They are quiet, expectant, and perhaps a little puzzled at first. What is this “mind-body medicine” all about? And then, as I begin to talk with them about fight-or-flight and stress, they become animated—calling up the unspeakable terror of the earthquake along with the biological facts and personal experience. I explain that just as trauma can produce the symptoms of ongoing stress: difficulty concentrating, sleeplessness, anger, lethargy, flashbacks of death and destruction. The techniques we are going to teach—slow deep breathing, self-expression and self-discovery in drawings, sharing one’s pain and hopes with others, and moving one’s body—can give relief; restore a sense of calmness, provide perspective, grant them a sense of control, open the door to the possibility of a future.

By the time Amy is explaining imagery and Kathy and Lynda are encouraging them in their drawings, the young women are alive with pleasure and discovery. They share first with each other, and then with the whole group. They show us pictures bisected by the barriers between the living and the dead, whom they miss so much, and third drawings that reveal the possibility of feeling, though bereaved, whole again in nature and with family and friends.

By the time we clear away the chairs and began to shake, the girls are waving their arms and laughing. When Bob Marley’s “Three Little Birds (Every Little Thing’s Gunna Be Alright)” comes on, they sing with him, and us. Some of us are still laughing, others crying in release, with gratitude as well as grief.

Afterwards, the Dean of the Nursing School speaks for a moment. “Words,” she says, herself crying, “cannot express what you have done for us today.”

“And,” I think to myself, “what you are doing and teaching to us.”

We teach them slow breathing to quiet the mind and body and relieve stress. They participate with eagerness and enthusiasm. Afterwards they clamor eager to “partager,” to share: “A feeling of calm for the first time since January 12^th;” “a letting go in the shoulders;” “this is the first time also,” one adds, “that we’ve had an opportunity to learn about our own psychology, to share our feelings, to look at what stress causes in the body and to feel relief from it.”

After a mid-morning break, 30 or 40 more people join. “We have spread the word,” one of the young men says with a grin. After we do drawings (of “yourself,” “your greatest problem,” and “the solution to that problem”), the HRC staff and volunteers share them in animated groups of three. “There is hope here,” say several, of their third drawings.

They are filled with sunlight after darkness of the second drawing; with music—drums and guitar—and dance and movement, after “the biggest problem” of buried and walled off emotions, broken bodies and silence: “It gives me direction,” says one young woman, and others agree. Several stand to show their drawings to the whole group; many more want to.

Then we push back the chairs and stand together, shaking our bodies and releasing tension. When the music changes, the young people sing together, clapping their hands. Afterwards, no one seems to want to leave. Little groups form around each of our faculty and staff.

Twenty-five or thirty of the Red Cross volunteers and staff write notes of appreciation. Most are translated from Creole and French by our interpreters, and a couple are in English. Here, in English, are a few:

“Today I have found the means to comfort myself when I have a problem, to change my way of thinking and looking at things in other people and in myself.” Jeanty

“I feel so good. If everywhere they could have someone learn these exercises and teach them in their neighborhood, everything would be okay for everybody, and accept life as it is. Thank you so much to teach us. May God bless you and protect you.” Myrka

Many of the young people say spontaneously that the experience, has, in the words of one, “taught me how to face the dangers that present themselves to me instead of flying from them.” Another adds, “I’m very happy with the information that I learned today. Now I know how to confront my fears. I would like to be a part of another one of your workshops. Thanks a lot. I’ll never forget you. We needed it.”

“I’m Elder,” writes a third, “I’d like to say I’m very happy and I say to you a big thanks to you for that. You’ve made me a messenger to a lot of people in the world. Thank you so much for your encouragement and the hope of living you bring to me. I love you very much.”

Many, many of the HRC volunteers and staff tell us how much they appreciated the copies of the exercises that we gave them, as well as the workshop, and that they plan to share what they have learned with others. But still, “we want to learn more.” A number invite us to come to visit with them, to bring “workshops of healing” to family members and friends in schools, tent camps, and churches in Port-Au-Prince and beyond.

