An Introduction to Mental Health

"Joseph believes he is already deceased, that he died in the earthquake."

On one of my first days in my feeding centre I met Joseph. At 11 years old Joseph looked 7 at most. Joseph’s family includes 11 children; they have been living in one of the tent cities of Carrefour after the earthquake. Joseph and his 2 younger siblings were referred to the MSF Inpatient feeding centre (ITFC) for severe malnutrition complicated by illness.

At the feeding centre we have successfully treated the two youngest children’s illnesses and they have gained enough weight on the therapeutic food MSF uses to be discharged home to their family. Unlike his brothers, Joseph has not thrived under the combination of therapeutic food and medical treatment. Instead, he became delusional and violent post earthquake, so traumatized by what he witnessed he now hears and sees things that aren’t there and lashes out at times towards others and himself. What broke my heart was his explanation as to why; Joseph believes he is already deceased, that he died in the earthquake. To me it seems as though he believes his spirit is already dead and he is simply letting his body catch up by refusing all treatment and food.

At an ITFC we are well equipped to handle the medical complications that come with malnutrition, Joseph’s case has presented us with special challenges. A very large part of the MSF response to the disaster in Haiti has been mental health, in my project we have psychologists who we work with. They however, have not been able to make progress with Joseph and our next step was to refer Joseph to a psychiatrist for an evaluation. Not as easy as it sounds, the psychiatrist is based 1.5 hours by car from us and with tightened security regulations in an already difficult context, it took 1 week to finally be able to arrange safe transportation. The day we went traffic was terrible and by the time we made it there was only 30 minutes left before we had to turn around and head home, so as to arrive before curfew. When we arrived I was so nervous, here we were with a child who rarely interacted with anyone and we had such a small window for the MSF psychiatrist to get a sense of him and put a plan in action. Imagine my relief when Joseph began talking and kept on going for the next half an hour. I left that day feeling hopeful, we had a plan, it had taken almost 2 weeks to put together but we had done it. Now we wait and see…

When Maslow was developing his hierarchy of human needs he made physiological needs the base of his pyramid. My experience thus far in Haiti has shown that safety and love can supersede physiological needs in the life of a child in crisis.