Cap-Haïtien: Reflection & Return

Every clinical rotation provides its own unique challenges, lessons, and professional growth. However, our time in Cap-Haïtien met these marks tenfold. The calling of our profession is to serve, and while the people we worked with expressed their gratitude for our thorough assessments and treatments, we each gained far more from the Haitian people than we were able to provide. The complexity of healthcare in Haiti cannot be experienced fully in two weeks or expressed in a single blog post. For those of us who have never lived without clean water or consistent electricity, even immersion is not enough to develop true sympathy. We witnessed resilience, heartache, suffering, and joy that doesn’t conform into to words.

Our final day in Haiti was spent on an idyllic beach on the northernmost coast. We all welcomed the reprieve to process our time together, discuss the things we had seen and felt, and soak up of the beauty of Haiti.

– Christine Higgins, FNP & CNM Candidate

 

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Cap-Haïtien: Playtime & Physicals

On Tuesday, we headed out of the beautiful Mont Joli and returned to Hope Haven, where we would be completing well child checks for the day. These checks consisted of not only gathering histories and performing head to toe assessments but also conducting developmental assessments. We were provided with Ages and Stages worksheets to guide us. These forms are typically provided to parents to fill out in the US at every well child check and assist with the provider’s assessment of the development in children in terms of communication, language, fine motor skills, and problem-solving.

There were numerous children there ranging from toddlers to older adolescents. One of the barriers that we faced this day was the lack of translators. Dr. Bussenius

asked us to focus on establishing trust through playful interactions and gathering objective data, so this was an opportunity to sharpen our head to toe assessments and to appreciate the value in simply enjoying the children we played.

In addition to completing the well child checks, we also found that many of these children had similar conditions as others within the community, such as scabies and parasites. We provided treatment and discussed what educational information we would want to provide families with children with these conditions with Dr. Bussenius. This gave us the chance to brainstorm and formulate plans from the role as the provider, with constructive feedback still being provided to us by our instructor. After completing these assessments, we stayed with the children to share in some of the toys, clothes, and treats we brought them from home. Seeing the smiles on their faces and the joy in their eyes simply from the attention we were giving them was truly heartwarming.

– Cortney Kaniewski, PNP-AC Candidate

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Cap-Haïtien: Service & Sickness

Sunday, we donned our “Sunday best” and loaded into the tap-tap. We were headed to L’Église Baptise de l’Espoir to attend services with the children from the orphanage. It was wonderful to see the community come together. They were very welcoming to us and shook all of our hands. The service was in Creole which was interesting, but they had Bible verses on the wall and pamphlets in English, which helped us follow along. The service lasted about 2.5 hours, but Dr. Bussenius informed us services can often last up to 4-5 hours!  After church, we dropped off the kids from the orphanage and worked on school assignments.  It was a relaxing day and nice to catch up on work, until…

Monday morning, we woke up ready to set up clinic at the airport. Our day was soon delayed when poor Nicole woke up vomiting. As soon as her first dose of Phenergan was given we headed to the airport. For the next few hours we provided care to the staff at the Cap-Haïtien airport. On this day, we saw about 50 patients. Since it was a smaller population we are able to go to the pool and relax after our clinic. Throughout our afternoon a few more of us began to get sick. This was no surprise to us after doing a little research from the CDC. We found “Protozoal pathogens generally have an incubation period of 1-2 weeks and rarely present in the first few days of travel”. According to guidelines, the sick began taking Flagyl and azithromycin. After dinner, we all crowded in Nicole’s room and took care of her. If you have to be sick when away from home, it’s best to be with nurses!

– Kathryn DeVillers, PNP-AC Candidate & Madison Olkes, FNP Candidate

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Cap-Haïtien: Clinics & Culture

Over the next few days, we had many kinds of adventures in our new environment. Each of our clinic sites boasted unique patients, surroundings, and experiences. From the rural mountainside to the private inner-city clinic, we have treated numerous infants, children, and adults principally for infectious etiologies including scabies, giardia, nematodes, and helminths. One unique case that required additional facilitation from the Lillian Carter Center was a young man with pronounced elephantiasis secondary to lymphatic filariasis. He will be traveling the length of Haiti to see a specialist on the Southern Coast.

