On the evening of January 12, 2010 the poorest nation west of the Prime Meridian was shaken to its core by one the strongest earthquakes to hit Haiti in over two centuries. In less than sixty seconds almost one third of the population of this Caribbean nation was killed. This already economically devastated country lost an estimated 7 billion dollars in property, land and other assets. While tens of thousands of lives were lost in that one minute, an estimated 250,000 lives would be lost by the time the dust from the crumbled concrete settled. It wouldn’t be until the sun rose the following morning that the people of Haiti would begin to piece together the horror that surrounded them amidst the ruin. From the moment news reached the surrounding world, hundreds of organizations began mobilizing their administration and volunteers to provide aid in any way possible. Military and medical personnel flooded in from every corner of the earth in hopes to begin the rebuilding process.
Heartline Ministries, a boys’ orphanage run by Bostonians John and Beth McHoul became a near-fully functional emergency room, operating room, labor and delivery and wound care center in a matter of days. Networks of other health care providers began springing up citywide, becoming a lifeline for patients in need of specialized care. Merlin, a team of medical professionals from the United Kingdom and Scotland began treatment of patients in need of skin grafts and other plastic surgery. Double Harvest, an existing clinic originally set up by a team of Mennonite missionaries, accommodated countless patients in need of orthopedic consultations and surgeries. The University of Miami set up a field hospital on the grounds of the Toussaint Louverture International Airport in Port au Prince to provide care and shelter to more critical patients of every age. The workforce consisted of doctors, nurses, paramedics and physical therapists. On February 1, 2010, I joined hands with this phenomenal team of medical professionals and servants to the people of Haiti. Over the next five weeks, I learned much more about resilience and hope than Merriam Webster could ever define.
Professional Growth and Development
I often describe my medical experiences in Haiti as being “well outside of my scope of practice.” While my university clinical rotations provided the cornerstones to my knowledge base in nursing, the situations in which I found myself in Haiti not only broadened my understanding of specific disciplines, but also cultivated a practical and profound appreciation for unexamined specialties initially disregarded during my undergraduate study such as wound care and labor and delivery.
Due to the nature of the relief work, I found myself elbow-deep in wound care and infection prevention. Patient after patient would enter the meager four walls of our clinic to have dressing changes and wound debridement on every skin surface from their scalps to the soles of their feet. R.P. was my first patient of the entire trip. This young man of 12 had suffered a severe shearing wound to the bottom of his foot. The wound stretched from the outside of his foot to the inside of his foot and contained several growing pockets of infection that were beginning to tunnel further into the pad of his foot. His infection required a daily debridement, or deep cleaning and removal of infected tissue, of the infected surface and vigilant observation. Over the weeks, we monitored for signs and symptoms of infection, being sure to keep him on a strict regimen of antibiotics to ward off any agent of infection. By week three, Remon’s wound had healed to a stage that Merlin considered a viable graft site. He remained overnight in their care and was returned to us in the morning for continued observation and treatment.
Fritz was at in his home in Port au Prince when the quake struck. While seeking shelter in the shadow of his stove, a pot of boiling water tipped over and engulfed him in a scalding surge, badly burning the skin of his face and scalp. Over a period of a few weeks, I was witness to a boy who began his journey through Heartline scared and frequently in excruciating pain, restored to health with minimal scarring. Having no previous experience in burn care, I gained extensive knowledge in infection prevention specifically related to these injuries. I learned about the intense topical antibiotic therapy needed to ward off infection and the sensitivity and gentleness that must be used while cleaning these wounds. Fritz was treated with bacitracin ointment on the burns directly, as well as antibiotics to further strengthen his defenses.
In addition to direct wound care, I was privy to several instructional consults with some of the staff from Merlin. Ehmer, a nurse from Great Britain who specializes in plastic surgery, enlightened me to some alternative methodologies in treating wounds and skin graft sites such as honey therapy. The British use honey frequently in the healing of open wounds. It was explained to me that the honey encourages moisture from deep tissue to migrate towards the surface, nearer the wound, in order to provide better vascularization and granulation of the tissue within the wound itself. This apparently aids and hastens the recovery of the injured tissue.
