Monday Morning Crisis Quarterback

The attention of most of the country continues to be across the Pacific in Japan. The loss of life is horrific. The material damage is enormous. The fear regarding the radiation in Fukushima is mounting.

Now is not the time for a psychological crisis intervention in Japan. The situation is still unfolding, and there are still significant basic physical and safety needs to be met. The best that can be done from a mental health standpoint in Japan right now is managing people's fear. Both the Prime Minister and the Emperor appear, from this vantage point, to be doing a pretty good job at exercising resilient leadership. The consistent emphasis on coming together and getting through this is good practice.

What about folks in the U.S.? Is there anything we can or should be doing for people here? I think there is.

First of all, everyone in the world needs some decent information about the radiation risk. With the exception of nuclear scientists, most of us have very little understanding of how much radiation is too much, how the current accident will affect people in Japan and whether it will affect anyone anywhere else at all. The news media is doing a somewhat better job of bringing in experts to explain this to us, but I think it would help if they acknowledged that none of us like hearing that there's any radiation at all, and that the biggest impact here is from fear, not nuclear byproducts.

People here who have family and close friends in Japan, particularly in the area where the quake and tsunami were, need something a little more. I think you could further separate that group into two -- those who come from Japan and have roots there, and those who don't trace their roots to Japan but have family studying or visiting there. Last Friday was ghastly for both of these groups, and it would not be surprising if they're feeling the affects even now, presuming that they now know how their loved ones fared in the quake.

For those who come from Japan, this incident is not, in some ways, over. The pictures the rest of us see and think are horrible are more personal. They may have lost homes or other special places. They may not be ready, yet, to process through their feelings and try to put them away.

For those who had family visiting or living in Japan but are not themselves Japanese, the incident is largely over and they are probably ready for some intervention. It would be totally understandable if they are having some issues with feeling irritable, having trouble concentrating, not sleeping well or having intrusive thoughts about the quake and the agonizing wait to hear from loved ones. They need to know they're normal -- it's the situation that isn't.

Then there is that group that is somewhere in a no man's land in between. They are from Japan, every picture is personal, the situation is ongoing, and they also experienced the traumatic death of someone they love. For them, some understanding and moral support is in order until the dust can settle a little more and they can start to come to terms with all of this.

I wrote yesterday about my son's friend, Taro. When I wrote, I wasn't sure which category Taro fell into. Late yesterday we confirmed that he is in this last category. He lost his grandmother and his home. The only bright side, perhaps, is that young children don't really understand death and loss as permanent things. But his family does, like so many other families in Japan, here and elsewhere. The latest estimate I've heard is 10,000 dead. That's a lot of people in limbo, waiting for this to be over so they can grieve.

As many of you know, I have a 5-year-old son. As you may also know, I believe strongly in talking to children about traumatic events if they affect your family, if they are going to hear about them from somewhere else, or if you are very affected by them. Since my husband, my 12-year-old and I are talking a lot about Japan and it is all over the news, I have been talking to my 5-year-old as well. This seemed especially important since he has a little friend in his kindergarten class whose family is from Japan. I'll call him Taro.

My son knows about earthquakes. He heard about the one in Haiti, and that learning was reinforced when I went to Haiti to do some intervention work with kids last summer. His class also recently learned a little about plate tectonics, and his science fair project involved modeling how mountains form using sheets of lard floating in a pan of water. So we had a starting place.

On Friday, I explained that there had been a very huge earthquake in Japan. He immediately exclaimed, "Taro comes from Japan!" He was happy about this -- he had a personal connection to a grownup thing. That's a big deal when you're five. We then talked about tsunamis, which he has also heard of from a children's book called The Magic Fan in which the hero saves the town from a tsunami because he has built a giant bridge over the village. We talked about how the earthquake starts a big wave, and how, just like water sloshing in the tub, it sloshes one way and then sloshes the other. In this case, it sloshed all the way to Hawaii and California.

Interestingly, my son seemed to completely miss the idea that this was a scary thing. He's in the stage of his life where science is very cool and big things moving in the earth are even cooler. He does not connect that real people just like him live where all this is happening. It's like a cartoon to him, and that's probably just as well. His comment after I explained all of this was, "On Monday, I will tell Taro that there was a big earthquake and tsunami in Japan." I suggested that Taro might already know.

Over the weekend, my son asked what a nuclear accident is. This feeds into another parenting principle -- if they're asking, you need to answer. But explaining nuclear power to an adult is hard enough, let alone a kid. I explained it this way:

There are lots of different ways to make electricity. A lot of times, to make electricity you need something very hot. Often they use fire by burning coal or gas. Another way to make something very hot is called nuclear reaction. They take two chemicals and they bang them together, and it makes a whole new chemical and it gets very hot. The chemicals are dangerous, so they keep them in a strong container so they won't make anyone sick.  After they use the chemicals to make the electricity, they're still hot, so they put water around them to cool them down.

In Japan, they had a very smart system. As soon as there was an earthquake, the chemicals stopped banging together. That was really good thinking. But the earthquake broke the part that puts water around the chemicals to cool them down. So they are really, really hot and people are worried because they might melt the strong container and let some of the chemicals out, and people could get very sick from that.

This explanation is not very precise, but I thought it wasn't bad for a five-year-old's purposes, and my son seemed satisfied.

