A psychologist's perspective on Port-au-Prince

Haiti, September 16, 2010

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  <span class="field-credit">
    Lisa Hoashi/Mercy Corps  </span>
    Psychologist Sandrine Kenol leads a Comfort for Kids training in her native city of Port-au-Prince. Photo: Lisa Hoashi/Mercy Corps
  <span class="field-credit">
    Nancy Farese for Mercy Corps  </span>
    Parents in a Comfort for Kids workshop learn how to best respond to their children's post-earthquake emotional and physical needs. Photo: Nancy Farese for Mercy Corps
  <span class="field-credit">
    Miguel Samper  </span>
    Orphelinat Foie Apostolique, a center which is participating in Mercy Corps' Comfort for Kids program. Comfort for Kids is a program that gives children post-trauma counseling. Mercy Corps will also be giving the participating children comfort kits, which include items like a stuffed animal, a blanket, sketchpads and crayons, a toothbrush and toothpaste. Tabarre, Haiti. Photo: Miguel Samper
  <span class="field-credit">
    Nancy Farese for Mercy Corps  </span>
    Photo: Nancy Farese for Mercy Corps

Sandrine Kenol left Haiti to study psychology in Canada and returned to her native country in May 2009 to practice her profession. Eight months later, a 7.0 earthquake devastated Port-au-Prince, creating urgent need for her mental health work. She joined Mercy Corps to help run our Comfort for Kids program, which trains teachers, parents and other caregivers how help children emotionally recover from the trauma of a disaster. Sandrine is a dedicated mental health professional. In addition to her work with Mercy Corps, she also has her own private practice in Port-au-Prince, and volunteers her time with the local YWCA to hold self-esteem workshops for young people.

We spoke in mid-July, six months after the January 12 earthquake.

Tell us about what you're seeing now in Port-au-Prince with regard to mental health.

When I returned to Haiti in May 2009, I wanted to work as a psychologist in schools that were less fortunate. I would go and offer my services as a counselor for children, but they always told me, “Well, we don’t use these services. We don’t think we need them. If we have a serious case, we will refer them to you.” What they were inferring was: “We don’t have crazy students so we don’t need you.” Most people thought that only crazy people would need a psychologist's help and have mental health issues.

Now people have seen the ways that the earthquake affected them mentally, emotionally and behaviorally. In kids, parents and teachers see how the earthquake experience has resulted in concentration problems at school or created excessive fear and insecurity.

Right after the earthquake, people were in panic mode because they were seeing behaviors in their kids that they were not used to or had not seen before, so they are really open now to receiving help. They have a lot of basic questions that they are now getting answered with the help of programs like Comfort for Kids. And they are getting the tools to help their children or their students.

Since the earthquake there are now a lot of mental health campaigns going on in Haiti. They are becoming more common and people understand more about mental health. After every Comfort for Kids training, people tell us that we should go everywhere in Haiti, not just Port-au-Prince, because they recognize the importance of mental health information in every day life too, not just in a post-disaster situation.

What kind of feedback have you gotten from caregivers who have gone through the Comfort for Kids training? What have they been able to do with the information?

We hold meetings once a month with about a 100 professionals and community members who have been through Comfort for Kids. At the meetings, we provide additional training and they also give us feedback about the information they have been able to use and new issues that arise.

One teacher told us that rather than disciplining students for misbehavior in the classroom as she would in the past, she has shown them more patience and understanding and has seen the results.

A mother who attended the training had been concerned about her 8-year-old daughter who had started wetting her pants again. She thought the child had regressed in her development. But after the training, the mother went back to her child and let her know it was okay and that she was there to help. The mother told me later that it changed everything, because then her daughter felt comfortable saying, “Mom, I have to go the restroom, would you come with me?” For this mother it was just a matter of letting her know that it wasn't that her daughter had forgotten how to go to the restroom, but that she was scared to go by herself.

We give them simple information like this, and they apply it to their lives. We also give them a book of exercises for the kids and they help a lot.

One of the teachers I met in Cité Soleil said that, for him, progress this school year was just getting kids back in the school building.

I’ve heard that remark several times. The kids want to go back in the building. The teachers tell us that they have been holding classes under a tent and the kids are really distracted. Or they're teaching the kids out on the playground. Well, for a kid, the playground is a place to play. So some teachers have told us that some of their kids have asked them to go back inside the classrooms. Even if it is hard and they're scared to be indoors. But the kids prefer to go back in the classrooms to learn. Not because they’re not afraid anymore but they prefer to go back there to learn. That’s a good step.

