From Wenatchee to Milot

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It’s always good to return to Haiti.

Milot is a special place for me. In mid-April I was fortunate enough to travel with a team of eight to Hôpital Sacré Coeur for another two-week visit to help provide services to northern Haiti. The team consisted of two urologists, an anesthesiologist, four nurses, and a highly skilled surgical technician. It’s a very long trip from our small town of Wenatchee, Washington, across the United States to Florida and then in Haiti. Each member of our team had made this trip before and was more than willing, if not excited, to return to the small little hamlet up against the mountains in northern Haiti.

This is an annual trip that I’ve been fortunate enough to be involved with since 2006. From the moment that the plane touched down at the airport at Cap Haïtien, we were ready to start to working. I feel very fortunate to have had this opportunity to return back to Haiti throughout the years.

The team that we bring down from Wenatchee is a legacy of the work that’s been done previously by Dr. Dale Peterson, a now-retired Wenatchee urologist. Dr. Peterson started coming into Haiti in the early ‘90s, when he helped pioneer early urological surgery in a country that even today has very limited urologic care. There were many obstacles to his work including inevitable political instability. His work was made much easier when he was joined early on by Fred Schuenemann, a very skilled surgical technician, who spent his early career working solely in urology.

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I joined Dr. Peterson in practice in 1996 and eventually I started coming down as well. Dr. Wallace Gibbons, my urologic partner in Wenatchee, has been involved the whole time as well. In our many trips, we have been blessed to have many different nurses and doctors from the Wenatchee area join us, and without exception, all have enjoyed their work and have been changed by their experience in this wonderful country. This most recent trip was a little extra special because we had Dr. Gibbon’s daughter Natalie, an oncology nurse at University of Washington, and my daughter-in-law, a recent nurse graduate, join us.

On this trip we reflected on the many changes we have seen throughout the years. The roads have improved, there’s more power available to the Haitians, and more clean water. The hospital has positively changed throughout the years. These local and regional infrastructure improvements complement long-term commitment of the hospital in Milot to provide high-quality care for the poor.

Our two weeks in Haiti would be insignificant without the continued support and help from the excellent Haitian physicians, nurses, and employees at the hospital. These are the professionals who are taking care of the poor day in and day out. I would like to highlight a couple of the outstanding Haitians who helped us on this trip.

Vanessa Evariste, an ICUS/PACU nurse, was a standout for our two weeks. She was hard-working, diligent, caring, and very friendly every day. The care that she provided was exemplary, and the patients thrived in her care. Many of our urologic patients require a lot of attentiveness immediate postoperative, and we could rely on her to do the job extremely well.

Another exemplary nursing example is Louis Veronia who helped care for our patients on the hospital ward. One evening in the middle of our trip, I was making rounds late one night. In that hospital wing, 10 of our urology patients were there. They all had catheters and wounds that need to be cared for. When I arrived, Louis was there caring for all of these patients diligently. She was at the bedside with me on rounds and helped me with the care of these patients. When I left that evening, I knew these patients were in good hands.

Monda 4 Joseph Vanessa Caitlin

Joseph with Vanessa & Caitlin

I would also like to compliment our interpreter Joseph, who is there for us every day to help out with the complex needs of the patients. His responsibility was to the recovery room staff, but he was more than willing to help us out with all our needs. Although we have all picked up some Creole and a little bit of French, the communication would be   impossible without someone with his commitment. He always has a smile on his face and is there to help.

We are very fortunate to work with Dr. Gerald Bernard, our colleague in general surgery on staff at the hospital. He is a great doctor and a very skilled surgeon. Throughout the years, we have had many chances to share patients together. He is most gracious at helping provide care for the patients after we leave and return home.

A very rewarding component of our trip is our chance to be involved in ongoing education of healthcare staff at the hospital. During this trip we were fortunate to have nurse anesthetist students working with our anesthesiologist David Wiggum M.D.

They worked side-by-side with Dave every day and both parties really enjoyed the experience. The students made great progress throughout the two weeks, and their enthusiasm for education was great. Some of these students gave up their Easter vacation days to work with Dave. We thought this showed a tremendous commitment toward their education. We also frequently had nursing students observing our cases. They were very interested and asked many questions. For one week on our trip, we had a Haitian trained urologist from Port-au-Prince come observe and help us for a week. It was a great exchange of knowledge.

I know that we provided some education, but we learned at least as much as we were able to give.

Monda 11 Fred and Jeff at work

Every year there are a couple of cases that stand out from the trip. This last trip, we had a woman with a large kidney stone blocking the only kidney she had. Normally we are born with two kidneys, but her other kidney had previously been ruined by other kidney stone problems. Because of this blockage, she was in kidney failure and would soon have perished if no intervention was provided. We were able to operate on her and remove the stone. The next morning she was doing great and had a smile on her face. We felt fortunate that we happened to be there when she had this problem.