This morning, I asked him if he had talked to Taro about the earthquake. He replied, somewhat dejectedly, "Yeah, he already knew about it." I said I wasn't surprised, and that I guessed Taro's family was very worried. I said (and kicked myself for not saying earlier), "A nice thing to say would be, 'I heard about the earthquake. I hope your family is OK.'" Then, out of nowhere, my son said, "Taro says his grandmother was swept away in the tsunami. He also says that his house is gone and he doesn't know where he will live when he goes back to Japan."

Now, let me say up front that I have no idea if this is true. I don't know if Taro said it, and if he did, I don't know if he meant it. It is not at all unusual for kids -- either Taro or my son -- to "try on" a tragedy to experiment with what it would feel like or mean if it were true. Of course, it might be true. My son said that this was a discussion he had with Taro after school at daycare, so it wasn't at all clear to me that the adults knew about it. I put in a call this morning to my son's teacher and left her a message to let her know, in case she didn't, that either this family has suffered a terrible loss or that the kids are trying this trauma on for size. This triggers yet another principle -- if the kids are talking about it, you need to be talking about it too.

My son is still not too phased by the situation. He knows about it, and he knows it touches his friend. It certainly matters to him. But it's about at the level of the extinction of the dinosaurs in his mind. It happened, but it so remote from his experience that there's no real need to worry about it. I don't know about you, but I find myself wishing I could feel that way sometimes, too.

Depending on where you live, the earthquake and tsunami in Japan may or may not seem like something that can happen to you.  Here in Michigan, our chances of an 8.9 earthquake are pretty low. Even a tsunami on Lake Michigan wouldn't reach my house. But a nuclear reactor accident? Before today I didn't even know where the nearest nuclear power plant to my house was (it's about 40 miles). Floods, tornadoes, hurricanes, blizzards, chemical spills . . . there are a lot of reasons why you might, someday, need to either evacuate your house or shelter in place.

FEMA has been on us for years to get ready. Most of us aren't. At a recent meeting of CISM providers, the FEMA director asked for a show of hands of how many people had an emergency bag for evacuations.  Less than half of us raised our hands. Then he asked how many had a plan for evacuating their family. In a room of 800 people, I was one of two.

Make no mistake about it. When the time comes to leave your house, you will not necessarily have any time to get ready. Depending on what the disaster is, you might have a day and you might have less than 5 minutes. That's not the time to be thinking about this for the first time.

So, let's get practical. Here is a list of things you can do, roughly in order of the ease of doing them. This list is not exhaustive, nor does it take into consideration every possible catastrophe that could befall you. But it's a start. Find something on this list you haven't done yet, and do it.

• Talk.  Seriously. Have a conversation with the other people in your house and make the following decisions:
• Where would you meet in the event of an evacuation at a time you weren't together. Pick someplace out of the immediate area.
  
• Where would you meet if that place was also evacuating.
• Who are two people outside your area who you will call in an emergency if you can't reach each other, so they can relay messages to the others when they call.
• If you have children and you have to evacuate during the school day, who is responsible for picking them up (if possible -- they may have to go with school personnel, keep in mind).
• If your children are home alone, where should they go? Who is a safe person who is nearby who can help them?
  
• Find out what the official evacuation route or procedure is, if there is one, for the catastrophe most likely to happen in your area.
• Educate yourself about that catastrophe. Find out what the dos and don'ts of surviving it are. Do this even if you think you already know. Conventional wisdom may well be wrong.
  
• Make sure you have a battery operated radio and a flashlight, and that everyone in the house knows how to use them. Also make sure everyone in the house knows where in the house is safest in the event of an earthquake or tornado, if applicable.
• Make a list of the medications everyone in the house takes, both so you can grab them on your way out and so you can tell people at the shelter if you don't have your meds.
• Make sure you keep 3 days worth of food in your house at all times. It doesn't have to be 3 days of great food, but don't let your cupboards get bare.
• Stock up on clean water. You should have one gallon per person per day for 3 days. If you have a chest freezer, you can stick a gallon or two in the freezer, which will also save electricity.
• Create a bag with the things you would need if absolutely everything else in the world were destroyed. This probably includes medications, vital documents, a first aide kit, and at least a little non-perishable food. Put a list in the bag of anything that isn't in there that you need to remember (e.g. your child's asthma nebulizer).

Not only will these steps help you stay safe, they will help you stay sane. In the event of an emergency, you want to be able to devote as much of your energy as possible to doing what needs to be done and not add to the crisis with your panic at not knowing what that is. Being prepared makes people resilient. That won't make a major disaster fun, but it will make it doable.

In 2004, I accompanied 12 middle school children on an exchange program for 11 days in Hikone, Japan. In case you're wondering, Hikone is southwest of Tokyo, north of Osaka, and nowhere near the major damage of the earthquake. However, all things are relative -- Japan is not that big a place. As part of our trip, I spent several nights at the home of a local school administrator, Masaru, and his wife, Kayo. We hit it off tremendously, and have kept in occasional contact ever since.

Yesterday morning, right after I heard about the earthquake, I sent an email to Kayo and Masaru, telling them we were praying for them and all of Japan and expressing our hope that they and their family were safe. This morning, I got a response. I should mention, by way of explanation, that although both of my friends speak fairly good English, they often use an automatic translator in email. I still give them credit, since I can barely order dinner in Japanese. Here is what they wrote:

Dear Naomi,

The earthquake made tsunami. And then it attacked the area of north in Japan. We felt a bit of the earthquake. All of family are safe. But over 2000 persons dead now in Japan. I worried about electric power of atomicenergy. That was broken. A lot of radioactivity was spread. A few days later or month later Japan will be more miserable. Now we are alive. Of course in future we live. But...   We hope a lot of people alive. If people are alive, we can make new Japan like Kobe city. Japanese have Bushido sprits. I believe so. Thank you so much for us to pray.

