It is an enviable opportunity to provide healing services to a country in need by combining a fairly large, diverse, multidisciplined medical team. Three nurses on missions did just that, and in the process, they saw that one person can make a difference. They share their experiences in the Dominican Republic (DR), Haiti, Kenya, and Uganda here in the hopes of inspiring others to do the same.
The Haitian and Dominican cane cutters and their families in the Dominican Republic are spread over some 350 bateyes (cane-cutting communities). They were in dire need of access to health care—and Marie Etienne, PhD, MSN, a professor of nursing at Miami Dade College, responded.
Etienne, who was born in Haiti, came to the United States at the age of 14. From her youth, she has seen herself as a servant leader and believed a career in nursing would provide opportunities to fulfill her aspirations. She has been a member of the Haitian American Nurses Association of Florida (HANA) and served as president from 2005 to 2007.
Today, she serves as the chairperson of the International Nursing Committee of the Red Cross. In 2005, an attorney and member of the Miami Haitian community visited the bateyes in the DR, and when he returned, he told her that he had seen living conditions of the migrant workers and they were être traités comme des esclaves (being treated as slaves), with no access to health care. He suggested that HANA do something to shine a light on the conditions in the bateyes and devise ways to help the workers and their families. Etienne took the findings of the attorney to the Haitian American Professionals Coalition (HAPC) and obtained support to conduct a needs assessment of the situation. One of the objectives of the HAPC is to examine and address issues affecting Haitians in the United States and abroad.
“We went on the first mission trip to the DR in 2005 to assess the need and take care of the people in the bateyes,” recalls Etienne. The team saw over 1,000 patients in the week they were there and realized the level of need was so great that they decided to do two medical missions each year.
Haitian cane cutters in the DR are not recognized as citizens, and children born in the country do not receive birth certificates. The sugar cane farming sector of the DR depends fundamentally on Haitian migrants, who represent 90% of the labor force in sugar cane cutting and are paid $1 per day.
The team, once assembled, included a diverse blend of medical and health care competencies and others who offered their availability in a supporting role. “But in 2006, I decided that we needed to get nursing students involved because there are certain things you can teach students in the classroom and certain things you can’t,” explains Etienne.
She received the support and participation of the college’s administration and trustees, who quickly approved and funded the project. “As a professor, I inaugurated this project as part of the students’ learning activity to get them engaged and to give back to the community so they may become global citizens and in the process enhance their cultural competence,” she says.
Twelve nursing students from the associate’s degree program were added to the team. The team travelled to the DR to do a one-week mission trip twice each year from 2006 to 2009—each time serving some 1,200 patients ranging from children to the elderly with a wide spread of medical and health conditions.
In 2010, an earthquake struck Haiti, killing over 200,000 people, and the mission’s focus shifted to Haiti. “Our attention turned to the needs in Haiti as relief efforts, and other nurses who were members of the [National Black Nurses Association] came together to share in the relief response treating wounds, stabilizing the injured, triaging patients according to symptoms, and whatever else was necessary,” says Etienne. “I went to Haiti about five times that year going back and forth. I also went to one of the universities to teach the nursing students basic skills and show how they can be empowered to take care of their own country.”
In 2012, the team was asked back to the DR because the health care needs persisted and the living conditions were deplorable. The people in the bateyes were doing their level best by any means necessary to survive, but the team decided not to go back in 2013 because the DR Supreme Court had ruled that the government could proceed to deport all persons who are in the country illegally, and that put a lot of fear into the workers needing health care.
Many Haitians arrive in the DR through open borders without legal documents and stay in the country this way. The living conditions of these communities are extremely poor, and immigrants generally live in impoverished barracks that have no electricity, no basic sewage services, and no potable water. There are no health services, recreational spaces, or schools. The workers work 12 hours per day on average and face the threat of deportation when they attempt to organize to obtain basic rights. “As the impact of the Supreme Court’s decision began to be felt, violence subsequently broke out and, for the sake of the students, I could not take them there that year,” Etienne explains.
On their visits, the U.S. team partnered with the Universidad Central del Este, which assigned 50 medical students for a week. They gave one rotation in the morning and one in the evening to work with Miami Dade College students. “We were assigned a primary school in one of the towns outside Santo Domingo, the capital, where we set up the clinic,” says Etienne. “We had registration in one area, a room for triage, and vital signs in another area. Then we sent the patients to see the primary care doctor, or the PA, and then they went to pharmacy, where all the medications were donated by U.S. Catholic charities and others. We designed a pediatric area, and it had balloons, coloring books, toys, and games just to make the children comfortable where we did play therapy. And for the elderly, we would triage them by themselves, keeping them hydrated so they can see the primary.
“Some have asked us if we feel like we are putting a Band-Aid on the conditions of people’s lives in the bateyes. I would explain that our purpose of going there was so we could save lives. One of the patients had a seizure, and if we were not there he would have died. Another had an asthma attack, and because of the ventilator machine we brought along with the administration of some albuterol and follow-up care, that patient recovered. We feel we are saving lives and making an impact. The people know that someone cares about them and that they are not forgotten,” says Etienne.
“God puts us here to serve other people, and if we can put a smile on someone else’s face—if we can change someone’s life—we should not think twice about it,” she says emphatically.
