Reducing Mental Health Disparities in Haiti
A report by Dr. Karen Roller about her December 2015 trip to Haiti to help implement National Board of Certified Counselor’s Mental Health Facilitator training.
In December, 2015, this author traveled to Croix-des-Bouquets, Haiti, with Global Trauma Research, Inc., a Brooklyn, NY-based non-profit organization whose mission is to increase access to culturally competent trauma counseling services to underserved minority populations. The trip was part of GTR's Haiti Trauma Project.
The purpose of the trip was to implement the National Board of Certified Counselor’s Mental Health Facilitator training. The group included a team of American volunteers (eight trainers and assistant trainers, three of whom are Creole-speaking Haitian-Americans) and Haitians (four interpreters, six kitchen staff). We were assembled by Florence Saint-Jean, Ph.D. (founder of GRT in 2012) to convene four half-day classes and a lunch debrief at the Haitian-American Caucus (HAC), which has directed by Haitian-American Sam Darguin since the earthquake of January, 2010. The participants were local professionals recruited predominantly by Mr. Darguin and by word-of-mouth from the previous year’s participants. Support staff included Dr. Moises Baptiste, a Creole-speaking Haitian-American who has been volunteering at the HAC since the earthquake.
Dr. Saint-Jean began offering the MHF training at the HAC in 2013, when she had 30 participants. In 2014, she had 40 participants. We were able to serve 60 participants this year. Due to limits imposed by space at the HAC and the number of trainers available, about a dozen interested participants this year had to be deferred to next year’s training. The participants included pastors, lawyers, medical doctors, nurses, civil engineers, journalists, pharmacists, accountants, teachers, lay counselors, aestheticians, and at least one oungan (Vodou Priest), as well as underemployed students of law, medicine, and languages.
The group was separated randomly into two classrooms on the first day, and participants stayed with their group, trainers, assistants, and interpreters throughout the week, allowing for group “forming, storming, and norming” processes to unfold.
Co-training with Dr. Saint-Jean
This author was paired to train with Dr. Saint-Jean. She is a Creole-speaking Haitian-American doctor of counselor education and supervision with a generously empathic presence, brilliant intellect, and commanding teaching ability. Her love of Haitian people and culture, her commitment to culturally-responsive service, and her mastery of nuanced therapeutic attunement were evident in her every interaction with participants, and she lead each class, and the training group as a whole, with unparalleled grace. Dr. Saint-Jean navigated charged emotional group discussions regarding the relative merits of various religious and spiritual interventions with an appreciation for how the local professionals would be able to integrate the MHF training in their own way, and increased awareness regarding how one’s own beliefs can either help or hinder the one we are trying to serve, depending on attachment to one’s agenda.
The participants were among the most engaged, passionate, curious, thoughtful, and serious students this instructor has ever met. Their deep questioning revealed a level of concern for their community, and respect for their role as a helper, that one would hope to see in every counselor-in-training. Their appreciation for the information and discussions was made explicit at the end of every class, and their initiative was evident in their own formation of an association for peer referral, consultation and support by week’s end. The graduation ceremony included testimonials, prayers, music, dancing, hugs and kisses, photographs, and contact information exchanges. This author has received emails from numerous participants, each sharing their gratitude and encouragement.
Curriculum and Culture
Because the MHF training curriculum is proprietary, the trainers were not able to receive a copy for review prior to arrival at the HAC campus. This author was dismayed to see, in PowerPoint slides intended for reducing mental health disparities for a global audience (currently implemented in 13 countries), that the majority of the clip art contains only white skin. Most of the statistics referenced were based on American norms (presumably because relevant regional statistics are not available), and the attending skills addressed were presented through an American lens, without making that explicit.
Dr. Saint-Jean was eventually granted permission to remove all the clip art for the participants’ handouts (though not given permission to add relevant clip art), and we opted not to reference the statistics when delivering the information each day. In our nightly debriefing sessions, we discussed ways to alter the curriculum so that culturally-responsive attending skills could be explored and practiced in the following days’ lessons. This author would like to pursue a methodical approach to determining truly culturally-responsive implementation of the MHF training, including data collection and analysis, for next year’s group at the Haitian-American Caucus, as well as future implementation in other countries.
A Holiday Celebration
The HAC is also an elementary school dedicated to the local orphanage, which houses 350 children who have lost their parents, or whose parents cannot afford to feed them. Due to ongoing instability throughout Haiti, the HAC is a walled compound with full-time security guards. The kitchen staff and security guards live on-site and enjoy a level of job security that evades many in Haiti. The HAC has partnered with Soles 4 Souls, to provide shoes to local community members. Director Darguin has also developed Let Girls Learn, to keep girls in school even when the family cannot afford to prioritize daughters.
We ended the training week with a holiday party for the children served by HAC. We disseminated donated gifts after a morning full of face-painting, arts and crafts, music, cookie decorating and a Creole-speaking Santa visit. My own three-year-old son was a part of the gift organization process, unloading 14 suitcases of donations and helping group gifts first by age, then per bag per student, so that even children not coming to the school (but who showed up to the party) could be sure to have something for Christmas.
Self-Care For Trainees
As self-care practice, the training group traveled to the coast for an overnight stay at Wahoo Beach at the end of the week. We celebrated our connections and the local beauty, increasing our awareness of the local context between Croix-des-Bouquets, Port-au-Prince, and surrounding areas. Seeing the area after a week of focused service helped ground the reading I had done in preparation for the trip, and Dr. Moises Baptiste’s nightly history lessons inspired further research. I am studying Creole in hopes that I can deliver more of the training directly (rather than through an interpreter) in years to come, and enjoy more spontaneous connections with the staff, participants and children. I am also delving deeper into the complex history of Haiti’s political, economic, and cultural history, as Haiti has further opened me through her most beautiful service providers.
For any student or faculty member interested in global outreach work, reducing mental health disparities, or Mental Health Facilitation training, Global Trauma Research impressed me with their ethical implementation of every aspect of such an endeavor. I endorse Dr. Florence Saint-Jean, Dr. Moises Baptiste, Sam Darguin, and the Haitian-American Caucus as a trustworthy recipient of your humanitarian support.
I would like to thank Dr. Allen Calvin, Todd Black, and David Powers, who made financial contributions to Global Trauma Research, and all the generous Palo Alto University students (including, but not limited to: Alisa Heraldo Orozco, Brigid Oram, Janet Ly, Thanh Truc Nguyen) who piled clothes, toys, beauty products, costume jewelry, games, puzzles, reading and art materials in the donation boxes bound for the children. For those I did not catch placing items in the boxes (a total of seven trips from the buildings to my car), know that your selfless gift lifted my own heart and that of everyone who helped get it to the child who opened it. I wish you could have seen the children’s eyes light up with glee at receiving a Christmas gift, and I wish you could have seen the gratitude in Dr. Flo, who said, “I never expected this much support." I am indebted to PAU for your copious love for those you’ve never met, and your willingness to share your abundance with those less fortunate.
May we know greater peace this year.