A Culturally Tailored Mental Health Program in Cap-Haitien

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“Haiti is my home and I want all Haitians to understand that mental health is not a stigma but a legitimate medical issue and not to be afraid to talk with a healthcare professional, and ask for assistance.” -Dr. Guerda Nicolas

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It will take billions of dollars and years to repair the physical damage caused by the January 12, 2010 earthquake that devastated Haiti. Over 250,000 people lost their lives and tens of thousands were injured. In the first few days after the earthquake, the immediate focus was rescuing victims with life threatening physical wounds, bruised tissues and crushed limbs. Finding help was much harder for those with mental health issues, bruised psyches or a crushed will to live. One year later, the battered bodies may be mending, but the mental health issues, and flashbacks still linger.
Dr. Rosina Cianelli, PhD, MPH, RN, FAAN, an Associate Professor and researcher in the Center of Excellence for Health Disparities Research: El Centro at the University of Miami School of Nursing and Health Studies, says “estimates are that two out of fi ve Haitians witnessed severe trauma including images of back yard amputations, severe physical injuries, and destroyed homes and businesses. Many have lost everything including their will to live and are in desperate need of psychological care.”

Cap-Haitien is Haiti’s second largest city and has the nation’s second largest health center. Hospital Universitaire Justinien (HUJ) is the primary sole hospital serving Cap-Haitien and is also the referral hospital for the entire Northern Health Department of Haiti, serving a population of more than 1 million people. While the HUJ’s physical structure is intact its capacity is severely strained by the evacuees who are suffering from serious injuries and mental trauma sustained in the earthquake. To deal with the infl ux of patients requiring immediate mental health issues, the HUJ has requested assistance from the University of Miami to establish a “culturally adapted” educational program to train healthcare professionals in Cap-Haitien on how to identify and treat mental health patients.

The new program funded by a grant from the National Institute on Minority Health Disparities (NIMHD) to El Centro, began last month. Cianelli, and a team from the School of Nursing and Health Studies including Dean and Professor Nilda (Nena) P. Peragallo Montano, DrPH, RN, FAAN, Dr. Victoria Mitrani, PhD, (El Centro Research Director), Dr. Carole Roseau, DNP, MSN, RN and Dr. Andree Vulcain from the School of Medicine, and Dr. Guerda Nicolas, a Haitian-American psychologist who is Professor and Chair of Educational and Psychological Studies at the University of Miami School of Education.
Nicolas, who over the past 14-years has implemented similar culturally adaptive and linguistically translated programs in Haiti, will direct the mental health component for the project – provide training, support and supervision, and provide direct psychological services. Nicolas will lead a team composed of Haitian-American mental health professionals including psychologists, social workers, nurses and mental health counselors, all of whom are experienced in disaster response and providing trauma-related services.

According to Cianelli, who serves as Project Director, “mental health, as defined by western psychiatry and psychology, has never been a priority in Haiti, a PAHO/WHO report counted just a handful psychiatrists working in the Cap-Haitien region providing care for over 1-Million residents. This program for the first time will focus on training healthcare professionals to treat the mind along with the body.” The program will educate 125 nurses, physicians and social workers in Cap-Haitien and the rural areas to identify the signs of mental health illness and offer immediate support for patients in need. The second phase will be to identify and provide more advanced training to a selected group of 25 – “on-site trainers,” who will expand the network of mental health services further into the region to sustain the long-term capacity-building at HUJ.
Dean Peragallo says this is a perfect example of how our long standing relationship with Haiti is making a difference, “there is a great need to expand the (HUJ’s) mental health services and expand mental health services to the (HUJ’s) five satellite centers which serve the greater Northern Haiti region. The lack of mental health services not only results in patients not being treated for mental health problems but also results in a misuse of resources because many patients are tested and treated for physical ailments, and cases of depression and anxiety diagnoses are missed.”
Nicolas agrees with Peragallo saying, it is critical to establish a sustained mental health effort in Haiti, “Haiti is my home and I want Haitians to understand that mental health is not a stigma but a legitimate medical issue and not to be afraid to talk with a healthcare professional, and ask for assistance.”


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