What other signs, big or small, have you been seeing of progress?  

Both kids and teachers told us they were having big reactions to any kind of noise following the earthquake. Teachers didn't know how to help the kids get over their fear. I would tell them, "Well, when you hear a noise, you have to explain to kids what is causing it. Because if it’s a truck passing in front of the school that makes a loud noise it's likely that you as an adult can identify it and say 'Okay, that’s not a threat to me,' but the kids don’t necessarily know that. So they started to do that with the kids, and it's helped. The kids have begun to react less to noises.

One teacher told us that she had three kids in her classroom that wouldn’t want to go play with other kids at recess. She found they wanted to stay in class in case there was another earthquake; they needed to have some kind of control. But even these kids are beginning to show signs of progress. They are beginning to live with the experience.

We don't tell kids that everything is going to be okay, because you never know. But we are helping them to accept that something bad might happen again in their lives, but they still have to live.

Now many people are starting to return to their houses. And a lot of parents say that at first their kids were sleeping with them, but now are starting to go back to their separate beds. They are still going to bed with a little stress and anxiety but still these are signs of progress.

At the same time, we still have a lot of teachers who are telling us that they have a lot of students who can’t concentrate in school, who used to have good grades and now they are at the bottom of the class. In the new school year, that will be something to continue to help them with. But still there has been some progress.

It sounds like you’re still finding that kids and adults continue to strongly feel the effects of the earthquake.

Yes. One thing that we find at the Comfort for Kids trainings is that while we mainly focus on helping kids, the adults always find a way to bring it back to them. We might say, "You'll find that after a traumatic event, a child might sleep a lot less, or a lot more," and they will say, "Yes, us too!" They bring it back to themselves because they have a lot of questions about themselves too. They ask, "Why am I not eating, why can't I sleep? Why am I always stressed, always anxious?"

Now that six months have passed since the earthquake, how have you modified the Comfort for Kids curriculum?

We don’t talk only about the effects of the earthquake now. Now teachers have questions about the kids’ changes in behaviors that are not necessarily related to the earthquake. For example, how to help a child who has lost a mother or father. They are seeing that the information we give them can be relevant to other circumstances, because kids can go through other traumatic or tough events.

Also, there are things we have added to the curriculum to help address issues that are surfacing due to so many young people living in camps. We've started teaching how to talk to them about drugs and alcohol, and about sexuality and sexual activity. People also talk a lot about kids being violent or aggressive in the camps and in the schools too. So we give them information about that behavior and teach them how to help resolve conflicts in ways other than through violence.  

We are also giving out information about how to prepare for hurricanes and how to help kids get through a natural disaster. We show them that unlike an earthquake, you can prepare in advance of a hurricane—you know when one is coming. We give them tips about making sure they have an emergency kit, with food and clothing, and a safe place to go.

How do you feel that people are coping with their grief, having lost so many loved ones, as well as their homes and possessions?

It has been hard for people to grieve because the loss was so unexpected. And in Haiti, funerals are a very, very important thing and no one had the chance to do them after the earthquake.

A woman I met yesterday told me something that was very hard to hear. She said, "I lost my child in the earthquake. Recently I was taking the bus home and I was certain I saw my son on the bus!" I said to her, "Well, that’s probably going to keep happening to you, because you lost him so suddenly." She said, "I still see him and reach out to him."

She never found her son's body, so she still has this feeling that he might still be alive.

People are only now starting to accept their loss. There has been a lot of denial. Also in Haiti, activities started really early after the earthquake. The earthquake happened on Tuesday, January 12, and by the next Monday the city and the marketplaces started back up again. Everyone started working really soon after the earthquake and I think that was part of the denial. Because people were shocked, but still they had to live, and they had to find something to keep them from thinking about what had happened. But even today you have evidence of what happened. You have rubble everywhere.

It's taking a long time for all of us to recover, but it's normal. Even for me, in January, I was expecting that in the summer, everything would be normal again. And now I am starting to accept that it’s going to take a long time. I’m starting to understand why it takes a long time, and I’m starting to accept that it’s not going to be easy. I think a lot of people were discouraged at first but when you see the amount of work that has to be done, you have to accept that it’s going to take a long time. And do what you can.