Abuse and Mental Health in Haiti

“It has been three days since someone asked me how I am doing.” –Jozyan

“It was NOT the beatings that I endured that hurt me so much, instead, it was the words they said to me that hurt me.” –a girl from Restavek Freedom

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These phrases are from Jozyan and a young girl who was in restavèk. I met Jozyan while I was waiting for a taxi to go downtown to Delmas in Port-au-Prince. She was sitting not too far from me along the street with her baby. That kind of picture is easy to find on the street and attracts my attention every time I see it. It presents the reality of Haiti’s struggle to take care of her children. I know if nothing is done, this woman will eventually be in the street with more children. More children in poverty mean an increased number of children in restavek or homeless in the streets.… I tried to keep my focus on the taxis driving by, but I wasn’t easily finding one. So I found myself waiting. Then, I turned my full attention to the woman and her baby, asking for the baby’s age, sex, and more.

“It’s a girl, and she has more than 1 year,” the woman told me.

“Are you breastfeeding?” I asked her.

She responded, “I breastfeed when I can, but because I don’t have enough food to eat, sometimes my body does not respond well to it.”

This situation is not strange to me at all. It is common, especially in Port-au-Prince to find women and children begging for food and money. What she said next caught my attention: “It has been three days since someone asked me how I am doing.”

“You know, sometimes people are in such a hurry that they are not paying attention,” I said to her.

We continued to talk, and I quickly learned that she was from the north. She had lived in Cite Soleil. Gangs and weapons had killed her husband. She had no family in Port-au-Prince, she had been at the primary school, and her parents had died, she could not continue to go to school, and her life was wrecked upside down.

I was interested to continue to talk with Jozyan, but I was hurried to get a taxi. While I was in the cab, I thought about Jozyan’s situation with her baby, about the tragedy she lived with her husband’s murder, and all other current living situations in the street . . . and especially the way she expressed the need to communicate. Her statement reminded me also about several restavek children who told me about their everyday lives while I met with them. The Executive Director of Restavek Freedom Organization, Joan Conn, wrote to me about a statement made by one of the girls. She said, “It was NOT the beatings that I endured that hurt me so much, instead, it was the words they said to me that hurt me.”

Violence affects the lives of many people and often negatively affects their mental health. In Haiti, the percentage of victims in difficult situations (child slaves, women, people with disabilities, and homeless) is high. Focusing attention on mental health issues in societies like Haiti, where many people live many tragedies, is important and very beneficial for individual health and for the health of the entire country.

In a sample of 120 women who were victims of the restavek practice when they were children, 96 percent were living with physical violence and suffered from verbal abuse, 86 percent of them have placed their children into child domestic slavery, 98 percent of the women had children before their time, 56 percent were victims of rape and attempted rape in the house where they lived, 12 percent went to some night school, and 85 percent suffered severe infections. None of them found the psychological support they needed.

Was Jozyan in restavek? I had not learned the answer from her, but her situation clearly shows that she needs more than economic support in order to help herself and her baby. There is likely no program substantial enough to support women like Jozyan, children, and those who are suffering economically while also counseling them or responding to their mental health needs.

If the help these women and girls need exists, it is not accessible to them.

“There are so many problems to manage every day,” a colleague told me.” “Mental health is not a priority.” But we know in cases like Jozyan’s, economic support without the accompanying psychological support will not be enough to help her. It will then be difficult for the children to find the balance they need to grow and prosper, it will be difficult for women who are victims, like Jozyan, to sufficiently play the role of mother for her baby, support her family, and be a contributor to her community and the country.

“Investing in mental health” are the words that represent the International Day, October 10 in Haiti. Haiti has only 27 psychiatrists and very few psychologists for the entire population of the country (more than 10 million). Also, 28.5% of adults have post-traumatic stress disorder, and 15% have symptoms of depression. Only one service telephone line (177) exists to alert authorities about cases of people who lose themselves in the streets. There are only two hospital Centers in the entire country of Haiti for people with mental illness. One is based in Port-au-Prince, and the other one is based in Croix-des-Bouquets. Only 1% of the national budget goes to mental health care.

It is evident that there are not enough mental health services for more 10 million people, and truly mental health personnel are almost nonexistent in Haiti. But, we can start with what we have and move forward. What about taking and developing some alternative paths to acquire mental health technician certifications, which could produce professionals who could help with at least the basic mental health needs of people? We could also ensure that more programs are instituted at the university level so that we can help more people join the domain of mental health care.

