The school is the College Canado Haitien, one of the best in Port-Au-Prince, we are told, before the earthquake and afterwards, too. The students, a few weeks after the school has reopened, are sharp in well-pressed maroon and khaki uniforms—the girls’ hair pulled through berets, the boys sideburns neatly trimmed, tout propre, I think.
Instead of the pre-earthquake concrete buildings, there are open sided wood and metal sheds. Sounds flow from one classroom to another, overlapping in a kind of reverberating clamor. Toward the end of one of our classes, when time of dancing is kept by nimble palms on desktops, the whole campus rocks.
Our equipe, our “team,” –the French is beginning to emerge from deep layers of my unconscious—includes six of us: Lee-Ann juggling logistics as before, with Cassidy, my assistant back home, here to help her and me; Amy, the social worker who is our clinical director, will come tomorrow. Today, Lynda and Kathy, psychologist and family physician, are with me. They are CMBM senior faculty who are adventurous enough to come and to commit to coming again and again. They and Amy will teach our Haitian colleagues and provide consulting and supervision as we build our program.
Today we have been invited by Frere Jacques Anthony Germeil, the principal, to College Canado Haitien. We will have an hour in each of four classrooms with eleventh and twelfth graders who have been told they will learn “lessons in dealing with stress.”
I lead the first class and the third, forty twelfth graders in each, sitting shoulder to shoulder at their desks. Lynda and Kathy, experienced with kids, but new to Haiti and to the trauma and loss that overwhelms the population, will lead the second and fourth classes.
We begin our classes lightly—a little goofily—“How do you breathe?”, I ask to general puzzlement, and then talk about babies doing it easily—naturally—their bellies rising and falling, while adults, and even high school students, cramped in chairs and on benches, barely move their chests. Laurent, my interpreter, and I act out the roles of cats in full fight or flight mode—hissing and growling at each other, and then stepping back to breathe easily. Lynda has her all-boys class—a surprise—consider Kobe Bryant, cool and relaxed, imagining his shots, inspiring the boys to imagine theirs swishing the net.
When we turn the topic to relaxation’s antipode, stress, the bravado of a few—“I’m fine, we’re all fine,” claims one boy; “it was simply a natural disaster” intones another—contends with the more complex memories of their classmates.
Soon, in each and every class, there is a rush of sharing of what happened on January 12th, of how surprise and relief yielded to horror. “I thought the shaking would be eternal. Then, it stopped, and I thought, ‘that’s not so bad, I am ok,’ and I laughed, then I saw my sister covered in dust like a ghost, and I was afraid. And then, underneath my neighbor’s house, there were twisted bodies.”
And the stories come—many, we learn, shared for the first time—and the classmates’ losses pile up: a mother gone, an older brother, “my best friend,” “almost my whole family,” We hear of bodies discovered under rubble and strewn on sidewalk, of dogs chewing on corpses.
When we ask if there are questions, a small forest of hands rises: “How do you go to sleep when these memories keep coming in nightmares?” “How can you breathe deeply to relax when the air is so bad?” “How do you deal with family members who now are arguing all the time?” “What do you do with your belief that another earthquake is coming, or as some say, ‘a tsunami’?”
More about the techniques we use to address these questions coming soon . . . .
Our last full day in Haiti brought us another unexpected and auspicious meeting. On our first visit to Haiti the month before, Rosemary and I had met with Dr. Claude Surena, an internist who is head of the Haitian Medical Association and principal advisor to the Ministry of Health. Dr. Surena was extremely enthusiastic about working with us. This time Dr. Surena was out of the country, and he suggested we meet with his colleague, Dr Jean Hugues Henrys.
The problem was that we could no more find Dr. Henrys — housed in temporary quarters and mostly out working in the clinics and hospitals — than we could Drs. Guiteau and Amedee-Gedeon. Lee-Ann called and called, and finally—“just one more time.” We reached him, and set an appointment for the last hour of our last day in Port-au-Prince.
It turned out Dr. Henrys, a genial host, was as happy to see us as we him, and was particularly eager for us to work with Ministry of Health employees. Their building had been destroyed, many of their colleagues were dead, and the ones who remained were carrying grief for lost friends as they dealt with the enormous needs of the population.