At the tender age of eight, Sharon Smith, PhD, believed that one day she would be a missionary. She knew she would go to Africa and serve in some capacity, but she never really knew how that would happen. “I just figured it would somehow come through my interest in health care,” she explains. As a young person, her aspiration was to be an oral surgeon, but she knew she would not like some of the situations she would see, so she chose nursing. She is currently a nurse practitioner at the Family Health Centers of San Diego.
“Nursing offered me more career flexibility. My roles as a nurse just fit my personality, so I am glad I chose nursing instead,” says Smith. “I didn’t know I would go to Kenya, but that is where I landed, and I have really enjoyed the connections and my experience working with the people there. That is what kept me going back.”
Smith’s first trip to Kenya was in 2006 with 12 members of a Pentecostal church group out of Carlsbad, California. A physician friend was unable to go and suggested that she go instead. Since then, she has been back twice on her own. Nairobi served as the primary hub on each visit, but on her first visit she went to the town of North Kinangop, about a two-hour drive from Nairobi, the capital.
She also visited the town of Tumutumu and spent time doing crafts with the children in a home for the deaf and hearing impaired. This was possible because the group from California included a young woman who could sign. The home for the deaf was adjacent to the Tumutumu Hospital, which provides care to approximately 3,000 inpatients and more than 16,000 outpatients each year. Tumutumu Hospital is one of the three mission hospitals in Kenya sponsored by the Presbyterian Church of East Africa (PCEA). Smith and her team came with hospital supplies that they delivered to the staff. The hospital had a large HIV clinic, and while the children waited on their parents, they were provided with school supplies and toys as gifts from Smith and her team.
As the visitors toured the hospital wards (floors), they were exposed to the differences between nursing practices in Kenya and the United States. They saw how much was lacking by way of resources and training. In a ward, there would be a patient with pneumonia next to a surgical patient with an open wound, who may be next to a patient with HIV. There was no segregation based on medical condition. In the pediatric ward, however, three or four rooms were set aside for preemies or small children who were intubated or on ventilators. Smith says that at this hospital there were one or two experienced nurses, but all the work was done by student nurses from the PCEA Tumutumu Nursing School. “They ran the hospital with the number of beds at about almost 200, inclusive of the maternity ward. There was no ICU, however,” she explains.
On her third trip to Kenya in 2010, Smith, who was at that time one of two nurse practitioners in the U.S. team of eight, visited an orphanage of 250 children and did physicals on over 100 of them, from newborns up through teenagers. This provided the orphanage with the children’s first medical records. While on this trip, Smith also had an opportunity to work with some of the nurses of Kenya on a very large, day-long health expo in the Maasai village. They performed health screenings, vaccinations, physicals, oral examinations and extractions, working alongside physicians and dentists from Kenya.
Smith did have an opportunity to see up close the delivery of care inside a hospital in Nairobi after a dog bit a member of the U.S. team and required medical attention. Her assessment is that the hospital provided care comparable to that found in most U.S. hospitals. “My focus and concern was, however, the care delivered by the rural hospitals,” she says.
For Kenyans, Smith is the sister returning home, so they go through the villages and alert the community that “our sister is coming home.” “They plan for my arrival ahead of time,” she says, “and I am planning my return in 2016.”
Raised by her community-minded grandmother, Angela Allen, PhD, took her mission trips to Uganda with concern for both the physical and spiritual well-being of the people of Uganda. The Detroit native received her doctorate from Arizona State University with a focus on geriatric and dementia patients, and now she is the clinical research program director with the Banner Alzheimer’s Institute in Phoenix, Arizona.
Allen visited Uganda in 2010 and 2012 for periods up to three weeks each visit. Her visits allowed her to interact with the elderly who might have some form of cognitive impairment. What she uncovered was that cognitive impairment was less of a concern than physical impairment, which prevented the people in the community from caring for themselves. Even though she had gone with a religious purpose sponsored by the Church of God in Christ, Allen did have an opportunity to do research in an area of interest to her. Virtually all of the team’s time was spent in towns like Jinja, a town of approximately 70,000 people and a two and half hour’s drive from the capital, Kampala.
The team fully identified themselves with the Ugandans they sought to reach by sleeping in their huts and immersing themselves into the life and rhythm of the communities. “The people were hungry for knowledge more so than food, so I taught them, spending time with the women to help them develop a sense of community and even preached to them,” Allen says. “I was well received because, after my first visit to the hospital in Hoima, I was invited back by the hospital. So, I took what I had learned from the qualitative observations I had conducted and returned in 2012 as part of a team of 25 people and a fully developed plan, including a full curriculum for the nursing students.”
Allen’s plan included addressing the needs of adolescents, especially girls, who needed to hear that they were appreciated and acknowledged as persons of value. With the help of town officials, she recruited young girls and, using an interpreter, exposed exposed them to two days of instruction on self-esteem and self-pride.
She also worked on securing hospital supplies through Project C.U.R.E. (Commission on Urgent Relief and Equipment) in Phoenix, as well as surplus supplies from hospitals where she had worked in the past. These filled several crates that were presented to the hospital in Hoima.
Lastly, Allen sought to teach a two-day class to the nurses, but in the process she realized that the level of training the nurses had received was comparable to the training provided to nursing assistants in the United States. Her observations of the accommodations provided to the patients was comparable to those Smith observed in Kenya (e.g., patients were not segregated by medical condition in the wards).
“This was a life-changing experience for me,” says Allen. “I never imagined that this visit to the continent of Africa would affect me so much. It was a very emotional experience because the need is so great. I reaffirmed that my purpose in life is to help others.”