As the pandemic appears to be winding down, this year we begin the journey of recovery. We are learning to live with the virus and with the collateral damage, the pandemic has caused. Among the most concerning long-lasting implications of Covid-19, the increasing mental health conditions can have a substantial effect on all areas of life, such as school or work performance, relationships with family and friends, and the ability to participate in the community. Blanc et al. argue that instead of combating the psychological stress with a war mentality, a global natural disaster mentality, one rooted in psychological first aid (PFA) framework and other related approaches such as psychoeducation, and psychosocial support will help us address the psychological needs to survive the pandemic.1
PFA is a human-centered and culturally-tailored intervention that was provided to Haiti in the aftermath of the 2010 Earthquake.1 Since then, PFA training has been conducted periodically as part of the Mental Health Needs Action Program (mhGAP) in the South of the country to strengthen the skills of the nurses and doctors in their ability to diagnose and understand various mental pathologies.2 As a country that is constantly bombarded by hardship, it is essential that care providers at all levels of the health pyramid be able to provide initial psychological assistance to people in distress.2
Blanc in a separate paper has also summarized 3 determinants to Haiti’s super resilience as follows: hardiness, creativity, and belief in traditional and complementary healing.3 The following 4 facts will give a background and elaborate on Haiti’s resilience:
In 2011 Haiti had between 20 and 27 psychiatrists, most of them in private practice in Port-au-Prince, between 100 and 194 psychologists (including both undergraduate and graduate-level), between 50 and 82 social workers, and between 3 and 20 psychiatric nurses working in the country.4Mental health, as defined by Western psychiatry and psychology, had not been a priority for the government. In the absence of a mental health policy, there was also no real planning of services.5
Given this long-standing lack of formal health care resources, Haitians often turn to religion for help, particularly when the causes of misfortune are unclear. A very large number of Haitians make use of traditional practitioners or religious healers when faced with mental health problems. There are several types of traditional healers available in Haiti who may treat specific illnesses or who address general well-being:
doktè fèy, medsen fèy (leaf doctor) or herbalists often treat illnesses such as colds, worms, diarrhea, and stomachache;
oungan (Vodou priest) or manbo (Vodou priestess) treat many conditions.
doktè zo (bone setters) treat conditions such as broken bones, musculoskeletal or joint discomfort;
pikirist (injectionists) administer parenteral preparations of herbal or Western medicine;
fanm saj (midwives) perinatal and natal care.
Prior to COVID-19, Haiti emerged from a political lockdown that lasted from September 2019 to December 2019. This violent civil unrest was initially triggered by an abrupt increase in fuel prices, a movement that became known in Creole as Peyi Lòk. During the Peyi Lòk, there were roadblocks and barricades in every corner of the country, with considerable repercussions to the education system, the transportation sector, and the economy. In addition to the devastating earthquakes and other natural disasters, the recurring episodes of political instability prepared them to adapt to the COVID-19 pandemic.3
Haitians’ ability to create and make art from their suffering is their trademark. They are known as an artistic nation.3 As part of the integrative approach to PFA, The First Lady of the Republic of Haiti, Elizabeth Préval, initiated a project called Plas Timoun, to help children cope with stressful events such as grievance, loss of homes, and relocation to temporary shelters, etc. Children would be transported to the Haitian Art Museum to participate in activities such as painting, theater, reading, games, music, pottery, sport, and socio-educational activities.1
Although the battle against the humanitarian and mental health crises in Haiti is far from over, many non-profit organizations such as Partner in Health, Catholic Relief Support, and the local Haitian Psychological Association are striving to remove the stigma against mental health by delivering mental health care that integrates both cultural beliefs about health and current biopsychosocial knowledge.6
Written by Jennifer ShuPing-Chen
References
Blanc J, Seixas A, Louis EF, Conserve DF, Casimir G, and Jean-Louis G. (2021). Lessons Learned From a Low-Income Country to Address Mental Health Needs During COVID-19. Front. Psychiatry 12:576352. doi: 10.3389/fpsyt.2021.576352. Obtained on March 5, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyt.2021.576352/full.
Pan American Health Organization. (2022). Mental Health and Psychosocial Support: Integrating Mental Health at Primary Care Levels in Haiti. Obtained on March 5, 2022 from https://www.paho.org/fr/nouvelles/27-1-2022-sante-mentale-et-soutien-psychosocial-integration-sante-mentale-aux-niveaux-des
Blanc, J., Louis, E. F., Joseph, J., Castor, C., & Jean-Louis, G. (2020). What the world could learn from the Haitian resilience while managing COVID-19. Psychological Trauma: Theory, Research, Practice, and Policy, 12(6), 569–571. doi.org/10.1037/tra0000903. Obtained on March 5, 2022, from https://psycnet.apa.org/fulltext/2020-61556-001.pdf.
Raviola, G., Rose, A., Fils-Aimé, J., Thérosmé, T., Affricot, E., Valentin, C., . . . Eustache, E. (2020). Development of a comprehensive, sustained community mental health system in post-earthquake Haiti, 2010–2019. Global Mental Health, 7, E6. doi:10.1017/gmh.2019.33. Obtained on March 5, 2022, from https://www.cambridge.org/core/journals/global-mental-health/article/development-of-a-comprehensive-sustained-community-mental-health-system-in-postearthquake-haiti-20102019/3F231A447792BDD499EC1C4C3A6C760E.
WHO/PAHO. (2010). Culture et and Mental Health in Haiti: A Literature Review. Geneva: WHO. Obtained on March 5, 2022, from https://iris.paho.org/bitstream/handle/10665.2/2791/Culture%20and%20Mental%20Health%20in%20Haiti.pdf?sequence=1&isAllowed=y.
Castle, A. (2020). Haiti’s Need For Mental Health Services Heightened During Covid-19. The Borgen Project. Obtained on March 5, 2022, from https://borgenproject.org/mental-health-in-haiti-2/.