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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Day 5 at Moultrie – Rained Out and Moving Out

BSN students getting ready for the last night of the first week (featuring stylish rain boots and fanny packs)

Lightening lighting up the sky as we begin to pack up our stations

Yesterday and today are the last two days of our first week and the time absolutely flew by!! Last night we once again lined up in our cars and headed out to a new camp to work with. We set up quickly on the main road leading into the camp so everything was flat and there weren’t too many bugs bothering us. The men who come to us are usually just coming off from the work in the fields and they were running a little late yesterday so we had extra time to all hang out. Over the week everyone in the disciplines has gotten close and become great friends so we no longer spend our free time with just a small group of people in our same specialty; instead, we used our free time to organize a quick soccer game for all of the specialties to play while others watched and cheered on their friends. After a few good soccer games, the workers started coming and and we all headed to our stations. I was at the blood glucose and hemoglobin station, which has become by favorite station to work at during the camps at night. All of the previous camps we had been to this week had only men, but there was a fair number of women who were working that came and saw us which was a new experience. Unfortunately, a few hours in we heard lightening cracking nearby and had no coverings for any of us so we had to pack up quickly and head back to the hotel. Normally when we are in class as students and we hear that we get to head home early everyone gets very excited, but there was a different tone when we were told we would be leaving early last night. Many of else felt sad and disappointed. We knew there was nothing we could do about the situation since the approaching lightening was a major safety concern, but it was hard for us to leave knowing there was a lot of men and women that we could not see or help out, but we hoped that we made an impact on those we did see.

BSN Student, Jessica Yang, testing blood glucose and hemoglobin on an Elementary Student while a pharmacy student helps keep her distracted and happy!

Today we woke up with our cars packed to go home and ready to head out to the last morning session at the Elementary School for the week. There were not too many kids to see and we got them all in and out quickly. I was working at the audiometry station testing the kids’ hearing with another BSN student which went smoothly since the kids knew there were no needles involved and they got to wear cool headphones instead!! We did not have to pack up too much since we would be back again on Monday but we made sure our stations were clean before getting into our cars and making the drive back up to Atlanta to be able to rest and refresh ourselves for a few days. I have had such an incredible experience this past week and feel like I’ve already learned and grown so much. Working in this unique setting has taught me so much about teamwork, flexibility, cooperation, and patience. I am so excited to be able to come back for one more week with people I’ve grown so close to and some new faces as well!

First week group with all of our BSN students, NP students, Pharmacy students, Dental Hygiene students, Physical Therapy students, and faculty!

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Day 4 at Moultrie – Blood, Sweat & (no) Tears

The farmworker camp we worked at and set up our stations

Last night a little after 6:30pm we arrived at a new farm, covered head-to-toe in bug spray and ready to tackle whatever the night threw at us. Thankfully there was no rain on the radar for the night, but this camp definitely brought some new challenges and surprises; there were no coverings at the camp so we were outside with the grass coming up to our knees. Even though we were at a new location, the set up went smoothly since we have settled well into all of our roles throughout the different disciplines. I was placed at the blood glucose and hemoglobin stations where we were doing finger sticks on the men that came through. Doing the finger sticks on the farmworkers can sometimes be challenging because their fingers are often very callused making it harder to draw blood for both machines. We’ve all learned techniques from each other to make the process easy for us and the men so we don’t have to stick them again. Sometimes we have to squeeze and massage down their hands (a process some nurses have termed “milking” the arm) and holding their hands down at their side to let gravity help the blood flow. The men were able to go around and see all of the nursing stations, the nurse practitioners, physical therapy, and dental hygiene throughout the night and get the help and referrals they needed.

 

One of the nursing students getting a good stretch from a physical therapy student during a break!

This morning we went back to Cox Elementary School to continue our care and screening for the kids. Another one of the nursing students and I went upstairs and got ready at our station that was testing height, weight, and BMI. Working with the children at the station was pretty simple, all we had to do was weigh them and measure their height but it required a lot of charting so, like yesterday during the vision screening, we took a lot of turns charting and keeping the kids entertained who were waiting. In our room we were testing in we also had a physician from Guatemala who was sitting with the kids waiting teaching them about Zika virus. She used coloring books and pictures to explain to them what the virus is and how they can help prevent it for themselves and others. The Zika virus is becoming an increasingly difficult problem, especially here in rural South Georgia during the summer months, so teaching these kids from a young age is very crucial. Our hotel we are staying at is also very kindly serving all of us dinner tonight before we head out to our last night at a farmworker camp for the week. We head home for the weekend tomorrow afternoon but we’ll be back Sunday night to start our second week of service here!

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Day 3 at Moultrie – Getting off on the Right Foot

Enjoying our delicious food prepared at the camp!

A little after 5:30pm yesterday evening, we once again loaded everyone in the program into our 30 car caravan to go back to the camp we helped at on Monday night. I felt a lot more comfortable and confident going back now that I had a night to see how everything was run and get used to the language barrier. Set up went smoother since we knew where everything went and it thankfully wasn’t raining or muddy (yet). All of the workers at the camp very graciously served our entire group a traditional Mexican dinner. The food was delicious and it felt so nice for them to welcome us into their lives in such a kind way.

Some of the housing facilities for the camp

Last night I was assigned to the foot care station where we cleaned the mens’ feet, cut their nails, moisturized and massaged their feet, and assessed for any infections or problems to refer them to the nurse practitioners and clinic. The foot care station is often the station that a lot of us nursing students dread, but it was set off to the side of the camp where we weren’t in the center of the hustle and bustle. A big part of the station involved educating the men on proper foot care and how to protect them from pesticide exposure in the field that can accumulate in their shoes, but since we got to sit with the men in a quieter environment, we could talk with them and connect and give them a bit of much needed relaxation and pampering. Unfortunately, a few hours into being at camp the clouds moved in and it began pouring so we had to close up the foot care station since it was outside. The other people working at the station and I ended up circulating and offering help at different stations as needed and tried to make the rest of the night as productive and smooth as possible.

 

BSN Student, Jessica Yang, hula hooping before the kids came in!

This morning we again returned to Cox Elementary School to help continue assessments and screenings on the kids in the summer school program. I was working at the vision testing station where we used picture charts to help test their vision for distance and also a book to check for color blindness. Gabrielle, one of the other BSN students, and I were working together and had a great flow with the kids as we would switch off having one of us filling out the kids’ charts as we tested their eyes and the other person pointing at the pictures and keeping the kids in the room entertained with stickers and funny glasses. I really enjoy starting the days working with the kids; they are so much fun to work with and they bring out a funny, silly side in everyone working and make the day so much more enjoyable. Tonight we are at a new camp working with a new group of men where more help, education, and learning can happen!

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