We talk in today’s workshop, do drawings, and talk more about what they’ve drawn. My French is emerging from the caves of my unconscious and I seem to be speaking comprehensibly, but I very much need Star to translate the kids’ replies and descriptions.
It takes the kids some time to do their drawings. Several had asked for pencils to outline what they will later crayon – this is a first in my experience — and Lee Ann fortunately found both pencils and a sharpener. But all of them are measured and methodical, controlling, it seems to me, the little in a dangerous and chaotic world that they can control. When I ask 13-year-old Remy why he is hesitant to begin, he tells me that he fears “it will not be good.” I show him my decidedly childlike effort. “This is not,” I assure him, “about being ‘good,’ just about drawing;” he laughs and starts to sketch.
I’ve told them to draw themselves, or friends, or something they like to do, or a house. The majority draw houses – several are many-colored and splendid; one is elegant, spare, as carefully ruled as a blueprint. Every child who has drawn a house tells me when we ask – Star now translating in Creole -that his or her house has been “kraze,” “destroyed;” when she follows up – “kraze completement?” – they nod solemnly. The drawn houses are memory and hope.
We ask thirteen year old Jime, the architect of the elegant house, where he is now staying. “Dans la rue,” he tells us. This is surprising. He is well groomed, tall and handsome and wears a blue button down shirt that is clean and has sharp creases in its arms. Katie Couric, who is interviewing me and the kids, asks him again, “Really? In the street?” “Oui,” Jime says as if his two month residence there were ordinary. I ask him, “How do you keep your shirt so neat?” “I iron it,” he says.
I’m back in Haiti, with Lee Ann, who manages our programs for population-wide psychological healing and Star who translated for us last time; Rosemary is in DC taking care of business. We are exploring partnerships, doing workshops for kids and caregivers. In Port-au-Prince there are no fewer people living in tents or on the streets, but more of them seem out and about, vertical even animated – selling and shopping, crowding toward tanks to fill bottles of drinking water (lots of small kids have been designated for this job) talking and moving with volume and even grace.
Last night and today we spend time at the University Hospital, where we are received with great courtesy by the Director Dr. Alix Lassegue and Marlaine Thompson, the nurse who acts as his deputy. Everyone there is working heroically, at and beyond maximum capacity: only 30% of the physicians have returned to work and 50% of the nurses: “Some, Dr. Lassegue says, have died, some have left the country, and some….” His voice trails off. Most of the work of the hospital, which is Haiti’s largest and most important, is still conducted in the tents which fill its grounds. This is slowly changing, Dr. Lassegue tells us, as engineers ensure, department by department, that the structure is safe; soon the emergency room will once again be indoors.
Today we do a mini-workshop for kids at the Hospital, gathering them from the tents where they have been staying, and from the line outside the pediatric out-patient department. A sweet shadow-thin teenage girl, Vania, has insulin dependent diabetes; Ruth a tiny six-year old girl and seven-year old Roberto have infections that resist all antibiotic assaults; Ruth’s mother walks beside her holding her IV bottle. Almost every child, we learn, has lost a family member or someone close to them.
Dr. Gordon with a young Haitian girl doing expressive drawing exercise
Some thoughts on Jonah Lehrer’s article from The New York Times Magazine, February 25, 2010.
In his article on the possible evolutionary purpose of sadness, Jonah Lehrer, a talented writer and knowledgeable scientists confuses an adaptive mechanism –the capacity for greater focus that the rumination of depression may afford – with a therapeutic one. Even more important, he does not address the causes of depression and, in accordance with his emphasis on enhanced problem solving, limits his discussion of therapeutic efforts to cognitive change.
Work with many hundreds of depressed people in my psychiatric practice and tens of thousands more in war, post-war and disaster situations around the world gives me a very different perspective and leads me to different conclusions. So many of us are depressed because we are living at variance with both our genetic programming and our need for meaning and purpose. We are affected so dramatically by losses of relationships, jobs, etc. because we are not sustained by the adequate social support that is a hallmark of traditional societies. We are subject to an unprecedented level of stress and overstimulation in our environment, to toxic food, and sedentary ways of living that are anathema to our evolutionary development and detrimental to our mood. Many of us lack a sense of purpose in our lives, a connection to something greater than ourselves that gives human life meaning, and can give us hope in difficult times.
