“We have been on a journey,” says the psychologist who is leading the final session of Mohammed’s group. She sits comfortably cross-legged on the floor, in her long coat and headscarf, next to the young man who is her partner on this last day. “We have come to know each other in a way that is not usual here in Gaza,” she goes on. “men and women speaking together from their hearts, all of us finding new friends.”
This is our last group and, as we check-in, and while my translator summons up her English, I find myself pondering old mysteries and contemplating new wonders. The dress of the woman’s co-leader: He is wearing a sport jacket and slacks, neatly pressed, and a tie, secured with a Windsor knot, a professional code of dress that many of the men favor. How much effort, I wonder, does it take to maintain such self-respect amid Gaza’s crushing, demoralizing constraints? And how does he do it with the dearth of dry cleaning facilities and the scarcity of solvents? I am impressed once again by the intelligence, dignity and, yes, elegance of a woman who, except for a tiny slit for her eyes is completely covered. Her assessment of herself this last day is so open, unsparing, witty – “I want to thank all of you,” she begins, “I realize now I have been too rigid, and often wrong, in my judgments; and I have been unnecessarily covering my feelings, not just my body.” I too realize once again – what a grace of these groups – that I have much to learn about my own preconceptions and judgments.
In this session we do drawings similar to the ones we do on the first day of the first training, pictures that often show us how much – sometimes how stunningly, satisfyingly much – we have changed since that opening group. The wires of a cage that contained an irritable, frustrated physician have turned into steps on a ladder which will bring him to a place of peace, among trees in his yard and within himself; a psychologist’s family members scattered across the landscape by misunderstanding in day one’s picture are now gathered in a comforting circle in which they are, like members of the mind-body group she is addressing, “sharing their feelings.”
Our leader has brought us candies wrapped in red foil, to celebrate our time together, and to mark its end. “I Love You” is written across them in silver. Another woman has brought us all pens “to remember this group when you write.” A third has baked a cheesecake, its top speckled with many colored candied glitter, with a single candle. “This is,” she announces, “to celebrate our journey and also,” she adds, “the Prophet Mohammed’s hijra,” his journey from Mecca to Medina in 622, “whose anniversary falls on this day.”
It was in Medina, I remember, that Mohammed created the umma, the spiritual community that is the model for Islamic society. It provides Muslims with the opportunity to gratefully practice the prayers and manifest the precepts and the code of conduct that Mohammed brought to them.
As our leader carefully divides the cake in squares I hear, as clearly as if he were once again standing in front of me, the closing comment of a young psychologist in our previous training nine months before. A tough, pale, earnest, bearded young man, he had spoken with some formality: “I did not know what to expect when I came; these techniques, it seemed to me, were foreign to Gaza. But as I have been here these days I have been so impressed. You and your faculty are so knowledgeable and such good teachers, and I have learned so much about myself as well as psychology. But even more important” – I can hear again his voice lowering, more intimate now – “you have all been so kind to me and all the participants, have made us feel so much at ease. I believe,” – I knew he was getting ready to conclude, but never could have imagined what he would say – “that this is what it must have been like in the time of the Prophet Mohammed.”
Our leader hands us plates, and we eat our cake and savor each other’s company. There is general sadness at “concluding this blessed vacation with ourselves,” as one woman observes, to general agreement. But there are also commitments to “meditate daily” and “shake and dance with my children when we are feeling overwhelmed, or stressed.” Everyone expects to “start mind-body groups for patients on the first of the year.” There are promises all around to be in touch in the months ahead – in the supervision groups that Mohammed and the rest of our faculty will be leading every week throughout Gaza, and less formally too. Phone numbers are exchanged and a paper passed around for email addresses.
And then our leader in her long coat and head scarf reaches over and turns on the CD player and stands and claps, and sways a little, while her young colleague in the sports coat, his collar open and tie now loosened, rises and steps to his right toward Mohammed and the other men, and begins the steps that will take them and me too, our arms on each others’ shoulders, in a small happy circle, around our room.
