Changing the Narrative on Mental Health in the Abacos

From the pulpit of Marsh Harbour’s Friendship Tabernacle Church, Dr. Petra Forbes didn’t recite passages from the Bible or sing verses from a hymnal to get her point across. 

Instead, the Bahamas Ministry of Health and Wellness representative employed a medical perspective to deliver a powerful message: Like diabetes, heart disease and other chronic conditions, mental disorders should be treated, not stigmatized. 

“When the body gets sick, we go to a physician for treatment and medication,” Forbes said during a recent Sunday service at the house of worship. “In the Caribbean for some reason, we forget the mind. But we must be kind to our minds and take care of our mental health.” 

Forbes’ message resonated with the more than 50 parishioners who packed the pews at Friendship Tabernacle that day. Nearly five years ago, their lives and those of thousands of others in Marsh Harbour, the largest town in the Abacos island chain, were upended when Hurricane Dorian battered the archipelago with Category 5 winds and towering storm surge, destroying homes and plunging many residents into emotional and mental despair. 

Some sought help. Others suffered in silence, afraid to seek assistance because of the stigma often associated with mental health conditions.

Mental Health in the Wake of a Disaster

Now, the University of Miami Miller School of Medicine’s Global Institute for Community Health and Development has set out to change that. Partnering with the Bahamas Ministry of Health and Wellness, it is launching a webinar series that will train health care providers throughout the Abacos network of clinics in how to diagnose and treat patients suffering from post-disaster mental disorders. 

“The goal,” said medical anthropologist Didi Bertrand Farmer, the institute’s associate director of global operations and partnerships, “is not only to support health care professionals in their important work of helping disaster victims cope, but also to change the narrative. If people in the Abacos with post-traumatic stress disorder and other psychiatric illnesses are continuously told that their behavior is their fault or that it is the result of the devil, the discrimination against them will never end.” 

Over the past two decades, 12 hurricanes have passed over the Bahamas, with eight of those cyclones being major hurricanes of Category 3 status or higher.

“And two of them—Irma in 2017 and Dorian in 2019—were Category 5 hurricanes,” said Brian McNoldy, a tropical cyclone expert and senior research associate at the Rosenstiel School of Marine, Atmospheric, and Earth Science. “Dorian was especially brutal since it actually stalled over the Bahamas at Category 5 intensity.” 

With the Bahamas often in the crosshairs of hurricanes, and with climate change fueling more powerful storms, the webinar series is badly needed, said Zelde Espinel, M.D., a Miller School assistant professor of psychiatry and behavioral sciences, who will lead some of the webinar sessions. 

“We know that people who have lived through the dangerous impacts of a hurricane or some other natural disaster and had to deal with life-changing adversities during the recovery process are often at risk of experiencing negative mental health consequences,” she explained.

Trauma Experienced by Victims, Providers

Miller School physicians who traveled to Marsh Harbour to support doctors and nurses rendering medical aid to storm victims got firsthand accounts of how the cyclone impacted island residents, listening to residents relate terrifying stories—from seeing family members washed away by floodwaters to being stranded on rooftops for days waiting for help.

In addition to the physical trauma they suffered, some of those survivors complained of distress, sleep disorders, depression, grief, and traumatic bereavement. 

Meanwhile, the frontline physicians and nurses at the Marsh Harbour Medical Center who treated those victims also were impacted by Dorian, experiencing fatigue and sleep deprivation. 

“And that’s part of the reason we started what we thought would only be a one-time webinar training series for those health care professionals,” Espinel said. “We were concerned about the well-being of our Bahamian counterparts. They worked long, stressful hours at the medical center there, and some of them, as a result, suffered their own mental health challenges.”

Didi Bertrand Farmer, second from right, associate director of global operations and partnerships for the Global Institute for Community Health and Development, stands with Bahamian health care officials at Marsh Harbour Medical Centre during a mental health awareness outreach event.

That initial training series, held during the height of the pandemic, included sessions on mindfulness, mental health and COVID-19 and self-care, as well as depression, anxiety, psychosis and other psychiatric conditions.

“We provided trained health care workers with crisis intervention techniques that would not only help them but also their patients,” Espinel said. “Now, we’re ramping up those efforts to train workers throughout the Abacos.” 

Community outreach, Bertrand Farmer said, is also a component of the institute’s efforts to address mental health in the Abacos. Those efforts began in earnest last fall, when she and Espinel spent a week in the island chain visiting area clinics and other venues to spread the word that mental health services are in place and are being expanded to help anyone who needs assistance. Bertrand Farmer and Espinel visited churches and plaza centers in Marsh Harbour and in smaller Abaco settlements such as Fox Town, Hope Town, and Sandy Point, conducting blood pressure and other health screenings and surveying residents about the levels of stress they experience. 

Posters and T-shirts with the message “Abaconiens, let’s talk mental health. It matters too” are being distributed, and public service announcements are airing on local radio shows. 

“Those outreach efforts will help educate people on the difference between mental health and mental illness, demystify mental health issues and reduce the associated stigma and taboos,” Bertrand Farmer said. 

“Whether it be storms, fires, floods, or earthquakes, the way in which natural disasters impact people’s mental health is often overlooked or pushed to the back end,” said Elizabeth Greig, M.D., assistant professor of medicine and co-director of the Global Institute, who accompanied Bertrand Farmer and Espinel to the Abacos last fall. “Our goal is to change that. With our push to establish mental health training and interventions throughout Abaco’s clinical network, we’ll be able to tackle mental health issues head-on and have programs in place to support those affected as a disaster unfolds.”

Tags: Didi Bertrand Farmer, disaster response, Dr. Elizabeth Greig, Dr. Zelde Espinel, Global Institute for Community Health and Development