The symptoms of depression – both the rumination on what went wrong and why that Lehrer focuses on, and the lethargy, hopelessness, decreased interest in sex and food that go along with it – are best understood and responded to not as an evolutionary advantage but as a wake-up call. They let us know that it is time to address the conditions that are creating the imbalances in our lives; to use food and exercise, meditation and imagination to improve our biology and enlarge our perspective, and to reach out to others—therapists, clergy, family and friends—who can help us. The true purpose and challenge of our depression is to wake us up to what is wrong in the way we live, to point us toward ways to become more fully human.
I’ll be on NPR’s Talk of the Nation this coming week, either Monday or Tuesday, for a show tentatively titled “Haiti – Picking Up the Pieces;” revisiting the country 7 weeks after the earthquake to hear about the psychological aspects of the Haitians, as well as the medical situation.
I’ll be talking about the trip Rosemary, Star, and I just took to Port-au-Prince and what we saw there, as well the way forward, helping Haitians heal after this disaster.
Check your local NPR station for listings and schedule for Talk of the Nation, and the audio interview will be posted shortly after airing here. I hope you can tune in!
Barth Green stands easily in the middle of the dusty yard in front of two small administrative tents, just inside the gate of the University of Miami’s Global Institute field hospital at the Port-au-Prince airport. His blue shirt is clean and crisp, cream colored pants still pressed, his grey hair combed straight back. There is a storm of activity around him, squalls of need coming from every corner of the encampment.
the busy life of a Haiti hospital director
Men and women in scrubs, some with IV bottles in hand, rush up to ask questions. Military commanders and visiting dignitaries stand in a small circle around him. Barth Green responds thoughtfully, unhurriedly, sometimes with humor, to each person in turn. He is the director of the hospital and of the entire facility – the huge tent which contains the operating room and the acute wards for children which are attached to it, the other large one for adults, the small tents for convalescence and isolation, the tent-barracks where hundreds of volunteers lie on cots just like the ones the patients have.
Barth Green is chairman of the department of neurosurgery at the University of Miami Medical School. Since 1994 he and his colleague, family physician Michael Fournier, have been leading Project Medishare in Haiti, helping (along with the US based Partners in Health and the Haitian Ministry) to bring good primary care to the Haitian countryside. When the earthquake hit on January 12, he and his colleagues moved quickly; volunteers arrived. Some were skilled as physicians, surgeons, OR techs and nurses; others were simply, surprisingly even to them. moved to help: “at least I’m another pair of hands,” more than one says. Since then the “barely controlled chaos” as several doctors describe it, has been providing treatment for thousands, saving lives. And a surprising life enhancing life changing experience of selfless service for many who have come to provide that treatment and save those lives. “For me,” a tired looking fifty-ish U of M ER doc confides, “this has been the most important experience of my professional life. Maybe,” he adds after a moment, ” of my whole life.”
In Barth Green the surgeon’s calm amidst crisis and attention to present, necessary detail is coupled with an understanding of long term needs. He knows that the deepest despair and the greatest distress may arise only when the immediate crisis is over; and he recognizes the importance of CMBM’s commitment to helping caregivers deal with their own stress and trauma and to teaching them to help the Haitian people to help themselves. He reads over our annual report and our tentative Haitian work plan, and shares them with Carl Eisdorfer, the former chair of Miami’s department of psychiatry, and present director of its program of aging, who has just arrived.
There are six rows of cots, perhaps twenty cots in each. Children lie on them. White bandages capping the stumps left after amputations are visible. Some of the kids are asleep; others seem barely conscious. Women and mobile, healthy children crowd around many beds. A large somber man bends over a tiny baby whom he holds with one hand and delicately feeds with the other. Doctors, nurses, and volunteers in scrubs move from cot to cot. Doctors, nurses and other volunteers stop to high five small children who have been orphaned by the earthquake – wards of the ward it seems – hand them gum or candy, hoist them in the air, carry them for a while before setting them down. Periodically four men bearing patients on stretchers move quickly down the center aisle to or from the operating room or intensive care unit.
Stevenson lies quietly in one corner of the room. He is seventeen, tall and slim, with a sweet, thoughtful, handsome face. We talk about what happened to him. Stevenson’s mother Dieula (“God is there”) sits on a cot next to his, placid, nodding her head as her son speaks softly, adding details.
Stevenson had just arrived home from school on the afternoon of January 12. He had changed his clothes and was getting ready to do his home work – or perhaps watch a bit of TV first, he hadn’t decided. When the house began to shake and pieces of the roof to fall, Stevenson rushed outside. As he emerged a slab of concrete crushed his right arm. His mother who was outside cooking, rushed to him, held him up. For two days they walked and hitchhiked, Stevenson’s arm shredded, till they arrived at the then rudimentary Miami hospital tent.