State institutions and private institutions should be committed to providing mental health assistance a place in their social programs in order to help people access mental health care. Helping thousands of women like Jozyan and thousands of children who are suffering to find good counseling is important for mental balance and equilibrium in Haitian society. However small, the change will have a major impact.

Until now only a few institutions have integrated this mental health approach into their programs, but they need to be encouraged and their actions need to be reinforced. Those who haven’t integrated yet should consider doing so.

While we are looking into putting in place a national mental health plan for Haiti, we can begin thinking of the simplest possible approach to addressing people with mental health problems in the society. Mental health care is an integral part of a complete system. For a long time, it was not considered a necessity, but today, we can’t deny its importance, where many people grow up suffering from many things (violence, insecurity, rape…) that have affected their mental health into the future and constitutes a great loss for the country that many other issues we face.

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Maltretans ak Sante mantal nan Ayiti

“Se premye fwa depi twa jou yon moun mande mwen kijan mwen ye ak ti pitit la”  –Jozyan

“Se pa baton yo bat mwen an ki pi fèm mal, se pawòl, mo, yo itilize lè yo pale avèk mwen ki fè mwen mal.”

–Yon jèn fi nan Restavèk Freedom

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Se fraz Jozyan ak youn nan timoun ki viktim pratik restavèk la te repete. Mwen te rankontre Jozyan, pandan map tann yon taksi pou ale anba Delmas/Pòtoprens. Li te chita sou twotwa bò lari a ak tibebe l nan men li. Se yon imaj ki fasil pou jwenn nan lari epi sa toujou atire atansyon mwen. Li tradwi sitiyasyon sosyal, ekonomik, difisil peyi a fè fas pou pran swen pitit li yo. Mwen konnen si anyen pa fèt, fanm sa a pral rete nan lari a epi fè plis pitit. Plis pitit nan pòvrete vle di ogmante kantite timoun nan restavèk oubyen nan lari. Lespri mwen te okipe pa jwenn yon taksi, sa pat twò fasil. Mwen te tounen atansyon mwen kote Jozyan ak tibebe a pou mande li laj ak sèks li.

“Se yon ti fi, li gen plis pase 1 lane,” Jozyan te reponn mwen.

“Èske ou ba li tete?” mwen te mande l

”Lè mwen kapab,” kèkfwa mwen pa gen ase manje pou manje, pafwa lestomak mwen pa reponn byen.”

Sitiyasyon sa a fasil pou jwenn Pòtoprens kote gen anpil fanm ak bebe yo kap mande nan lari pou manje oubyen pou lajan. Men sa Jozyan te di mwen te atire atansyon mwen: “Se premye fwa depi twa (3) jou yon moun mandem kijan mwen ye.”

Mwen te reponn li, “kekfwa moun yo prese sa fè yo pa gade sa kap pase sou kote yo.”

Nou kontinye pale, epi mwen aprann ke li te soti nan zòn nò. Li te viv nan Site Solèy ak mari li. Nèg ak zam te rantre lakay li epi touye mari l. Li pa gen okenn fanmi nan Pòtoprens. Li te lekòl lontan lè li te timoun, men manman li ak papa li te vinn mouri, li pat ka kontinye ale lekòl ankò, lavi li te chavire tèt anba.

Mwen te enterese kontinye pale ak Jozyan, men mwen te prese, pou jwenn yon taksi. Pandan mwen nan taksi a, mwen tap reflechi a sitiyasyon Jozyan ak tibebe a, sou trajedi li te viv ak asasina mari li, ak tout lòt sitiyasyon lap viv nan lari a….e sitou a fason li te eksprime bezwen pou kominike. Sa te fèm reflechi tou a plizyè temwayaj timoun ki rete kay moun te rakonte sou lavi yo chak jou pandan mwen tap rankontre ak yo. Direktis Egzekitif Òganizasyon Restavèk Freedom la, madan Joan Conn te voyem yon mesaj sou sa youn nan demwazèl nan òganizasyon li te temwaye “se pa baton yo bat mwen an ki pi fèm mal, se pawòl, mo, yo itilize lè yo a pale avèk mwen ki fè mwen mal.”

