With a giggle, Esther Balthazar bursts into song. Her head sways in time with the music, her smile grows with the melody. She’s singing one of her favorites—a hymn of hope. A cold breeze rustles through the lush grove of palm trees at her home in central Haiti, but Esther’s warm, confident voice cuts through the chill.
Pulling a turquoise towel around her shoulders to guard against the wind, Madame “Fifi” Demme joins in the last few lines of the verse. As Esther's adopted mother, she knows the young woman's long journey to becoming the stellar student and enthusiastic singer in her church’s youth choir that she is today.
One year ago, Esther was in a completely different state. Unresponsive and catatonic at times, she heard voices, cried uncontrollably, and often lashed out at those trying to help her. “If we asked her to do something, she’d get angry. If we asked her to sit, she’d stand,” recalls Fifi, who found her while on a missionary trip to the southern coastal town of Jérémie. Fifi knew that she couldn’t leave the troubled woman on the streets amidst the earthquake rubble, so she and her fellow missionaries brought Esther back to their home in Cange, in the Central Plateau of Haiti—less than a mile from the hospital operated by PIH’s Haitian sister organization Zanmi Lasante (ZL).
ZL psychologist Dr. Tatiana Therosme believes that Esther had a pre-existing psychotic condition that was aggravated by stress and trauma following the massive earthquake last January. She and PIH mental health director Dr. Giuseppe Raviola started Esther on a low-dose of an antipsychotic medication in March, with instructions to take the medication every night, gradually increase the dose, monitor closely for side effects, and go to the clinic if she experienced any problems.
The medication, along with therapy sessions and a stable home with Fifi’s family, helped to stop Esther’s psychotic episodes, and she has since become an active member of her community. She began studying in preparation to resuming her education, began a small business selling snacks by the side of the road, and was invited to join her church’s youth choir.
By October, the ZL mental health team, visiting Esther at home, decided that she was doing so well that they could try taking her off of the medication. Dr. Raviola recalls that Esther was reluctant to stop the medication, as he had originally told her that she would possibly need to take the medication for up to a year, or longer. She was concerned that she wasn’t fulfilling her duty to adhere to the regimen. Dr. Therosme and her team carefully explained to her that any course of treatment depends most on each individual person’s response—and in Esther’s case, she had responded so well to the regimen that it was felt to be worth trying to stop the medication, albeit with close follow-up.
Since then, Esther hasn’t looked back. She enrolled in school in November, and is currently taking a seemingly overwhelming number of classes: Math, Physics, Biology, Haitian Literature, French Literature, English, and Spanish. It’s as if she’s making up for lost time—she’s in her second to last year of high school—this will be her third time beginning this grade, having failed or dropped out in previous years due to her illness. This time, she’s determined. According to her mother, she never misses a day of school—she’s in class six days a week—and always does her homework. “She’s good, and smart, too smart to not be in school,” Fifi proudly asserts.
Since stopping the medication Esther has also become noticeably slimmer than she was just three months ago, as her appetite has gone down to normal in the absence of the medication. “She’s taking a break from eating,” Fifi jokes. The other change--she's no longer selling snacks at the side of the road. She and Fifi start laughing at the mention of her commerce project. "She ate all the commerce!" teases Fifi, while Esther protests that she hasn't had time between her studies and choir practice--which she attends twice a week.
Esther knows that she is incredibly fortunate. Finding treatment for mental health issues in Haiti is exceedingly difficult, particularly so prior to the earthquake. In the whole country, there were only 10 psychiatrists and 9 psychiatric nurses working in the public sector, according to a 2003 World Health Organization report. Esther's own mother suffered from severe untreated mental health issues. She died when Esther was just 14 years old.
Following the earthquake, the need for mental health services has only grown. With so many lives lost, so many displaced, over a million left without homes, hundreds of thousands of people suffering life-altering physical injuries, and in an unstable environment, it's not just those with pre-existing conditions, like Esther, who are in need of care.
The PIH/ZL mental health and psychosocial team has hired 17 new psychologists since the earthquake, and has expanded its team from 25 to 90 clinicians, social workers and social work assistants, and community health workers. Together, they are currently caring for thousands of patients who are currently undergoing individual therapy, in addition to working with the many communities, schools, settlement camps, and churches they provide with support, education and materials.
As the sun sets over the grassy hills surrounding Cange, the temperature continues to drop. Esther still appears comfortably warm in just a red t-shirt as she continues to sing her hymn. The wind cuts through the smell of hot tar steaming off the nearby newly paved road as over-laden trucks rumble and motorcycles roar by, shaking the ground beneath Esther's house. A year ago, similar rumblings could have triggered further mental health issues. But today, Esther just sings louder.