Less than Nothing
UND and NDSU partner to give medical and nursing students life-changing, hands-on fieldwork experience in Haiti.
It was an email that brought relief to many anxious folks in North Dakota:
“Back in Port-de-Paix, after visiting affected hospitals, condition well-controlled now. Some deaths and serious injuries, but all seen and treated. We will resupply and try to get some HaitiOne supplies to them, and then return to [Mission of Hope] tomorrow with two other cities to visit on return trip in the Nord Ouest region. Back to our regular mobile teams by Wednesday.”
So wrote Bryan Delage, MD, assistant professor in the Department of Family & Community Medicine at the UND School of Medicine & Health Sciences (SMHS), of his team’s on-the-ground efforts in Haiti in October 2018.
Despite the patchy Internet, Delage had managed to send a hasty update to family, friends, and colleagues back home in the wake of a magnitude 5.9 earthquake that struck just outside of Port-de-Paix on Haiti’s northern coast.
Not as bad as 2010, Delage told everyone, but bad nonetheless.
As part of an interprofessional team participating in a joint UND-NDSU Global Health elective in Haiti, Delage had spent the previous day helping train Haitian providers in screening for cervical cancer with Adam Hohman, DNP, FNP-BC, from the NDSU School of Nursing; NDSU doctor of nursing practice (DNP) student Carly Hanson; and Genevieve Thompson, paramedic with Sanford Health Education and Fargo- Moorhead Ambulance.
A partnership between the UND Department of Family & Community Medicine and the NDSU School of Nursing, the elective course allows fourth-year medical students and second-year DNP students to bolster their interprofessional competency and critical care skills in a resource-poor environment.
“Things were going well,” said Delage, “until the earthquake shook the island. Adam and I have military experience and were asked by [host organization] Mission of Hope if we would participate in the response. Of course we said ‘yes.’ We provided some of the first boots on the ground to the region in terms of damage assessment for our partner organization to pass on to the government—but didn’t have to provide much medical care.”
First visiting Haiti with his daughter in 2013, Delage said he connected with the Mission of Hope and its partner organizations, Innovating Health International and HaitiOne, out of a desire to improve health on a global scale.
“I’d done [Individual Readiness Training] missions before in Ghana and Hawaii,” continued Delage, who was a member of the Army National Guard from 1989-2004 and the Air National Guard since 2004, and manages a team based in the Haitian city of Titayen—which translates to “less than nothing.” “I’ve always been interested in participating in humanitarian efforts overseas, with an emphasis on increasing peoples’ access to quality medical care.”
Hohman confirmed Delage’s account, explaining how for as long as he can remember he has felt an obligation to run toward disasters to help. Although this was his first trip to Haiti, the Air Force Reservist had already seen two deployments to Iraq and one to Germany to assist in the Iraq and Afghanistan wars.
“Nearly 90 percent of people in Haiti have no access to quality health care,” said Hohman, a former volunteer with the Red Cross who was also on the ground in Washington, D.C., in 2001, providing aid in the wake of the 9/11 attack on the Pentagon. “I felt my skills in critical care transport would translate well to an environment like Haiti.”
Describing how his team’s job was to engage in rapid field assessments of the impact the quake had on the region’s medical infrastructure, Delage later wrote to his colleagues at the SMHS that his team began by visiting a hospital in Port-de-Paix rumored to be damaged and absent supplies.
Left-to-right: Genevieve Thompson, Carly Hanson, Adam Hohman, and Bryan Delage
“The patients had all been seen, and they had closed their surgical center, which was the most damaged building on their campus,” Delage later wrote. “We left supplies to care for wounds and to restock, and moved on to LaPoint, about 10 miles from Port-de-Paix. The hospital there was intact with some buildings showing cracking, but no collapsed buildings. They had received about 130 patients, admitted 30, and had five deaths. They had sent out four patients by Mission Aviation Fellowship to other hospitals, and had performed 12 amputations. We then traveled to the last hospital along the coast that was close by. After leaving supplies for dressings for the management of patients with amputations, we traveled to Saint-Louis-du-Nord, but their hospital had no damage, as it was made primarily from shipping containers. They had seen 50-60 patients and had two deaths.”
“The Uses of Haiti”
Although not spending time in the typical classroom, students enrolled in the travel course—MED 9555—are required to both prepare for the experience and reflect upon it.
Part of that coursework, said Delage, includes reading one or more book chapters by Paul Farmer, MD, the founding director of Partners In Health and chief of Social Medicine and Inequalities at Boston’s Brigham and Women’s Hospital. A winner of the MacArthur Foundation’s so-called “genius award,” Farmer has written extensively on Haiti, often in ways that problematize Western nations’ role in helping create or prolong the humanitarian crises that have become chronic in the country.
Describing how political and economic forces have “structured” both disease risk and violence in Haiti, creating a population that suffers from the highest rates of maternal and infant mortality and lowest life expectancy in the hemisphere, Farmer writes in Pathologies of Power that “Working in contemporary Haiti…one learns a great deal about suffering.”
“We read from the Tracy Kidder book on Farmer [Mountains Beyond Mountains] and his book The Uses of Haiti,” added Delage. “He describes well how our own foreign policy has global impacts that are not always good. I’ve both seen and spoken with Haitians who say [Farmer’s] critiques are fairly accurate.”
Referencing both Farmer and the 2010 quake—the tragedy of which was multiplied when United Nations peacekeepers reintroduced cholera in to the country that year, creating an epidemic that killed tens of thousands of people—Hohman recalls his shock upon seeing one especially grim feature of the Haitian health “system.”
“You know how other places have isolation rooms or triage spaces for people with pneumonia or flu?” he asked. “Well Haiti has these ‘cholera containment rooms’—for a disease we’ve not really seen in the U.S. for 100 years.”
According to Hohman, such experiences help him to reconsider regularly both his nursing practice and his instruction back home.
“From a teaching point of view, working with patients whose language is different from mine really allows me to work on my exam skills,” he said. “It helps me learn to be more flexible and reminds me and our students that you can provide safe and effective care even without fancy equipment. That’s important for students especially to see.”