Let me paint the picture of where I called home for a week. In the heart of south Georgia is Moultrie, population size around 15,000 people. For a birds eye view comparison, Atlanta has about 33 times that population. The paved roads are lightly sprinkled with dust and the buildings are slightly rundown. However, the energy and spirit of the children and farmworkers starkly contrast their surroundings. This experience provides a unique opportunity to work alongside interdisciplinary practices such as pharmacy, dental, physical therapy, and mental health students from schools across Georgia. Morning camp involved performing routine screenings on school children, and night camp involved screenings for farmworkers in a field or nearby local break station. We served as an extension with the local clinic to provide healthcare services.
At 8:30 AM, we drove less than 10 minutes away from our hotel to the local elementary school where as a collective unit, we provided child approved physical therapy exercises/activities, blood pressure and hemoglobin screenings, hearing and vision testing, dental care, and a final visit with a NP-S. As kids started lining up to be partnered with a NP student, we were making final adjustments to our booths to make them kid friendly. We practiced a handful of rarely used skills such as a fundoscopic exam that is usually deferred in my previous clinics to ophthalmology/optometry. My most memorable kid was a 4th grader who was held back a few grades. After completing my exam, I stood up to walk her back to the front when I looked down and saw her frustration as she was sounding out words in her coloring book. I could tell she was upset and looked up at me. Two thoughts came to mind, I could either walk her back up front and grab another kid, or I could sit back down and help her sound out the words. I sat back down and we practiced her reading skills. I didn’t know how many hours she had at home with her family to improve her reading, but I knew I could give her an additional 5 minutes of my time to get through that 5 sentence paragraph. My pediatric professor gave us advice when we encounter kids for screenings. More often than most, kids don’t come to the doctor’s office unless they are sick. She noted that when you do see them, use your time with them and be that point person to lead discussions and start education early. I wanted to ensure that the time that I shared with them was spent treating that experience as an opportunity for steps towards success.
As a NP student, consulting pharmacy and PT has been a saving grace. Instead of placing a referral into the system and questioning if the patient will even go or be contacted, I can walk 40 feet away from my station to access their expertise within the same field, pun intended. The opportunity to work with interdisciplinary specialties strengthened my critical thinking skills and sharpened my plan of care. For example, I diagnosed a patient with tinea cruris and unfortunately, we did not have ivermectin on hand. I consulted pharmacy and came up with a game plan of starting them on clotrimazole cream and gold bond with emphasis on counseling them on educational points for prevention. At the end of the day, would this treatment plan mirror what I would do in a private primary care setting? Probably not. I would have access to a chain pharmacy that supplied the oral medication and I would have the patient send me a telephone encounter letting me know if the treatment worked or failed as part of continuity of care. Working in this environment of this magnitude allows me to be more thoughtful about the present and knowing that whatever I tell this patient in the here and now, will be my first and last contact of care. Knowing the weight that this carries and understanding that we may be the only healthcare opportunity for some of these farmworkers in the US, buys into the vision that our team makes a difference.
EDITOR’S NOTE: The 2020 immersion took place earlier this year before social distancing, travel restrictions and shelter-in-place orders were enacted to combat the COVID-19 pandemic.
Rewarding (adj.)- affording satisfaction, valuable experience, or the like; worthwhile.
Our first couple of days at the Missionaries of the Poor was eye-opening in many regards. Despite living conditions and often failing health, the residents maintained a happy disposition and greeted us as if we were long-time friends.
To see the emotional uplift of the residents as soon as we entered the room was instant gratification. Our hearts were full as we provided basic care such as dressing, feeding and moisturizing the residents. The women were overjoyed as we painted their nails in an array of colors while the children were ecstatic to engage in playful banter and simply being held.
While the purpose of our trip is to conduct assessments on residents and aid the Brothers and Sisters of the ministry, perhaps our greatest responsibility and greatest reward is to surrender ourselves and our typical ways of life to be one with the Brothers, Sisters, and residents.
We ate as they ate, prayed as they prayed, and although most of us are not Catholic we respected their customs and truly immersed ourselves into the experience.
Jamaica itself is beautiful in many ways from the delectable food with flavors that dance on your tongue to the abundant mango trees and palms. Though the city of Kingston is impoverished, it is adorned by its beautiful mountains and unrelenting sunshine.
The days are long but each day as we turn in, we look forward to the experiences tomorrow will bring.
7:00 AM: I feel more confident going into clinical today. I did so many blood pressures yesterday and got really good at them so I’m excited about doing them again.
10:00 AM: We started the clinical with a song and prayer led by the pastor’s wife. The singing was so beautiful! I know religion is a big aspect of the Haitian culture and being a part of the prayer really made me feel like I was a part of their family.
