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Archive for the ‘mental health’ Category

By Nayla Khoury*

Rosanna stood in the middle of a circle of benches, outside of Medishare’s compound in Casse; her hands were raised and waving. She was speaking about Jesus and to no one in particular. I asked Wilfred, our newly trained interpreter, to translate for us.

“She is talking about someone who is trying to kill her with a machete,” He told me. “She is praying to Jesus for the sick.”

I asked him to speak in the first person and to try to follow her speech, however rapid and rambling.

“She is not making any sense,” He told me. “She is fou.”

This was my first impression of Rosanna, a small and energetic 74-year-old woman whom we have begun to know over the past two weeks. In our effort to learn about mental illness in rural Haiti, “fou” or “crazy” is a term that we encountered early on.

Some people described fou as someone who does bizarre things, walks around with tattered clothes and talks to him or herself. I had seen quite a few people labeled as “fou,” who even Project Medishare nurses stayed away from, telling me that a “fou” could be dangerous. The western medical student in me wanted to translate this into a term I could understand; “fou” it seemed, referred to someone with severe mental illness, perhaps overt psychosis.

The next week, I accompanied Aimée, a public health student, on a home visit to Rosanna’s house. After the Medishare motorcycle could no longer navigate the rugged terrain, Juno, a local Haitian, led the way to Rosana’s house on foot. The walk to her house was beautiful; from this elevation, we could see the Thomonde River to our left. I saw fields surrounded by mountains to our right. Juno explained that he had worked on these fields in the past and that he knew Rosanna. He described her as a sweet old woman who likes to pray a lot. He denied that she had any mental illness.

After a 30-minute hike in the mountains of “Vingt-Cinc”, we turned right onto a skinny path that crossed a field. I could see Rosanna from afar, her body bouncing up as she walked toward us; she was carrying wooden chairs in her hands. She smiled broadly and kissed Aimée, Ken (our translator) and me on the cheek. Juno enveloped her in a hug, lifting her off the ground and swinging her tiny body. She squealed.

Rosanna introduced us to her son and grandson who lived next door, then took us on a tour of her house. We told her that her place was beautiful. She shook her head, saying, “Not when it rains.” She apologized for not having more to offer us and for the state of her small house.

Her house was certainly small; her bed was within arms’ reach of her kitchen table. Yet it was clearly a home. Outside of her house hung nicely arranged pots of purple plants.  Her belongings were neatly organized:  boxes were stored on wooden planks above her bed, every inch of her space well utilized. She showed us how she lined the walls with decorations, which consisted of many seemingly random magazine pages.

Afterwards, the four of us sat down under the mango tree next to her son’s house. Rosanna talked to us about her life. She explained that her role in the community is to pray for people. She spoke rapidly and with passion; from time to time, Ken was able to put a hand up to pause her in order to translate for us.

Rosanna explained that she first took Jesus into her life when her son was younger and had a sickness. She explained that a Loogau, a person who comes to take babies, caused her son’s sickness. Rosana discovered that she had special powers sent by Jesus that enabled her to detect the Loogau and throw away the bad spirit. She spoke of animals with wings and other stories we could not follow, even with our translator by our side.

Later conversations would reveal that a Loogau is actually commonly understood as a normal person by day that can manifest into any form at night. Our research assistants excitedly explained that one could become a Loogau by going to a Hougan or voodoo priest. It was a way to make money, one research assistant explained, since Hougan’s needed people to be sick to stay in business. Often, however, a person did not even know that he or she was a Loogau because it could be inherited. If one’s grandmother was a Loogau and you were the first to cry after her death, you might become a Loogau. Loogau’s could transform babies into animals that a parent might unknowingly eat.  Our research assistants joked and laughed while sharing these stories, but one explained that he had goosebumps while talking about such a “creepy” subject.

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By Jennifer Browning

Students from Emory University have been working with Project Medishare staff in Haiti’s Central Plateau this summer trying to understand how mental health is understood in rural Haiti. The students hope that this is the first of many trips to work toward improving psychosocial services in the Central Plateau.

“This summer is the first of hopefully many steps,” Bonnie Fullard said. “Right now we are trying to lay the groundwork for some type of psychosocial support through Project Medishare. We are trying to understand the needs the way mental health is understood and discussed in rural Haiti and the resources that are already in place.”

Fullard who is a second year Masters in Public Health (MPH) student also working toward her doctorate in anthropology is spearheading the focus group discussions on the project while working training the research assistants.

“We are working at mapping these current local resources available, but at the same time we are using resources used in the U.S. and sort of adapting them here,” Fullard said.

Hunter Keys, a first year nursing student at Emory, said one of the major challenges the research group faces is the language. While the group has been taking Creole lessons at the university to prepare them for this project, there is still an issue about how the language translates in regards to mental health.

“I think one of the challenges is getting a sense of the language and an understanding of the language barriers,” Keys said. “We are really trying to get an understanding of the local language and how mental health is expressed here.”

To assist them with this, the research group found four English/French translators who also are serving as research assistants to help them understand the true understanding of mental health in the rural area.

“One of the examples is the concept of emotions, for instance, a word that we use to describe as emotions for example is the French word, sentiment, is feelings,” Keys said, “but we have been told that in Creole sentiment is reserved for amorous relationships, so sitting around in a group talking about sentiment might conjure up the wrong images. “

Keys said that even the Creole word for mental health doesn’t necessarily translate.

“Even the translation for mental health in Creole, santé mentale doesn’t necessarily translate among rural Haitians. Maladie mentale –a mental illness is immediately thought of as being on the extreme end of mental illness and we are trying to take a more global approach to a more encompassing view of mental illness.”

Fullard agreed with Hunter in that in rural Haiti there is not an actual term for mental health.

“In that sense it is something that is not really talked about,” Fullard said. “When it is talked about it is a really stigmatized topic where people here immediately describe it as “fou” or “crazy” so that it is hard to talk about the things we want to get to, which are the more mild to moderate disorders such as depression, anxiety, and post-traumatic stress disorder(PTSD).”
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