Vyolans kelkeswa fòm li pran afekte lavi moun epi souvan li afekte negativman santé mantal moun. Nan ayiti, pousantaj moun ki viktim sitiyasyon difisil (timoun restavèk, fanm ki viktim, andikape,…) wo anpil (m pa ka jwenn pousantaj egzat la). Mete atansyon sou pwoblèm sante mantal nan soyete tankou Ayiti kote anpil moun ap viv anpil trajedi , enpòtan epi benefik anpil pou sante endivisyèl ak pou santé tout peyi a.

Sou yon echantiyon 120 fanm ki te viktim pratik restavèk la lè yo te timoun, 96% te viv vyolans vèbal ak fizik ak sibi maltretans/ 86% nan yo te mete pitit yo nan restavèk, 98 fanm sou 120 te fè pitit anvan lè yo/ 56% te viktim vyòl ak viktim atanta vyòl nan kay kote yo te rete/ 12% te ale nan ti lekòl diswa/ 85% te soufri gwo enfeksyon. 0% te jwenn sipò sikolojik ki te nesesè pou yo.

Eske Jozyan te restavèk, m pat gentan aprann sa, men sa ki evidan sitiyasyon klèman montre ijans yon akonpayman sikolojik an plis akonpayman ekonomik pou ede l ak pitit li. Manke pwogram akonpayman ekonomik ak sikolojik pou sipòte Jozyan, timoun ki maltrete ak lòt moun kap soufri, ki reponn a bezwen yo genyen. Si yo egziste, yo pa aksesib pou yo.

“Gen tèlman pwoblèm ki pou jere chak jou, yon kolèg te di mwen, sante mantal pa yon priyorite.” Men nou konnen nan ka sa yo tankou Jozyan ak jèn demwazèl Restavèk Freedom nan, sipò ekonomik la san sipò sikolojik la pa ase pou ede yo, li pral difisil pou timoun sa yo jwenn balans yo bezwen pou grandi, li pral difisil pou fanm tankou Jozyan ki viktim akonpaye pitit li kòmsadwa, jwe wòl manman li pou pitit li, itil fanmi li, kominote lap viv, peyi li….

“Envesti nan santé mantal”, se tèm jounen entènasyonal sou santé mantal 10 Oktòb ki sot pase a. Ayiti gen selman 27 sikyat pou tout peyi a (10 milyon abitan). Apre 12 Janvye: 28,5% granmoun prezante syndrom post-tromatik epi 15% prezante sentom depresif ki enpòtan , genyen tou yon liy telefon (177) pou alète otorite yo sou ka moun ki pèdi tèt yo ki nan lari, gen 2 sant lopital inivèsitè santé mantal pou tout peyi a ki baze Pòtoprens ak Croix-des –Bouquets. Sèlman 1% bidjè nasyonal la ale nan santé mantal.

Li evidan sa pa ase pou yon peyi ak plis pase 10 milyon moun, li vre pèsonèl sante mantal preske pa egziste nan peyi a. Men nou dwe koumanse ak sa nou genyen e nou ka koumanse. Sa nou wè nan devlope kèk demach altènativ pou vinn genyen teknisyen nan Sante mantal sètifye ki ka ede ak bezwen bazik yo nan sante mantal? Ranfòse Inivèsite yo ak plis pwogram Sante Mental pou plis moun kapab enterese ale nan domèn sa a.

Enstitisyon leta, prive, kap entèveni nan diferan domèn sosyal nan peyi a, dwe entegre aktivite pou moun yap desèvi kapab jwenn santé mantal. Ede milye moun tankou Jozyan ak milye timoun kap soufri jwenn yon bon akonpayman sikolojik enpòtan pou ekilib mantal yo ak ekilib sosyete asyisyen an. Piti koulye lap gen yon gwo enpak. Jounen jodia, sèlman kèk enstitisyon entegre apwòch santé mantal la nan pwogram yo, men yo bezwen ankouraje epi ranfòse. Enstitisyon ki poko fè sa dwe konsidere sa.

Pandan nap chache mete an plas yon plan nasyonal santé mantal pou Ayiti, nou ka koumanse pa apwòch ki pi senp la pou adrese pwoblèm mantal moun ap viv nan sosyete a. Swen mantal se yon aspè entegral nan sistèm pran an chaj moun. Pandan lontan li pat konsidere kòm yon nesesite, sa ki fè anpil moun grandi ak pwoblèm ki afekte santé mantal yo pi devan e ki konstitiye yon gwo pèt pou peyi a.