These idealistic, committed, bright young people (some Red Cross staff, most volunteering), are such an important resource for Haiti’s future. They have a tremendous appetite for learning about themselves and the world, and for helping others. I would very much like to do a full professional training for them.

We use a variety of techniques in our workshops, including explanation of the fight-or-flight and stress responses, meditations, guided imagery, and shaking and dancing. We also do a drawing exercise that has been enormously helpful to children and adults in war, post-war, and post-disaster situations, in Kosovo, Gaza, Israel, and New Orleans, and with US military. For a while, everyone—bent over paper, crayons in hand—becomes young, earnest, playful, surprised.

The drawings allow people to tap into their intuition and imagination without effort. As a series of pictures unfolds, they find themselves creating images they’d never imagined, sketching solutions to problems that seemed insoluble.

In Haiti, we guide our groups through three drawings. The first picture is of “yourself,” the second, “you and your greatest problem,” and the third calls for “the solution to that problem.” (We modify the exercise when we use it with children: read my post about using the drawing exercise with Haitian children in the General Hospital.) Afterwards, participants share their drawings in groups of two or three, telling what they see in what they’ve created and how it makes them feel. Then they have the opportunity to share with the entire group.

As you will see, the results are often touching, and almost always surprising.

Here are a few examples and snapshots of the workshops in which they are created:

For L’Institut Haïtien pour la Doctrine Sociale Chrétienne (Haitian Institute for the Christian Social Doctrine)

Such wonderful, accomplished people: 100 of them—physicians, architects, lawyers, police officials, business men and women. All, in this time of crisis, are renewing their commitment to the welfare of those who have suffered even more than they have. They tell us about the terrible sadness—their own, and others—and about unaccustomed irritation that surfaces at home and at work, as if, somehow, angry will could restore what has been lost.

An obstetrician/gynecologist, tall, broad-shouldered, powerful and handsome in a bright, tailored shirt, has come “for rest and peace—I have not slept since January 12th.” He says he works “always” to forget the loss of his house, the deaths in his family—his sister, nieces, nephews—as well as to care for his patients. In his second drawing (a picture of his biggest problem), he is inside a tunnel, tiny as an ant, lost, unable to touch the equally tiny figures outside. In the third (a picture of his problem’s solution), the figures are larger, recognizably human. They are dancing together and he is laughing, “for the first time since the quake.”

For Anse-a-Veau diocese—nuns, priest, lay brothers

Out in the countryside a couple days later, we are meeting with priests, nuns, and lay brothers in Bishop Dumas’ diocese. It’s like rural Africa out here: lush, green and very still, faded pastel cottages with tiny yards in which seeds, sown or thrown, produce a few vegetables and fruits. We begin and end our visit with Bishop Dumas’ blessing and simple ceremonial meals: tiny, boned, tender white fish, rice, beans, greens, fresh lemonade and thick coffee.

The religious, in straight-backed chairs, are as still and elegant as the statues in the porticos of Chartres. They are so attentive, so sweet tempered amidst the flood of suffering, homeless, city people that the earthquake has forced back to the countryside. One priest draws a scene of despair—“The Cross of Death—Good Friday without Easter Sunday,”—and then, in his third picture, much to his amazement, produces a sun that covers the page with radiant yellow. “It’s the sun of freedom. Together we can overcome.”

They dance, too—nuns, brothers, and priests together—as freely and as happily as children. Before we finish in mid-afternoon, another, older priest calls the Bishop from the next diocese. It turns out he would like us to come there.

More soon about another workshop, this time with the Haitian Red Cross staff and volunteers . . .

While Kathy and Lynda teach the fourth class, Laurent, Cassidy and I sit with – I’ll call him “Andre” – in the only quiet, moderately private spot we can find: our vehicle.

Andre says that he has great difficulty falling asleep, and when he finally does, nightmares always come. “I feel so helpless. I cannot talk to anyone.” He grabs his throat with every other sentence. When I mention the gesture, he tells me that his “words are stuck in my throat. And I am afraid to cry. It is not manly.”

