Global Health Nursing in Haiti
Elizabeth Donahue, a Nurse Practitioner at Mass General’s Ambulatory Practice of the Future, was granted a Center for Global Health Travel Award to co-lead a group of Boston College nursing students on a trip to Haiti.
I touched down on Port-Au-Prince’s single runway and stepped out of the airport into a wall of heat among 20 other nurse practitioners, nurses, and both graduate and undergraduate nursing students from Boston College. Smiling internally, I begin to encounter the familiar feelings from past trips to Haiti; oppressive heat and humidity, the scent of something burning nearby, and a complete lack of personal space as we crowd onto a shuttle toward the baggage claim. Before I know it, we are haltingly snaking through the capital city in the open back of a small Toyota pick-up truck and watching everyday Haitian life go by.
We arrive at Hôpital St Croix and our gracious hosts are there to greet us with open arms and folks who have become friends soon hear of our arrival and stop by to welcome us. I feel an overwhelming mix of emotions when I see Watson, Mario and Marcos for the first time – relief that they look well and happy, that they are working and going to school, comfort in their presence and relaxed as if no time has elapsed since our last meeting. They are our colleagues in the field, working to translate the personal and sensitive aspects of a medical encounter in service of their neighbors seeking care. There is a flutter of hugs and fist bumps, exchanging sak’ pase and n’ap boule before we eventually retire to our bunks.
Sunday morning is when our work begins. Each day we move to a different village somewhere within a 2-hour drive of the hospital in Leogane. We go where the Ajan Sante – the Haitian equivalent of the Public Health Commissioner - directs us, though we have requested to be sent to villages where there has been no care for long periods of time. We spend a few minutes strategizing and then move to set up our stations – a makeshift waiting room, triage area, provider space and a pharmacy. The students and veterans work seamlessly side by side with our experienced Haitian translators while we begin to see patients. Some days we arrive at a clinic location and find hundreds already waiting, other days our translators use a megaphone to alert people in the community of our presence. Nursing students start by giving each patient a medical record card, obtaining and recording their vital signs and starting a history. Trends begin to emerge – mothers bringing children for well-child checks, coughs when the evenings get colder (in Haiti, this means 85 degrees at night and has children reporting to clinic in wool sweaters and caps), elders escorted by their children to be evaluated for joint pains and failing eyesight, vaginal infections caused by bathing in local water sources rife with bacteria and fungi, and long-untreated hypertension. There are other diagnoses that emerge though these are not chief complaints – subtle rashes that indicate scabies are lurking under a child’s skin and require eradication, signs of malnutrition in pediatric patients with protruding bellies, patchy alopecia and below average heights.
As each day ends, we reflect on the patients, the work, the country, and the culture. And I continue to do this at home – both when I intend to and in ways that I do not anticipate. Moments from Haiti enter my awareness in flashes, almost impossible to contextualize or summarize. I feel that this visit, combined with those before it, has made me a better nurse in my every day work. I am more aware of the larger impact of community on health, place more importance on meeting patients “where they are” and considering whether or not patients have the resources they need in order to achieve what I am asking of them in terms of health. I am so grateful for the support of friends, family, and colleagues at the MGH Ambulatory Practice of the Future and Boston College, and the MGH Center for Global Health.