Bushido, if you're not familiar, is roughly translated as "the way of the warrior." It is the Samurai way, the basis for much of the value system that underpins Japanese society. To say that the Japanese have Bushido spirits is to say that they're tough and they'll stick this out.

This email has stuck with me all day. "We will make new Japan . . . The Japanese have Bushido spirits." Part of the mythology of this tiny, earthquake-prone country is that earthquakes happen to reorder the world. They set things to rights. They allow things to start over. In some traditional prints, money is seen in pictures of earthquakes to show the redistribution of wealth.

This view of earthquakes is very foreign to most "westerners." But it makes a lot of sense. If I never experience earthquakes, or only small ones once in a blue moon, I see them as scary and negative. If I experience them all the time, sometimes really big ones, I need to come to some peace with what they mean and why they happen. That doesn't make them fun, but that makes them bearable. This is what Japanese tradition has done for Japanese society. The whole country, in some sense, has had training in resiliency from earthquakes.

The Japanese have Bushido spirits. They will make a new Japan, as long as people are alive. Tonight, watching the news from the failing nuclear power plants, that last piece is the kicker. The Bushido spirit is needed from those scrambling to cool those cores. I hope it's enough.

In Japanese mythology, Namazu is a giant catfish who lives in the mud on the ocean floor. The god Kashima restrains Namazu with a stone, but from time to time Kashima loses focus and Namazu wakes, thrashing around and shaking the ocean floor. This morning, 80 miles off the coast of Sendai, Japan, Namazu awoke.

An earthquake measuring 8.9 on the Richter Scale hit northern Japan just after midnight Eastern time. The resulting tsunami devastated coastal towns in Japan, and then made its way across the Pacific, hitting many island nations, Hawaii, and the west coast of the United States. While the loss of life in the U.S. is nothing compared to what has happened and continues to happen in Japan, the damage to ports and harbors is considerable.

This is the largest earthquake in Japanese recorded history. It is likely there has not been one this big in Japan for more than 1,000 years. This earthquake was almost 100 times stronger than the one that devastated the nation of Haiti in 2010.  In a country that builds and practices and prepares for "the big one," this was the big one.

While I don't mean to minimize in any way the devastation in northern Japan, the lives lost, or the very real dangers still posed by emergencies at two nuclear power plants damaged in the earthquake, it's also important to recognize the strengths present in this situation. Japan's construction standards are clearly designed to take an event like this into consideration. If you compare the destruction and loss of life in Haiti, where no such building standards existed, to what we are seeing in Japan, it is clear that Japan was as ready as you can be for something like this. The first news report I heard on the radio this morning was from a reporter standing on a balcony overlooking Tokyo. Just the fact that there is a single balcony left in Tokyo tells you how well the Japanese prepared.

The horror we feel considering what has happened in Japan, then, is very different than what we experienced after the earthquake in Haiti. In Haiti, we saw roughly 230,000 people wiped off the planet by a natural disaster and by the unpreparedness and fragility of life in abject poverty. In the United States, we suddenly knew, in a way that many of us hadn't before, that Haiti was our neighbor and that we needed to step up and help.

The horror many of us feel today is different. Far fewer people have died. Japan is much farther away. And, as I've already said, they were prepared. At the same time, we generally regard Japan as being something "like us." While the culture of Japan may be different, it is a highly industrialized, modern country. We have high expectations for their ability to function in all kinds of circumstances. So we watch what is happening there and realize that if it could happen to them, it could happen to us. In Haiti, we felt guilty. In Japan, we feel scared.

Of course, this is not a one size fits all situation. If you have family in one of these countries, have traveled there, or feel some other connection, then one of these quakes may have hit you in a particularly poignant way. I have traveled to both places and have friends in each. Not surprisingly, as I wait for word about people I know in Japan, my mind drifts to worrying about folks in Haiti I haven't heard from in a while. That's the way it is sometimes. Namazu makes connections when he wakes.

If you were killing time on Twitter around noon Eastern Time today, you might well have gotten the impression that there was something big going on in California.  Shortly after noon, news filtered out of an earthquake measuring 9.2 on the Richter Scale near the Aleutian Trench, south of Alaska.  A tsunami warning was issued, and a few minutes later a magnitude 7.2 earthquake hit California.  Then came the tsunami.  If you weren't paying close attention, you might have been alarmed, but none of it was real.  It's part of an exercise running today and tomorrow called Exercise24, or X24.

The purpose of X24 is to test the use of various tools on the Internet in the event of a major disaster.  X24 has been using Twitter (with the hashtag #X24 and clear warnings of "This is a test.  This is not real."  They have a page on Facebook.  They are using Google Docs to exchange requests for aid and match providers with requesters.  The idea is to see what works and what doesn't, and whether there are uses for social media and the Internet in such a situation that folks might not already have thought of.

Exercises like this one are used in emergency response organizations all over the world.  Sometimes they are simulated using actors to portray victims or criminals, and sometimes they are done entirely virtually, merely sitting around a table and talking through what should happen next.

