March 3, 2010

Doctor's regret: 'My work here is not done'


— A native of Haiti, Dr. Ralph Saintfort is a psychiatrist from Rock Island, Ill., who has worked as a clinical volunteer with Portland-based Konbit Sante since 2003.

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Dr. Ralph Saintfort, center, a psychiatrist and Konbit Sante volunteer, and colleague Dr. Gena, left, talk with a local radio host in Cap Haitien about mental health issues related to the earthquake that destroyed Port au Prince. Photo Courtesy Konbit Sante.

During their visits to Cap Haitien, Saintfort and his colleague, Dr. Malcolm Rogers of Scarborough, typically teach a variety of psychiatric subjects to medical residents and staff specializing in family medicine and internal medicine at Justinian Hospital.

Konbit Sante has worked in Cap Haitien for a decade, working at Justinian and a clinic in the Fort Saint Michel neighborhood of Cap Haitien to improve the public health system in the country's second-largest city.

Nate Nickerson, the executive director of Konbit Sante, has been in Cap Haitien since days after the earthquake to coordinate volunteer efforts and arrange for supplies that are desperately needed to care for the wounded.

Cap Haitien wasn't damaged in the earthquake that devastated Haiti's capital, Port-au-Prince. But daily busloads of victims continue to arrive there, seeking treatment. About 1,000 Haitians displaced by the earthquake are staying at the Cap Haitien gymnasium, where Saintfort works with colleagues to provide psychiatric counseling for the traumatized survivors.

The following are excerpts from Saintfort's letters to Rogers, used with permission.


JAN. 26

Hi Mac. I miss you. It's been hard to e-mail. Both Nate (Nickerson) and I are up catching on e-mail (it's about 5:30 a.m.) . . . service has not been reliable and staying in touch with people has been difficult. Every staff member here has had a loss or two. They too need some emotional support.

You may have seen my post late last night about working alongside two Haitian psychologists (Noesil Elise and Huandy) that I met at the local gymnasium. The gymnasium is two blocks from the Justinian. It has become a processing center triaging displaced people from Port-au-Prince.

These people arrive with various needs: shelter, food, medical and psychosocial. I have set up a makeshift mental health clinic in two areas in the gymnasium: one area for individual therapy/evaluation/acute case management, and another area for group psychotherapy.

The group psychotherapy sessions are on a rotating basis for 45 minutes to an hour at each interval. I have better impact doing this, reaching more people at once. They are good patients and get the hang of it very quickly.

For people with more pressing issues, i.e. pre-morbid depression or anxiety, prior hx/o trauma, or suicidality, they get pulled aside for more one-to-one evaluation or counseling. Also some people are seen first one-on-one based on what they report on their triage sheet.

I have been giving out Benadryl as a sleep aid and Tylenol for pain relief. I do not have any anxiolytics on hand, but I have written prescriptions for Diazepam for those with panic attacks. We now have a system in place that the local civil workers are comfortable with and they are grateful to have this resource on site.

Getting back to Justinian folks. The mood is somber among many staff members. They are overworked. No new interns or residents are coming to Justinian at this time. They were due to report to duty to Justinian in the middle of January. Those rotations have been delayed.

I saw Dr. Gena and Dr. Pierre for the first time yesterday. Dr. Gena was at the hospital briefly in the morning, but gone by noon to attend to a wake in the family in Limonade.

He has a sister who suffered an open fracture. She is receiving treatment at a hospital outside of PaP (Port-au-Prince). He has family members that are missing, not heard of yet since the earthquake. He is (in) good spirits, however, and very pleased to see me. I am too pleased to see him.

We have set up an agenda for the week that includes (a) local radio program discussing mental health issues related to the earthquake, (and) two separate sessions for group counseling for house staff and administration. They, too, need some intervention to process what has taken place. They are dealing with the same issues that I have encountered among those affected by the earthquake.

I do not want to forget this. I have reconnected with Margarette. She is the psychologist we met previously working on the CDC AIDS project. She has joined me along with the two psychologists mentioned above. She too saw patients with me.

At the end of the day I did do some didactic with them on PTSD, GAD, PA, and MDD. We touched based on bereavement issues also. I have found some Creole screening questionnaires for PTSD. I plan to start using that today . . . more on that later.




Hi Mac. I have been pretty busy, and I am feeling pretty useful. The system I've developed at the local gym is working quite well. The volume of people I have provided services to has increased significantly. I had several young students in a couple of groups today. They are devastated by (the) loss of friends, family members, school and their teachers. Many of them feel a great sense of despair over their future . . . no education equals more poverty. They are lost!

Schools here in Cap Haitien are still closed. I still walk daily to the hospital, but I miss the ambience of the morning rituals that you and I had grown accustomed to on prior trips; kids going to school, parents walking their kids to school, the array of colors of the school uniforms representing various schools. I am heartbroken!

I walk now toward the hospital with more urgency to get to the emotionally wounded, lost, and confused. My Haiti cherie is badly battered, broken, and its people are in great need of comfort and consoling. My work here is not done.

Edy has been a great resource in helping me negotiate with a local radio station to do a program focusing on the psychological impact of the earthquake. Dr. Gena and Dr. Pierre of Justinian Hospital will collaborate with me on this effort. The local radio station has a large audience that also reaches listeners in Port-au-Prince.

They have agreed to record the program and rebroadcast it a couple of times. This will be a great opportunity to do some psychoeducation on the many issues confronting those affected by the earthquake. We will take questions from the audience during the program.

There is more to be done in the days ahead. I will keep you posted.

Best, Ralph


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