October 10, 2018 at 4:00 in the morning we met at Logan airport to begin our journey to Haiti. For Sheryl and I this is our 4th trip to BLB and this time we felt it important to bring Susan Sawyer, who is a pediatric nurse practitioner. We also brought along a graduate nursing student, Kim Campbell who is specializing in adult geriatric advanced practice. Our nurse practitioner specialties covered women’s health, family practice, pediatrics and geriatrics so we had all bases covered.

We left with 6 large hockey bags full of medications and medical supplies. This is a big barrier for us in that we are limited in what we can get for medications. Brothers to Brother Foundation has supported us in every trip and provides us with these supplies. We are very thankful for this but continue to look for other ways to get this need met.

Organizing supplies and medications with Mirlaine and Madona

We did three days of clinic from 9-1 and saw close to 200 patients, with the majority of being women and children ages 6 months to 12 years. Here are a few highlights and lessons learned from these amazing encounters.
  

Clinic day 1 -

This day started out with all of us calling for Susie – we needed our pediatric nurse practitioner to examine our first patient. A 2-year-old asleep, but very limp and what appeared to be unresponsive. After she checked her heart rate, respirations and pupillary response, she was still not responding. Finally, she opened her mouth and probed with a tongue depressor which prompted her to wake up. We found out that her father worked at BLB and immediately took her out to him. She responded with open arms and a smile as he approached reassuring everyone that she was fine.

*Lessons learned – children in Haiti are very deep sleepers and because they lack protein in their diet their tone is much less than what we see in a healthy 2-year-old in the United States. This is because many children don’t have a balanced diet and are breastfed longer therefore lacking adequate nutrients for muscle development. We saw many children who continued to breastfeed into pre-school age years. This can cause delayed development in the normal oral muscular movements needed for chewing and swallowing. Which can result in difficulty swallowing when they finally do try solids. Adding solids is typically encouraged around 4-6 months so this chewing/swallowing reflex develops properly.

Day 1 also brought us a mom with an 8-month-old with fever and bronchiolitis. Since they had no electricity, Mom was determined to provide care for her child and brought the baby in for the three days that we were there to receive nebulizer treatments. By day 3, her lungs had started to clear, and she was afebrile.

Clinic day 2 –

Mid-morning a mom and her 5 children walked several miles from the mountains and arrived at the clinic with a variety of concerns. Mostly related to dehydration, abdominal pain, fungal infections and malnourishment. The children were ages 12, 11, 8, 4 and 20 months.

The oldest daughter, a beautiful young girl, had a few concerns. She complained of abdominal cramping and changes related to puberty. As we reassured her of these normal developmental reproductive changes, she casually mentioned that she could not see out of her right eye. Through questioning we found out that an ember from a small fire built for cooking entered that eye causing blindness. Basic survival is full of so many risks in Haiti! We informed her that a team of eye specialist will be coming to BLB in January 2019 and that she should be seen by them. Mirlaine, the nurse at BLB will help her get to the clinic that day.

During our visit with this family, the mother related that they had not eaten, as they had no food or water. We encouraged them to use the water source from BLB and Cherylann arranged for us to visit them later that day to see how else we could help them.

Their home was a small hut put together with galvanized metal sheets and burlap bags. It was located on the edge of a ravine at the base of hill that frequently got washed away when it rained. We spent time with the kids and later drove the mother back to BLB where she was given a month’s supply of beans and rice.

 
 *Lessons learned – The families in Haiti have tremendous will to survive and can adapt to most situations! They also have limited education regarding the normal physiologic changes that occur during development and the adolescent period. The same holds true for women during pregnancy. What we realized there is a great need for education on normal physiologic changes that occur during pregnancy as well as changes during puberty. Individualized and community education would greatly benefit this region.
  