12:00 PM: I’ve forgotten how hard it is to do interviews. I’m asking the patient questions to figure out what the problem is but I miss basic ones that Dr. T picks up on right away. She’s amazing!!! She can ask 3 questions and immediately figure out what the problem is versus me who has spent an hour with the patient and still hasn’t gotten to the bottom line haha. Her level of expertise only comes with time and I’m excited for the day that I can hopefully do what she does and as amazingly as she does it too.
6:00 PM: I am back home and today was a great day. I learned so much from Dr. T and saw the kindest patients again today. I saw Dr. T put her hand on a patient’s chest and say, “I would say that his temperature is 100.5” haha. The best part was that she wasn’t kidding. She said, “When you’ve been doing this as long as I have you don’t need a thermometer anymore”. She also loves saying what is going to happen then once it comes true replies with “Who said it? Not me!” hahahahaha. She’s the best. I worked with Elissa today. Taylor and Peyton were also doing assessments with me. It’s soamazing seeing how much they have grown as nurses and I am so proud to call not only my group but the entire class my friends and future colleagues.
I wasn’t sure what to expect from our first clinical day. Once we arrived at the site, we were given a tour of the area and began to set up for the clinic. The students were divided into 3 groups based on their clinical focus. One group was responsible for taking vital signs for each patient and determining their chief complaint while the other two groups were tasked with doing a full physical assessment on either adult or pediatric patients.
Before arriving in Cap Haitien, our cohort fundraised for the clinic and the orphanage by selling stethoscope name beads to students and faculty of the Nell Hodgson Woodruff School of Nursing. In just this first clinical day, we saw the impact that the money we raised had on this population. We distributed 50 meals to patients who were malnourished and reported not eating that day. Children with growth delays due to malnourishment were given ensure to promote growth and development.
One of the most memorable patients of the day was a 5-day-old baby who was completely lethargic. It was discovered that the mother had been feeding the baby watered down tea because a witch doctor instructed her not to breastfeed. Therefore, the baby was not receiving the nutrients he required that would have been provided by breast milk. Luckily, we had some formula on hand and were able to teach the mother how to mix the formula and feed the baby properly. Formula is an expensive commodity, so some of the money raised was used to buy her formula to feed the baby.
Towards the end of our day, a mother came in with her two young girls who were diagnosed with scabies and a fungal infection. The fungus was growing over their entire bodies and the younger girl had lesions on her head from the fungus. A classmate and I bathed the girls, scrubbing the younger girl’s head with a toothbrush, and treated them with an antifungal cream. After dressing both girls in new clothes, we held them and gave them lollipops. Both girls had the most beautiful smiles and were happy to be clean. We sent them home with the antifungal treatment and 2 new sets of clean clothes. The impact that our actions had on this population in need was apparent to us after just one day in the clinic and we all were excited for the remainder of our experience.
Today we got the opportunity to do a few different site visits to better understand the culture and lifestyle of the Haitian people. We took an open air truck which allowed us to really experience the sights and smells as we drove to our first stop, The University of Haiti Campus Henry Christophe located in Limonade. While there we visited several classrooms, the library and got to see the work of the art students and speak to the faculty of the music program. It was interesting to compare the similarities and differences between the university and universities in the United States. One big difference is the lack of an online system to share grade information; so instead, all student grades are posted publicly on bulletin boards outside the classrooms.
After touring the university, we headed back in the open air van to visit a local hospital, Fort St. Michel. It was shocking to see at first as it was very different from what you imagine when you hear the word hospital; it was mostly outdoors, with small treatment rooms for separate needs, such as tuberculosis, a dental clinic, and different areas for pediatrics and adults. Although it may be so different from what we are used to here, it was also inspiring to see how the Haitians do the best they can to take care of sick individuals. There were easily over 100 patients waiting to be seen and the director of the hospital informed us of the many free services provided to locals. I really appreciated the opportunity to visit these different sites and get information directly from local residents of Haiti because even if I return to visit Haiti again, it is unlikely I will have the chance to go on similar visits.
After getting our bearings in Haiti, it was time to begin preparation for researching the population around us as well as preparing for the upcoming clinical days. We set out from the resort towards town to meet with Dr. Twilla Haynes and Elizabeth Woods. On our journey down the mountain, we were able to view the culture around us and how it impacted each of our senses. The sights of brightly colored buildings and vibrant social scenes easily caught our gaze. The sounds of music, laughter, and continuous honking became the soundtrack of our trips to town. The smells were dependent on our location in town. You could smell a range of things such as beach air or food cooked by local vendors. The taste of the air around us was a mixture of humidity and dirt stirred up from the streets by taptaps weaving in and out of the traffic.
Once we arrived at the Mont Joli, we were able to acclimate ourselves to the supplies needed for the clinic days. Dr. Twilla went through each “tackle box” thoroughly and explained to us where it would be located on clinical days. These tackle boxes contained medications and supplies needed to treat patients for various issues such as scabies, diabetes, and hypertension. This orientation to our supplies helped put our first day jitters somewhat at ease as we prepared to serve the people of Haiti.
