Dr. Maryvonne Bargues is an MSF psychiatrist. She leads a 19-person MSF mental health team that includes 13 Haitian psychologists, working at MSF's Saint-Louis hospital in Port-au-Prince. She explains how, four months on, people are still feeling the earthquake's psychological aftershocks.
Are people here still suffering from the psychological impacts of the earthquake?
Four months after the earthquake, many people remain in what I would call a state of "complete confusion of land and body". Most of my patients are afraid of being swallowed up by the earth. The earthquake is literally in their body and the noise is always present. They have major sleep disorders. They live in a constant state of fear and continue to have flashbacks, during which they re-experience the awful moment of the quake. In April alone, I saw 70 patients who were in a state of acute delirium, confused and unable to think clearly. Many have stopped speaking and eating. They are in a state of mutism and complete stupor. After two or three weeks of sessions, they improve. I try to speak in their place and, gradually, they become a bit more present and begin to return. There are also people who are grieving deeply and who present with depression and melancholy.
Is there a way for them to commit to the future?
I would say that they are somewhere between nostalgic and discouraged, but they do not have a sense of resignation. Many patients tell me, "We will never get through this." All the walls may have fallen down here, but these people are facing a wall. Four months after the quake, not much has changed. "Will we be able to go back home?" Their houses are gone. In the best of circumstances, they have a tent. It's almost a luxury to have a tent, but it's not a house. The people in the camps are living in crowded, unsafe and violent conditions. The conditions are nearly unbearable. Many people had small businesses that were swallowed up by the earthquake. Living conditions are horrific and many people think that things will not change.
What are MSF's primary activities in the area of mental health?
I lead one of MSF's mental health teams. It is composed of 19 people, including 13 Haitian psychologists, a psychiatrist, a psychiatric intern, a social worker, a children's activity leader and two interpreters. We focus our activities within MSF's medical facilities and in the camps where earthquake victims live. We also visit local organisations. We hold between 35 and 40 individual sessions every day. That means the consultations are short but you can say a lot in 10 minutes, you know. I see each patient at least once a week. If they are in an acute state or delirious, I see them every other day. We also hold group psycho-social sessions, targeting people of the same age, such as children, for example.
What is the advantage of being a psychiatrist in this situation?
There are only 8 or 10 psychiatrists today in all of Haiti. As a result, many psychotic people are referred to me. I am both a psychotherapist and a psychiatrist, so I can prescribe medication. This can make a difference for people who have trouble sleeping, for example, or for those who have undergone amputation or become paraplegic as a result of the earthquake.
MSF psychologists have given over 12,300 individual consultations to earthquake victims, since January. Psycho-social activities at medical facilities and in camps have been organised for a total of 58 800 Haïtians.