The idea is that having a great plan is wonderful, but you won't really know if you have a great plan until you try to use it.  The problem is, if you need to use it, it's really too late to discover it's not all that wonderful.  In addition, being taught or trained how to do something in an emergency is different than actually doing it.  For example, if you had a choice between two surgeons with exactly the same education, one who had done your procedure five times this week and one who had only watched other people do it, who would you want?  Simulations also serve as inoculation training for first responders.  They introduce various traumatic possibilities to people in a relatively controlled way.  When a real emergency hits, there are fewer elements that the responders' brains have never encountered before.  This makes them more resistant to the effects of the trauma exposure, and more able to stay calm and do their jobs.

There are two truths about exercises like this.  Truth #1 is that something will happen or not happen during the exercise that no one, in all of their planning, ever thought about.  This is, in some sense, the entire point.  By running a drill, you can discover what is missing from your plan.  Truth #2 is that, no matter how extensive your drills are or how many you have, during an actual emergency something will happen that never happened during the drill.  There are, in turn, two reasons for this.  First, every emergency is different and you can't possibly simulate every possible scenario.  Second, people behave differently in an actual emergency than they do if they know it's just for practice.

X24 is an interesting exercise because it uses the Internet -- and hence the whole world -- to practice in.  The organizers should be cautious, however, in leaning too much on this exercise to answer specific questions about how the Internet would handle an emergency.  I strongly suspect that the number of people retweeting the #X24 tweets and posting information to Facebook, as well as looking for information on emergency and news sites, during the exercise is a tiny fraction of the number who would do so if an actual tsunami hit California.  You can tell from this exercise whether you can use Internet tools to share information, but until it actually happens we won't really know if those tools have enough capacity to make it a good idea.

Frequent Quarterbacker Edwin dropped me a note earlier this week to suggest that I might like to write about the flooding in Pakistan, seeing as how it is being branded one of the worst natural disasters ever.  In case you missed it, 20 million people have lost their homes and an estimated two thousand have died.  Those surviving are, aside from being homeless, at tremendous risk for disease and starvation. 

This is certainly a crisis, and certainly the sort of thing I write about.  So why haven't I?  My reasons are somewhat specific to me.  The flooding in Pakistan hit the news in this country during the second week in August.  It may have gotten coverage before that, but certainly not a lot.  My regular readers know that during the second week in August I was in Haiti, doing crisis intervention following their earthquake in January.  I first heard about the flooding the day I returned and, to be perfectly honest, I was resentful that there was another natural disaster.  My gut, emotional reaction was that Pakistan was stealing the spotlight from Haiti, and they should wait their turn.  That was not a rational reaction, of course, but it was real.

I shared that reflection with Edwin when he asked, and he said that, in some ways, he had a similar reaction.  The floods were too much, too soon after the Haiti earthquake (not to mention the Chile earthquake, the gulf oil spill, etc.).  It's interesting that he described it as being too much, as though he (and by extension, we) couldn't absorb it all.  Others would say that the rapid succession of disasters has made us numb.

Edwin and I are no alone, however, in not really focusing attention or assistance on Pakistan.  In contrast to the reaction to Pakistan, international aid has been very slow in funneling to Pakistan.  I haven't seen any cell phone text message fundraising campaigns, and there is no "We Are the World for Pakistan."  I'm absorbed with Haiti.  Edwin feels like it's too much too soon.  What's up with the rest of the world?

I think there are a number of factors in play here, and any one of them may play more or less of a role for one person or another.  If one doesn't resonate with you, keep going down the list.  Something will.  In addition to what I'll call the "natural disaster overload" described above, here are some things I think are going on:

• Floods are calamities in slow motion.  Unlike an earthquake, there is no shocking breaking news that shakes us all out of complacency.  The moment when a flood goes from a problem to a catastrophe is not clear, and the more time we have to get used to something the less likely we are to feel like it requires action.
• The impact is measured in lives displaced, not lives lost.  Two thousand people is a very large number, but the death toll from the Haitian earthquake was more than one hundred times as great.  Death gets our attention.
• It's Pakistan.  Americans, at least, don't particularly like the Pakistani government, despite the fact that they are technically our allies.
• It's Pakistan.  The Pakistani government is notoriously corrupt, and the country has a significant Taliban presence which makes operating there very difficult.
  
• It's Pakistan.  There is a tremendous anti-Islamic sentiment in this country right now.  While relatively few Americans would consciously decide not to help because these are Muslims, the anti-Muslim rhetoric makes it much easier to not notice that these are people.

I've taken way too long to start blogging about the situation in Pakistan.  I'll devote some more space to it in a few days.  In the meantime, I'd like to recommend two of my favorite disaster relief charities, both of which are doing relief work in Pakistan because they already had people on the ground when the flooding started.  Please consider a donation to Doctors Without Borders, the American Jewish World Service, or the relief organization of your choice.  Disaster is disaster, and disasters shouldn't have to compete for whose is more important to get our attention.

Me, with one of my new friends

It's been 12 days since I returned to Michigan from Haiti.  That seems both the blink of an eye and an eternity.  My return and reentry has presented an interesting opportunity for me to experience some of what I hear when I talk to people who have been in emergency situations first hand, because, while I was not in the earthquake itself and I was fairly comfortable for a brief week in Haiti, the shock to my worldview presented by what I saw and heard was real.

