I am on the bus heading back to Boston after visiting my family in Brewer, Maine over the holidays and it was, as most travel is, an interesting experience. The characters that fill the bus are amusing and I enjoy people watching. I spend a lot of time traveling as the Chief Nursing Officer at Partners in Health. Travel can be exhausting -- long plane rides, unexpected delays, and many hours in cars traveling on dirt and half-paved roads. In mid-December, when Boston and many parts of the U.S. were in a deep freeze and digging out from snow, I was in Haiti where it was sunny and hot, working with the Zanmi Lasante/PIH Haiti's nursing team.
We traveled for hours in between our sites throughout the Central Plateau and Artibonite regions and one stop was in Belladère, a community near the Dominican Republic border. The hospital there is old and in disrepair. There are many patients and there is not enough staff, supplies, medications or reliable running water. As we walked past overcrowded wards and through throngs of people to meet the hospital's Chief Nurse, I was anticipating meeting a stressed out and de-motivated nurse leader. Who I met instead was a dynamic, larger than life personality who filled the small room with her warmth, humor and energy. Miss Chachoute has been at this small public hospital for over 20 years. She spoke passionately about the needs of her patients and literally danced in her seat when we talked about putting a nurse mentor/educator full-time at the hospital.
During our visit, Miss Chachoute talked about her nursing staff -- many had also been there for a decade or more. Magically, as we spoke, a few of the nurses she had been praising showed up in her office. Miss Alix stood there proudly as her praises were sung by her manager. It was only later in the car ride back to Port-Au-Prince did others tell me that the nurses had been called by Miss Chachoute while we were talking. I had been so enthralled with her enthusiasm and our conversation that I did not even notice she had picked up her cell phone and made a few quick calls. When I asked the secret of her success of such dedicated nurses working with her, she talked about the need to care for and recognize hard work. She mentioned providing juice and a snack for the night shift nurses as she worries they don't have enough money to bring food for their long shift. It is only when I specifically asked, did she tell us that she uses her own money to provide the juice and snacks for her staff.
As we walked through the hospital, Miss Chachoute greeted patients and staff with kind words, hugs and warm humor. Although the poverty and need was still painfully obvious, laughter followed us throughout the day. Roodeline Valcourt, the Zanmi Lasante nurse educator, had begun her nursing career at the hospital in Belladère so she had many stories about her time there. It is a hard place to work as a nurse, it is even harder to be a patient. We were in the maternity ward, the pediatrics ward, and finally in a makeshift building alongside the hospital, the cholera treatment unit.
Haiti is a tough place to live and be healthy. According to the CIA Factbook, it ranks 34th in maternal mortality and 41st for infant mortality globally. The mothers that make it to a hospital like Belladère and receive care are the lucky ones.
The cholera tent was hot and had 12 patients of all ages receiving intravenous fluids for treatment -- a very slow day. A law suit was filed against the United Nations (UN)) on behalf of five cholera victims by the Institute for Justice and Democracy in Haiti, a Boston-based rights group. The lawsuit asserts that the UN in Haiti was responsible for introducing the disease through sewage contamination from its barracks of a peacekeeping force from Nepal.
"Forensic studies, including one ordered by the United Nations, have identified the culprit bacteria as an Asian strain imported to Haiti by Nepalese members of the United Nations peacekeeping force," a New York Times article reported.
The UN still has not conceded any responsibility and the organization has asserted diplomatic immunity from any negligence claims.
After spending a few days at Hospital Universitaire de Mirebalais, a national teaching hospital that PIH, in collaboration with the Haitian Ministry of Health, opened this past April, we were off again in the car -- this time to Petite-Rivière-de-l'Artibonite. Accompanying us on this visit was also Miss Amazan, a long time Zanmi Lasante nurse educator and leader. Miss Amazan is a quiet and dignified nurse who has been a nurse for decades in Haiti.
Although it is a Saturday, the Nurse in Charge Miss Tilien comes in to meet with us. She is a young and serious nurse who speaks softly, but eloquently about the needs of her patients and community. When in conversation about the needs of the nursing staff, instead of asking for computers or gifts for her nurses, she asks about sheets for the patients, dressing supplies, and medication stock-outs. The responsibility that this young nurse -- who could earn much more in the private sector, but chooses instead to work in the public system -- has on her shoulders is sobering.
As we were leaving and piling in the car, she asks me one last question, "What suggestions do you have for me and what can I do to improve as a nursing leader?"
Humbled by her earnest and sincere question, I was silent for a moment or two then told her honestly that she was doing an amazing job and that we could all learn a lot from her and her patient advocacy.
On the ride home, we were quiet. It was almost the end of a two-week trip for me in Haiti and Kate, the new nurse educator for PIH who is working as a "nurse accompagnateur" for the Zanmi Lasante nursing team, was beside me. Roodeline Valcourt, the lead nurse educator for Zanmi Lasante, was in the front seat answering an urgent text from another site and Julnet -- our kind and accommodating driver was at the wheel.
I was tired. My to-do list was an arm's length long and I was anticipating the Christmas frenzy that would greet me when I flew back home. I watched out the window as the country side of rural Haiti passed by me and for a few moments I closed my eyes. With my mind wandering and frenetic as always, I was drawn back to the present when I heard a beautiful voice from within the car. Miss Amazan sitting in the back with Kate and I softly started singing Christmas carols in Creole.
On my bus ride back to Boston a few weeks later, I was tired again from the holidays. I looked out the window and saw the layers of ice coating every surface and bending the trees until they looked like they would snap. I closed my eyes again and was brought back to the extraordinary women that I had spent time with in Haiti -- new nursing leaders like Kate who have enthusiastically been embraced by the Zanmi Lasante nursing team. She will blossom under their kind guidance. Haitian Nurse leaders like Beatrice, Roodeline, Miss Chachoute, Miss Tilien and Miss Amazan are all tireless, patient and nurse advocates who inspire us daily to continue our fight against poverty and health inequities.
It is an uphill battle. We don't have enough resources and have an ever increasing line of patients at the door, but our nursing leaders and the quiet strength and sweet voice of Miss Amazan will keep us going. Happy New Year.