Andre tells us that on January 12th, he was supposed to pick up “my cousins who I love very much, at the University.” He called to them that he couldn’t. They stayed late, and died when the building collapsed.

These cousins, “my best friends,” lived with him and were more like sisters—“one light skinned, one dark,” he smiles with the memory. “I feel so guilty. I want to go back to the time and save them, but it is not possible. I have concluded,” he lowers his voice here, “I do not want to be left behind.”

I recognize the self-annihilating weight of this guilt, have seen it burden young and old in Kosovo, Israel, Gaza, have heard how it torments the nights of soldiers and marines returning from Iraq and Afghanistan.

“Would you,” I ask him, “be willing to meet your cousins in your imagination to talk with them and ask for their advice?”

“I have them always in my heart, but when I talk with them, it makes me cry.”

I tell him that he needs to cry—that releasing his emotions will open his throat, that perhaps his cousins have something to say to him that will help him with his guilt. He nods in agreement.

I ask him to close his eyes and breathe deeply with his belly soft, as we did in class. “Imagine that you are in a safe and comfortable place—a place where you feel good.” He does and I ask him to imagine that his cousins are there with him.

“Would you be willing,” I say, “to ask them for their advice?”

He nods his head.

After a while, his face softens and small tears appear at the outer edge of his eyes.

“Did they come?” I ask.

“Yes.”

“What was it like? What did they say?”

“I was so happy to see them. They told me to keep living my life and that I was not responsible for their death.”

“Write it down,” I say to him, after he has opened his eyes “and look at it every day. “Keep living your life. You are not responsible.”

I notice that he is breathing more deeply and no longer clutching at his throat.

Making our way back to the classroom, I feel how urgent it is to train hundreds of people to do this tender, powerful, necessary work.

We’ve just returned from our visit to Haiti today. I look forward to taking a look at what you’ve got to say on this and other posts from Haiti soon.

Here they are:

1. Slow deep breathing with the belly soft. This, we explain, is the antidote to the flight or flight and stress response that the earthquake has inscribed in the kids’ minds and bodies. Soft belly will quiet their physiology, slow their racing thoughts, give them a little perspective on the flashbacks of dead bodies, the horror of loss and the ambush of fearful anticipation. Knowing—feeling—that they can breathe deeply and relax, they will have a small but important sense of control in world where so much—whether or not they can concentrate or sleep, where they live and how they will make a living—is, or feels, beyond their power to affect.

You can experience a relaxing guided Soft Belly meditation here, at The Center for Mind-Body Medicine’s website.

2. Later we do some shaking and dancing so they can let go of fixed patterns of physical tension and mental preoccupation; can feel their bodies moving freely; can raise their energy, lift their mood, and lower their anxiety. They clap and laugh and shout and afterwards, flop happily onto their hard seats.

3. We also explain the value of sharing here in the classroom, at home, or with a friend, the pain they feel and the fears and concerns that arise.

Many of the kids would like us to do more, to tell them where they can go to practice the techniques and talk to others. For now, I say, “you have each other and your families. We are giving you these techniques, written in French. Practice them at home and we will come back to your school. Soon we will be training many people, including some of your teachers, to do this with you.”

The story of how CMBM’s model helped Andre, a Haitian boy, overcome feelings of grief and guilt, coming soon . . .

Instead of the pre-earthquake concrete buildings, there are open sided wood and metal sheds. Sounds flow from one classroom to another, overlapping in a kind of reverberating clamor. Toward the end of one of our classes, when time of dancing is kept by nimble palms on desktops, the whole campus rocks.

Our equipe, our “team,” –the French is beginning to emerge from deep layers of my unconscious—includes six of us: Lee-Ann juggling logistics as before, with Cassidy, my assistant back home, here to help her and me; Amy, the social worker who is our clinical director, will come tomorrow. Today, Lynda and Kathy, psychologist and family physician, are with me. They are CMBM senior faculty who are adventurous enough to come and to commit to coming again and again. They and Amy will teach our Haitian colleagues and provide consulting and supervision as we build our program.

