I recently was invited to speak on a panel organized by the new NGO Committee on Mental Health at the United Nations. The title of the session was, ‘Refugees and Mental Health.’ After giving this some thought, I accepted the invitation and began my preparation.
I decided on a couple of experiences I felt would best highlight the topic. I opened up with a short video clip from the initial days post-earthquake in Haiti in Jan 2010, followed by a slide presentation to emphasize the magnitude of the stress all the victims and health professionals were under. It showed victims triaged and sent via military helicopters, often unaccompanied children and adults, 70 miles north to the best equipped hospital at the time in Milot, Hopital Sacre Coeur, just outside Cap Haitien. Victims were either sent there or to the USNS Comfort ship just off the coast of Port-au-Prince. The census of the hospital went from its typical 120 beds to almost 500 in those weeks! We had to get creative—and aren’t nurses the most creative!!??
A soccer field turned into the helicopter landing—almost every 10 minutes more victims were delivered. They were carried by volunteers to a ‘make-shift’ emergency/triage area on a basketball court of a school, where they were immediately assessed, given pain medication and sent to radiology for x-rays. From there, it was determined, more often than not, surgery was needed. People just showed up with a piece of surgical tape on their forehead or arm to say what part of their body was injured, with possibly a bandage wrapped around the area. A donation of tents that fit 50 recovery beds helped with the massive overflow of people recovering from surgery.
Our typical 1500 annual healthcare volunteers had to come to cover just one month—the place was bursting at the seams! However, the physical, emotional and spiritual roads to recovery were addressed and met. A culture who normally ostracized any person with congenital defects that caused loss of limb (because what good could they do—they needed all their limbs to work to survive!) now found hundreds of thousands of people in similar desperate situations. But this common pain and problem actually unified them.
The morning that the first amputee, a 20-year old man received his fitting for a prosthesis, he entered the tent, threw up his crutches into the air and began dancing and smiling and yelling for joy! THIS was made the benchmark for those expecting their own prosthesis to come.
The circumstances of grief, death of children and many adults, took its toll on the healthcare workers and all volunteers as well. We had to pull many off their assigned duties to provide breaks and allow for them to try and process what they have been caring for—no one had ever seen some of the horror they were now witnessing—how can anyone prepare for such a thing!?
Everone would eventually suffer from PTSD—Pst Traumatic Stress Disorder, in one way or another, and to varying degrees. As I shared with the audience, when people experience ‘flashbacks’ 90% of them are back in the past of what they experienced, and only 10%9n the present. Therefore, of they are having para-sympathetic responses—increased heart rate, respirations, blood pressure, etc—they are stressing themselves psychologically but also physically. When this occurs over and over with time, PTSD get manifested in a variety of physical ailments as well.
We now had a country in need of something they never acknowledged needing previously—the need for mental health experts.
The second experience I highlighted was a different experience. A trip to care for the women and girls who survived the ‘rape camps’ existing in refugee camps in Bosnia-Herzogovina. To add insult to injury, most, nearly 90%, of men—their husbands, fathers, brothers, friends—were executed and eliminated (often witnessed by them) then placed in a mass grave in Sebrenicia — being excavated for identification of victims at the same time of our visit by the Int’l red Cross. So, to say, the women and girls were traumatized is an understatement, yet all their concerns were if we had heard anything about their loved one(s) if he/they had been found and ID’ed.
Dealing with rape victims is a specialty in itself—therefore, all our teams members were required to go through special training in Washington, DC with NOVA, National Organization for Victim’s Assistance, before heading over to Bosnia. We were made to go through many role-playing scenarios to fully engage (as much as possible) in what the victims may be experiencing. This proved to be invaluable.
We also visited children’s refugee camps and found most could only express the horror they had experienced through art and drawing pictures. These paintings were heart-wrenching.
Upon our return to the US, we were required to stay in DC before returning home to our families for a special intense de-briefing. Anyone who has done missions such as these know, like vets returning from war, no one really knows or understands what you’ve been through. Hence, this turned out to be a very needed part of the process for every team member.
Although very two different experiences were described and presented with very different sets of circumstances, yet both have a common denominator — and that is both causing PTSD and long term mental and possibly physical effects.
I ended my talk by describing a terrific experience showcased at the World Economic Forum in Davos, Switzerland. It was called “A Day in the Life of a Refugee” put on by Crossroads Foundation from Hong Kong, with strong, experienced volunteers role-playing their parts. At the debriefing, following the 1 ½-2 hour ‘experience,’ everyone agreed that it was just ‘too real’ and so upsetting. Some people had to leave the experience prior to the end, but most did not. All agreed they felt fear, anxiety, not wanting to meet eye contact with their “rescuers” along with complete loss of control and vulnerability. One learns that nothing from your previous life—education, title, status—means anything when you’re in a group setting treated like cattle. A volunteer, a former Special Ops Officer, stated the experience is about 15% of the actual fear, anxiety, etc., levels compared to the real circumstances. This was unfathomable to most of us going though the ‘day in the life of…’
However, this experience is/was life-changing on how everyone will then see the refugees as the victims they are and have a glimmer of the issues they must deal with forever throughout their lives. Something that is invaluable—to put yourself in someone else’s shoes—always helps your own perspective.
I recommended that this be showcased at the United Nations for all to experience
