Trauma In Paradise

Written By Dr.Alejandro Paiz

The waters of Lake Atitlán have a sedative force when you observe them, especially with the typical spectacular sunsets as a backdrop. Until recently, this was the only balm available for the poorest of the mentally ill in the Atitlán Basin. The beauty of the region hails from its unique topography, an irregularity that, while lovely, magnifies the onslaught of nature.

In 2002, investigators from Brown University, the Pan American Health Organization (PAHO) and Guatemala´s Health Ministry conducted a study—“psychosis in an indigenous community”—in Santiago Atitlán; in it, they tried to conceptualize local psychosis and evidence the presence of these disorders. After studying the results, the Guatemalan government offered clinical attention to all the patients indexed in the study. However, owing to lack of resources dedicated to mental health, the treatment did not start at that time—to the detriment of 40 unattended schizophrenics.

In 2005, Hurricane Stan scourged Guatemala. One of the most affected places was Santiago Atitlán, which suffered massive landslides and floods that killed entire families and left communities bereft of basic services.

Soon after Stan, the Health Ministry sent “human relief” teams, including psychologists and psychiatrists, to help local leaders to cope with the devastation. This was the start of the “municipal disaster network” and a “mental health network” directed by Dr. Juan Chumil Cuc, district health director. He saw anxiety and emotional suffering on equal with physical and social suffering and decided to rank mental health as the district´s second priority (in contrast to the rest of the country, where it’s designated second to last of the almost 20 health priorities). This decision brought attention to Lake Atitlán, and the Health Ministry in cooperation of PAHO began efforts to support this network and initiate clinical attention.

In November 2008, the ministry’s mental health program and PAHO were able to place a psychiatrist to work for the region, and Sololá´s mental health department started. This department assists in two fashions: hospital attention and a community program.

The National Hospital of Sololá now boasts a mental health outpatient clinic, offering psychiatric and psychological attention as well as liaison psychiatry, a children’s program and training to psychology students. Last year over 1,000 people were attended to, and Sololá´s hospital became a “Mental Health Regional Reference Center” for patients from Quiché, San Marcos, Quetzaltenango, Totonicapán, Huehuetenango, Chimaltenango and Suchitepéquez. The commonest diagnoses were post-traumatic stress disorder (PTSD), panic attacks, depression, social phobia and psychosis.

At the community level, actions are coordinated with Santiago Atitlán’s mental health network, with visits every Thursday. The focus is prevention, de-stigmatization and sensibilization. Outpatient attention at the health center and home visits to the severely ill are other elements. Fifty-five percent of the diagnoses are anxiety related, and PTSD is again the most prevalent disorder due, in general, to the lingering consequences of natural disaster and the long-ago concluded civil conflict.

The departmental strengths include support from the Sololá health office, the national hospital, the media and local authorities; the cooperation from PAHO and the private sector; and, in particular, Guatemalan family cohesion and care, which makes it easy to attend and follow severe patients. Gaps include the lack of personnel and of financial resources and poor access to psychotropic drugs. The main threat, however, is labor instability. Nonetheless, the department has functioned continually for almost four years, extending proper medical attention to the Sololá population. There is no doubt that physical and mental health must go hand in hand.