In Haiti’s rural mountain communities, the stigma and fear surrounding cholera can be as life altering – and at times as life threatening – as the disease itself. The physical suffering of uncontrollable diarrhea and vomiting is often accompanied by severe social isolation, rejection by family and friends and job loss.
“In some communities where we have arrived, incredibly remote villages in Saut d’Eau and Savanette, almost everyone in the community has been or knows someone who has been sick with cholera,” says Elysee Noesil, a PIH/ZL psychologist working in central Haiti. “There were some lucky ones who had had the chance to get to the hospital, and others who were unable to and their loved one died at home.”
Some patients are abandoned at treatment centers, while others die hiding in their homes – afraid of social rejection. Even those cured of cholera are often shunned by communities terrified of bearing the mark of the scourge.
“The stigma around cholera is killing people more than the bacteria itself,” continues Elysee. “Family members do not want to go near loved ones with cholera, afraid they will die as well. They are afraid to touch them to get them to the cholera treatment center. Still others died because they were ashamed to let their family know they had cholera, afraid they would lose status in the community.”
As part of a comprehensive treatment plan to control Haiti’s cholera epidemic, and in conjunction with a comprehensive medical and disinfection protocol, PIH has taken steps to address the psychosocial needs of cholera patients.
Healing the mind after cholera attacks the body
With their Haitian sister project Zanme Lasante (ZL), PIH/ZL has hired 17 additional social worker assistants to help identify patients who would benefit from psychosocial support groups intended to help reintegrate them into the local community.
Led by Father Eddy Eustache, director of ZL’s psychosocial and mental health program in Haiti, PIH/ZL developed a four-session curriculum to aid psychologists working with post-cholera patients. The initial three group sessions – including one called “Loving My Body After Cholera” – address self-worth and self-image for patients after they recover and help identify factors that could prevent or help reintegration.
The fourth session involves home visits from psychologists who speak to family members about the importance of accepting their loved one while continuing to protect themselves. After the visit, the family is given a hygiene kit with water purification tablets and soap to help sanitary conditions inside the home.
“Support groups enable cholera survivors to find a network of people with similar experiences, who have lived through the devastating physical as well as emotional stress that cholera has created. It is amazing to see the change in people’s perceptions of their self-worth from the first session, to the fourth,” adds Elysee.
Mourning traumatic death and disposal
Cholera deaths are dramatic and quick – people who succumb often do so within 24 hours. When cholera strikes a rural mountain village of a few hundred people, it is not uncommon for 20 to 40 people to succumb.
After death, the bodies of cholera victims are bathed in bleach, all orifices are blocked, and bodies are placed in a body bag to prevent further contamination. This strict protocol robs survivors of traditional grieving and burial practices; proper funerals and ceremonies are ignored as bodies are laid to rest in mass graves as a final precaution.
“In Haiti, we believe the dead remain with us, and this is why we perform rituals before burying a loved one, says Elysee. “For example, we hold a wake for the departed, the community provides strength and support to the family to show they are not alone in their grief.”
“But with cholera, where we must dispose of bodies in an almost-savage way, these rituals are unable to occur for infection control purposes,” explains Elysee. “When someone dies of cholera, their family is unable to truly grieve, and they don’t have the means of fully accepting that their family member is gone.”
“The services are like a symbolic funeral, we help people understand that their loved one can continue to live in their memories even if physically absent.”
As an offering of assistance during the grieving process, PIH/ZL psychologists are conducting non-denominational memorial services for each cholera victim in affected communities; including song, candle lighting and remembrances of the person who died. “Those who are stronger support those who are weak,” continues Elysee.
As with all of PIH/ZL’s comprehensive treatment and healing approaches, psychologists, social workers and community educators involved in the service take time to discuss proper hygiene and prevention measures, hoping to curb the deaths that warrant such services.
“Grief is very healthy and one of few chances communities have to express feelings and relieve stress,” says Elysee. “After the memorial finishes, we see smiles returning to people’s faces, we see people embracing and shaking hands, and we see everyone deciding that they must continue living.”