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Nursing, Health Care in Recovery Mode in Haiti

The latest cohort of 15 graduates celebrated the successful completion of their studies in late October. (Photo courtesy of FSIL)The latest cohort of 15 graduates celebrated the successful completion of their studies in late October. (Photo courtesy of FSIL)

In the early 2000s, Hilda Alcindor had already had a decades-long career as a nurse and teacher. Her two daughters were grown and making their way in the world. Alcindor was living in Miami, where she worked at Mt. Sinai Medical Center and taught at North Miami High School. She was beginning to have the sort of feeling with which some empty-nesters are all too familiar.

“One Sunday I was at church,” Alcindor tells Diverse. “For some reason I was thinking, ‘I’ve got to ­find my purpose in life.’ I was alone in the house so I needed to ­find something to do. Even though I was working, I said to myself, ‘I can do better than that.’”

Serendipitously, Alcindor says, she soon received a call from organizers affiliated with the Presbyterian Church who were working to create a nursing school, FSIL (Faculté des Sciences In­firmières de l’Université Episcopale d’Haïti), in Léogâne, Haiti. They were looking for a dean for FSIL and wanted to know if she would consider the position.

At ­first, Alcindor was skeptical. “I said, ‘I don’t know how to be a dean,’” she says. Nevertheless, Alcindor was persuaded to make a visit to Léogâne to visit the new school. Soon, she was sold on the idea. With its new leader in place, FSIL opened its doors to its first class of 36 Haitian students in 2005.

Fast forward 10 years and FSIL has already graduated 115 students. The latest cohort of 15 graduates celebrated the successful completion of their studies in late October. FSIL was recently evaluated during the Haiti’s Ministry of Health reconnaissance, or accreditation process, of the country’s nursing schools. FSIL was ranked among Haiti’s best.

What differentiates FSIL from other nursing schools in Haiti is that it offers a baccalaureate in nursing. The majority of nurses in Haiti, including those at the public university, are educated no further than the diploma level.

From the outset, FSIL students were taught by Haitians and volunteers from the United States. “Our real goal is not to teach, but to teach the teacher,” says Dr. Joanne Pohl, president of the Haiti Nursing Foundation (HNF) and professor emerita at the University of Michigan School of Nursing. “We are very focused on the development of our Haitian faculty. We really want this to be Haitian run and Haitian led.” HNF is a nonpro­fit that was incorporated in 2005 to serve as FSIL’s fundraising arm.

All these accomplishments would be remarkable in almost any context, but set against the challenges that Haiti has faced, particularly in the past five years, they are all the more striking.

Le tranblemanntè

Haiti is the poorest nation in the Western Hemisphere and the health needs of the country are great. According to the latest available World Health Organization (WHO) statistics, which date from 2000 to 2007, there are 3 physicians per 10,000 persons and 1 nurse per 10,000 persons in Haiti.

The country was already severely underresourced when an earthquake of a catastrophic 7.0 magnitude struck in January 2010, killing hundreds of thousands of people. Many buildings were destroyed or badly damaged. The nursing school in Port-au-Prince was leveled, collapsing on top of nursing students and faculty. Léogâne, the town where FSIL is located, was close to the epicenter of the earthquake.

According to some estimates, 90 percent of the town was destroyed. Miraculously, FSIL’s buildings survived unscathed, which Pohl attributes to the care and the resources that went into building it.

In the aftermath of the earthquake, FSIL became an emergency medical center. International doctors and aid workers made their way to Léogâne to provide medical assistance and other aid to survivors. Pohl estimates that 5,000 refugees passed through the school during that time. Nursing students were called into action to assist those injured or displaced by the earthquake.

“The students — why would they — had never seen anything like this,” Pohl tells Diverse. “They had been taught the basics, but were early in their education so had not yet learned how to suture or deliver babies. In addition to assisting other health care professionals and easing the physical and emotional pain of the injured, they were suddenly delivering babies every night. They were only first- and second-year nursing students but they worked night and day during that horrific time.”

HNF and FSIL were far from the only medical or nonprofit entities to provide relief to Haitians in the aftermath of the earthquake. The massive scale of the international effort to bring help to the devastated island is well known. Among the throngs of organizations and aid groups that were inspired to reach out to the Haitian people after the earthquake was a group of nurses from Hunter College in New York.

“When I heard that the public school of nursing in Port-au-Prince collapsed on top of the faculty and students, killing many of them, I [thought], ‘We can educate nurses, we can go help,’” says Dr. Carol Roye, a former professor of nursing at Hunter College and current associate dean for faculty scholarship at the College of Health Professions at Pace University.