Video from Days 4 & 5 of Gaza Training
Dear friends,
Here’s another video update of our 2009 Gaza Advanced Training Program (ATP)! You’ll see another technique we use, chaotic breathing, a form of very “active meditation” illustrated at minute :37. You’ll also see the introduction to the “fishbowl,” in which we demonstrate to the trainees the small group model, at 1:24. (Small mind-body skills groups meet privately, so this demonstration during training is the best way we’ve found to show the health and mental health professionals attending how to lead their own groups.)
Jim
Finding Freedom Under Siege
I just returned from another trip to Israel and Gaza to visit our programs there and to plan for the future. I’ll tell you about what happened sometime soon. Right now, I wanted to share with you some testimonials from health and mental health professionals who participated in our most recent professional training in Gaza (March 7-11, 2009). It was, as you’ll see, an extraordinary five-day experience. Jamil Abdel-Atti and his Palestinian team gave just about all the lectures (I filled in some) and led all the small groups. Amy Shinal, our CMBM clinical director, and Afrim Blyta and Yusuf Ulaj, Kosovo psychiatrists and dear brothers with whom I’ve worked for ten years and I provided consultation and supervision; and Dan Sterenchuk and Lee-Ann Gallarano, from our DC office, offered invaluable administrative support. But the training and the beautiful spirit came with our wonderful Gaza team.
Here, then, is what some of our participants had to say:
The information, the relaxation techniques, meditation, and deep breathing. I deeply discovered myself and how to take care of myself. I discovered my neglected body and promised to be taken care of. I forgave my friends and relatives I have neglected and lived far from. Spirituality, I had neglected that part for so long, but realize how important it is for my healing. Grateful for the ability to apply these new techniques in my work. I met new friends. The family tree gave me a very good space to think of my relationships that I’ve ignored.
• Ensherah Zqoot
Gaza for Psychological Health Program
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First, I want to express my feelings. I’m happy and feel like I own the world. The training was wonderful and excellent. I felt changes in my physical, psychological and mental status. The techniques were great and worth teaching and sharing in such a training. For the first time I feel involved in a training for myself. I feel safe and comfortable with the team and the facilitator Jamil, who shared his feelings with us. I want to thank him but can’t find words to express my gratitude. I won’t forget the efforts of everyone who participated in this training. I just want to say I’m truly happy.
• Jabr Hussien Theibet
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I benefitted a lot from this training. I debriefed lots of feelings and emotions. I truly thank the mind-body medicine team especially Dr. Jim and Jamil and the rest of the faculty. I hope I will be involved in the advanced training so I can help others like you helped me.
Mohd Abu Omirah
Psychological Support Association
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I was asked by my professor in the university to participate in this training and I didn’t know anything about it. I felt sad and angry during and after the war, and I was furious about everything. Felt insecure and that all my dreams and rights have been violated on the beach of Gaza. I was thinking sometimes why live? And why continue living as long as we’re continually exposed to those violations? In the five days of this training my life has changes completely. I felt dreams could come true and might will not last long cause day is coming soon. I felt I was born again, like a new person. I felt like a loving human being, full of happiness and hope for the Gaza children. I have many things to say and deep happiness inside but I didn’t want to talk much and bore you. In the last moments I had in room 402 that I will never forget for I had sad and happy moments. I want to thank Mr. Ahmed Theibet and the small family I lived with for 5 days and for Jim, Jamil and the rest of the faculty. Thank you all.
Anonymous Psychologist
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This training provided me with the following:
1. To control my feelings when I face external stimuli
2. How to respond in a rational way and wisdom in the face of acute and difficult situations.
3. My wish that we implement this program with schools’ teachers and guidance and counseling staff at the Ministry of Education to enable them to deal with students and how to face difficult problems.
Abeer Fathi Shareef
Supervisor
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Thanks to Jamil and his incredible team on the fabulous training. Also thanks to Dr. Jim and his team. These techniques are consistent with our Palestinian and Islamic culture and this is the secret beyond the programs success.