And then, as the meeting was winding down, another man entered the room. It turned out to be the Minister of Health, Dr. Alex Larsen. Dr. Henrys filled him in on our work and what we had been talking about and went on to make a suggestion. “It says in your proposal,” Dr. Henrys–a quick study– reminded us, “that you want to have a ‘Haitian leadership team.’ It is important that you work with the future leaders too, with medical students, and others concerned with the social sciences.”
“Yes,” I say, “we do that in the US. That would make me very happy.”
“Perhaps he has not told you,” Dr. Larsen interjected, smiling, “but Dr. Henrys is the Dean of our Medical School.”
Next post: the very successful workshop we offered to American Red Cross workers during our visit.
One of the sure but less obvious signs that our work is going well, and that it is meant to go well, is the increased incidence of synchronistic experiences– of happy, unexpected, unpredictable coincidences –that forward what we are doing.
These events don’t arise without effort; in fact, they often come only after we have worked very hard, and when the desired result — in this case, meetings with key figures in Haitian healthcare — seems altogether unattainable. We had two such unexpected happy events – meeting with four more remarkable people on the last two days of our visit.
On our fourth day, April 9th, I led a workshop for American Red Cross staff — it went very well, and I’ll tell you about it later. For some days prior to it, however, we had tried unsuccessfully—by phone and email—to reach the leadership of the Haitian Red Cross, an organization that is central not only to emergency recovery, but to providing long-term services and education to the Haitian population. Everyone wanted to help but nothing seemed to work. We encountered unanswered phones, voicemail messages that languished, outdated e-mail addresses. We did hear that the Red Cross leaders were busy developing and supervising projects all over Port-au-Prince so we thought we might be able to follow leaders and track them down.
As we drove from one destroyed neighborhood to another, I remembered these “personal searches” were what we’d done in Kosovo after the war when the land lines weren’t functioning and cell phones were rare. Finally, hot and seat-sore from riding over Port-au-Prince’s pothole-punctuated, rubble-strewn roads, we accepted what seemed inevitable: we would have to wait till next trip to meet the Haitian Red Cross leadership.
However, since it wasn’t yet dark, I—ever optimistic– thought we might pay a visit to the University of Miami Medishare hospital, where I had spent so much time on my first visit to Haiti. It turned out we couldn’t find that either.
“Maybe,” our driver opined, “someone at the Red Cross installation nearby”—he gestured to one we had not yet visited—“would know where it is.”
“Okay,” I thought as we arrived, “let’s ask about Medishare. But let’s also try just once more to see if anyone knows where we can find the Red Cross president, Dr. Michael Amedee-Gedeon and Dr. Jean-Pierre Guiteau, the Executive Officer.
When I mentioned their names, the guard looked uncomprehending. Still, I handed him my card. Ten minutes later he returned with instructions to bring us ahead. As we walked over the crushed stone toward a newly constructed building, a man as puzzled to see us as we would be surprised and delighted to see him, approached.
He was, it turned out, Dr. Guiteau, a long-time leader in public health with a particular expertise in and concern for Haiti’s children. Still a bit puzzled but exceedingly gracious, he invited us to the conference room and offered us coffee. Soon we were soon joined by Dr. Amedee-Gedeon, who made us feel as if we were not only most welcome but long expected. She said she specialized in nutrition, as well as public health. She had previously been, Dr. Guiteau told us, Haiti’s Health Minister.
I described our work, stumbling a little at first even in English, because I was still amazed that we were actually talking with them. When I finished, they asked a few questions about the length and scope of our training and the research we had done on our work with professionals and with traumatized kids. They told us how concerned they were about the stress their staff and volunteers were experiencing—“So many have lost family and friends themselves.” They appreciated that the skills that we had to teach could be helpful to these burdened men and women as well as to their many thousands of “beneficiaries.” They were particularly interested, given our experiences in Kosovo and Gaza, in how we might help the large number of amputees whom, they feared, “would never live up to their potential.”
Next post: Meet the Minister of Health Dr. Alex Larsen, and Dr. Jean-Hugues Henrys
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 . . .
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.
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
In Haiti three days of “memorializing the dead,” of prayer and fasting have begun.
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.
More in days to come.
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.
I’ll post more this afternoon, about our visit to the tent city outside our hotel and the people we met there.
“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.
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.)