1 in 5 Haitians unable to cope mentally

The battered bodies may be mending, but the minds still struggle.

As many as one in five Haiti earthquake victims have suffered trauma so great with the multiple shock of lost homes, jobs and loved ones that they won't be able to cope without professional help, doctors say.

In a country where mental-health services barely existed before the earthquake, building the required support is a huge challenge. The symptoms can't be diagnosed by stethoscopes, blood tests and X-rays, and can take time to surface after the initial shock of the disaster.

"It's not about immediate psychological counseling," said Dr. Lynne Jones, a senior medical adviser for the International Medical Corps. "It's about assisting mourning. People cannot recover if their social needs are not met."

Jones, a veteran of natural disasters and wars from Bosnia to Indonesia, is teaching front-line doctors how to identify "disabling fear" and, quite literally, hold people's hands and listen.

Hugo Emmanuel is one of the untold thousands of people who doctors say have lost the ability to cope.

"Stay away! I don't want you to touch me," he barks at an American nurse who only wants to wash his shattered lower leg.

Emmanuel, 49, is an educated man of spindly limbs but voluble spirit who lies on a mattress on the floor of the kitchenette in the Espoir Hospital in the capital's eastern hills.

He tore the cast off his leg last week. For days after he arrived two weeks ago, he let only the hospital director feed him; he claimed that everyone else was trying to poison him.

Emmanuel, who lies in his underwear beneath a white sheet and towel, is at least getting personal attention. Most of those diagnosed with severe trauma are treated as outpatients because there is no room for them in the country's 91 functioning hospitals.

"The doctors in such situations tend only to hand out tranquilizers," Jones said. "We don't want them to do that."

Tranquilizers are hardly sufficient for earthquake victims such as Emmanuel, who lost his house, both of his parents and his job.

"I was in a coma-type situation," Emmanuel said in graceful French that reflects his experience as a Quisqueya University researcher. "Every time I think about losing my family, I lose my mind."

He quickly corrects himself. "I'm not crazy. I just think I'm suffering from psychological shock."

The hospital's director, Dr. Gusse Darline, said that Emmanuel is sporadically amnesiac. But that's only part of his problem.

"He didn't want to come into the hospital for treatment. We had to drag him in," she said.

Darline says she doesn't know what to do with Emmanuel once his leg heals.

Port-au-Prince's only psychiatric hospital is barely functioning. All but 11 of its more than 100 pre-earthquake patients were removed by relatives who feared that the building would collapse in another earthquake, said Dr. Peter Hughes, an Irish psychiatrist who arrived late last week and is studying the situation.

Hospital nurses have refused to accompany Hughes into the building -- though it appears structurally sound to him -- because "they are absolutely petrified" of another earthquake, he said.

"There's no electricity and no running water. Some patients are in a barred room. There is a need for mattresses and working toilets."

It is not known how many mental-health workers are available to help in Haiti.

Pan American Health Organization officials who are coordinating medical care among more than 200 aid groups have only just begun to create a database of hospitals, patients, doctors and medical resources.

But it seems clear that Haiti will have to train more of its own personnel to work on the front lines with people suffering from psychological trauma.

"The most urgent need ... is not food and water which is temporary," said Pierre Brunache Jr., an official with the Citizens Network for Foreign Affairs who led a survey of relief workers and victims. "The most urgent need is for psychiatrists."

PAHO's Dr. Jorge Castilla, who is the lead coordinator of the aid groups in Haiti, issued an urgent request yesterday for mental-health professionals.

"But this is not easy because they have to be able to adapt to the culture and the language," he said. "I can't have hundreds of volunteers coming here who don't speak the languages."

Castilla said he is looking to the French Caribbean islands of Guadelupe and Martinique as possible sources.