Haiti Immersion May 2015, team member
Helen Baas RNC, UNMC medical students: Amal Hamden, Prriya Maillacheruvu, Alyssa Malley, Ian Parsley, Abby Riese, Santiago Rozo, Steffen Spencer, Shelby Travis, and James Goedert , PhD, P.E., Professor of Engineering, UNL and Martha Goedert, CNM, FNP, PhD, Assistant Professor CoPH, CGHAD
This May 2015 immersion partners second year medical students with Haitian partners who have been working in the Central Plateau in projects concerning health (www.midwivesforhaiti.org/) and engineering (Flower of Hope School). The students were selected based on their interest in serving vulnerable populations globally and locally upon return to Nebraska. The students were also selected because of the flexible nature of their personalities, and their enduring dedication to serving vulnerable populations. They, as a whole, are interested in becoming servant leaders while remaining relationally involved in projects that are population-based and service-oriented.
The impetus for this immersion has been introducing eager and engaging young physicians to the Central Plateau region of Haiti that is the economically-poorest region of the western hemisphere. The region is relationally rich and economically poor. These students have also been targeted for MPH program interests, concerning a combined MD/MPH.
The Central Plateau region is one of the most impoverished in Haiti and the place chosen for joint projects with Haitian partners and the Goederts’. An eleven-year project, Midwives for Haiti, has been a place where Martha has been able to join other midwives in educating skilled birth attendants to address the high rate of maternal and infant mortality and morbidity. James Goedert has been able to work in partnership with Haitian and Nebraskan, Washington, Ohio and Virginian volunteers to create a sustainable school building program at the Flower of Hope School.
This immersion was self-funded, and will continue as long as there is student interest and institutional approval to travel to Haiti. Participants can provide an overview of the projects and the plans that continue for partnerships and involvement in Hinche.
Haiti Immersion, May 2015 thank you
“Where after all do universal human rights begin? In small places close to home—in places so close and so small that they cannot be seen on any maps of the world”. Eleanor Roosevelt
An immersion is only as successful as the participants. This group of eight medical students at the beginning of their second year of studies was an inspiration to others in the Central Plateau of Haiti.
This immersion could not have happened without the support of President Bounds and Doctors’ Gold, Davies Peters, Panigrahi and Khan. I want to personally thank you for your belief in the abilities of this group to make a difference, serving with a global health team in an under-served region of Haiti.
Highlights of the week include working in partnership with Haitian and Cuban physicians and midwives at community-based clinics. The Central Plateau is the poorest region in the poorest country in the western hemisphere. The students quickly developed expertise with routines to expedite population health screening and primary care triage. The students were quick to recognize the link between anatomy, physiology and basic science as it applied to baseline screenings from womb to tomb. Together we saw 650 people and delivered 550 pounds of medical supplies to six different health care groups in the Hinche, Mirebalais and the Port au Prince area. It was altogether a difficult, grinding clinical time with great rewards for the students’ perseverance and patience. They coped graciously with hot, crowded, remote working spaces, serving Haitians who were desperate for the medical and midwifery care. The Midwives for Haiti clinics are based in small houses, churches, schools, in a hub and spoke method of outreach through a mobile jeep transport, piled high with suitcases of medications, sheets, screening kits for HIV, syphilis, GC/CT, malaria, Hemoglobin, and Doppler’s for fetal heart tones.
We saw patients who would not have survived without the medications we dispensed: a three week-old with pneumonia and respiratory distress, an eight week old with pneumonia and balanitis, a septic pregnant mother at term with tooth abscess that was developing a fistula for drainage, and a 78 year-old with necrotic, septic brown spider bite, exposing the underlying bone. Others were quickly triaged for life-saving care at distant sites: Abdominal Aortic Aneurysm (AAA) in a 49 year-old farmer, a nine year old with heart failure from suspected congenital heart defect, a teen with post-strep glomerulonephritis, another teen with renal involvement from obstructive renal lithiasis, a 15 year-old Type I diabetic with a twenty pound weight loss with no access to stable food supply.
The students developed during their shadowing experiences, the skill to identify heart murmurs, signs of intestinal parasites, kwashiorkor and marasmus, asthma, hepatomegaly, severe anemia, jugular distension, late signs of heart failure and COPD, fetal heart tones, breech positions at term, and Elisa test preparations in the field for screening positives (HIV, malaria and syphilis). The energy and compassion of the students touched the communities served, the midwifery and medical professionals we worked alongside, and especially the children at the village schools and the Maison Fortune Orphanage where we resided.
On our final day, I was able to complete a training of the trainers for lifesaving skills, “Every Newborn Action Plan” (ENAP). ENAP is the second in a series for life-saving programs created by the American Academy of Pediatrics in coordination with the World Health Organization to improve infant survival. I trained seasoned midwives and the professors from Midwives for Haiti as trainers. To finalize the course, UNMC medical students were trained by the Haitians in infant resuscitation and lifesaving skills of the first 24 hours of life. The surprise factor for the students and for the Haitians was not missed, adding to the impact and success of the training.
None of this could have been possible without your administrative support. Although the project was student-funded, the students voiced interest in continuing similar activities as immersion in population health activities. At each site, when students delivered supplies and equipment, they saw the intricate web of care delivered by groups striving to be part of a sustainable answer in relieving the great health care disparity in the Central Plateau. Five hundred and fifty pounds of supplies were delivered to the Mother Teresa Azil Refeeding Center, Midwives for Haiti Mobile Clinic, Flower of Hope and St. Matthew School outreach clinics, St. Theresa Hospital, and the Partners in Health’s (Zanmi Lasante) new facility in Mirebalais.
