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There isn't a scratch on Victor Gary's body, but the 39-year-old police officer was so emotionally crushed by the earthquake that he can hardly bear his own weight.

When he tries to straighten up in his chair, his upper body lists like a wilting sunflower, or his shoulders curve forward, making his body seem like a shell, something hollowed out.

His eyes are bloodshot. He can't sleep, can't contemplate even leaving the borrowed yard he's been camping in since his house collapsed on top of one of his children, let alone put on his uniform.

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"In my heart, I know I'm not ready to work," he said, eyes welling the other day. "You work for 14 years to build a house. You lose it in an instant, and you lost your kid, too."

He paused to wipe away tears before asking for help contacting a mental-health worker.

"In other countries, they take care of people that work for them," he said. "Out here, it's nothing."

With the physical injuries sustained by the population largely under control, attention is shifting to the acute but invisible trauma suffered by people like Mr. Gary. Some estimates suggest 60 per cent of those affected by the earthquake are suffering the psychological aftereffects - depression and anxiety, as well as psychosomatic symptoms such as stomach aches, insomnia and diarrhea.

The question is what to do about them. Haitian officials and international aid workers admit the country is vastly under-equipped to deal with the mental-health crisis that has been developing since the earthquake. Until recently in Jacmel, hospital administrators had been referring mental-health cases elsewhere because they had no capacity to treat them.

"We're seeing signs that a lot of people are suffering from great depression," said Zidor Fednel, the government's regional delegate in Jacmel. He said more than 50 per cent of the people living in Haiti's southeast region are in what is being termed "great need." Although a national mental-health strategy is in development in Port-au-Prince, it's unclear if the government will be able to muster the resources to help them.

"Everybody is in an unfortunate position," Mr. Fednel said in an interview at his makeshift office - a tarp-covered wooden table holding his laptop and cellphone on the driveway next to a partially condemned heritage building in Jacmel's old quarter.

Mr. Fednel said he would like to institute a broad program of psychological assessments across Jacmel in the coming weeks, with a special focus on the school-aged children that many health workers fear will have a difficult time transitioning back to classrooms. However, it is unclear who might conduct the assessments.









Mr. Fednel said he has no idea who to turn to. Psychologists are scarce in Jacmel and Port-au-Prince.

"We don't have a lot of psychologists … maybe there is 10 for all of the population of Port-au-Prince," said Marie-Carmen Flambert Chéry, a psychologist and university professor. She said nearly 300 psychology students are on the verge of graduating from programs in Haiti's capital. While many of them have been dispatched to run support groups in camps for internally displaced people, including at the Champs de Mars in Port-au-Prince, their efforts won't be enough to meet the need.

"We don't have enough psychologists to test or to assess children," she said. "Students can do parts of the work, but sometimes you need professionals."

She said she is involved in discussions with Médecins Sans Frontières about the possibility of dispatching more students in the coming weeks in the affected areas outside Port-au-Prince, such as Jacmel and Léogâne, to help with mental-health needs.

Meanwhile, two MSF psychologists from France and Italy have been working in Jacmel over the past two weeks to assess the population and perform "psychological triage."

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Much of that has involved trying to "normalize the meaning" of the earthquake by placing it in its scientific context, said Francesca Paola Crabu, one of MSF's clinical psychologists. Many Haitians, she said, are carrying the impression that the earthquake was a sign of "religious punishment."

She and her colleagues have been teaching relaxation and breathing techniques to help patients deal with the stress of continuing aftershocks. They have also been working to build confidence among community leaders to promote mental health.

"This is a great opportunity for Haitian people to decrease the stigma of psychological issues," she said.

"In the underdeveloped countries, the mental-health stigma is much higher. [But]right now, they are all in the same boat. They all need psychological counselling."

Debra Hutton, a child psychologist from Ann Arbor, Mich., spent part of the week conducting poolside therapy sessions at one of Jacmel's hotels because there was nowhere else to do the work. She said patients mostly complained to her about anxiety and heightened heart and respiratory rates.

She also met with staff members from Pazapa, a Canadian-run school in Jacmel for developmentally challenged children that was destroyed in the quake.

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The teachers, she said, are worried about the children and how they'll respond to the classroom setting if school opens again. But fear among the children isn't their only problem.

"The teachers are traumatized too - they're dealing with their own sadness. Many of them can't sleep at night," she said.

"It's like a 9/11. You can't go through something like this without being affected in some way."

That includes Mr. Gary, the policeman. He was asked to go back to work one week after losing his house and his 12-year-old daughter, whom he was unable to rescue from the rubble. He worries that he'll lose his job or be reprimanded for deserting his post. But he's going to need more time, he said.

"One year won't be enough to return to myself."

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