Ehmer provided me with lessons in the usage of silver nitrate in the treatment of over-granulated wounds. It was explained to me that the compound actually acts as a cauterizing agent; when the silver nitrate comes in contact with the water component of blood it becomes nitric acid which is able to cauterize, or “knock back” the over-granulated tissue. My new knowledge base was used on numerous occasions throughout the remaining weeks of my trip.
Another rotation during my undergraduate experience in which I never truly invested much time or energy was my familiarity with labor and delivery. I had never considered the true fascination of a human birth to be a desirable career move, nor did I feel I would be adept in my nursing skills when it came to delivery and post-partum care. However, within the first two weeks of my stint at Heartline, I experienced my first live birth. Before the trip was over, I assisted in the delivery of two beautiful baby girls and a handsome baby boy. Aided by the calm and collected tutelage of Beth McHoul, who incidentally was training to be a nurse midwife, I participated in everything from internal exams to the “catching” of the infant; the suctioning of the neonate’s nose and mouth to the cutting of the umbilical cord. My assessment skills were sharpened through constant attentiveness to the subtle ebbs and flows of the baby’s heartbeat in-utero. My critical thinking skills were put to the test when one of our babies’ cords became wrapped around his shoulders and Beth and I needed to make hasty yet rational decisions on how to safely get the baby delivered without harming the mother.
Appreciation Versus Entitlement
One sentiment that may be expressed in the medical community in more developed nations is the attitude of entitlement. This attitude may be expressed in a patient’s unwillingness to wait for the nurse to fill orders or for a patient to be in constant demand for additional items, comfort needs or medication. It is my responsibility as the nurse to determine which needs for which I can provide for immediately, which of their concerns I am capable of alleviating in the desired time, and which requests can be appropriately held until a later time. It is when these priorities are being determined that the patient may feel their entitlement more immediate and more accommodating care is being threatened.
While many Haitian people exploit the American tourists that come through their borders, when placed in a clinic or health care setting, Haitians have a much different attitude. Never would a patient request any medication or assistance without first saying please. And as they were returned to their beds or as you passed them their medication, they would never forget to thank you. They interacted with the medical staff with courtesy and respect. I believe that nurses are not always appreciated for the work they do. In Heartline’s clinic, the nurse and the doctor’s work never went unappreciated. The people served by this clinic realized their great need for care and were so thankful when that aid arrived.
Culture of Pain, No Prescription Needed
While there may be a pharmacy on most street corners in Port au Prince, pain medication must not be heavily distributed among the Haitian population. One huge difference between the patients I encounter in my emergency department here in the city of Akron and those I worked alongside in Haiti is each population’s need for pain medication. In the emergency department, it would not be uncommon to require up to six milligrams of morphine before someone’s pain even begins to subside. In Haiti, however, we did not require nearly that strength of analgesic or narcotic. In fact, narcotics were used only during more invasive procedures. Most patients within Heartline’s clinic required nothing more than ibuprofen to have a decent night’s sleep. We had several patients with external fixators who requested between two hundred and four hundred milligrams of ibuprofen before bed and they would sleep the entire night through. I have found that I need at least six hundred milligrams to simply ward off an incoming headache. This is another testament to the strength of these people. They know not the culture of opioids and narcotics but only the mentality of resilience and perseverance. When you have spent your lifetime working through aches and pain without pharmaceutical aid, your tolerance for such a nuisance as pain is apparently much greater.
Faith to Heal
Through different consultations and meetings with the aforesaid organizations in Haiti, we found something was noticeably different in the community at Heartline. John and Beth McHoul were known in the community for reasons other than this clinic. As previously stated, the building we were operating out of was, in fact, a boys’ orphanage prior to the earthquake. John and Beth ran a church as well. They had traveled to Haiti on a short-term missions experience twenty years ago, and have lived in Haiti ever since. Through their genuine and apparent faith, they’ve established themselves in the community as quality and upstanding citizens of Haiti.
For the patients at Heartline as well as for the workers who came to serve, services would be provided for these patients to give them an opportunity to worship God and spend time listening to the Holy Bible being preached. In these moments, pain was apparently lifted and sorrow seemed to be carried away. Mothers who had cried the whole day through were smiling, with tears of joy now running down their cheeks. Hands were raised all over the clinic as shouts of “Alleluia” and “Amen” rang out. These services would go on for over two hours at times. On more than one occasion they would call the “whites” out to the bedsides so they could sing us a song they had learned in English.