We had $1800 of medications, 5 soccer balls, and 7 Frisbees and enough joy and inspiration to last another decade. Half of the students have decided to add an additional year to their studies with an MPH year of course work. The students touched providers and patients; they know they made a difference with our partnerships in Haiti. Thank you for your belief that this immersion was possible and that it should be allowed to go forward with great impact on our global health community.
Martha Hoffman Goedert, CNM, FNP, PhD, FACNM
May 2015 Haiti Immersion team:
Amal Hamden, Prriya Maillacheruvu, Alyssa Malley, Ian Parsley, Abby Riese, Santiago Rozo
Steffen Spencer, Shelby Travis, Helen Baas, James Goedert and Martha Goedert
Midwifery week Martha Goedert response
Almost forty years ago I was called to the privilege of being at the bedside of birthing families. Sitting with women birthing around the world produces a heart of gratitude along with an attitude of caution. Midwifery covers the emotional spectrum from joy to terror, sprinkled with holiness of new life.
No neighborhood is able to claim ownership of ‘good birth’ or to be immune to poor outcomes. However, women who have no educated skilled birth attendants have enormous disadvantages during their childbearing years and beyond.
There is no veneer to cover up the stark reality that for many women birthing is a fatal event. Preventable maternal and fetal deaths affect our whole world. When a mother dies, many times children are orphaned; sisters, wives, daughters are lost, along with the babies they carry.
I have been presented with a great opportunity by Seed Global Health, partnering with Peace Corps to serve as a visiting professor and midwife in Tanzania. There is great privilege in coming alongside my Tanzanian colleagues in the classroom and clinical settings. Birth is the same around this world and I can attest universally to the great effort and courage of women. Some women birth in X-rated settings similar to one in 64 life-time risk of dying in childbirth found in regions of sub-Saharan Africa, Haiti, or India. Others have the privilege of birthing where every necessary health care advantage is available.
During this year of service, I know not exactly the plans my team will implement, but I do clearly know why I have been tapped to do this work. Together with my health care colleagues we will explore every possible strategy to reduce maternal and neonatal mortality in this centrally located region of Tanzania. Collectively we have great insights and years of experience, and we have support from Seed Global Health and Peace Corps both in-country and in the States. The irony of all successful programs is that they must be supported at a high level but implemented through close relationships on the ground.
Nothing happens that is sustainable and life-affirming without warm, loving relationships among people at work. Although we don’t often talk about ‘love’ in our professional work, it has been my career-long experience that only love changes critical situations. Joseph Campbell in his teaching of young coeds once remarked that it takes as much courage to love another human being as to fight a war. And so it seems that we need great courage and enormous love to tackle together this problem of mothers and babies dying around the time of birth.
The full moon last night reminded me of the universal nature of our work to promote safe and healthy birthing. There was a rare eclipse both hemispheres could witness. Perhaps the place of beginning is to realize that as midwives we are no different and that our shared humanity is bound up tightly with our ability to make our mothers and babies safe globally. We intrinsically know some universal truths about our work.
We know that we have our best outcomes when we work in respectful interdisciplinary teams.
We have experienced the synergy of our own work setting, with young and old nurses, midwifery partners, wise and able medical consultants and patients who have become like family. And we have lived together through life-saving events, shoulder dystocia’s, postpartum hemorrhages, cases of thrombophilia’s that shake you to the core, along with successful newborn resuscitations. We know that together we are much bigger than we could be alone. We also know that while midwives’ work is often invisible, our touch and abiding presence are unforgettable.
And we intrinsically are aware of the privilege we have to be midwives. We have had our most vulnerable patients surprise us with important messages that deepen our own professional resolve and learning, and expand our capacity to love and to hope.
You are part of the solution to increasing the number of skilled providers training other health care providers globally. We must build capacity to improve health care accessibility and outreach for our most vulnerable neighbors. Please consider the Seed Global Health and Peace Corps team opportunity as a Global Health Service Partner. Experienced physicians, midwives and advanced practice nurses are needed to respond to disparities in our world. Sustainable concerted efforts to build capacity through educational partnerships in health care institutions and universities do make a difference. Your hands can become part of the group who admits that this is the toughest job they have ever loved.
Below is an excerpt from my musings after hearing a speaker last month in Dodoma, Tanzania. I no longer am timid about asking for volunteers who can make a difference in our world.
The speaker dressed in the conference kanga was not an old woman, not a Shikamoo like me with grey hair. Yet clearly she had experienced more than enough death in her short years. She joined eight hundred women crying together, healing each other, like sitting at the bedside quietly when a friend or patient has experienced loss. And then my tears started, universally, someone reached out to touch my shoulder, as I reached another’s. You would see, across language and culture, the universal compassion in the eyes of another woman.
I thought, perhaps we should have more crying from the podiums in our own country. When will it be “enough”, losing mothers and babies? I have heard this wail before, around the world, but I have grown weary of the needless loss of life in sub-Saharan Africa and in Haiti.
Where are the midwives? What could possibly be more urgent this year as UDOM visiting faculty than training midwives and young faculty? There is such urgency, there must be no excuses; our African partners are ready for a change in this precious loss of human resources, mothers and babies.
“Tuna fika”.the group sang, in the Tanzanian fashion of encouragement, several parts, one voice, and reverberations off stone walls that echoed the call. “We come”.