Today we have been invited by Frere Jacques Anthony Germeil, the principal, to College Canado Haitien. We will have an hour in each of four classrooms with eleventh and twelfth graders who have been told they will learn “lessons in dealing with stress.”

I lead the first class and the third, forty twelfth graders in each, sitting shoulder to shoulder at their desks. Lynda and Kathy, experienced with kids, but new to Haiti and to the trauma and loss that overwhelms the population, will lead the second and fourth classes.

We begin our classes lightly—a little goofily—“How do you breathe?”, I ask to general puzzlement, and then talk about babies doing it easily—naturally—their bellies rising and falling, while adults, and even high school students, cramped in chairs and on benches, barely move their chests. Laurent, my interpreter, and I act out the roles of cats in full fight or flight mode—hissing and growling at each other, and then stepping back to breathe easily. Lynda has her all-boys class—a surprise—consider Kobe Bryant, cool and relaxed, imagining his shots, inspiring the boys to imagine theirs swishing the net.

When we turn the topic to relaxation’s antipode, stress, the bravado of a few—“I’m fine, we’re all fine,” claims one boy; “it was simply a natural disaster” intones another—contends with the more complex memories of their classmates.

Soon, in each and every class, there is a rush of sharing of what happened on January 12th, of how surprise and relief yielded to horror. “I thought the shaking would be eternal. Then, it stopped, and I thought, ‘that’s not so bad, I am ok,’ and I laughed, then I saw my sister covered in dust like a ghost, and I was afraid. And then, underneath my neighbor’s house, there were twisted bodies.”

And the stories come—many, we learn, shared for the first time—and the classmates’ losses pile up: a mother gone, an older brother, “my best friend,” “almost my whole family,” We hear of bodies discovered under rubble and strewn on sidewalk, of dogs chewing on corpses.

When we ask if there are questions, a small forest of hands rises: “How do you go to sleep when these memories keep coming in nightmares?” “How can you breathe deeply to relax when the air is so bad?” “How do you deal with family members who now are arguing all the time?” “What do you do with your belief that another earthquake is coming, or as some say, ‘a tsunami’?”

More about the techniques we use to address these questions coming soon . . . .

The problem was that we could no more find Dr. Henrys — housed in temporary quarters and mostly out working in the clinics and hospitals — than we could Drs. Guiteau and Amedee-Gedeon. Lee-Ann called and called, and finally—“just one more time.” We reached him, and set an appointment for the last hour of our last day in Port-au-Prince.

It turned out Dr. Henrys, a genial host, was as happy to see us as we him, and was particularly eager for us to work with Ministry of Health employees. Their building had been destroyed, many of their colleagues were dead, and the ones who remained were carrying grief for lost friends as they dealt with the enormous needs of the population.

And then, as the meeting was winding down, another man entered the room. It turned out to be the Minister of Health, Dr. Alex Larsen. Dr. Henrys filled him in on our work and what we had been talking about and went on to make a suggestion. “It says in your proposal,” Dr. Henrys–a quick study– reminded us, “that you want to have a ‘Haitian leadership team.’ It is important that you work with the future leaders too, with medical students, and others concerned with the social sciences.”

“Yes,” I say, “we do that in the US. That would make me very happy.”

“Perhaps he has not told you,” Dr. Larsen interjected, smiling, “but Dr. Henrys is the Dean of our Medical School.”

Next post: the very successful workshop we offered to American Red Cross workers during our visit.

These events don’t arise without effort; in fact, they often come only after we have worked very hard, and when the desired result — in this case, meetings with key figures in Haitian healthcare — seems altogether unattainable. We had two such unexpected happy events – meeting with four more remarkable people on the last two days of our visit.

