The names and some details of the case have been changed to ensure anonymity. Melan provided permission to write about his story, with the understanding that it would be potentially read on the internet by people all over the world, and would describe some of his experiences of the previous several years. His mother provided written permission.
At around 11am on Saturday, I was asked to see an 11 year-old boy, Melan, who had been brought to the MSF Outpatient Department for a fever and sneezing. The physician who saw him was advised that since the typhoon, Melan has been more isolated and played less with friends, and thus made the referral to mental health services.
Melan looked like any boy his age. He had a mop of shaggy hair, jeans, and avoided eye contact most of the time. He peered up now and again, and had a sad look that wouldn’t shake. I told him that he didn’t have to be here, that he could leave and come back another day, but it might be good for him to talk given the sadness his mother described. He thought it best to continue, despite his hesitancy. He wouldn’t speak for a little while, but eventually said that he has been “feeling down because of the storm.” Regarding his experience of the typhoon, he said that “the winds tore the roof open and trees fell down… tidal wave… many things happened.”
Melan’s mother watched with an uncomfortable anguish as he spoke through his tears, remaining silent yet present as he expressed himself.
He was in the family home, with his mother and cousin (age 6). He awoke around 5am when the roof-top ripped off his house. He had heard that a big storm was coming, but he thought it would be like the many other storms that he had witnessed, so he was not worried when he went to sleep. The first floor of the house flooded, and Melan joined his mother and cousin for the next four hours. He spoke with his mother throughout the storm, and he felt that she and he “were fine.” When the winds died down, he walked outside, and found that “many things were destroyed… electrical posts, houses, almost everything in the house, roads.” He thought that his house could have collapsed, as many others had. Melan did not see any dead bodies, but heard of casualties, and of others seeing bodies in the street.
Melan had no close friends or family who died in the storm, nor was anyone in his school injured or killed.
After the Typhoon, like so many others, Melan and his mother went to Manila to stay with family. He felt safe in Manila, and thought of the storm “sometimes.” He returned to Tacloban five days prior to having presented to the MSF hospital. He was sleeping relatively well, and had no nightmares, but thought of the storm during the daytime “sometimes.” He could go many hours without any thoughts of the storm. As he said this, however, tears washed down his cheeks. I asked where the tears were from, and he answered, “the people who were killed in the destruction.” He could not identify who, just that they were people from his city.
At this point his mother was crying quietly, and I was quite taken with his story. It was becoming less clear, however, what was driving his sadness and self-isolating behaviour three months after the incident. Melan had no psych history, was on no medications and had an unremarkable medical history. Nobody in his family had ever been seen by psychological services of any kind.
I asked Melan if the darkening clouds, rain and winds were worrying to him, and he said that they were not. When asked what he would say to a younger child if they were frightened in a storm, he responded: “calm down, there is nothing to be afraid of.” And he reiterated that this was his belief, not simply the consolation of an innocent. Melan did not recall having been frightened by a storm or any other act of nature prior to or since typhoon Yolanda.
The most difficult part of the memory of the typhoon was “the part where many people died… the part that friends or family could die… I could be alone.”
This could be called existential angst. Death and loneliness drive many symptoms, but as the discussion continued, it did not seem to be the generator of his almost palpable terror. And then it came out. When asked if there was any time in his life when Melan felt alone, powerless to what could happen next, he started to cry more forcefully, sometimes gulping air as he spoke. It was wrenching to me, and his mother put an arm around him as he continued. He spoke of the time when he was 7, and a 10 year-old male student “punched him” once and taunted him several times. This bullying behaviour took place at and around school-time, and lasted about 1-2 months.
Melan refused to go to school a few times, but his parents and teachers were, to his recollection, unaware of the problem. The bully did not target Melan specifically, as he was known to bully the younger kids. On direct questioning, Melan said that the bully probably did not even know his name, and the bullying stopped because the older boy forgot about Melan.
We spoke about feelings of helplessness and fear given circumstances out of our control. Melan cried a fair bit, but decided to continue.
We spoke of his father who had been a migrant worker in Dubai for 8 years, and how he has a good relationship with him, speaking on the phone every week, and seeing him once a year for a week.
Melan’s plan for the near future was to “be with friends this week… try to forget about the past… not think of bullying.” We set up an appointment for the following week.
This story hints at many things. I want to underscore something that has become glaringly apparent as time goes on in my career and life: that a sizeable chunk of human misery is perpetuated by factors within someone’s control, often discretionary.