We have begun to understand the challenges of continuity of care within the Haitian healthcare system. For example, we have continued to monitor the care of the child transferred to the local hospital where is he being worked up for both HIV and TB. With the help of Eternal Hope in Haiti, he will continue to receive care, regardless of ability to pay.

Several of our FNP students had a crash course in the management of sexually transmitted infections and family planning; multiple young women were seen back to back with concerns about reproductive health. The team was able to provide them with extensive education regarding barrier protection and availability of multiple forms of birth control, including Depo-Provera and Nexplanon, at the nearby women’s health clinic.

We have valued our hours off as well. Traversing the Iron Market, where all the locals purchase their clothing, housewares, produce, and meat – sometimes while it is still alive! – was a view into Haitian culture that few foreigners can experience. Haggling at the souvenir markets gave us the opportunity to test our burgeoning Creole. The Citadel, a massive fortress built in the early 1800’s that overlooks the city, provided stunning views of the surrounding mountains and an insight into the complex history of the Haitian government.

– Christine Higgins, FNP & CNM Candidate

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Cap-Haïtien: Arrival & Adventures

Note: Wi-Fi in Northern Haiti has been spotty due to frequent storms and power outages. We are thrilled to belatedly share our adventures!

Our day began Monday morning in Atlanta. We caught an early flight to Miami. After a short layover and some Cuban sandwiches, we continued to our final destination: Cap-Haïtien, located on the Northern Coast of Haiti.

We deplaned on the tarmac and jostled our way into the crowded immigration line. Looking for our baggage… we found that it was directly in front of us in the single roomed international airport.

Breezing through the Customs Officers’ inspections, we went outside to meet our fearless leader Dr. Bussenius. We were whisked away in the tap-tap, the double-wide, open bed truck that would remain our sole source of transportation. Wilnick, our constant companion and Haitian guide, rode with us through the bustling city and up the steep hill to arrive at the lovely Mont Joli Hotel.

We made our way down the flowered path to our rooms. After dinner, we settled in for the night excited to begin our immersion clinical experience.

On our first clinic day, we awoke bright and early, excited to get to work.  We piled into the truck and started off through town.  We were surprised to find that Cap Haitien has a rush hour to rival Atlanta’s!

After we got past the traffic, we stopped at the women’s hospital and dropped off two of our students to work for the day.  The rest continued, past the sugarcane fields, down a long county road line with grazing cattle and goats.  Nearing the end of the drive, we were greeted by many people, young and old, walking down the dirt road towards the Eternal Hope Orphanage.  We stopped briefly at the metal gate, which was let open by a guard.  The truck drove through and the gate quickly closed again.

We hopped off the truck and began setting up the clinic in the shady courtyard of the orphanage.  Several members of the team went outside of the gates and began triaging pediatric and adult patients.

Our busy outdoor clinic buzzed with activity as adult and pediatric patients were seen and treated at several different stations. A child was found to be so ill that he needed to be taken to a nearby hospital; two students accompanied him along with our trusted driver, Luken.

With supplies running low, we finished up clinic in the early evening.  We saw 300 patients, more than had ever been seen on a single day.  We headed back to the hotel, tired but happy at the end of a full day.

-Michele Carranza, ENP Candidate

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Day 7 and 8 at Moultrie – Going with the Flow

A nursing student checking the hearing of an elementary school student

It’s nearing the end of the last week of our Farmworker Family Health Program trip in Moultrie and I can’t believe my time here is almost done. Every one here has gotten so much into their routine that the days almost seem to meld together, flowing from one task to another. In the past few mornings at the elementary school, we have been seeing the last few kids that needed to go through the stations as well as a few kids that needed to be re-screened if they didn’t pass certain tests or assessments. Wednesday morning I was doing vision screenings with another BSN student and we were testing a boy in the second grade. As we were having him read the shapes in the chart we noticed he could barely make it past the first few lines of shapes and was squinting and leaning forward; after the full assessment it was very obvious he had vision problems and would get a referral to a clinic where he would likely be getting glasses. He was right at the age where having difficulty seeing would make it more difficult for him to learn and pay attention in class and ultimately affect his overall education, but because we were able to catch this problem early, his vision will be able to be corrected. A lot of times doing so many of these screenings for hearing, vision, blood pressure, and blood glucose can seem repetitive, especially if a majority of the kids are healthy, and I sometimes lose sight of the fact that these tests can catch major problems early on for these children.