As I mentioned in my last post, I had some foresight to recognize that I might not be firing on all cylinders when I returned.  In addition to upgrading my flight to first class, I also prearranged with colleagues from the community crisis team on which I serve to have someone talk to me when I returned.  I was not surprised that I needed it.  I was somewhat surprised at the reasons I needed it.

I expected to come back with visions of destruction and tales of horrible trauma running through my head.  For the most part, that did not happen.  What I did not expect was to come back feeling as attached and responsible for the people I met as I did.  The conditions under which virtually everyone is living are of a type we simply would not permit in the United States.  Even after Hurricane Katrina when, it might be argued, we as a country failed our fellow Americans in a way never before seen, we did not permit this kind of living conditions for this long.  It felt callous to spend a week and then pack up my things and go because I "had" to leave.  It even felt callous to be asking for help with what I had experienced.  I experienced a week.  Those kids are experiencing a lifetime.

This brings us to another layer of how I was feeling.  Yes, it has been seven months since the earthquake.  In reality, however, while things are worse for these families now than they used to be, they weren't starting from a great position to begin with.  The level of poverty in Haiti is incomprehensible to someone used to US standards.  Most of the poor here would be doing fairly well compared to Haitian poverty, and in Haiti there is no government safety net.

I came back feeling like I hadn't accomplished anything.  I hadn't helped anyone.  I had come down, picked up my gold star for going, packed up and gone home.  Worse, that was all I could do, because the level of need is so high that even the most fabulous volunteers are not even going to make a dent in all that needs to be done.  I felt, and to some extent still feel, truly helpless.  And I feel that the world community has, throughout the 200+ year history of Haiti, failed in a moral obligation to at least try to give everyone a decent chance at a decent life.

At the same time, I feel guilty for talking like that.  Yes, things in Haiti are bad.  But this is people's home, and now I know some of those people.  I wouldn't walk into a friend's house and comment on how small or broken down it is.  Can you imagine going over to the neighbors and saying, "Geez, your house is a pit?"  In the same way, while it's no secret to the people in Haiti that they are poor and have little, it doesn't seem right to insult their country or their living conditions.  The fact is, they are making do with what they have, much better than I think I ever could.  They are playing the hand they've been dealt, and they're playing it pretty well.

So, I have mixed feelings.  That is the name of the game when it comes to complex, traumatic situations.  In these moments, I find myself thinking about the teaching we have in Judaism that, when God made the world, it was intentionally left imperfect.  It is up to us to repair the world, in partnership with God.  This, of course, is an overwhelming task.  No person could possibly repair everything that is wrong in our world.  Rabbi Tarfon, one of the great thinkers, is quoted in the Pirkei Avot (ethics of the fathers) on this subject:

It is not for you to finish the work, but neither are you free to desist from it.

I know I did something in Haiti.  Was it enough?  No, because it could not possibly be enough.  But I did not desist from the work, and I find some small comfort in that.

I hope you've enjoyed reading about my experiences in Haiti.  You can read this series from the beginning here.  We now return to your regularly scheduled Quarterback, commenting on the news as usual.

Sun rising over Leogane as we left for the airport

Day 9 -- Saturday, August 14, 2010

I woke up Saturday morning at 3 AM and absolutely could not fall back to sleep.  I finally got my iPod and played some games for a while and then dozed off.  My alarm woke me at 5.  Hillary and I were both leaving that morning, so we had arranged to share a ride to the Port-Au-Prince airport.  Fearing "Haitian Time," we told the driver that my flight was an hour earlier than it was, and then left extra time on top of that.  We were supposed to leave at 5:30.  One of the women who works at the camp came into the guest house shortly after I got up to make sure we were awake, and we quickly finished our packing and got ready to leave.

Those of you following this whole series may recall that when I came to Haiti I had donations of clothes for the kids and lots of workbooks in my luggage.  On the way back, the main compartment of my suitcase was filled with dirty laundry, and both my carry on and checked luggage were much lighter.  It also helped that anything I did not have a definitive purpose for was left with the kids.  I packed up my mosquito net and left it and my repellent for Christopher.  The two boxes of snack bars I had brought with me were long gone, given to kids who told me they hadn't had anything to eat on a given day.  My fan, flashlight and batteries were given to Daniel's family.  I had my clothes, my journal, my iPod and not much else.  We left the property at 5:30, with no opportunity for a morning goodbye to anyone other than Amelia. 

Driving back through Leogane and into Port-Au-Prince was again surreal.  The relative tranquility of the camp was replaced with more visions of rubble, collapsed buildings and tent cities. 

We had been warned not to let anyone "help" us with our luggage at the airport.  However, a porter had grabbed my suitcase long before I even got out of the car, so I let him bring me to Spirit for check-in.  I got out a dollar to tip him, and he said, "For fast check-in, price is $5."  I knew I was being had, but it wasn't a lot of money, so I dug out a $5 bill, whereupon he said, "For fast check-in, price is $20."  I told him no, and took my luggage and placed it on the first security scanner belt.  In Port-Au-Prince, you actually have to go through security to get into the airport, on top of the screenings to get on a plane.

After waiting in line for an extremely long time, I checked my bag and went upstairs to where the shops and cafeteria/bar is.  I wandered around and bought gifts for my kids.  My son collects vehicles of all sorts, so I bought him a model of a tap-tap.  My daughter collects keychains, so I got her a keychain with a tap-tap on it.  Finally, I bought a bottle of rum for the friend who was meeting me at the airport in Detroit, and went out to the counter to get something to eat.  A snack and a coke later, and it was time to go through security.  After a few minutes they called my plane, and I started down the hall to the entrance.