Roye and her colleagues at Hunter College saw that Haiti needed many more primary care providers. “It was very clear to us when we went to Haiti after the earthquake [that] there was almost no primary care,” she tells Diverse. Roye and her colleagues formed the nonprofit Promoting Health in Haiti (PHH) in 2011 to advance the education of primary care nurses in Haiti.

When PHH started to plan out how it would help to address the need for primary care nurses in Haiti, the organization first approached the national university system. “We wanted to start our program in the public sector so we would be able to reach the broadest pool of already trained Haitian nurses, those with associate degrees or diplomas,” Roye says. “But working with a government system is time-consuming.”

The cogs of the Ministry of Health and the national university, rarely speedy in the best of times, were further slowed by the earthquake.

“Finally, we decided, ‘Look, we don’t want to wait anymore, let’s get this started while we continue to work with the public sector,’” Roye says.

FSIL, as a private school offering a baccalaureate program, looked promising, Roye says. The first family nurse practitioner (FNP) cohort, selected from FSIL graduates, started out with 20 students in 2013. That original cohort is expected to graduate from FSIL in the spring of 2016.

One of the challenges for the prospective FNP graduates now is finding opportunities to fulfill their supervised clinical hours, Pohl says. “It was the exact same situation in the U.S. 50 years ago when nurse practitioner programs started and there were no clinical programs for them, because they weren’t in existence yet. The other challenge is to get physicians to understand the nurse practitioner role, because as it [is] now, there is no such role,” Pohl explains. “It takes some real creativity in a country like Haiti to get those clinical experiences in.”

PHH, in the meantime, has arrived at an agreement with the national university. This development means that, once FSIL’s current FNP students graduate, the program will draw to a close. PHH is transferring the full focus of its efforts to the public university system.

Roye says that she has great hope for FSIL’s students and graduates.

“These nurses are so committed to their country; they’re so excited at the possibility of being able to really provide quality primary care to people who currently are not getting it,” she says.

Looking further afield, FSIL plans to start up a nurse midwifery program in the fall of 2016. FSIL is partnered with Frontier Nursing University (FNU), a nursing school in the United States, to develop a program by the fall of 2016. An FNU representative said that FNU and FSIL faculty would start collaborating as of this November.

The aftermath

Statistically speaking, FSIL was fortunate to still be standing after the earthquake. According to a 2010 report from the Interuniversity Institute for Research and Development (INURED), 87 percent of Haiti’s higher education institutions were damaged or destroyed in the earthquake. Schooling was disrupted in the disaster, and many educated Haitians fled, syphoning away doctors, teachers and nurses when they were most needed.

Prior to the disaster, there were at least 159 institutions of higher education in Haiti, according to the INURED report. By 2015, there were more than 400, according to Haiti’s Ministry of Health. Many of the newly formed institutions were private schools and it was not clear whether all offered a quality education. The reconnaissance that occurred in 2015 was the first to be done since the earthquake.

One of the concerns with the private schools is that some command tuitions of $4,000 to $5,000, which is a lot to the average Haitian that makes $400 a year. Ensuring that the schools are providing a quality education is all the more important in light of the cost to students.

FSIL’s total cost is $4,000 per student per year, which covers tuition, room and board, books and uniforms. What distinguishes FSIL from some other schools is that many students are supported by donors. Students pay a certain amount, but most receive significant financial support, Pohl says.

Another concern in Haiti is retaining well-educated nurses and doctors. One of FSIL’s great successes is that only seven graduates have left the island. Alcindor, who sees the financial and social challenges that her students must confront on a daily basis, explains that it can be difficult to persuade nurses to stay. For one, nursing education is time-consuming and expensive, but the salary prospects are low.

“The hope is for our graduates to stay in Haiti. That’s the goal. My hope, if not theirs, is that they might return to their homes to nurse,” Alcindor says. “At the same time, I don’t want to be naïve either. They’ve got to be paid. The working conditions have got to be adequate for them to stay there. My hope is to have some people investing to build more hospitals in Haiti.”

Alcindor says the average salary for a Haitian nurse is about $400 or $500 per month. Although that is certainly better than the poverty that some Haitians are constrained to live in, it is also not a princely sum. Haitian nurses may also find themselves working in suboptimal conditions due to the lack of resources at many hospitals.

Haiti has approximately 11 million inhabitants, few of whom are able to access a qualified doctor or medical professional. Given the current imbalance in the numbers of doctors and nurses, it may take decades before the ratio of medical professionals to inhabitant begins to approach that of developed countries.

Nevertheless, organizations like PHH and HNF are working toward a day when Haiti will be self-sufficient, able to educate future medical professionals without significant external support. As Roye says, “Our ultimate goal is to not be needed anymore. Eventually, they’ll be able to do this on their own.”

Catherine Morris can be reached at [email protected].

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