A view from the camp we worked at Wednesday night

BSN Student, Molly Murphy, providing foot care to one of the farmworkers while two Nurse Practitioner students help assess

On Tuesday night we went to the same camp as Monday night, but this time we were prepared: we knew it was going to be raining again that night so we set up everything inside the screened in building so we didn’t have the delay of relocating all of our supplies and tables inside. It was a small, compact space we were working in but everyone stayed focus and we were able to move around each other without any major collisions. On Wednesday night we were at a new camp that was slightly smaller than the previous two nights so the pace was slow going at first. This came as no surprise to us, but it of course began raining around 30 minutes into seeing the men through the stations. This camp had no coverings to go under, but luckily there was no lightening so we knew we could stay and find a way to continue working. Some of us braved it in the rain with ponchos and umbrellas and others were set up in some collapsable tents where we tried to keep as many people dry as possible. Everything out at these camps is an unexpected adventure and this night was no different.

BSN Student, Jenny Choe, providing education on high blood sugar management with the help of a translator

When we are working with the men, we have amazing translators that are with us at each station as well as with each dental hygiene student, pharmacy student, and the student nurse practitioners as they complete their physicals. However, there aren’t always enough translators to be at every spot we want them so they often have to get relocated where they are most needed at the time, which is what happened to me when I was working at the blood glucose and hemoglobin station when our translator was needed at another location. At first I was worried to be without a translator to help explain to the patient what I was going to be doing and how to explain and educate them on their results, but as I have talked about previously, this group of people here is always so willing to help anyone.We almost immediately had one of the pharmacist students come over to us and offer help translating what she could as we had other nursing students go ask others for some key Spanish phrases to tell and ask the men. Even in times of chaos everyone here is able to pull together and make sure we accomplish the goals we came out here to do. We are seeing one final group of men at a camp tonight and then finishing charting and packing up at the elementary school in the morning. As I write this we have less than 24 hours left on this trip and I hope to enjoy every minute and help everyone I can!

 

 

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Carchá

This past Friday, Monday, and Tuesday we spent time with the midwives of Carchá teaching them the same three topics that we taught the midwives in Chisec. That’s where the similarities end though. This group of midwives was vastly different from our first. There was a wider range of education to begin with, some couldn’t write or read and others who could read and write in multiple languages. There were women who were activists trying to fight for more rights for midwives. There was a mother of 19 who had delivered all of her babies herself – two of her daughters were there as midwives with her. There was a woman who had been a nurse for the government and changed to become a midwife.

I like to think that the six days we spent teaching these midwives has changed us all. We complain about salaries and hours and working conditions in the States, but it’s nothing compared to these women. They don’t get paid for anything that they do. They are on call 24/7. They don’t get vacations or sick leave. They walk at night for miles without lights to show them the way and then deliver babies on dirt floors by candlelight. I know they don’t have the same risk of malpractice – but they have a greater risk of maternal/fetal morbidity and mortality.

While I would like to say that all midwives in the States do what they do because they love it, I’d also like to think I’m not naive enough to believe that. The midwives here do this because they view it as a calling from a higher power. They do it for the love of their community and the love of their women. They do it in spite of constantly being put down by the government, of constantly being scorned, of constantly being waved off like they are unimportant – like they’re something less than others. I’m just in awe of them.

Teaching here was harder for all those who did it. We’re tired and languages are harder when your brain isn’t firing as sharply as it normally does. We all struggled to understand and to communicate. We struggled to accommodate the variety of educational levels. We struggled with illnesses taking out two of our more proficient speakers on the last two days. We struggled with patience for each other. It’s definitely been a harder go this time around on all fronts.

