Watching CNN’s non-stop coverage of the cataclysm in Haiti isn’t easy, but it’s too compelling to turn off. I think it’s going to be easier to watch tomorrow because the massive amount of aid flowing into the country might finally begin to be distributed to the people that need it. That’s been the frustrating part, seeing planes landing at the airport filled with supplies then flashing to the reporting in the city where people are still on their own some 50+ hours after the disaster. I’ve gotten so used to the rubble and bodies in those reports that it’s become almost "normal," but then some picture pops up of a five story building that looks like a stack of pancakes with bodies sticking out, and the reality of what happened there wells up again. It’s different from the Tsunami in that they had roads when the water receded. Haiti’s infrastructure has essentially disappeared altogether as the buildings collapsed into the roads. This video from a street cam recorded the earthquake as it happened. It’s short, but through the shaking, it shows the dust beginning to rise from the collapsing buildings.
Friend Carl and I have been discussing the topic of Resiliency, a big topic in the field of trauma right now – and he’s involved in developing a psychometric to try to quantify it. The term arose from the observation that there is a wide variability among individuals in their vulnerability to traumatic events. One of the things that strikes me watching this footage is how calm the Haitians are in the face of all the carnage. The streets are lined with bodies; there’s no food, water, or shelter; medical care is slim to absent; and yet they seem to be caring for themselves and each other remarkably well. They have no way of knowing how much aid is heading their way, yet they are adapting in a surprisingly orderly fashion. I think anyone watching who is used to seeing people in this kind of situation would say that the Haitians are quite Resilient.
Several things might explain why. It’s the poorest of places, so subsistence living is an everyday reality there. Most Haitians live on $1 – $2 dollars a day. Likewise, the country has a history of environmental diseases, wars, and dysfunctional governments. As everyone points out, living in Haiti is something of a trauma in the best of circumstances. And they’ve already had their share of natural disasters.
In many ways, the hurricane season of 2008 was the cruelest ever experienced in Haiti. Four storms – Fay, Gustav, Hanna, and Ike – dumped heavy rains on the impoverished nation. The rugged hillsides, stripped bare of 98% of their forest cover thanks to deforestation, let flood waters rampage into large areas of the country. Particularly hard-hit was Gonaives, the fourth largest city. According to reliefweb.org, Haiti suffered 793 killed, with 310 missing and another 593 injured. The hurricanes destroyed 22,702 homes and damaged another 84,625. About 800,000 people were affected–8% of Haiti’s total population. The flood wiped out 70% of Haiti’s crops, resulting in dozens of deaths of children due to malnutrition in the months following the storms. Damage was estimated at over $1 billion, the costliest natural disaster in Haitian history. The damage amounted to over 5% of the country’s $17 billion GDP, a staggering blow for a nation so poor
The year 2008 was only one of many years hurricane have brought untold misery to Haiti. Hurricane Jeanne of 2004 passed just north of the country as a tropical storm, dumping 13 inches of rains on the nation’s northern mountains. The resulting floods killed over 3000 people, mostly in the town of Gonaives. Jeanne ranks as the 12th deadliest hurricane of all time on the list of the 30 most deadly Atlantic hurricanes . Unfortunately for Haiti, its name appears several times on this list. Hurricane Flora killed over 8000 people in 1963, making it the 6th most deadly hurricane ever. An unnamed 1935 storm killed over 2000, and Hurricane Hazel killed over 1000 in 1954. More recently, Hurricane Gordon killed over 1000 Haitians in 1994, and in 1998, Hurricane Georges killed over 400 while destroying 80% of all the crops in the country…
In fact, many of the emergency crews converging on Haiti have already been there before in response to these recent Hurricanes and floods. So is resilience related to previous experience with traumatic situations? Surely that is a factor of some kind. A major element of traumatic experience is unexpectedness. For Haitians, disaster is not unexpected. Another factor is commonality of experience. People whose trauma is solitary such as rape victims seem much more vulnerable than people who are suffering together as in a natural disaster like this. Soldiers, for example, are more resilient together than when they are alone. But previous experience with trauma and hardship isn’t the whole story. In World War I when traumatic illness first came to the world’s stage, it was obvious that the longer a soldier was in the combat theater, the more likely he was to develop traumatic symptoms. That observation has been recently reconfirmed with our troops in Iraq/Afghanistan. The incidence of P.T.S.D. rises dramatically in troops with multiple deployments [much worse…].
But does the observation that the Haitians are adapting to this dramatic situation even have anything to do with what is implied by the concept resiliency – something like an immunity to traumatic experience? There are plenty of soldiers who function quite well in combat, only to come home to be plagued by traumatic symptoms. We call traumatic mental illnesses – Post Traumatic Stress Disorder. Resiliency is not a term that refers to how a person responds when they are in traumatic situations. It refers to what happens afterwards. Do they develop symptoms later – often long after they are out of the situation? In fact, some previously traumatized people do better in subsequent traumatic situations. It’s "peacetime" where they have their difficulties.
It’s hardly the time to talk about studying resiliency in the Haitians. Right now, their seeming resourcefulness in the face of this disaster is something to admire and respect, not a focus for medical research. But somewhere down the line, it will be important to look at the psychological aftermath of this event. Most of what we know about traumatic illness comes from "mass trauma" – natural disasters and wars. When large numbers of people experience the same thing, it’s easier to sort out the factors that determine the long term consequences.
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