Concordia University Health Professionals in Haiti January 2019; Learning and Serving in Rural Haiti

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Photo of Cassy Zinke, Barbara Floyd, Caroline Barrett arriving in Haiti
Cassy Zinke, Barbara Floyd, Caroline Barrett arriving in Haiti

Our health team consisted of Cassandra Zinke RN, BSN, 2016 CU graduate, Caroline Barrett MD, CU biology graduate 2008, and Professor Emeritus Barbara Floyd, DNP, CNM, retired nursing professor (2016). This was Barbara’s 7th service trip to Haiti; her first trip was in 2010, not long after the 2010 earthquake. Cassy Zinke joined Barbara for the second time. She is Barbara’s former student in nursing school and is now a labor and delivery nurse at Providence St. Vincent Medical Center in Portland. Completing the team was Caroline Barrett, MD, a 2008 CU Biology graduate and a graduate of OHSU Medical School. Caroline was in her final year of residency in family medicine with Community Health Care in Tacoma, WA. She graduated from this residency in June 2019. This was Caroline’s first trip to Haiti; incidentally, she is Barbara’s youngest child and only daughter.

Trip planning began with multiple meetings over the fall of 2018, when we mapped out our itinerary, bought tickets, and oriented ourselves and each other to the expectations of the trip. Barbara service in Haiti started in 2010 on her first trip to work with the Midwives for Haiti program in Hinche Haiti. Midwives for Haiti educates Haitian nurses in key midwifery skills in the effort to reduce maternal and infant mortality in Haiti, the country which has the unfortunate distinction of having the highest rates of maternal mortality and infant deaths in the western hemisphere. During that first trip Barbara met Mr. Pierre-Louis Joizil, a university student who had a dream of starting the first middle-high school in his rural community of Fontaine/Pignon, Haiti. Barbara visited that school while it was under construction in 2012 during her second service trip to work with Midwives for Haiti. Each year since 2015 Barbara has worked with Midwives for Haiti and St. Gabriel School and she began taking along small groups of students and graduates in 2016.

Photo of Barbara, Cassy, and Caroline   Sunday morning walk near Midwives for Haiti house.
Barbara, Cassy, and Caroline Sunday morning walk near Midwives for Haiti house.

Week 1
We left Portland late evening January 4th, with an overnight flight to the east coast, on to Miami, where we boarded the plane to Port-Au-Prince, where we were met by Midwives for Haiti drivers Ronel and Jonel, and by Midwives for Haiti staff who were returning to Haiti after the Christmas holidays. Arriving quite fatigued after almost 24 hours of travel including the overnight flight, we aimed for an early night, but Dr. Caroline was roused from her bed to examine a foot injury of a young boy who lives near the midwives’ house. Each night for several days she was working with Perrine, (clinical supervisor at Midwives for Haiti) examining, cleaning and dressing that boy’s wound from the injury he suffered playing soccer barefoot on a rocky field with broken glass. Our service activities that week included prenatal clinics and hospital rounds of high-risk mothers awaiting labor and birth, and labor support in the delivery area, where Caroline had opportunity to teach a Haitian medical student how to deliver a baby. After completing our daily clinical work we held babies the Azil, a feeding center for malnourished infants and toddlers; and visited the girls orphanage in Hinche, where Cassy and Caroline painted nails, played with the soccer ball and played hand slapping games, while Barbara read stories in English and Haitian Creole. Less exciting but necessary work included sorting and stapling exams the Haitian midwifery students took that week and organizing a linen closet in the midwives’ house.

Highlights with Midwives for Haiti
From Caroline: “During our week at Midwives for Haiti, I found myself routinely inspired by the in-country staff who have left their lives in their home countries of the U.S. & the UK to come train midwives in Haiti and help decrease the maternal/infant mortality rate in the country. I thoroughly enjoyed spending evenings talking with them about their experiences working with the Haitian people and what life is like living in Haiti. On one of the days I spent in Labor & Delivery, I provided labor support to a 19-year-old first time mother who was struggling in labor. I spent hours with her, holding her hand, rubbing her back. Towards the end of her labor, a young male medical student came and joined me, providing empathic care to the young woman, encouraging her to be strong. I coached him through the delivery process, and he helped her deliver a healthy baby girl, the placenta and no tears were to be seen! It was very fun to teach someone so excited to learn and committed to helping women have good birth experiences.”
From Cassy: “On my first day at the hospital, I was able to provide labor support to one laboring woman. I spent all morning with her assisting her with position changes and breathing through her contractions. From my experience, it did not look like labor support was expected at the hospital. If I had not been there, this woman would have probably labored alone. I was able to go back and see her and the baby the next morning. She was very excited to see me and show off her baby. She thanked me for the support I had provided her and for being with her through the day. I felt honored to be able to support her and aid in making her birth a more positive experience. I was glad to have at least made a small difference in this woman’s birth experience. I also greatly enjoyed working with the women at the midwives’ house and I enjoyed learning from them.
From Barbara: “Two highlights at the end of the week were visiting a class in which Haitian midwives taught pregnancy warning signs to traditional midwives, and a hike to Bassin Zim, a beautiful waterfall near Hinche. I am enthralled by the spirituality of Haitian students, midwives, and pregnant women each time I heard them singing “How Great Thou Art” in French or Creole, before class and before clinics. I love reconnecting with Midwives for Haiti staff and students each time I visit.

