Home visit in Haiti’s Central Plateau: Emory students interview locals to gain better understanding of mental health in rural Haiti
By Nayla Khoury*
Rosanna stood in the middle of a circle of benches, outside of Medishare’s compound in Casse; her hands were raised and waving. She was speaking about Jesus and to no one in particular. I asked Wilfred, our newly trained interpreter, to translate for us.
“She is talking about someone who is trying to kill her with a machete,” He told me. “She is praying to Jesus for the sick.”
I asked him to speak in the first person and to try to follow her speech, however rapid and rambling.
“She is not making any sense,” He told me. “She is fou.”
This was my first impression of Rosanna, a small and energetic 74-year-old woman whom we have begun to know over the past two weeks. In our effort to learn about mental illness in rural Haiti, “fou” or “crazy” is a term that we encountered early on.
Some people described fou as someone who does bizarre things, walks around with tattered clothes and talks to him or herself. I had seen quite a few people labeled as “fou,” who even Project Medishare nurses stayed away from, telling me that a “fou” could be dangerous. The western medical student in me wanted to translate this into a term I could understand; “fou” it seemed, referred to someone with severe mental illness, perhaps overt psychosis.
The next week, I accompanied Aimée, a public health student, on a home visit to Rosanna’s house. After the Medishare motorcycle could no longer navigate the rugged terrain, Juno, a local Haitian, led the way to Rosana’s house on foot. The walk to her house was beautiful; from this elevation, we could see the Thomonde River to our left. I saw fields surrounded by mountains to our right. Juno explained that he had worked on these fields in the past and that he knew Rosanna. He described her as a sweet old woman who likes to pray a lot. He denied that she had any mental illness.
After a 30-minute hike in the mountains of “Vingt-Cinc”, we turned right onto a skinny path that crossed a field. I could see Rosanna from afar, her body bouncing up as she walked toward us; she was carrying wooden chairs in her hands. She smiled broadly and kissed Aimée, Ken (our translator) and me on the cheek. Juno enveloped her in a hug, lifting her off the ground and swinging her tiny body. She squealed.
Rosanna introduced us to her son and grandson who lived next door, then took us on a tour of her house. We told her that her place was beautiful. She shook her head, saying, “Not when it rains.” She apologized for not having more to offer us and for the state of her small house.
Her house was certainly small; her bed was within arms’ reach of her kitchen table. Yet it was clearly a home. Outside of her house hung nicely arranged pots of purple plants. Her belongings were neatly organized: boxes were stored on wooden planks above her bed, every inch of her space well utilized. She showed us how she lined the walls with decorations, which consisted of many seemingly random magazine pages.
Afterwards, the four of us sat down under the mango tree next to her son’s house. Rosanna talked to us about her life. She explained that her role in the community is to pray for people. She spoke rapidly and with passion; from time to time, Ken was able to put a hand up to pause her in order to translate for us.
Rosanna explained that she first took Jesus into her life when her son was younger and had a sickness. She explained that a Loogau, a person who comes to take babies, caused her son’s sickness. Rosana discovered that she had special powers sent by Jesus that enabled her to detect the Loogau and throw away the bad spirit. She spoke of animals with wings and other stories we could not follow, even with our translator by our side.
Later conversations would reveal that a Loogau is actually commonly understood as a normal person by day that can manifest into any form at night. Our research assistants excitedly explained that one could become a Loogau by going to a Hougan or voodoo priest. It was a way to make money, one research assistant explained, since Hougan’s needed people to be sick to stay in business. Often, however, a person did not even know that he or she was a Loogau because it could be inherited. If one’s grandmother was a Loogau and you were the first to cry after her death, you might become a Loogau. Loogau’s could transform babies into animals that a parent might unknowingly eat. Our research assistants joked and laughed while sharing these stories, but one explained that he had goosebumps while talking about such a “creepy” subject.
Rosanna’s son explained that she had been like this his whole life and that people in the community knew her as a woman who prays to Jesus. He did not find anything abnormal or strange about her behavior or speech. Later, the priest of a church Rosanna attends also explained that Rosanna is a sweet old woman who is poor. She prays for people to make money and is well accepted in the community.
When our interview was complete, Rosanna told us that she was headed to the market. Before we left, Rosanna ran around the back of her house to find us mangos and pineapples. She found a long stick with which to whack down the cashew fruits. It was quite a sight to see: a 74 year-old woman, adamant about obtaining the last remaining cashew fruit from the highest branch. She jumped up and down until she was able to get it for us. We were not allowed to leave her house until our hands were sufficiently full.
On our walk back to the Medishare compound, our translator explained his belief that she was “fou” because of the way she did not answer our questions and because of the things she said. On starting the process of translating her interview, other research assistants agreed that something was “not right in her head.”
In our six-week stay in Casse, our student group is seeking to understand different types of mental illness; how they are perceived, explained, and understood. Although my mind is in the process of training to hear a story and think in terms of the Diganostic and Statistical Manual of Mental Disorders (DSM-IV), I am realizing that perhaps these terms do not apply. Was Rosanna Bipolar, Schizophrenic, or simply Jesus-loving? Did these terms even really matter?
What is more interesting and pertinent to our research is to understand what people mean by “fou” and their perceptions. Some people described causes of fou in terms of persecution or jealousy; someone might go to a Hougan and send bad spirits to a person to make them “fou.” A catholic priest discussed other causes of “fou,” such as experiencing severe trauma, economic circumstances, and a general lack of justice in Haiti.
It is debatable among those we talk to here whether or not Rosanna is “fou.” Unlike other patients we are meeting, she is able to live in a house by herself, walk to the market, cook, jump up to gather fruits for us, and is well-accepted in the community. We are still awaiting a more thorough translation of her interview to learn more about her story. However, our brief interaction with Rosanna has taught me that even the term “fou” is not straightforward; it has different meanings for different people. In short, to be “fou” or not to be “fou” depends very much on whom you ask.
**Nayla Khoury is a third-year of medical student at Emory School of Medicine school. Her method for the mental health project being conducted by the Emory team is focusing on participant observation in the clinic setting as well as interviews with community health workers and assisting with the case study process.