Grief (The Story of Mirlande)

On an earlier visit to Haiti, I was fortunate enough to be invited to an “English Club”.  No, it was not an elitist club created for and by the blan, but rather a group of Haitians that would meet and practice their English.  It was fun!  They’d propose a topic and have philosophical discussion, in English, about it.  I quickly found that I wasn’t necessarily there to participate in the conversation, but more to help their pronunciations #StillAnOutsider

One such meeting took a turn I would have never predicted.  The topic was depression or, more specifically, “Who was more depressed – Haitians or Americans?”  Wow.  Let that sink in.  It seems so trivial, but then it starts hitting on so many different levels.  To me, at first, it was a no brainer.  I offered than in my brief (especially at that time) medical service in Haiti I very rarely came across patients whom I thought would meet criteria for depression using any sort of scoring system.  However, in the U.S. I feel like MDD is one of the more common diagnosis codes that end up in my notes.  Diabetes Mellitus Type II. Morbid Obesity. Major Depressive Disorder #TrendMuch?  I was hooked to the conversation.

In the group, the overwhelming response was that Haitians were more depressed.  I mean, they would HAVE to be, right?  Half of the morning in rural Haiti is spent getting water.  Most don’t have steady employment.  Food insecurity is common.  Infectious disease and trauma are daily occurrences.  This conversation was just two years removed from the Earthquake that claimed hundreds of thousands of lives and unquestionably impacted every single person in Haiti.  Plus, it was hot as hell where I was and there were no AC units to be found #FirstWorldProblems.  How could you disagree with their argument?!?

It stuck with me.  Mental health is a wholly under-represented field in low-resource countries.  Somehow, my friends at Respire are accomplishing the impossible by offering mental health counseling to their students.  The results and stories are both sad and amazing.  But it wasn’t until I was on this most recent trip to Gran Bois with ServeHaiti that I realized how vital this service is to community wellness.  (I hyperlinked to both organizations' websites if you want to see more about the awesome work each are doing or are interested in donating time / money / goods).

The story was sad.  A 6-month-old was brought in by her father because he couldn’t get her to eat anything.  She was laying in our hospital crib covered by a tattered blanky.  The kind of tattered you’d expect next to a toddler that just didn’t want to let go of their baby blanky.  Her brown eyes wide open and just piercing through me.  No smile.  No tears. 

The dad didn’t offer much for nonverbal cues as I began my infant exam.  That’s when we went from sad to tragic… “The mother had been working in the garden when a rock fell and hit her head and she died.”  Hold up.  Imagine, real quick, that you’re hunched over a 6-month-old auscultating her heart and trying to get any kind of reaction out of her with silly faces.  Then your interpreter drops this bombshell on you.  A monotone, run-on sentence that punches you right in the gut. 

“Wait…. What??”  “That’s what he said.  The mother was working in the garden when a rock fell and hit her head.”  “When did it happen?”  “Last Friday.”  It was Wednesday.  The girl hadn’t eaten anything in six days.  The staff at the clinic had started her on Plumpy Nut RUTF and Oral Rehydration Syrup as well as a vitamin regimen and some antibiotics for kicks. 

Powerless is seeing a problem and not being able to provide a solution to it.  And boy did I ever feel powerless.  Her problem extended well beyond any physical ailment.  She was grieving.  I imagine she was confused.  She needed to be nurtured.  Held.  Breastfed by her mom because that’s all she knew.  The father needed counseling.  How the hell does he deal with this?  Single parenthood is tough in the states (speaking not with personal experience), but I can’t even try and relate it to rural Haiti.    

It was a heavy reminder to me that mental health is more than just depression and “feeling the weight of sadness” as it was once characterized in a Zoloft commercial.  It’s about grieving.  It’s about coping.  Addressing PTSD.  It’s about the mind working through problems that modern medicine struggles to define let alone treat.  It’s about a community that doesn’t isolate a patient struggling with bipolar disorder or schizophrenia like they’re a crazy demon.  It’s about a healthcare provider who realizes that alcoholism and addiction can’t be treated with a pill or incarceration.  These treatments often require deep, interpersonal relationships, trust and a spiritual healing.

The first photo is her on admission and the Facebook image gives a little more background into some family dynamics from a couple of other volunteers.  This picture is her after ten days in the clinic.  Thank you to Liz McDermott and Sarah Stafford for the updates.

I don’t yet have a conclusion for the little girl’s story.  I hope the ending is far away and happy, but I fear the worst.  Even in the U.S. a tragedy like this would be very difficult to recover from.  They were the last patients I said goodbye to on my way out.  Her eyes still wide and vacant.  His eyes confused and full of fear.  I think I speak for the whole team that saw them when I say their faces will never leave my mind.