April 1st, 2010

Resiliency at heart of emotional recovery

In the wake of Haiti’s earthquake, psychologists reach out to survivors

A natural disaster – like the January earthquake in Haiti – may happen in minutes, but the long-term effects linger long after the story disappears from the headlines.

“We focus so much on the event and what it’s like and people sort of think that it’s over,” says Pedro M. Barbosa, Ph.D., associate director of adult patient psychiatry and staff psychologist at the Cambridge Health Alliance in Massachusetts, which has had a Haitian mental health team for more than 20 years. “But (the trauma) comes in waves, and frankly I think we haven’t seen all of the effects yet.”

The CHA has been active in forums and consultations with community and government groups and with outreach efforts to ensure Haitians receive needed services. Massachusetts is home to the third largest Haitian population in the United States.

After the initial earthquake, Haitians were re-traumatized by aftershocks, living outdoors and in unsafe conditions, losing their homes and possessions, dealing with loss of limbs and struggling for basic medical care and necessities.

Carline Jean-Baptiste, Ph.D., staff psychologist with the CHA’s Haitian Mental Health Clinic, who was born in Haiti and immigrated to the U.S. at four, experienced her own loss in the aftermath – a cousin who had survived the quake suffered a fatal heart attack later. “It is a situation that is very close to me,” she says. “It’s personal as well as clinical.”

“One of the services we provide here is just giving people space to be with themselves and talk about their worries,” she says, like the short-term (‘How do I get better?’) to the long-term (‘How am I going to find the strength to rebuild?’)

“Just sitting with people and listening to their stories, just being a witness to it, I think it’s very powerful,” Jean-Baptiste says.

“One of the things that has been very moving is I felt really privileged in hearing people’s stories of survival and resilience; the way people mobilized even before assistance came,” Jean-Baptiste adds. “They were the ones digging people out and sharing what they had.”

Barbosa agrees it’s important not to focus on the negative. “We have also seen a lot of heroism and resiliency,” he says. “There are ways to intervene that are about strengthening communities and ways people can come together to sort of undo the tragedy that has befallen them.

“When we meet with groups, certainly we talk about the clinical services that are available, but also try to strengthen natural community,” Barbosa says.

Susy Sanders, Ph.D., trauma specialist and psychologist at Morning Bridge Center in Phillips, Maine, also believes in focusing on resiliency and strength-based response.

“Resiliency doesn’t ignore suffering, it embraces and acknowledges and sees it clearly, but it also sees the person in a strength-based perspective, which is more hopeful,” she says.

Sanders says, like all of us, Haitians woke up that morning with assumptions about what their lives would be like that day. “Suddenly that was all taken away, shattered. The first thing that happens is people are attempting, psychologically, to put together a set of assumptions they can function on that meets the new needs. It’s a reorganizing of a psychological framework. That takes a while.”

“(The Haitian people) have some really excellent characteristics to their culture that are supportive of resilience, however,” Sanders adds. “Yes indeed this was horrible and they needed to have immediate and ongoing help because of how everything collapsed around them. So we’re going to be out there for a long time meeting their basic needs. But as far as their psychology goes, one of the strengths that they have as a culture is that they are very tight-knit. And we know that resilience is found when there are certain attributes, and one of them is connection to others.”

Jean-Baptiste says the main focus for many Massachusetts residents has been getting proper care for survivors. “People are trying to get their loved ones (to the U.S.) so that they can get adequate medical care,” she says.

“The people here lost so much vicariously and directly,” Barbosa says. “There are many immigrants here who have been working 20-25 years in second and third jobs to save and build (retirement) homes in Port-au-Prince. It certainly challenges their sense of meaning and all they’ve been working for here.”

Sanders notes it is important to recognize symptoms of compassion fatigue, secondary posttraumatic stress or vicarious trauma among the Massachusetts Haitian community. “Sometimes it’s worse for someone watching because when you are in the middle of something even though you are helpless, you are trying to do whatever you can do,” Sanders says. “But if you are observing all of that, you are helpless. So the sense of overwhelming helplessness is going to be a huge factor, in whether there’s a development of secondary stress.”

Jean-Baptiste has visited local schoolchildren and helped them organize fund and supply drives for victims. “A lot of the kids were affected. They were thinking of concrete ways they could help the community, so that they could feel like they were doing something,” she says.

Barbosa notes the CHA is reaching out to churches, community and government organizations and using the Community Crisis Response Team (CCRT) model of resiliency to help them best use their resources and reinforce natural skills of self-care.

The Haitian community does not traditionally embrace mental health care. “That’s not the first line of support for Haitian-Americans,” Jean-Baptiste says. “They oftentimes will say, ‘I’m all right,’ when they really aren’t. They are having difficulty sleeping. They are having flashbacks. They are worried about family members left behind in Haiti. They are grieving family members.”

One woman told Jean-Baptiste she believed God saved her for a reason. “Despite whatever is going on, their faith in God is unwavering,” Jean-Baptiste says of the Haitian community. The woman also relied on culturally-sanctioned herbs to help her through her trauma.

Barbosa feels it’s important to respect the inherent coping strategies that people have, “whether it’s through folk medicine or their spiritual beliefs,” and to maximize those strategies.

Sanders echoed that philosophy. “In essence, they are teaching us – about their worlds, their beliefs and what works for them,” Sanders says. “It’s more than just respect. We also need to individually come to know and understand each person and how they make use of that belief system, how it works for them and then help them build on that, help them draw from that. Because that is how they are going to get well. That’s their resilience.”

For more information about local efforts to help the Haitian community: The Haitian Coalition of Somerville: www.haitian-coalition.org; Tri-City Haitian Relief: http://tricityhaitianrelief.blogspot.com; The Cambridge Health Alliance’s Haitian Mental Health program: http://www.cha.harvard.edu/psychiatry/mh_haitian.shtml

By Pamela Berard

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