Arriving at the only critical care hospital in Haiti, Angelee Geisler received a briefing from the other Americans serving there. The phrase “it’s third-world problems seen through first-world eyes” was brought up several times. The reality of this phrase would soon come into light.
At the hospital, Haitian caregivers were doing all they could with limited supplies and training. But the situation was stark. Little soap, no towels. Few gloves. Not enough medication. Bed space so scant that people were sometimes turned away despite needing life saving treatment because there was no where to put them, and others literally died as they wait for help.
Working through interpreters, they cared for patients who spoke Creole, and maybe French.
They not only had to bridge the language gap, but also reconcile major differences in standards of care. Most “disposable medical equipment” was re-used, including items such as oxygen masks, bag valve masks, IV lines, vent circuits, C-collars and suction equipment.
The medicines and labs were ordered based on what was in stock that day, if it was available at all. Labs were done without computers. Pipettes, petri dishes and reagents with manual blood counts were the norm. Patients weren’t billed later for services. To be seen at triage, a family had to pay the consult fee in advance: 200 Haitian Gourdes = $4.70, which is equal to about two days’ wages.
“I thought I was prepared for how different it was going to be, I remember going into it thinking, I am going to help them and teach them,” Angelee said. “But getting there, I just thought ‘Wow, how am I going to do this and get through this week? I have so much to learn from them!”
Angelee had come to Hospital Bernard Mevs in Port-au-Prince with her sister, Heather Haynie, and 10 other mid-Missouri caregivers.
For the sisters, it was a chance to serve together as they approached career turning points. Angelee had graduated with her nursing masters degree — she works at Boone Hospital Center as a Nurse Practitioner with the hospitalist service— and Heather was entering her last year of nursing school at Central Methodist University.
They wanted trip to remind them about the value of nursing and what it means to care for people truly in need. That reminder was everywhere.
Each day at Hospital Bernard Mevs, a staff of just over 150 Haitians, aided by about a dozen of foreigners, treats up to 350 of Haiti’s sickest adults, children and premature infants. All forms ofsevere illness and injury arrive at the hospital gate. People fight and push to get into this facility. In fact, armed guards are posted at the front gate.
That’s where Angelee first saw 14-year-old Yevens, laying on a bench, unconscious, waiting to be seen. He came to the hospital with decreased mental status and high fevers. He was scanned and found to have multiple abscesses in his brain. Once Yevens was admitted to the intensive care unit, Angelee did her best to care for him. She took his vital signs and gave him the medications that were available. The local Neurosurgeon was called, but stated there was nothing they could do to help him. The American caregivers also worked with the Haitian doctors to research and identify a treatment plan for Yevens. This included spending time educating a local medical staff neurosurgeon about a modern procedures that could help save Yevens.
The neurosurgeon agreed to perform the procedure and he was started on antibiotics and went to the OR the next day. His stability was touch and go for several days and they all wondered if he was going to wake up. The hot conditions, buzzing flies, and limited antibiotics on hand made a positive outcome seem less than positive.
“In terms of standards of care, once again, there are major differences between the US and Haiti,” Angelee said. “In Haiti, emergencies are nothing. In the US, we try to eliminate all bad things. In Haiti, bad things are a way of life. If someone is dying, there’s no sense of urgency. It happens all the time. In the week we were there, we put 11 people in the morgue. And this was the best hospital in Haiti.”
However, day by day, Yevens began to improve.
“The care and the education we provided made the difference for him,” Angelee said.
Sharing information about the latest care practices with the Haitian caregivers was part of their mission at Hospital Bernard Mevs.
Yet with so much information they could share, there was very little time to teach given how many patients needed to be cared for each day. Angelee described it as being “too busy to even think.”
The exhausting days left her homesick, tired, hungry and emotional. At the end of the day, she and Heather would go sit on the hospital roof and try to comprehend what they just experienced.
“It was just, wow, did that really happen today?” Angelee said.
Because the caregivers were often overwhelmed, staff and supplies were short, the patients in Haiti rely on their families to shoulder much of the care. The norm there was for families to do the ADL’s for the patients: bathing, feeding, bathroom services, linens,etc. Most families slept on the tile/concrete floor under their patient beds, or outside on a concrete bench for the entire hospitalization.
During her week in Haiti, Angelee became close to Yevens’ older sister, who was always at his bedside helping with his care. Even without a common language, the two communicated through looks and hand gestures. They formed a bond.
While Yevens continued to improve, Angelee worried what would happen after she returned to Missouri.
“I remember the day I left there, hugging the sister and thinking he may not make it,” Angelee said. “We thought, he made all this progress, but what’s going to happen when we leave?”
Today, back at Boone Hospital, Angelee said the trip to Haiti was transformative. It’s changed the way she works with patients here. She feels thankful for many the resources Boone Hospital provides.
“It definitely made me more appreciative of the things we have here,” she said. “It made me realize what a difference we can make.”
And, in this case, she truly did save a life.
In early June, Angelee got word Yevens was not doing good. “He developed multiple empyemas in his lungs and they put in bilateral chest tubes and had to go to surgery to try to drain the lung abscesses and then had a more aggressive washout in his head. The following week, he then coded and was intubated. After several days, he continued to be unresponsive and on June 24th he made a DNR and no further surgeries were planned.”
June 7th, Angelee received a call, he was awake and chugging Ensure. Mid-June, Yevens had been cleared to leave Hospital Bernard Mevs. He was walking, talking, and giving the nurses teenage attitude. He and his sister were going home.
“I am so thankful for this experience. ‘third-world problems seen through first -world eyes’ has taught me we can all make a difference, including, our own town, not just in other countries. I thought I was going down there to ‘save them’ but it was me who they saved by opening my heart and mind to the true meaning of ‘patient centered care’. I learned it’s not all about tests, and consults, and knowledge to answer or solve every problem. You need to listen, adapt, and learn because every patient (or every country) is different and it’s not a one size fits all box.”