Fadel Shath
Gaza Mental Health Center
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Training was very enjoyable in terms of changing the track of our lives and jumped with it that big leap. Therefore I have decided to change my life and to reshape my issues. I felt that the training was extremely individualized and it was directed for us as professionals, where always we are asked to care for others and in a very few occasions somebody remembered us and worked for us rather than the patients cases and clients. Thanks a lot for all of those who were behind the program.
Tawfig Abed A Hadi
PCRP
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This course made us realize that our hearts are like Jim’s, very beautiful and valuable. By awakening all the shine that it contains you had awakened our souls which was about to disappear in the sea of torture. We have lived moments that could be the road to the shining future.
Sada Ghabin
Head of Guidance and Counseling in Ministry of Education
Gaza Mind-Body Training in the News
Dear Friends,
Check out the great AP story by Karin Laub about our Gaza training–
At the Washington Post (you may have to close an ad first to read it)
Or at Google News
It’s an great take on how our mind-body skills training is an unconventional fit, but an immense help, to people within the Palestinian culture. (Great picture of me shaking & dancing up front, too (!!!))
We’re in Israel now—flying back to the States soon. More soon.
All the best,
Jim
Progress in Gaza
I said that I would write more about our work in Israel and Gaza, but the work-and trying to find funding so that we can continue it-is taking up so much time (joyous, exciting time, to be sure) that I haven’t been able to write.
Still, I thought I would send along this very brief summary that I forwarded to our US Mind-Body Medicine faculty.
Hi everyone,
Just a couple of words from Gaza City: overwhelming, amazing, touching. That’s three words.
We (Jim, Amy, Afrim, Yusuf, Dan and Lee-Ann) had a great visit with our Israeli faculty. They are doing many interesting and exciting projects including groups that combine mind-body skills and Jewish spirituality, joint Israeli Jewish and Arab groups, and many groups for traumatized children and adults in Sderot. In fact, we made a visit to Sderot and had a chance to talk with teachers who are using mind-body skills in wonderfully creative ways with children in the SCIENCE AND RELIGION SCHOOL. The kids have experienced shelling on and off for eight years and are having all kinds of problems with concentration, bed-wetting and anger.
Naftali who heads up our Israeli program, is on the track of a major initiative in the South which will build on the work that he and his team have already done. We are working together on developing cooperative relationships and future funding.
Thanks to Danny Grossman, a friend to whom Aaron and Debbie Kaplan introduced us some years ago, (with able assists from Naftali and Smadar who handle the administrative work in Israel), we were all able to get into Gaza. It took a couple of extra days for Afrim and Yusuf, but Naftali and Tami and Ayelet from our Israeli faculty kept their spirits high while they waited. Once in Gaza, we began with visits with grieving families. There are whole sections of Gaza that have been completely destroyed and many thousands of people who are without homes. “I am very small,” one ten year old girl told us, “but the tent the 20 of us are staying in is even smaller.”
We went on for a day of meetings with our Gaza faculty. The next day, we had more site visits including one to Dr. Izzeldin Abuelaish, whose three daughters were killed. He’s an amazing man, an OBGYN who works in Israel as well as Gaza and through some miracle of wisdom and compassion, has managed to transform his suffering into a visionary project for the education of girls in Gaza-“not just so they will think, but so they will think freely”-and a mission to promote greater Israeli-Palestinian understanding.
We’re now about to start the 4th day of our PTP. Our Gaza faculty, which Jamil heads up, is doing virtually all the lectures and leading all the groups and our international team is consulting/supervising. The Gaza group is doing an absolutely wonderful job. They are so open-hearted and skillful-I’d say over the last 18 months, they’ve each lead anywhere between 6 and 20 groups and it shows.
Participants (there are over 140 of them) are speaking of issues that they have never before discussed and beginning to solve problems that have troubled them for years-not to mention finding practical ways to ease their high levels of anxiety and deal with nightmares, flashbacks, etc. All of them-faculty and participants-are so eager to learn and to share what they are learning. They are an inspiration to all of us.
There is much more to tell and I will when I have more time. For now, I send all of you my love as well as my gratitude for being with us on this and many other adventures.
Jim
