By DALE SINGER
On a mid-September day last year, the tiny island of Dominica braced for Hurricane Maria's assault on the Caribbean.
It approached as a Category 1 storm, but when it made landfall late on Sept. 18, 2017, it had suddenly strengthened to Category 5, with winds of 160 miles an hour.
Islanders examine damage done to a residential area on Dominica by Hurricane Maria. The storm packed winds of 160 miles per hour when it made landfall Sept. 18, 2017.
By the time it had moved on, the island had suffered "complete devastation," in the words of Corinne Francis, a Dominican native who is CHRISTUS Health's vice president of mission integration and community benefit. She said 90 percent of the housing stock had been destroyed.
The newspaper The Guardian said the island "was reduced to rubble, lurching from paradise with a burgeoning ecotourism sector to abject poverty and ruin in a single night."
But Maria also left behind emotional and mental scars that can be just as damaging as smashed houses and downed trees, and harder to repair.
"It affected everybody in such drastic ways," Debbie Shillingford said of the hurricane. "People were walking like ghosts."
Graduates of CHRISTUS Health's Mental Health First Aid distance-learning class attend a luncheon in Dominica in April sponsored by the health system. The man on the right was a guest at the event.
Shillingford was one of 12 Dominicans who took part in the first Mental Health First Aid training, arranged by CHRISTUS Health via conference call from Irving, Texas. Angela M. MacDonald, the program manager for community benefit at CHRISTUS Health, and a certified Mental Health First Aid trainer, taught the course following the curriculum created and managed by the National Council for Behavioral Health. The course is offered throughout the US.
Francis said the program taught the Dominican volunteers to spot symptoms of anxiety and stress, then help support individuals dealing with depression and post-traumatic stress in Hurricane Maria's aftermath. The storm devastated Dominica's economy and recovery has been slow.
"There was a lot of unrecognized depression, with people feeling hopeless," she said. "The country is very poor. People have to basically rebuild, with minimal help from the government or overseas donations."
Shillingford said Dominica has limited mental health resources and only a small number of psychologists and psychiatrists live on the island. The Mental Health First Aid program is designed to make maximum use of that cadre of medical professionals. CHRISTUS intends to offer the distance learning instruction again.
Recognizing when help is needed
The Mental Health First Aid model uses a system known as ALGEE — assess, listen nonjudgmentally, give reassurance and information, encourage appropriate professional help and encourage self-help and other support. MacDonald said students "do not leave the class with the ability to put up a shingle and start clinical activity. That's not the purpose of the class at all. It's to be able to have a discussion with loved ones about mental health, about depression, about schizophrenia.
"Just because I know how to recognize the symptoms of a heart attack, I may not be able to diagnose it, but I can call 911 to get someone who is skilled in that area," she said.
When it comes to mental illness, Francis added, the need for trained assistance is crucial, but there are cultural barriers to accessing it.
On a 2008 visit home during Dominica's independence celebration, Corinne Francis wears a blouse in checkerboard colors that are traditional to the island. She is CHRISTUS Health's vice president of mission integration and community benefit.
"There is a huge stigma around mental health in Dominica," she said. "People think of you as being completely abnormal. No matter what diagnosis you have — depression to bipolar to schizophrenia to whatever DSM category it is — people see you as a misfit in society."
Regular conference calls
Using phone services donated by Digicel, which provides connectivity to the island, MacDonald conducted the eight-hour training over several weeks of evening classes. The trainees were themselves screened for emotional trauma from the hurricane.
As this year's hurricane season approached, with so much devastation still visible, Francis and MacDonald said memories of Maria stoked hypervigilance and fear among islanders.
"Hearing wind puts people on guard," MacDonald said. "It's the dread of the unknown. The hurricane caught everyone off guard. It got very powerful very fast, and not everyone understands that it's okay to have the reaction you're having to the rain. You're just bracing yourself for the unknown."
But, Francis and MacDonald said, having CHRISTUS to provide support, even from far away, has been a source of comfort to survivors.
"People know that our mission is to extend the healing ministry of Jesus Christ," Francis said. "And that ministry is not limited by geography."
"It's important that we make sure that CHRISTUS Health touches the children of God, domestically and internationally," MacDonald added. "We're all under the same sky."
» View a video on CHRISTUS training of Mental Health First Aid volunteers in Dominica here
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