Before we could get on the plane, a handful of security personnel rescreened our luggage by hand.  I then picked up the rum (which of course couldn't go through security so it had been dropped at the plane door for me) and got on the plane, settling in next to a Haitian man.  He buckled himself into his seat, clutching a manila envelope for dear life.  I looked at it, and realized it was an immigrant visa to the United States.  I offered him words of welcome.  The plane took off, and I started to cry, the first of many times that day.

Customs and immigration in Fort Lauderdale were relatively speedy, and I got my bag and headed over to Delta.  I had truly not known how I was going to be feeling when I returned, and so I had made some plans before I left on this trip to deal with the real possibility that I would be a wreck -- physically, emotionally or both -- coming back.  I had cashed in some frequent flyer miles to upgrade this last leg of the trip to first class, which turned out to be wonderful.  I just needed to feel pampered, which a bottle of water (which I really needed since I had probably been mildly dehydrated all week) followed by a beer, unlimited snacks and wide seats were just what the doctor ordered.  Before I knew it, we were in Detroit.

My husband had left for the weekend to pick up my daughter at camp, but I knew that I might not feel much like driving myself home from the airport.  We had therefore arranged for a dear friend to watch my son for a few hours and pick me up.  I highly recommend being met at baggage claim by a 5-year-old who loves you and hasn't seen you in a long time for anyone whose ego needs a little boost.  As I came down the escalator, a little voice screamed "Mommy!!!" and my son came tearing down the terminal towards me.  I felt like a rock star.

My bag was the first one off the plane, and my friend, son and I headed out to her car.  We headed up the highway, chatting, and I described some of what I had seen.  As we drove along, we came to a place where an overpass had been demolished and a new one built.  The remains of the original bridge were in a pile by the side of the road.  As we drove past, I caught myself about to point out the pile as an example of the kind of destruction the earthquake caused before I realized that, of course, that wasn't earthquake damage.  I realized then that the reentry to my life at home was going to be even bumpier than expected. 

After a nice dinner, we headed home.  I enjoyed my first hot shower in more than a week, although of course I hadn't wanted hot showers in the heat of Haiti.  Nonetheless, I enjoyed being able to control the temperature.  I got out in my centrally air conditioned house, tucked myself into my nice soft bed, and went to sleep.  As I drifted off, I thought about Daniel, sleeping in his tent almost 1800 miles away, and I cried again, not sure if the tears were for him or for me.


Tomorrow -- Reentry and Reflection

The kids with perfect attendance get their crowns.

Day 7 -- Friday, August 13, 2010

While the property where we were staying in Leogane was not really a farm, there were a smattering of farm animals hanging around.  Cows and goats were on the field to one side, and most of them belonged to people from the area who brought their animals to graze.  There were two or three roosters and a family of ducks that roamed free throughout the property, and the occasional dog, cat or pig happened by.  Each morning as the sun came up, I was awakened by one of the roosters crowing.  It bothered me the first night, but after that I got used to it and went back to sleep each day.

On Thursday night, however, something was different outside.  Some dogs appeared to be getting into a fight of some kind directly outside the bedroom window.  They were barking and growling for what seemed like hours, and I had a terrible time going to sleep.  No sooner had they stopped, it seemed, when a rooster and one of the dogs appeared to get into a heated argument.  The rooster would crow, the dog would bark, the rooster would crow again, the dog would bark louder, the rooster would crow louder, and on it went.  Once in a while a cow would chime in from the field, making for a scene that would have been downright funny had it not been the middle of the night and had I not been trying to sleep.  I finally gave up around 5 AM, and so I was quite tired and downright cranky as I entered my last full day in Haiti.

The plan was to grab the three kids we were most worried about before the assembly started that morning, but there was general chaos and disorganization, and we weren't able to do it.  The entire morning was devoted to the last day assembly, during which the various groups of children reported on their activities, performed music, dancing and skits, and generally had a good time.  Hillary had some Burger King crowns she had gotten donated for a craft project, and the kids with perfect attendance got crowns.  Soon, everyone, even the adults, was wearing a Burger King crown.  This might not have gone over very well in the United States, but in a place where Burger King does not exist, the difference between a BK crown and some other kind of crown is nonexistent, and the kid were very happy.

Sometime around 11:30, I hit the wall.  I could not keep my eyes open any more, so I snuck back into the guest house and laid down.  While the music from the assembly was substantially louder than the livestock from the previous night, I was able to put some white noise on my iPod next to my head and go to sleep for about 45 minutes.  When I woke up, the festivities were still underway but almost over.

Amelia got hold of the head counselor for the older children and made it clear that we needed to talk to some of the kids before they left.  Her first thought was to get all 16 kids who had scored high on the assessment, but in the time we had I felt it was most important to reach the children who were suicidal.  Two of the three of them were there that day, and we took them aside together. 

I explained that we wanted to talk to them because they were two of the children who said they had thought about killing themselves, and we were very worried about them.  I gave them the choice to talk to us together or apart, and they both wanted to be apart.  One of them, Olivia, waited off to the side while we spoke to the other, Nicole.  As it turned out, while Nicole was clearly upset and depressed, she was not currently suicidal.  She was 18 and had lost both of her parents in the earthquake.  She was one of the few kids who had a house, but she had no family and no way of supporting herself.  We spent some time problem solving with her, trying to come up with ways she could make sure she had food and was able to go to school, and ways she could find adults to talk to and confide in.  I was not at all sure we had really helped her much when we moved on to Olivia.