The education and lessons that I learned in Milot help me in daily life back in Wenatchee. We are so thankful to have the opportunity to serve in Haiti. We look forward to our return to Haiti.

Monda 10 Teamwork Jenn Monda, Dave Wiggum, Kelly Zellafrow

Teamwork! jenn Monda, Dave Wiggum, Kelly Zellafrow

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Kidney Stone in Solitary Kidney

Kidney Stone in Solitary Kidney

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PACU: I found the overall level of nursing care to be much improved this year. I would especially cite Vanessa in the recovery room. She was always welcoming and professional in her approach to PACU admissions. She would greet the staff and patients with a smile and immediately set about the task of assessing the patient while attaching the cardiac and respiratory monitors. She demonstrated compassion, professionalism, warmth and a strong sense of organization and a plan for how she intended to run the unit each day. I would be happy, comfortable and pleased to work with her anytime.

Nurse Anesthetists: The cooperation of the professional nurse anesthesia staff continues to be a hallmark of the operating rooms at Hôpital Sacré Coeur. The hard work and cooperation of the night nurse anesthetist in seeing patients preoperatively and writing orders the night before was very much appreciated.

Each time I travel to Milot, I sense an increasing amount of teamwork and collegiality that contributes positively to the care of our patients. Massiane, Sandra, Denise and Chantelle work well as a team and I feel humbled by the mutual display of trust in taking care of some of the more complex cases. Massiane demonstrated a willingness and an ability to take care of small children that was impressive. Sandra managed two difficult cases, one a woman hemorrhaging from a ruptured ectopic pregnancy, the other a man who had suffered a knife wound to his chest and liver, with a calm professionalism.

Nurse Anesthetist Students: I was privileged to have the opportunity to work with two nurse anesthesia students, Veline and Judeline. The experience was the highlight of my visit to Milot. The two students demonstrated a commitment and enthusiasm to learn the science and art of anesthesia.
They were willing to try some new techniques and approaches and challenged me to explain the rationale. They would show up early and be ready to work. There were no delaying case starts with those two actively bringing patients to the operating room!

I was particularly impressed by the students’ commitment to learn. We visited Milot during Holy Week and Thursday was scheduled to be a day off. Both Veline and Judeline came to work, enthusiastic to learn and do cases on their scheduled day off. Judeline also decided to skip the bus ride back to Cap Haïtien and work late to participate in the care of two additional patients. My understanding is that she had to walk home. Both students demonstrated the willingness and motivation to learn that will help them grow to be fine practitioners, they were truly inspiring.

-Dave Wiggum,MD

My experience working in the PACU was a positive one. Some of the nurses welcomed me coming in to help out with surgeries. Vanessa was the nurse we connected with the most. She was warm and open to our being there. Working side-by-side with the nurses in the PACU is good for patient outcomes. We can share knowledge with the Haitian staff and vice versa. Language is always a struggle so the best way to learn is by watching each other’s actions. By watching Vanessa, as well as the other nurses, I was able to learn new things. I was also able to see the nurses doing a great job of continuing bladder irrigation for our TURP and suprapubic prostatectomy patients.

–Jenn Schroeder, RN

As my second time volunteering at Hôpital Sacré Coeur, I noticed a great improvement with the level of nursing care provided by the recovery room nursing staff. There was a definite sense of pride and accomplishment seen in the work of the Haitian nurses. The nursing staff was attentive to their patient’s needs, controlled post-op pain, and monitored for post-op complications in a busy recovery room. One nurse in particular, Vanessa, always greeted our team with a friendly smile, provided excellent nursing care, and spent time educating the nursing students she was working with. She was gracious, showing much patience as we attempted to bridge the language barrier and shared many laughs with our team! Vanessa was just one of the many nurses who showed compassion and dedication to their profession. I noticed a new focus on education, as nursing students were encouraged to play an active role in patient care and were supported by the Haitian nursing staff. I learned a great deal working alongside the nurses at Hôpital Sacré Coeur and can see a bright future for nursing in Haiti!

–Caitlin Mcabe, RN

At Hôpital Sacré Coeur everyone speaks the same language. Questions asked and conversations had may be spoken in Creole, English, French, or Spanish, but the intention and mission is all the same – patients first. The beautiful part of health care, and nursing in particular for me, is the reality that despite the culture, linguistic, & resource barriers that may exist between our healthcare teams, we can unite for a week to learn and grow as professionals and individuals. Working the PACU with Haitian nurses, there is unspoken understanding of assessment, intervention, and evaluation necessary to keep patients safe and happy that allows us all to work together. Universal truths and needs that we all have as human beings surface.

I cannot think of a better way to bridge cultural and geographic barriers than to jointly focus our efforts on making a handful of people’s lives maybe just a bit easier.

-Natalie Gibbons, RN