The surgeon amputated Stevenson’s arm with a pocket knife, Lisa, a volunteer from New York tells me, crying with the memory. “There was only eight minutes of anesthesia,” she goes on, “and he just said ‘I am fine’.” Stevenson is still in bed a month later because the above elbow stump has been infected and reinfected. An IV with antibiotics flows into the back of his left hand. I teach him and his mother him some slow deep breathing to quiet the pain a bit, to help them sleep.
With Star interpreting from Creole Dieula and I talk some more. Only when I ask after the rest of her family does she tell me, turning aside for a moment first, that her daughter died in the ruins of their house, that in fact her entire extended family of aunts, uncles and cousins also perished. “There is no one,” she says with the tragic matter of factness, the enormous grief barely held behind a dam of determination, that seem to me emblems of this entire catastrophe, “except for my boy and myself. And after this hospital we have nowhere to go.”
I tell Dieula and Stevenson how much I appreciate them talking to us, how sorry I am for their terrible loss, how they have helped us to understand the pain and the plight and the strength too of the Haitian people. I explain that we are going to be visiting with other people in the hospital and that we hope to use what we have learned from them and others to help staff and patients here and elsewhere to deal a little better with their grief and all the uncertainties of the future. She says that is a very good thing and much needed.
I am not at all sure if we have been of any help at all. And yet when we greet Dieula a few hours later, as she sits on a bench, she favors us with a smile that brightens the overcast afternoon. “You have not forgotten,” she says.
In Haiti three days of “memorializing the dead,” of prayer and fasting have begun.
thousands gather to memorialize the dead
We drive downtown, past blocks where some houses are still erect and others down, victims we are told of neglected building codes, and others where everything is flattened like discarded, half-eaten sandwiches; fragments of concrete and stone and dust are everywhere. S.O.S. signs are chalked on walls. We pass open air congregations, gathered like human lakes in front and on the sides of tent encampments, several hundred people here a few thousand there, listening to sermons in Creole, raising their voices in song. On the radio one preacher exhorts his listeners to ask God’s forgiveness for drinking, smoking and going to voodoo priests. Requiems for the dead are broadcast, and reminders of God’s power to see and do all, to help us go, and live beyond death.
Haitians gather for sermons
We park at the Champs du Mars. A hundred thousand people are here, or more, it is hard to tell. They fill an amphitheater where the speakers stand, flood across fields and roads, flow among the thousands of tents that have been set up, sit in the trees overhead. The Haitian people, we are told, are like those who were with Joshua at Jericho: They have no weapons but God will save them. The messages from the Haitian President as well as the preachers, are similar – have strength, have faith; we will work together for the future. Men, women and children, most in tee shirts and loose blouses, some in surprisingly neat even stylish clothes, sing and raise their arms ( a few extending bibles upward) to praise God and shout “Hallelujah”. The mood is somber and suffused with determination, but also celebratory. “We are,” one lean fortyish man with dreadlocks tells me, holding my hand and looking at me with urgent fellow feeling, “here to give thanks to God, to rejoice for our brothers and sisters who have perished, to love one another.” Drums begin to play and a breeze, as if summoned by them, blows through the noon heat. We are all clapping and dancing now. None of the Haitians,needing to remain strong, seems to be crying, though sorrow rises like steam from their bodies; tears come to Star’s eyes and mine.
the cathedral in ruins
Afterwards we stop at the Cathedral. A nearby music school has disappeared, its students dying with it. The Cathedral, once one of the city’s glories, is a skeleton, its only note of celebration bright bougainvillea in what was once a garden. You can see through the great building now, from one side of the transept to the other, from the porch at the back through the nave to the chancel at the front. Across the street people too injured or tired or dispirited to attend services that require standing are camped in rubble against a wall, a few possessions piled around them, burlap for bedding. At the head of one’s pallet is an astonishing sign of faith and hope, taped to the wall: a picture of the risen Christ, emerging from a blue sky, returning victorious to earth.
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.
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.
We’re on our way to Haiti now, via the circuitous route that the damaged Haitian airport and the daunting US weather demand. We’ll be arriving on Thursday to begin working with people on the ground and exploring partnerships with the Haitian government and local and international NGO’s, churches, schools, and other community groups. I’m going with Rosemary Murrain, our Director of Administration and Finance, who has worked in Haiti, and Star Myrtil, a young Haitian woman who has been a Program Manager for NGO’s and speaks Creole as well as French.
Welcome to my blog.