 

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Day 6 at Moultrie – Teamwork Makes the Dream Work

BSN Student, AshleyAnne James, checking hemoglobin and blood glucose while a pharmacy student helps comfort the child

Sunday night we arrived back in Moultrie, Georgia to our hotel that was comforting and familiar. They welcomed us back with dinner in the lobby and we got to meet and mingle with the new pharmacy students and dental hygiene students that would be joining us for our last week of work. Monday morning we were back at the Elementary School making sure we got off to a good start to help try to get the rest of the kids at the school seen by all of the stations this week. I was back at the kids’ favorite station, blood glucose and hemoglobin. Unlike the very first day where some kids didn’t know they would have to get their finger stuck, word of mouth had spread and they all knew that it was coming. Some kids had prepared themselves as they sat down with me, handed me their finger of choice, and looked away trying to focus on the stickers. Other kids had gotten so nervous that they were in tears before they even got to the table, thankfully there were not too many like that. Over the last week we helped learn and teach other some tips and tricks to make it easier for the kids such as having them count stickers when we did it or even holding their hand a certain way so they couldn’t see the blood. Even though this was the pharmacy students’ and dental hygiene students’ first day at the school and they were getting used to the flow, they were always so quick to lend a hand and help; whenever they would see a kid sitting with us starting to get nervous or cry they would immediately come over and comfort the kid and ask if there was anything they could do. Even in an unfamiliar environment, it’s so nice to see that everyone is so willing to help each other across our disciplines of work. All around the Elementary School the saying “teamwork makes the dream work” is proudly displayed on various posters and it definitely rings true for our team.

Dental Hygiene students setting up inside after escaping the storm

The storm at the camp approaching fast! Photo taken by NP Student, Geoffry Hall

After a little bit of rest back at the hotel, we headed out to a new camp to help provide services to the men. We drove through quite a few muddy roads but finally arrived and began setting up. After the first few men came through we noticed some dark clouds in the distance but were keeping our fingers crossed it would just pass by us. Every thing started getting busy which meant I normally just focus on my patient in front of me and not many other distractions around me, so I was startled when one of the faculties members came up to our station and told us to pack up because the storm was coming right for us and it looked bad.Thankfully, the night would not be a waste; there was a portion of the camp that had a building and screened in windows we could move to instead of heading home. We all crammed into this small space, setting up chairs and extra tables where we could and made do with what we were given. It was definitely a challenge working in a smaller space that got noisy and hot very quickly, but we were happy that we could help out everyone that came to see us. Not every thing goes according to plan when we are out working, but in the last week we learned so much about flexibility and cooperation and have seen in person how important it is. It really is a team effort these two weeks and I am so thankful to be on a team with everyone here.

 

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Men Nan Men and Church Service

We spent the last two days with complete immersion into the Haitian culture. We started Saturday morning at Complexe Educatif Men Nan Men which is a multi-lingual school funded by Foundation For Peace in pursuit of teaching English, Spanish, French, and computer classes for less than $4 to the student. The students were quite curious and eager in asking questions about the American culture and our perspective of Haiti.

        

Christine (left) and Ektaa (right) conducting English classes.

Later in the afternoon, we set up a clinic in the schoolyard where we saw about 80 students. What was unique about this experience was that some of the students helped in translating; they were very ecstatic to practice speaking the English they have been learning for the past few months.

Nicole gathering patient history.

We attended a Haitian church service on Sunday morning at Pastor Valentin’s church. We were greeted by a very friendly community and participated in singing and dancing at the church that was led by only children. It was great to see how involved the children were in putting this event together.

Our leader, Helen, thanking the church members for a warm welcome.

Shortly after the service, we were guided by the Foundation For Peace staff to tour the local community. We took a bit of a scenic hike through many fields to a small village where church members live. They were living in quite unfortunate circumstances where a small hut would be home to at least 8 people. Despite their living conditions, the people of the community welcomed us with open arms.

  

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Day 2 and 3 Care in the Community

Days two and three were a whirlwind, as we embarked upon an adventure in the villages of Kwa Kok and Jaquet. Within two days we were able to see greater than 200 patients. Making diagnosis were drastically altered by the norms of the Haitian culture and prevalences of diseases in the community such as malaria, dehydration, typhoid, parasites, and nutritional deficiencies.

  

 

 

 

 

 

 

 

We were able to gather information from our patients with the help of our hardworking interpreters, who worked hard at gathering appropriate patient history. They also went above and beyond about educating us on Haitian culture.

The eve of both clinical days were spent sorting and labeling medications appropriate for our patient population. In comparison to the US when treating our patients we were often unable to use first line treatment, we were required to be creative with our medication choices.

Despite the overwhelming amount of patients seen we were able to work well as a team and meet the needs of our patients.

  

 

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