Clinic Day 2 - 

Another heartbreaking story was a young girl age 10 who complained of chest pain, fatigue and shortness of breath. While Susie listened to her chest, she heard a holosystolic murmur, so loud that it could be heard without the stethoscope touching her chest. These murmurs are very severe and caused from a major defect from birth. We also learned that she came to the clinic with her grandmother both of whom had not eaten. The great kitchen staff at BLB gave them a peanut butter sandwich and water. She was referred to a cardiologist in Port-au-Prince for care and her family was made aware of the immediate concern for follow-up.

*Lesson learned – It’s not easy finding a specialist in Haiti…This is a condition that would be diagnosed at birth. In a country where access to health care is limited, these severe diagnoses can go undetected and could easily lead to grave situations. 

During this day we saw several older boys ages 17 and 20 both presenting with acid reflux and hypertension. It was hard to imagine a 17-year-old presenting with hypertension. Both boys had limited education and worked at odd jobs sporadically.

We were able to treat the reflux but advised both to follow-up at different clinic for management of hypertension. For both of these diagnoses we educated on ways to reduce risk and researched holistic options for treatment. Ginger root and baking soda added to water can help with stomach complaints and garlic for hypertension. Using all resources in a region deprived of medical services is so important.

Before we finished for the day, a young woman who was pregnant with twins came to the clinic. She was unsure how far along she was in her pregnancy but measured close to term. Her blood pressure was elevated, and she was spilling large amounts of protein in her urine. Preeclampsia is the diagnosis associated with these finding and is a major concern in pregnancy as it can lead to adverse events to both mom and baby. We emphasized the importance of immediate follow-up, but she had no ride. She had walked to our clinic, so Franky, one of the BLB drivers brought her to a clinic nearby.

A few hours later we learned that this clinic would not take her – this often happens in Haiti. Refusal of care if they anticipate a potential adverse reaction. She now needed a ride to another clinic farther away. BLB helped by not only bringing her there but kept in close contact with the hospital to be sure she received the care she needed. She was admitted overnight and had a c-section the next day. Thankfully, Mom, baby boy and baby girl are all doing well.

Clinic Day 3

On day 3 a particular patient comes to mind. It was late morning we were starting to get tired. A 17-year-old boy comes in by himself and sits down. He reports congestion and back pain. After a few questions we quickly realize these are two completely separate issues. Sheryl asked our interpreter Walter to ask a few questions about the back pain .... have you had a previous injury did you sustain any trauma? Walter translated these questions. We were not at all prepared for the response that our patient provided. He proceeded to tell us that he has this pain from beatings he received from his parents but now he lives with his sister. Sheryl then asked Walter to question if he felt safe now? Walter looked puzzled, then proceeded to translate. Our patient looked up at Sheryl and Walter, then down at the floor. He began to fill up. As he wiped a tear from his eye he told us he did feel much safer with his sister and they don’t see their parents anymore. Reflecting back on this I think he was so appreciative that someone asked about his feelings. Most of their living is just survival. 

The success of our clinic could not have happened without the help of our interpreters Walter, Wilmann, Frankie and Madona. They were professional and attentive in translating for us. They helped us understand cultural issues that impact the health of the people of Grand Groave and provided us the opportunity to communicate with our patients.

We were also able to collect a tremendous amount of data on all who came to the clinic. This will help us track usage as well as guide us on future health initiatives for the clinic and community. Thank you Cherylann and Eileen for all your work to capture this important information.

A big thank you to Fredo! He spent a few days with us in the clinic helping to stay organized with supplies, medications and patient flow. He was a tremendous help and his kindness was felt even in the busiest moments.

Mirlaine, BLB’s live-in nurse has been with us since the onset of our clinic time in Haiti. We are so appreciative of her time educating us on health issues in Haiti and we would never be as successful and efficient with our time if it wasn’t for her. She is a valuable resource and an excellent nurse. A joy to collaborate with!

Our last thank you goes to Be Like Brit, Regis College and Health eVillages for giving us the chance to do what we do best. Each time we are here we can feel the impact and we can see the trust we are gaining in the community.

We can’t wait to come back!

Susan Sawyer – PNP

Sheryl Kelleher - FNP

Lisa Krikorian – FNP, WHNP

Kim Campbell – AGNP student