On our fourth day, April 9th, I led a workshop for American Red Cross staff — it went very well, and I’ll tell you about it later. For some days prior to it, however, we had tried unsuccessfully—by phone and email—to reach the leadership of the Haitian Red Cross, an organization that is central not only to emergency recovery, but to providing long-term services and education to the Haitian population. Everyone wanted to help but nothing seemed to work. We encountered unanswered phones, voicemail messages that languished, outdated e-mail addresses. We did hear that the Red Cross leaders were busy developing and supervising projects all over Port-au-Prince so we thought we might be able to follow leaders and track them down.

As we drove from one destroyed neighborhood to another, I remembered these “personal searches” were what we’d done in Kosovo after the war when the land lines weren’t functioning and cell phones were rare. Finally, hot and seat-sore from riding over Port-au-Prince’s pothole-punctuated, rubble-strewn roads, we accepted what seemed inevitable: we would have to wait till next trip to meet the Haitian Red Cross leadership.

An example of Haitian streets

However, since it wasn’t yet dark, I—ever optimistic– thought we might pay a visit to the University of Miami Medishare hospital, where I had spent so much time on my first visit to Haiti. It turned out we couldn’t find that either.

“Maybe,” our driver opined, “someone at the Red Cross installation nearby”—he gestured to one we had not yet visited—“would know where it is.”

“Okay,” I thought as we arrived, “let’s ask about Medishare. But let’s also try just once more to see if anyone knows where we can find the Red Cross president, Dr. Michael Amedee-Gedeon and Dr. Jean-Pierre Guiteau, the Executive Officer.

When I mentioned their names, the guard looked uncomprehending. Still, I handed him my card. Ten minutes later he returned with instructions to bring us ahead. As we walked over the crushed stone toward a newly constructed building, a man as puzzled to see us as we would be surprised and delighted to see him, approached.

He was, it turned out, Dr. Guiteau, a long-time leader in public health with a particular expertise in and concern for Haiti’s children. Still a bit puzzled but exceedingly gracious, he invited us to the conference room and offered us coffee. Soon we were soon joined by Dr. Amedee-Gedeon, who made us feel as if we were not only most welcome but long expected. She said she specialized in nutrition, as well as public health. She had previously been, Dr. Guiteau told us, Haiti’s Health Minister.

I described our work, stumbling a little at first even in English, because I was still amazed that we were actually talking with them. When I finished, they asked a few questions about the length and scope of our training and the research we had done on our work with professionals and with traumatized kids. They told us how concerned they were about the stress their staff and volunteers were experiencing—“So many have lost family and friends themselves.” They appreciated that the skills that we had to teach could be helpful to these burdened men and women as well as to their many thousands of “beneficiaries.” They were particularly interested, given our experiences in Kosovo and Gaza, in how we might help the large number of amputees whom, they feared, “would never live up to their potential.”

Next post: Meet the Minister of Health Dr. Alex Larsen, and Dr. Jean-Hugues Henrys

Dr. Emmanuel Justima

I originally met Justima (it’s his last name; as he said, he likes to be called that to distinguish him from “other Emmanuels”) at a “psychosocial cluster” meeting to which Lee-Ann and I had been invited. Perhaps 30 nongovernmental organizations (NGOs) were present. All are working with “psychosocial” issues: the emotional challenges, psychological, and social needs of the close to 2 million people who have lost family members and/or been displaced by the earthquake.

Justima, tall, broad shouldered, slim, in black pants and a crisp checked shirt, entered the room halfway through the meeting and shook hands with the UN coordinators. He stood tall and at ease at the front. When his turn came, he spoke in a voice loud and clear enough that even I– aurally challenged, and still scrambling to recover my French–could understand. And just in case I or anyone else had missed his meticulous instructions on prompt program registration with the Haiti Ministry of Health, he repeated it in flawless English.

Afterwards, Justima began our hour-long private meeting by announcing that PNI (psychoneuroimmunology– the scientific foundation of mind-body medicine), was his “passion as well as [my] professional field of expertise.” For a moment I thought he was putting me on. Another Emmanuel (last name Streel), the psychologist who coordinates the NGO psychosocial programs, had just told me about his own interest in mind-body medicine. “Vraiment?” (“Really?”) I said to Justima in my best, quizzical French.