This was the perfect day before diving fully into our long clinical days. It was a day of relaxation on a private island in beautiful Haiti. We took a taxi boat to get to the island, passing beautiful scenery such as the mountains. The waters were crystal clear and the sound of the roaming waters was refreshing. To top off the beautiful day, we got to indulge in freshly caught seafood, perfectly seasoned with Haitian spices.
What a great day! We woke up early, had breakfast at the hotel and then travelled by bus to the Citadel. It was amazing to drive through the different towns on the way. So many different smells and scenes than we are used to: children getting washed by there mothers in outdoor wash basins, the trash along the coastline with goats and pigs intermixed, the women carrying heavy loads on their heads with perfect posture and balance, and the tap-taps, motorbikes and other vehicles going in every which way. We slowly made our way out to the rural area that surrounds the citadel and the scene changed to open fields peppered with palm trees, with cows grazing. We quickly learned that Haiti is a beautiful country with a diverse landscape. Once we finally arrived at the Citadel we climbed on all climbed on horses and rode up the mountain. It was wonderful to see the view from the trail as the horses carried us. When we got to the top we were given a guided tour all around the grounds and throughout the structure. We learned that the Citadel was built to help protect Haiti from any possible French invasion, because at the time Haiti had recently earned its independence. We also heard the folklore of how Henri Christophe, Haiti’s president, committed suicide by shooting himself with a silver bullet and that his remains are buried somewhere on the Citadel grounds. After the tour most of us walked back down the mountain where we loaded back into the van and headed to the Sans-Souci Palace. This was a magnificent structure that housed Henri Christoph and his wife, Marie-Louise. We walked over the grounds and took pictures. It was a marvelous day and a wonderful experience to see the local people of Cap Haitian and to learn more of the history of beautiful Haiti!
On Thursday, June 26th, eleven (11) intrepid nursing students from the Emory School of Nursing’s Distance Accelerated BSN program embarked upon a two week immersive population health clinical practicum in Cap-Haitien, Haiti. After a short 1-1/2 hour flight from Miami, our first glimpse of Haiti was from above, eagerly peering through the airplane windows. Striking was the turquoise colored water that was so clear it allowed unobstructed views deep beneath the ocean’s surface. Then, starkly contrasting nature’s splendor, the cityscape began to come into view showing dense clustering of buildings and people. Clouds of smoke dotted the landscape which we later witnessed was from the burning pile of trash. Our plane continued its descent and soon we were on the ground, the plane filling with the applause of passengers aboard. Upon landing and deplaning, we were warmly welcomed and greeted by a local Haitian band. With traditional music playing, we made our way through passport control and collected our bags from baggage claim which contained many medical supplies and donations that students brought with them, including collectively ~20 lbs of suckers for the pediatric population (adults, too) that we would be serving during this clinical rotation. Once outside the airport, we boarded our bus and began our trek to the hotel, the Cormier La Plage. Our population health assessment began in earnest as we viewed the street scenes. We observed massive traffic, mostly of motorcycles and automobiles, racing and swerving with no stoplights, signs or speed limits, all avoiding the dips and broken pavement. The buildings seemed to be in various states of decay/repair, affected by earthquakes, hurricanes and overpopulation which have affected the island. The greatest contrast, against the backdrop of the beauty of Haiti, were the waste disposal issues, trash covering the beach and roadways and the acrid smell of burning trash filled our nostrils.
We arrived safely at the Cormier La Plage, we were again struck by the beauty of Haiti – the waves crashing on the beach, palm trees swaying and bright blue skies. We had made it! As we settled into our rooms and unpacked, we met for a debriefing of our first impressions and an overview of our itinerary. As we arrived safely at the Cormier La Plage, we were again struck by the beauty of Haiti – the waves crashing on the beach, palm trees swaying and bright blue skies. We had made it! As we settled into our rooms and unpacked, we met for a debriefing of our first impressions and an overview of our itinerary, ready for an experience of a lifetime.
The Moultrie Farmworker Program serves both migrant
farmworkers and their children. Migrant farmworkers come here on a special visa
called an H-2B visa which allows them to work on a farm in an area that was
unable to hire residential workers. They fill an important gap in human capital
and without them you’d be hungry. Oftentimes they leave their families and
their home country and go months or even years without seeing them. In addition
to emotional stress, they also face multiple challenges such as long work
hours, sub-optimal working conditions, and limited access to healthcare. This
benefits not only their families but your families across America.
The interdisciplinary team that comes to Moultrie for two
weeks every summer seeks to alleviate some of the physical and emotional
pressure that is inherent to these individuals. For some, this is the only
interaction they will have with the healthcare system while they are in the
United States. By the end of week 2 we were able to do more than 300 well-child
exams, and provided episodic care about 300 farmworkers. While this is a small
drop in the bucket, we hope to have alleviated some of the discomforts faced by
this population during our time in Moultrie.
Each discipline was able to expand their cultural and
clinical horizons during our time here and we feel grateful and humbled by this