Unlike Nicole, Olivia was clearly suicidal.  I went down the usual assessment questions with her:  How often do you think about killing yourself?  What do you think about doing?  Would that be hard or easy to do?  What do you think are the chances you will actually do it?  This girl was straight out of a textbook on suicide, and she was at tremendous risk.  While we were talking to her, her mother came along and she gave us permission to bring her mom into the conversation.  

A Doctors Without Borders clinic in Port-Au-Prince

Had this been a student at my school or a person I was working with in the community at home, I would have referred her to the psych emergency room and made sure she went.  I was in no position to do that, in part because there is no hospital in Leogane right now.  I did the best thing I could think of, which was to impart to her mother how very serious and dangerous this was, and ask her to take her daughter to Doctors Without Borders right away.  I tried to give her language to use with them that would convey the seriousness of the situation.  I said to tell them that a mental health volunteer had assessed her daughter and felt she was in serious danger of hurting herself, and that the volunteer insisted she needed medical attention right away. 

I have no idea whether the mother took her daughter there, or whether Doctors Without Borders had any way of helping Olivia.  It was the best we could do to make the referral and to tell Olivia she was important, that we understood how much pain she was in, and that there was help for her if she could just hold on.  She seemed to believe us.  As I went back into the house for lunch, I said to Amelia and Hillary, "That is the work I came here to do."  While I was worried for Olivia, I also knew that this, unlike any other problem I had worked on all week, was a situation where I had specialized knowledge that could make a difference.  I just hope it did.

After lunch, Daniel attached himself surgically to my hip.  He knew that this was my last day in Haiti, and he clearly wanted to be around me.  The feeling was mutual.  We sat on the porch for the entire afternoon and into the evening, sometimes just us and sometimes with Christopher, playing cards, drawing in my journal and playing Doodle Jump on my iPod. 

My confidence in my ability to communicate with Daniel in French had improved over the week, even though my French itself probably had not.  Still, I ventured into some heavier topics with him.  We talked about my family, his family, and our respective religions, and about stereotypes of Haiti and of black people that are common in the United States.  We talked about his school, and I told him about how important it was for him to do well in school.  We even discussed the possibility of him going to college on scholarship some day.  He asked if it was difficult to come to the United States, and if he could come visit me someday.  I gave him my contact information and email address, and he and Christopher gave me the email address of Christopher's uncle, who also lives on the property, to use to contact them.

As the night drew to a close, I gave Daniel my battery-operated fan, my flashlight, my extra batteries for both and an extra bottle of bug repellent.  I gave Christopher my cards, which he was constantly playing with, and promised him I would leave my other bottle of repellent for him when I left in the morning.  Daniel admitted he was sad that I was leaving, and I certainly was as well.  He asked me if I would return to Haiti, and I told him the truth -- I didn't know.  I told him that if I did, I hoped he had a house when I returned.  He said he wanted one too, but that he really wanted a telephone and a DVD player.  He is, after all, thirteen.  In my lousy French, I summed up the trip, and our newfound friendship, before I headed off to bed:

Before I came here, I didn't know that I loved Haiti.  Now I know that I love Haiti and I have people I love in Haiti, so maybe I will come back.

Tomorrow -- The Journey Home

The Quarterback, Amelia and Hillary at the beach

Day 7 -- Thursday, August 12, 2010

Thursday was beach day, and we were told we would be leaving at 9:30.  It soon became evident that this meant 9:30 "Haitian Time," since the assembly didn't start until around 9:30.  In addition to the usual prayers, the head counselor lead the children in prayer for their safety on the trip.  I don't want to read too much into this, because I suspect the prayer was exactly the same one she would have offered any other summer.  However, Eloise had told us that many parents were still quite skittish about sending their children to the beach.  There was a small tsunami with the earthquake, not like the big one in southeast Asia a few years back but just big enough that if you happened to be standing on the beach or in the water when the earthquake happened you probably would have drowned.

At around 10:30, a school bus painted blue and white drove onto the field next to the gazebo, and the children began to pile on.  There were about 125 kids and about 10 adults going on the trip, and any teacher will tell you that far exceeds the safe capacity of a school bus.  The kids and regular counselors got on, and the volunteers were told we would take another bus.

After the kids had been on the bus for several minutes, I heard voices yelling my name.  Christopher and Daniel were leaning out the window, and when they saw they had my attention, they motioned to me to come to the bus.  I jogged over, and they asked me why I wasn't going to the beach.  I explained that I was going separately with the other volunteers, and they seemed very happy.

Our tap-tap

The "other bus" we were taking was not what would pass for a bus in the U.S.  Haiti has an informal system of vans and converted pick-up trucks called "tap-taps" which function as somewhere between buses and taxis.  They are brightly painted, and people stand on the side of the road and hail them, or you can call them if you and they both have a phone.  People ride in, on and on top of these vehicles to get around.  One had been called for us.

It was about now that we noticed that the school bus wasn't leaving.  The kids had been on it for a good half hour, and we imagined the heat was horrible.  The driver was now standing in front of the bus with the hood open.  It had broken down.  At about 11:10, we piled into the tap-tap, the bus driver got the bus going, and we headed towards the beach.