“Yes,” he replied. “And, of course, we have to teach people to help themselves. There are only 10 psychiatrists in all of Haiti, and not many more psychologists.”

It has long been clear to me, after work with many other traumatized populations, that self-care and mutual help are logical centerpieces of a population-wide mental health program. But how surprising, and how wonderful, that someone so central to the Haitian mental health plan not only welcomes our way of working, but is steeped in the science that supports it.

Justima sits across from me at a narrow table in a prefab corrugated metal UN building, flanked by internationals concerned with similar issues. He takes care of business carefully but briskly, reminding us again of registration requirements, offering to find the most competent translators to put our materials into French and Creole. He carefully repeats phrases I don’t understand.

Around his mouth and in Justima’s eyes, amidst striking efficiency and intelligence, I see the smile of a man who, with all the weight the world has put on him, still enjoys life. I look forward to working with him, and to spending more time with him.

I regret that we didn’t get any pics of Justima. More pics next installment, when we meet Drs. Guiteau & Amedee-Gedeon of the Haitian Red Cross . . .

On the other hand — and there is definitely another hand — the Haitian people are blessed, at least within the fields I’m coming to know best (medicine, mental health, and public health) by a leadership group that is knowledgeable, thoughtful, and skillful, as deeply committed to the welfare of its people and as open-minded as any I’ve found anywhere in the world. These Haitian leaders seem at this crucial moment in history far less encumbered with the self-importance and pride that afflicts many national and, indeed, professional leaders I have known. Their commitment to the welfare of their people and their compassion trump received truths and narrow professional prerogatives.

Here’s a pic of Haiti streets finally looking a little more alive:

Already you’ve met two of these remarkable people: Alix Lassegue, the physician who directs the University Hospital, and Marlaine Thompson, the nurse who works closely with him. Together, they embrace the flood of people who overwhelm the hospital. They shape the comprehensive services for the complex problems that their patients, overwhelmed by the earthquake as well as the ordinary calamities of Port-au-Prince daily life, bring to them. In the next few blog entries I’ll introduce you to several other of these remarkable men and women, the welcoming leaders and kind teachers with whom we hope to be working closely in the months and years ahead.

Monseigneur Pierre Andre DuMas

There are certain people, who upon entering a room, fill and light it up. Monseigneur Pierre Andre Dumas, bishop of the Diocese Anse-a-veau/Miragoane and president of the Catholic Church’s service arm, Caritas, and Dr. Emmanuel Justima, a psychologist who is a leader in shaping the Haitian national mental health plan (whom you’ll meet next installment) are two.

Pierre Andre DuMas is tall, supple, gray-haired, and dressed in gray vestments. Sitting with him I feel myself warmed by his abundant energy and his generous sweet nature. Though I have never met him before, I somehow feel that I know him. Like my old close friends, we simply share what is most important to us, find ourselves embellishing each others’ narratives, and quickly invite each other into our unfolding lives.

I tell Pierre Andre a little bit about our work and where we have done it, and he smiles with recognition. He invites me to present our way of healing trauma to Haiti’s religious leaders, “as soon as we can arrange it.” It is part of his job, he tells us, to bring together Protestants as well as Catholics, Jews, Muslims and Voudoun practitioners.

He tells us about the thousands who have returned from Port-au-Prince to his rural diocese and the dislocation and suffering they bring with them. On Good Friday, he hiked up a nearby mountain with 6000 people from his diocese. “We sat by a waterfall and breathed deeply, relaxed — Like your work, no? Some of us swam. All of us needed a catharsis.”

When I give him a copy of my book Unstuck, I assure him that he will enjoy it even though he’s not depressed. “I know that you know that I am not,” he says. “If you are still alive,” he adds, opening his hands, “you have to stand up and give hope.”

Next installment, meet Emmanuel Justima, a psychologist working on Haiti’s National Mental Health Plan