Haiti and the Children

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1 Haiti and the Children Post Earthquake Marlene Goodfriend

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3 The Facts Port au Prince and surrounds were at the epicenter 50% of medical facilities in western Haiti were destroyed The pediatric department at the general hospital was badly damaged The nursing school collapsed Families lost homes, possessions and most importantly, loved ones Many experienced severe injuries

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11 Initial Psychological Reactions to Disaster Response varies with age Initial responses do not mean a disorder 0-2 years: irritability, crying, regressive behavior, clinging, sleep disturbance, appetite disturbance, hyperarousal 3-5 years: regressive behavior, becoming mute, re-experience of event, appetite disturbance, sleep disturbance, fearfulness, hyperarousal, somatic complaints

12 Initial Reactions 6-11 years: fearfulness, somatic complaints, hyperarousal, re-enactment, withdrawn, guilty, school problems, sleep and appetite disturbances years: appetite disturbances, sleep disturbances, flashbacks, somatic complaints, loss of interest, behavioral problems including conduct problems

13 Variables Influencing Reactions Degree of exposure to death, dying, destruction (epicenter) Potential for recurrence Family members affected Availability and reaction of caretaker Separation from family Displacement from home Destruction of schools, churches Physical injury

14 Reactions 6 weeks post EQ Aftershocks: families fear a re-occurrence and sleep outside 12 y/o boy with anxiety and an increased startle response 10 y/o girl who wakes up at night fearful the roof will fall on her

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16 Children 3 months post EQ Refusal to go into a building or house School refusal Awakening in the middle of the night screaming Bed wetting when previously toilet trained Refusal to eat Refusal of a 6-month old to take a bottle, but responding to talking and singing Withdrawn children, refusal to speak Self stimulating behaviors toddler with head banging Hyperactivity Aggression Rape increased with tent living

17 Immediate Interventions Promote a sense of safety Promote connectedness Promote calming Promote a sense of self efficacy and collective efficacy Instill hope Hobfoll SE, et al, Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence, Psychiatry (4):

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22 Factors affecting recovery Frequency of exposure to traumatic reminders: decrease media exposure Quality of family functioning: routines, loss of parents, caretaker functioning Adverse living conditions: food, water, shelter School and community environment Physical injury and disability

23 Factors contributing to resiliency in Haiti Strong sense of survival Importance of family Belief in God Receptivity to help Enjoyment in music, dance, art

24 Psychological Reactions Post-traumatic stress disorder Depression Anxiety Psychosis Separation anxiety disorder Phobic disorders Somatization Hostility/aggression Learning problems Behavioral problems

25 Earthquake Anxiety Most frequent chief complaints of adults: palpitations, headaches Do not meet criteria for PTSD Intervention: explain to patients that anxiety is a normal response Too early for PTSD

26 Post-traumatic stress disorder Exposure to a life threatening event Symptoms > 1-month duration Re-experiencing of the traumatic event Avoidance of reminders of the event Symptoms of hyperarousal

27 Mental Health Programs Education of health care workers Integration of mental health with primary care Parent-child groups in the camps Psychiatrists at the hospitals Rapid eye movement training Calming techniques Return to Happiness Program

28 On going challenges Lack of adequate housing & schools Disruption of neighborhoods Rainy season Burn-out of Haitian medical professionals & NGO workers Lack of collaboration of NGOs Distribution of funding Special populations

29 New Populations of Children Displaced families Bereaved children Orphan children Exploited children Children estranged from families Injured children Children with disabilities, i.e. amputees

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