Saturday, August 21, 2010

My Trip to Haiti -- Part VI

Kids getting ready for our group.
Day 6 -- Wednesday, August 11, 2010

Today, Amelia and I planned to go through the assessment at the back of the workbook with the kids.  First of all, Amelia had been told by our coordinator that if nothing else we had to do the assessment, and second, we figured that given that there were so many kids and time was short, this would give us a good idea of where to concentrate our efforts.

The assessment is essentially a checklist in two parts.  The first has to do with what the child experienced before, during and after the earthquake, with each thing given a certain point value.  Some items are factors that put the child at psychological risk.  For example, having a parent who had died before the earthquake is worth +15 points.  Having a parent killed in the earthquake is +35.  Other factors are protective.  For example, having reliable housing within one month after the earthquake is -5.  Having daily access to the people close to them is -10.  The second part of the checklist is a list of post-traumatic stress reactions the child is currently experiencing and which are new or have gotten worse following the earthquake.  These also are given a point value.  Difficulty sleeping is +5.  Thoughts of suicide are +35. 

The instructions for the checklist are adamant about two things.  First, the checklist is to be filled out by an adult who is familiar with the child, and second, any child who scores more than 100 points is to have a medical evaluation.  Those of you closely following our heroine, however, may notice two problems.  First, we had 50 kids and limited time.  Second, we had no medical personnel on our team.

Amelia and I decided the best way to do this, which was suboptimal but probably sufficient, was to go systematically through the checklist with the whole group, asking kids to self-report on each item.  We told them not to worry about the numbers, just write yes or no (or, more accurately, either "oui" (French) or "wi" (Kreyol) or "non") and we would score it later.  Of course, the questionnaire was not worded in what we in the education biz call "kid-friendly language," so for each question, I would explain the French and Kreyol questions in their books in English developmentally appropriate language and Amelia would translate my explanation back into Kreyol.

The first thing we noticed was that a large handful of kids were not responding to the questions at all.  The second thing we noticed was that a fairly large number of kids said that they had not had one parent die before the earthquake, but had had both parents die before the earthquake, which was both not possible (you can't have two dead parents without having one) and not true (these were uniformly kids with two living parents).  Eventually, she started trying to help kids better understand questions individually while I continued on, using Krystal, a Haitian-American woman who was there with another volunteer group, as my translator.

When we were done, which took absolutely forever, I took the stack of questionnaires back to the guest house to score them before lunch.  I was stunned.  Of the 45 children who answered the whole checklist (some had left in the middle), 16 had scored above the magic 100 point threshold, and 3 said they were thinking about killing themselves.  Every single one of the 45 said they had multiple stress symptoms, seven months after the earthquake.

I need to emphasize that these kids did not appear, to the casual observer, to be troubled in any way.  I had watched them play and work for three days, and while I didn't know what they had been like before, I would not have pegged this as a group of kids with "issues," and I certainly could not have picked the highest scoring 16, or even the 3, out from the others.  The level of suffering they said they were enduring was tremendous.  At the same time, I knew that they had had a lot of trouble understanding some of the questions, so it was possible that some of the scores were artificially high or, I hated to think it, artificially low.

Amelia and I talked about what to do after lunch.  We had discovered, at the end of the camp day, that there was a beach field trip planned for the whole camp for Thursday, and we already knew that Friday would be devoted to a big celebration for the last day of camp.  That meant that, effectively, we had no more time to work with the kids.  At the same time, we had 16 kids who might be in significant distress, and three who might well be in imminent danger.

One of my CISM instructors used to say, "Do what you know you can do well, and get out of there."  With that in mind, we decided there were two things we could do.  One was to try to help some of the kids who were staying on the property, since we could work with them outside of camp hours.  The second was to try to assess how much danger the three who said they were suicidal were actually in.  We hatched a plan to do both of these things on Thursday, and I went to bed.

Tomorrow:  When Fun Gets in the Way of Trauma


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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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