Nursing 101 in the Tropics: Perspective from a nurse volunteer in Haiti

On May 16, I left Pittsburgh, PA for the experience of a lifetime to work as a volunteer nurse in support of relief efforts in Haiti. My trip was arranged through my employer, Bayada Nurses, a national home health care agency that is recruiting and sponsoring registered nurses and licensed practical nurses to work in Haiti for one month. Bayada is coordinating the trips for registered nurses through International Medical Corps, a non-profit organization that has been sending medical personnel to assist with relief efforts around the world for over 25 years. Bayada previously worked with International Medical Corps in Kosovo in 1999. I am an experienced nurse and supervisor, but nothing could have prepared me for how I would deliver skilled nursing services to my patients. Nursing curriculum in the US briefly details diseases endemic in the tropics such as malaria, typhoid, diphtheria, and tetanus. Most nurses in America will not care for people with these diseases in their lifetime, but in Haiti, it is an everyday occurrence. Metrics used to measure health in the West do not apply in developing countries. For example, people in Haiti function at much lower hemoglobin levels, largely due to chronic under-nutrition and malaria.

Children are typically small for their age compared to growth charts used in the US as the result of chronic under-nutrition. Before the earthquake, access to medications and health care was infrequent or non-existent for most. It also appears that infections here are resistant to drugs that are effective in the US.

My assignment was split between one of International Medical Corps’ 15 primary health clinics, locatedin the heart of the “tent city” that now fills the grounds of the former Petionville Country Club, and the emergency department of L’Hospital Universitat d’etat Haiti (HUEH), the largest hospital in Port-au-Prince. My work in the clinic and the hospital were two very distinct experiences, with each one having their own separate set of challenges.

The clinic at Petionville Club is made up of two tents that sit on a wooden platform above a sea of red and blue tarps that are home to some 40,000 men, women, and children who were displaced by the earthquake. Many of the cases we see here are women and children with skin diseases, diarrhea, and malaria. While these ailments are both treatable and preventable, diarrhea, and preventable childhood disease account for 80 out of every 1,000 deaths in children younger than five, according to the World Health Organization. That is why having care available to these vulnerable populations is so critical to saving lives, particularly as the rainy season approaches.

In contrast to the primary health setting of the clinic, my work at the hospital has focused on emergency and intensive care as part of International Medical Corps’ response to the immediate aftermath of the earthquake. At the height of the response, more than 900 people came through the hospital seeking medical services, most of which was provided in tents averaging 100-degree temperatures. At present, the patient load has lowered significantly and the Emergency Department was able to move back inside the hospital to its original location.

No Westerner would be able to believe what the hospital system is like here. I am amazed at how the hospital has evolved in such a short time because of International Medical Corps’ and similar groups’ ongoing efforts. But the hospital still lacks advanced medical technology, forcing US-trained medical professionals to think on our feet and make do with what is available. On any given day, the way we administer treatment might change depending on what is available to us.

We see many kinds of cases here, including anxiety and mental distress, violent trauma, gunshot wounds in adults and children, severe lacerations, and advanced malaria and tetanus. HIV/AIDS is also highly prevalent. We have also been treating many “hysterias” or PTSD. This experience has shown me how different cultures manifest traumatic stress differently. In Haiti, people will seem to experience paralysis and catatonia. It’s very strange, but if you give them a Tylenol they recover. Some people arrive DOA via ambulance, family members carrying them, via makeshift stretchers.

One patient that that I will always remember is Christopher, a 27-week gestation male infant, who came into the Emergency Department with hypothermia and very near death. Without an incubator on-hand, we used a technique called “Kangaroo Mother Care,” where skin-to-skin contact between mother and baby is used to raise the infant’s core body temperature. Largely because of this technique, we were able regulate his body temperature, even in the absence of an incubator. Christopher fought for life for more than 72 hours under our care, but tragically did not make it. We all called Christopher our miracle baby while he was with us in the ER. and I think many of us will always remember him because he held on against all odds. What we do is so appreciated by the local people. While they are visiting the clinic or hospital, they want to be seen for everything because they may not have the chance to be seen again for a long time. I was changing the dressing of a patient with an amputation and the father of a young man in the next bed said, “You Americans are good people.”

I felt so proud to be an American.

But beyond the international assistance, it is the resilience of the Haitian people that will rebuild Haiti. Regardless of where I worked, the transition in Haiti from emergency response to long-term development is evident. The nursing school at HUEH that collapsed in the earthquake, killing more than 100 students, is now resuming class. HUEH residents and staff now have a more regular, consistent presence around the hospital. National doctors and nurses, rather than international volunteers, now run the primary health clinics.

At the hospital, the patients’ families are just as important for patient care as we are, making sure their family member is bathed, clothed, fed, and nurtured. In the camps, people come to visit the clinic in perfectly ironed shirts and dresses, even though they are living in tents. Everywhere you look, people are carrying on and rebuilding their lives.

It is this resilience that I will bring home with me and it is why I am confident that I have learned more from the Haitian people than they have from me.

Help us save lives.