Having spent five days inside the grounds of the camp, it had been easy to forget that we were actually at ground zero for the earthquake.  While the living conditions of survivors were in evidence daily, the destruction caused by the quake was not.  As soon as we ventured out of the gates, however, it was back to reality.  Rubble, empty foundations and collapsed buildings were everywhere.  Where there weren't building remains, there were tent cities.  Very few buildings were standing and undamaged.  We continued through what, I suppose, had once been the center of town and out onto a dirt road which wound its way to the shore.  At 11:30, we got out of the tap-tap and waited for the kids to arrive.

The remains of a building near the beach

What was perhaps most striking about the beach was that it could easily have been on any island in the Carribbean.  With all the poverty and misery in Haiti, it's easy to forget that it is, in fact, a beautiful tropical island.  The beach had a lot of garbage and debris on it where the tap-tap let us off.  There had been heavy rains for several nights in a row, and it probably wasn't that clean to begin with.  Once the kids arrived, we headed down the beach to a much cleaner and nicer stretch, and to a house owned by Eloise which also had withstood the quake. 

As soon as we arrived, the kids started taking off their clothes and putting on whatever they were going to swim in.  A majority had bathing suits, although the two-piece suits didn't necessarily match.  The smallest kids were mostly in underwear.  Some kids wore shorts and t-shirts, or suits that obviously were too small or too big.  No one cared.  As soon as the counselors gave permission, everyone headed into the water.  I took my time getting ready, and by the time I walked towards the beach, a little girl decided I was late and needed to be pulled into the water.

The scene in the water was unlike any that would be permitted at any camp or school trip in the U.S.  Adults stood around the perimeter of a relatively small area of water.  125 children all squeezed into this area and jumped all over each other in what, in my experience, is "no horseplay or you're out of the pool" behavior at American venues.  I asked one of the counselors how many of the kids knew how to swim.  He had no idea.  The motion of the children kicked up sand from the ocean floor, meaning that when children went under water they couldn't be seen.  I spent most of my time praying I wasn't going to have to rescue or, God forbid, not rescue any children.

Once I had been yanked into the water, four or five kids at a time clung to me for dear life.  While I understood the impetus, I was truly afraid they were going to send me under the water and I wasn't sure I'd be able to get back up with them on top of me.  Add to this that Christopher and Daniel very much wanted to be around me, and showed their enthusiasm by leaping on top of the pile of kids who were already holding on to me.

After a swim it was time for lunch.  Some men who appeared to be camping on the property brought out freshly picked coconuts and, while the kids played, the adult paid them 25 gourdes (about 60 cents) each to hack off the top of the coconuts with a machete so we could drink from them.  It was fabulous.

The plan had been for Amelia and me to grab the three children who said they were thinking of suicide and talk to them sometime today.  However, it was pretty clear we were not going to be able to do that in all the hubbub.  This was difficult for me, since my training is certainly not to let it go when a child says they are suicidal.  The fact that we had already let it go for 24 hours was disturbing enough, but there really wasn't a way to even find these kids (whom we did not know), let alone assess them.  Finally, Amelia went and spoke to the head counselor, and we agreed we would talk to the kids before assembly the next day.  After another swim, we headed back down the beach to the bus and the tap-tap, and back to camp.  We were due back at 2:00.  We arrived close to 3:30.

After dinner, Amelia asked Daniel if he would like to talk to us about the earthquake, and whether he thought some other kids would too.  He said yes, and told us he would ask around to see who wanted to come.  At about 8:00, we sat down on the porch to talk to Daniel, Christopher and Christopher's cousin, Marie, age 10.  Each told us what had happened to them during the earthquake*.  I asked each of them what they thought was happening, and they all had different ideas, but each of them mentioned that it had crossed their mind the island might be sinking into the ocean.  This was not something that had even occurred to me, but then, I don't live on an island.

We discovered that none of them had much of an idea what causes earthquakes.  This seemed important.  Even though earthquakes can't be predicted reliably, I surmised that the idea that they "just happen" made their fear that it would happen again more pronounced.  I was right.  After a brief lesson in plate tectonics, all three of them visibly relaxed.

We spent some time talking about the definition of bravery.  The kids, both this group and the many others, did not seem to feel they had been brave during the earthquake.  They were using a definition of bravery that equaled not being scared, and they felt that no one had been brave.  I asked them what they thought the most important thing to do during the earthquake had been, and they told me it was to get outside and away from buildings, to pray for survival and to find their families.  I pointed out that that is exactly what they had managed to do.  They may have been scared, but staying alive was their number one priority, and they had done it.  I also told them that I knew it was hard to talk about this, and so the fact that they told us their stories and how scared they still were meant that they really were brave.  They like that.

It was 10 PM, and Marie was visibly exhausted and wanted Christopher to walk her to her tent in the dark, so they left.  I told Daniel he needed to go to sleep, but he refused.  I asked him what time he went to sleep usually, and he said 11 or midnight.  I asked him what time his mother wanted him to go to sleep, and he said 9, looked embarrassed, said goodnight and headed toward his tent.  I went inside and, as I tried to sleep, contemplated something that another volunteer, a Haitian-American, had told me at the beach:

It's good that you're here.  Only by coming here can you know that these children are human.

* You might reasonably be expecting me to relate the children's stories at this point.  I have struggled with how much to share, because what they say is supposed to be confidential.  I have decided to strike a balance by only relating what I believe anyone who knows them already knows and what I said to them, rather than all of what they had to say.

Tomorrow -- The Work We Came Here to Do

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