When a country is attacked by an unanticipated calamity and has limited resources, providing efficient and safe mental health care as well as psychosocial services presents considerable obstacles. According to the case study, mental illnesses continued to impact Haitians following the 2010 earthquake. An international team comprised of two nonprofit organizations (Zanmi Lasante, ZL, and Partners in Health, PIH) collaborated in expanding mental health and psychosocial services to Haitians as part of an emergency response to the country's 2010 earthquake. While delivering disaster response services, the collaboration between the two organizations assisted them to develop a guiding model to guide the scalability and expansion of the mental health services provided by the Zamn Lasante health care system on a long time basis with an aim of broadening the mental scaling in Haiti communities.
After the disaster/ earthquake, through the program implementation and collaborations, several efforts were advanced to assist the organizations to coordinate their planning together with other organizations that were interested in supporting all the establishes mental health programs after the disaster including non-governmental organizations , government bodies, humanitarian corporations, universities and the foreign academic medical centers . The collective intervention initiated by the two organizations was framed into four categories for action. These categories include the research, training, advocacy, direct service, and delivery. This paper presents the role of humanitarian interventions using the four categories in the provision of mental health and psychosocial services the Haitians for purposes of mental and health recovery following the 2010 Haitian earthquake.
Introduction
The Haiti Earthquake of 2010 was one of the most devastating natural disasters of the 21st century. The Earthquake that took place on 12 January 2010 at 1653 hours Haitian time (2153 Hours UTC) had a magnitude of 7.0. The Earthquake had its epicenter in the town of Ouest, which is located about 25 km from the Haitian Capital Port-au-Prince (Beverly, 2013). The Earthquake had 52 aftershocks that within the two weeks of its occurrence that devastated various parts of the country. These aftershocks had up to a magnitude of 4.5 and even more.
Fig.1 an Illustration of some damages caused by the earthquake in the Miami city
The Haiti earthquake was caused by sliding of plates between the North American plates as well as the Caribbean plates. According to Geologist, these two plates moved slowly past each other in an east to the west direction through a process called the Strike-slip boundary (Beverly, 2013). This led to some stress up as well as along this boundary as well as along the faults where sections of the crust had been stuck together. When this stress was finally released, it caused a strong movement that made the two sides of the fault to also react by moving thereby generating the massive Haiti Earthquake (Thomson, 2010). Experts have named the fault system that caused this Earthquake Enriquillo-Plantain Garden.
Expanding the mental health services that are effective, safe and community sounding presents some of the significant challenges due to precipitous social challenges, poverty, and human loss among other competing needs of people in the community (Kobetz et al, 2012). Following the disaster, a team of humanitarian Haitian organizations and Americans who were working in the international healthcare organization and the partners in heath decided to mount a response to the disaster by focusing on the provision of mental health services to survivors (Raviola et al, 2012). These organizations recognized the absence of mental health services in Haiti after the earthquake and decided to address the mantel health needs in the Haitian communities through collective effort that could support both the earthquake and emergency communities (Safran et al, 2011). These humanitarian the established foundation to for addressing mental challenges on a long-term basis. The 5x 5 intervention model was established to guide the planning process in the mental health care systems in Haiti. One year and a half from the disaster, the Zanmi Lasante and Partners in Health made 20,000 appointments for individuals and groups that required psychosocial and mental health services.
Literature review
There been a continuing growth of literature about the strategy of various stakeholders in addressing mental health consequences of the earthquake in the Haiti communities (National Institute of Mental Health, 2010). There are several studies that have documented specifically the impacts of the earthquake in relation to psychological effects of the Haitian earthquake among the Miami Haitians, a community that represents all the Haitians that are currently living in diaspora (Desir, 2011; Kobetz et al, 2012). From the surveys which were conducted aftermath of the earthquake in march 2010 sampled Haitian American and non-Haitian American that lived in Miami communities (Shlomo et al, 2012). The study was to assess those impacts of the earthquake in relation to generalize anxiety, psychological distress, and other related mental symptoms. The survey found significant psychological effects in the in the American- Haitians who were sampled. This survey used a number of items to make an assessment about the indirect exposures to injury, death, damages and losses sustained by the Haitians after the earthquake (Shlomo et al, 2012; Shultz et al, 2012). The structural modeling equations indicate that there was a positive and robust relationship between the assessed levels of symptoms of the mental disorder and the scales of earthquake exposure (Shultz et al, 2012.
The role of humanitarian organizations towards ensuring mental and health recovery aftermath of the 2010 Haitian earthquake
The initiative to respond to the 2010 Haitian earthquake included charitable organizations, the Haitian government, and the for-profit organizations across the globe (WHO, 2010). The response began by soliciting humanitarian aid that was designated to assist the Haitians. Some countries decided to arrange and send disaster rescue and relief workers and supplied humanitarians directly to the damaged zone in the Haitian countries (WHO, 2010). Whereas other countries decided to solicit a national funding and raised the funds to support, the nonprofit groups that worked directly in the Haitian communities (WHO, 2010). According to the 2013 relief web, a total funding of approximately 3.5 billion US dollars was given to the Haitian government for disaster recovery. Most of the countries decided to send a large number of medical staff, disaster relief, and technical teams for security personnel and reconstruction of the habitat to the citizen. It is noted that countries such as the United Kingdom, United States, Italy, Cuba and the democratic republic of Canada managed to send over one thousand disaster recovery and military personnel each (UN Office for the Coordination of Humanitarian Affairs, 2011). In addition, the international community also provided adequate assets such as the Nava vessels, aircraft carriers, field hospitals and a hospital ship as well as emergency facilities after the deserter. In fact, the first country to mobilize support after the occurrence of the earthquake was the Dominican Republic. The support was purposely to rescue Haiti and save people’s lives immediately after the earthquake.