Challenges Met
From Caroline: “I think my most significant challenge was seeing the differences in medical care provided to women at the hospital in Hinche. Staffing shortages, medical supply shortages, shortages of diagnostic testing, lack of funds to pay for all these needs lead to situations I have not encountered in urban American hospitals. I had to force myself to take a step back and recognize that the reality of medical care in Haiti is very different than the reality of medical care in the United States and that there are many people in government and in NGOs, both Haitian and foreign, working to improve patient care in Haiti and that progress is being made.”
From Cassy: “I think that my biggest challenge was being at the hospital and knowing how little I could do to change things. There were many practices that I saw that would never have occurred in the states. I had to take a step back from the situation and remind myself that they do not have easy access to any medication needed or adequate staff for the number of patients in their care. Midwives for Haiti is working to change some of the practices of the past. I was challenged to focus on doing the things that I could do. I tried to model compassionate care as an example for the students and nurses present, but I had to realize that I could not impact long term practice changes in the two days I had in the hospital.”

Photo of Caroline and Cassy with girls at orphanage in Hinche.
Caroline and Cassy with girls at orphanage in Hinche.

Week 2
After our very rich and wonderful first week in Hinche, we were met by Fontaine/Pignon friends, Mousanto and Pierre-Louis, who drove us to Fontaine, where we lived at St. Gabriel School for the next 5 days. Barbara’s friend and translator, Youseline joined us there. Since 2015 Youseline has been Barbara’s translator, culture guide, and companion when in the Fontaine area. Saturday afternoon we walked around Fontaine, visiting families with whom Barbara has developed friendships over the years. We attended a Catholic Mass on Sunday morning at a church down the lane from St. Gabriel School. That afternoon we met with the school principal, Mr. Oles, to confirm scheduling, and we sorted out donations we had brought. Some of our donations include hygiene kits for boys and girls, and cloth menstrual kits (from Days for Girls) for the female students. For our last two trips the school principal, Mr. Oles, requested that we focus our classroom education on pregnancy prevention; our translator, Youseline, urged us to also focus on preventing sexually transmitted infections (STI). The three of us were a strong team in presenting information and answering lively questions from classes with grades 7 through 13, with ages as young as 12-13, and as old as 20-28. It is quite a range of ages and developmental stages, as many Haitian students have had interruptions to their education and return when they can. After teaching 4 classes Monday morning, we made an afternoon visit to Bien Faisance, the community hospital in Pignon. We aimed to increase our knowledge of what services are available to students and at what cost. The visit culminated in the hospital administrator offering the services of hospital clinic staff to join our classroom teaching the next two days.

Highlights with St. Gabriel School in Fontaine
From Caroline: “At St. Gabrielle’s school, I really enjoyed teaching students about pregnancy prevention and STI prevention. I enjoyed answering questions and dispelling myths about pregnancy and infection. Most of the students were very engaged in our teaching and seemed to genuinely appreciate the opportunity to learn more about how to take care of their own health & bodies. Making connections with the local hospital that provides free birth control and providing accurate information about access and availability of birth control to the students was very rewarding. I loved stargazing on the roof at night, sharing dinners with Brother Bill and talking about his experiences teaching students in Africa, the U.S. & Haiti and life in rural Fontaine. The sense of community & welcome we received from the teachers, the principal and local community members was moving.
From Cassy: “My biggest highlight from Fontaine was being successful in connecting the students with necessary family planning resources in Pignon. They seemed to not have any knowledge of the resources available to them, and it was wonderful to be able to help empower the students to take control of their own sexual health and safety. Furthermore, I greatly enjoyed spending time with Brother Bill and learning from his experiences in Haiti. He is an amazing man who has done so much in his lifetime and it was a pleasure to learn from him. The hike to the Citadelle and spending time at Cormier Plage was a great way to top off a fantastic trip as well.”
From Barbara: It was satisfying to hear the Haitian professionals validating our teaching as we were 100% on the same page in communicating accurate information. I especially loved hearing the Haitian physician talking to groups of girls, and then boys, empowering each of them in affirmation of their ability to protect themselves from pregnancy and infections.

Photo of Midwives for Haiti class or traditional birth attendants (Matwons) in Pandiassou.
Midwives for Haiti class or traditional birth attendants (Matwons) in Pandiassou.

The Last Few Days
After five days in Fontaine we left on Thursday January 17th. Our driver Berteau, drove us north to “the Citadelle”, a fortress on a mountain top that was built by one of the first rulers of Haiti following the successful war for independence from France; it is now a world heritage site. After our hike we travelled on to Cap Hatien, where Barbara visited a St. Gabrielle graduate who is attending nursing school in that city. We checked in at Roi Christophe hotel, and had dinner with two nurse friends of Berteau, both of whom aspire to become midwives. Our last full day in Haiti was Friday, which we spent at Cormier Plage, a beach resort near Cap Hatien. The warm water and beach were heavenly. Saturday was a long day of travel toward home with lots of time to reflect on our rich experiences learning and serving in Haiti. It was a joy to share these two weeks in Haiti with Caroline and Cassy, and especially gratifying to have the opportunity to make the connection between serving Midwives for Haiti and service to St. Gabriel School.

Photo of  St. Gabriel School students.
St. Gabriel School students.

Looking Back
Reflecting on our learning and serving experiences in Haiti, I realize that our experiences can be viewed through the prism of ACNM global health competencies and skills. We added to our personal skills in global understanding and used our clinical skills in very low resource settings. We practiced professionally and ethically in our quest to provide both clinical services and education with the goal of making our small contributions toward health equity and justice in Haiti, the poorest country in the Western hemisphere.

For more information about Midwives for Haiti, and about St. Gabriel School in Fontaine, please visit their websites:
https://midwivesforhaiti.org/ https://www.friendsoffontaine.com

By Barbara O’Malley Floyd, CNM, DNP
Member: Division of Global Engagement
Education Committee
omalleyfloyd@msn.com
bfloyd@cu-portland.edu