What we noticed over those few weeks, however, was change. When patients would leave us for other facilities, they’d be begging those facilities to return them in time so that they may attend church; they desired to be in their community.
For the community built throughout these services created something special within Heartline. As stated by members of Merlin, Miami and Double Harvest, our patients were different. They were happy. They were hopeful. They had each other and they had their faith. This seemed to bring them hope. Healing is a mental process as much as it is physical. They used their time together in worship to heal in their hearts and in their minds.
Personal Growth and Development
In a medical culture where policy guides every clinical decision, we as a healthcare community have settled into a rigid compilation of rules, requirements and regulations. And while our statutes have been established to protect patients and their rights, my adoption into this unyielding profession created a deep-seeded necessity to abide by any and all rules. To enter the world of medicine within the country of Haiti would shatter that idea of stringency.
I went with the assumption that aseptic technique would be the least of my worries, however I anticipated a similar hierarchy of responsibility when it came to clinic organization. I, being the nursing student, would work under the guidance of a registered nurse and my responsibilities would probably include IV starts and changing the linen. For the first few days, I simply took note of how the clinic operated. It was comforting to find doctors and more seasoned nurses with a hesitant approach to the nursing student when it came to delegating tasks in my direction.
But along came Dr. Pete, and that theory became null and void. Dr. Pete was an excitable, passionate man; brilliant and compassionate in his practice. Dr. Pete was always looking to provide a learning experience. He began to pull me away from menial tasks of organization to assist him on different procedures. Together we attended to a ruptured artery in a woman’s ankle, removed a man’s toenail after it had been crushed by a “tap-tap,” Haiti’s version of a taxicab, and established and maintained IV access in a Labrador retriever-bull mastiff crossbred dog.
Through those experiences, I slowly transitioned into the role of an RN. Medication administration began to feel more natural; assessments of patients were crucial for me to master; but perhaps the greatest personal gain from my experience in Haiti was the development of instinct. We were forced to utilize only the tools available to us on any given day. We were reliant upon our own hands, our own ears, and our own eyes. While a monitor may be a quick and efficient way to read a patient’s blood pressure, to acquire the skill of being able to listen and hear for those significant pulse beats while children are playing, worship leaders are singing, dogs are barking and chickens are clucking all around you; it inspires a feeling of accomplishment and of great aptitude. From these experiences, I gained confidence. Being careful to steer towards self-assuredness, avoiding arrogance, I slowly began to piece together all the principles and knowledge that I had been storing up for the past three years.
Resilience and Hope
I was privy to a beautiful portrait of resilience. One patient, in particular, struck me as the picture-perfect embodiment of strength. After being buried under rubble for thirteen days, a young woman was found alive, badly injured and eight months pregnant. She was immediately flown to the U.S.S. Comfort where they delivered the baby. It took the doctors and nurses several days and attempts to convince this young woman that the child was, in fact, hers. She was unwilling to believe that God would have allowed not only her to survive, but also her child. She was transferred to our clinic for further recovery and so that breast feeding classes and post-partum care would be provided. In addition to her new child, this young woman suffered a pelvic fracture from the earthquake. Within mere weeks, she was walking to the bathroom with the aid of a walker, for she refused to use a bedpan. On that first night as we watched her pull herself from bed, stood proudly next to her cot and moved ever-so-slowly, yet so deliberately to the bathroom, I knew I was watching strength triumph over fear. A Haitian proverb that became a team mantra for this missions experience states, “Lespwa fe viv,” which translates to “by hope we live.” Through this young lady’s determination and resilience, and by those same traits displayed throughout the majority of our clinic’s patients, I gained an understanding of what strength and hope truly look like in the face of destruction and loss.
Dye Mon, Gen Mon.
My time at Heartline was forever life altering. The lessons I learned both in medicine and in the healing power of the spirit were invaluable. I had an open door to serve in Haiti and more continue to open for so many service opportunities, even here in Akron, Ohio. The Haitian people have begun to rebuild. They’ve begun the healing process. But they remember one proverb of their own as they push through each new day; Dye mon, gen mon. “Beyond mountains, lie more mountains.” They know that this is only one step in building back what they lost. And they know as they hit peaks and valleys along the way that their journey as individuals, as a culture, and as a people is far from over. For over this mountain lay more and more mountains to climb.