The international healthcare organization with prior experience and knowledge in the provision of health services in Haiti together with its copartners such the PIH and the Haitian organizations Zanmi Lasante decided to respond first to the acute medical crisis that hit the country following the earthquake. In corroboration with the international healthcare organizations, the PIH and the ZL introduced sustainable programs to reduce mortality and transmission of infectious diseases such as HIV and tuberculosis and established feasible and reliable mental health care programs that can inclusively integrate mental health services in their endeavors. PIH decided to start its healthcare systems in Haiti in conjunction with a number of medical centers in the United States and the Harvard medical school. The healthcare systems were strengthened in low-resource countries by making a grounded framework for human rights categorized into four categories namely healthcare management, advocacy regarding crucial healthcare needs, systems management, and research. These categories were tackled independently to contribute the ongoing endeavors towards achieving a better health environment through building local capacity in the delivery of long-term mental health services (Bauer et al, 2010).
The first action establishment of mental health care programs started by assessing the services that were already existing within the Zanmi Lasante (ZL) area (Bauer et al, 2010). The actions also started by organizing the meeting with health workers and services providers of mental health services in the Zanmi Lasante (ZL) regions and the Port-au-Prince areas where the disaster had led to the fatality of so many Haitians and made a lot of damages as well (Bauer et al, 2010). The mental health care team worked with United Nations representatives from other organizations while making weekly meetings to establish a coordinated service strategy (United Nations Development Program, 2011). In addition, the minister of health in Haiti recognized that the mental health need of the Haitian population had been ignored due to the earthquake. The earthquake exposed most of the members of the public and the public heather sector in desperation of the mental health care system. After the earthquake, most of the people who had mental health complications were being ignored and languished in locked inpatient wards, others were left wondering on the Haitian streets, and there were few psychiatrists working in Haiti now (James et al, 2012).
A small group of humanitarian from the PIH/ZL group decided to take a responsibility and advocate for mental health service response. After the recognition of the mental health care service crises, the nation, minister requested for the support from the PIH/ZL team to develop national dictate response to mental healthcare. This initiative served as the basic model to develop a community-based service system toward provision of mental health care services. Under the ministry leadership, the Haitian government becomes part of the broader planning efforts to establish a coordinated strategy for mental health care services.
The mental health care service team understood the relevancy of the building an effective mental health care systems and in this context required a strong, systematic, and evidence-based approach that praised local knowledge.
In the first year after the earthquake, the psychosocial program of the ZL group on educational, socioeconomic, and mental healthcare needs of the population especially in families affected by HIV and children.
Fig 2: A line of children receiving humanitarian support
The initiative operated on an assumption that the emotional distress of the Haitians is due to poverty and lack of shelter as well food requires a clinical intervention and solicitations (Carson et al, 2010). The platform organized by the ZL team was to provide the upset earthquake response to mental health needs. In the month of February 2010, the interoperated team from the PIH/ZL mental health and the psychosocial department decided to commemorate the survivors and the loss of lives and provided comfort, emotional healing, and the consoling to all the survivors at the ZL hospitals. The mental healthcare service delivery director who was also the Haitian priest organized the morning services as the religious team that combined psychological language and spiritual language (Schafer A, 2010). The ministry of health recognized this initiative and decided to use the national address systems to emphasize the importance of mental health care and morning.
Most of the groups that were recognized as the vulnerable to mental health challenges include those who had sustained injuries, survivors of gender-based violence and the young children who need too much protection. The effect of the earthquake extended to people who already had the preexisting mental disorders or related symptoms of mental loss and trauma, healthcare providers and Haitians that lived in the diaspora as well as others that responded to the disaster relief programs in supporting the organization programs (Montpetit, 2011; Cerda et al, 2013). The mental health care team was actively engaged in the treatment of both mental health needs and psychosocial complexions of community members, building capacity for mental health services well as the psychosocial challenges and supporting the mediation of health in an effort to develop a national plan for mental health.
Fig3: an illustration of active engagement of the humanitarian team
The complete evidence-based recommendations and practices helped the mental health care team to come up with initial and mental health care response to the community members. The response was composed of the provision of support to the ZL members of staff, developing community programs, launching social activity to support children growth and training more psychiatrists to provide psychological first aid, implementing an enhanced manage healthcare services in all the communities, training physicians to provide mental health care and manage several distress states.
Much as humanitarians tried to put many efforts in responding to the earthquake, the several factors hampered the progress of some of the humanitarian’s programs. These factors include destroyed infrastructure, the aftershocks, loss of lives, collapsed buildings, blockage of streets, and lack of power especially in gasoline station pumps, loss of the seaport to the capital and lack of traffic control facilities (VOA News, 2015). In addition, the coordination of disaster response was also hampered damages on the Haitian ministries of the government.
Fig 4; the map showing the Haiti’s access to the sea
Conclusion
In the low resource context, mental health and psychosocial services response after the earthquakes and other related disasters have all was been hampered by difficulties in coordination of intervention from individual groups, non-governmental organizations, NGO's, and individuals from local communities and the government at large. This case study has described the role, which can be played by humanitarian groups in providing the response to mental healthcare services post the disaster and harness the mental health in disaster-affected communities. The case study provides the best mechanisms the can be put in place to support the communities. These efforts include disaster response services delivery by laical fractionates following the occurrence of the earthquake, designing and implementing a basic model that can guide the humanitarian activities, coordination of the humanitarian organizations and groups as well as linking training, research, and advocacy activities to the services offered by the humanitarian organizations. The case study also describes the roles psychological teams health services situations where the mental health services are stigmatized and ignored. The case study finally looks at the room for needful implementation of similar efforts in case the disasters or earthquake happens again. In addition, these efforts act as long term solutions to support the disaster relief communities.
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