Bringing vital skills to operating rooms in Haiti

By Melissa King

	(Right to left) Zanmi Zante nurses Lydie Presnar, Jeanne Myrléne Astrémond Taveús, Marie Myrléne St. Vil Marius and Sanon Marie Mylande (in back) gather with Joyce Granara, RN, director of surgical services, before a laboratory session at Lawrence Memorial Hospital.

Every since she was a child growing up in Haiti, Marie Myrléne St. Vil Marius has wanted to dedicate her life “to people who have nothing and are in need.”

That commitment carried Marie through nursing school, and later, motivated her to leave the relative comfort of a hospital in the capital city to work at PIH’s partner organization Zanmi Lasante (ZL) in Haiti’s isolated and impoverished Central Plateau. Most recently, it brought Marie and three colleagues to Boston to receive formal training for operating room nurses that is not offered anywhere in Haiti.

In late June, she and Sanon Marie Mylande, Lydie Presnar and Jeanne Myrléne Astrémind Taveús became the first international students to complete the Introduction to Perioperative Nursing Course at Regis College in Weston, Massachusetts.

Known in Haiti as instrumantistes, perioperative nurses are critical members of the operating room team who prepare patients for surgery, maintain a sterile operating room environment and to monitor patients carefully during surgery.

Partners In Health and Regis College pooled resources to provide this formal training to the nurses, who will use their new skills to enhance patient care, to help review surgical equipment needs and to improve the flow of operating procedures at two ZL sites in Haiti – Cange and Belladère.

"Our hope is that the nurses will work with operating room teams to develop and implement updated standards of care,” said PIH Advocacy and Policy Director Donna Barry.

The beginning of an academic collaboration

In a country that only spends about US$2 per person on health care each year, limited resources present a challenge for health professionals like Marie who are providing health care to the nation’s poor.

This is compounded by the fact that their jobs are socially challenging. Marie and the other nurses report to work for 14 consecutive days, followed by a three-day weekend; they are home with their families only a few days per month. It is this kind of dedication that defines PIH staff and their commitment to solidarity with those living in impoverished settings.

In the autumn of 2007, PIH staff—together with Regis College's Dean of Nursing Toni Hays and faculty member Nancy Street—met with leaders of nursing schools in Cap-Haïtien and Port-au-Prince to learn how they could help improve education for nurses in Haiti. This was the formal beginning of what all institutions hope will be a long, fruitful partnership.

When Ophelia Dahl, PIH’s CEO, went to Haiti earlier this year, ZL’s chief surgeon mentioned that it would be very helpful if some nurses had specialized operating room training. Upon her return, she and Donna Barry met with Dr. Hays and mentioned this priority need.

Regis College stepped up to help fill the gap, offering to provide free tuition and housing if PIH could bring students from Haiti to Boston to take part in the perioperative nursing program, find clinical placements and cover the other costs. PIH took them up on the offer and found another willing collaborator in Boston Medical Center, where the nurses were paired with preceptors to take part in clinical observation.

The perioperative nursing program, which is now in its fifth year, provides registered nurses with a solid understanding of the theories, principles, skills and best practices of perioperative nursing. It is a collaboration among Regis College Nursing Program, Lawrence Memorial Hospital, Hallmark Health’s Center for Professional Development and several Boston-area hospitals.

From the classroom to the operating room

Marie eyed her “87.” An hour before class, she and the other Haitian nurses had already convened to go over their tests from the previous week.

While she had scored far above the mean, Marie reviewed each question carefully to see how her answers could have been better. “The [Haitian] students have been very motivated,” observed Laurie A. Hillson, RN, MSN, who developed the course. “They are always asking for more resources and information.”

	Zanmi Lasante nurse Sanon Marie Mylande lays out surgical toolsas colleague Jeanne Myrléne Astrémind Taveús and Joyce Granara, RN, director of surgical services, look on.

Hillson, who is the coordinator of continuing studies at Regis, said that the nurses were motivating the rest of the class, as well. “They are getting us to think more globally,” she said. “We are learning more about how much waste we have, and how we can better conserve.” Colleagues at Lawrence Memorial and its clinical affiliates are now collecting medical supplies to send to Haiti—materials like suction tubing and gowns that are unused and have not expired, but that they are required to dispose of if a surgery is canceled.

When the nurses were not in class at Regis College, they were either taking part in laboratory sessions at Lawrence Memorial Hospital, or in clinical observation at Boston Medical Center (BMC).

Unlike many of their fellow classmates, the nurses had seen some of the technologies at BMC only in books. Sanon said they were impressed not only by the sheer variety of tools, but by the fact that there are so many types of operating room nurses in the United States. “It is interesting to see that in nursing teams here, every person has a specific job and there are more people to provide the same care,” she said.

The nurses say they were also pleasantly surprised that some of the hospital staff they met in Boston are of Haitian decent. The irony is that Haitian nurses have long been part of the fabric of New England hospitals. There are currently more people from Haiti taking up residence in Boston than in Cap-Haïtien, Haiti’s second largest city.

The Road Ahead

Now that the nurses have completed the program, they face the added challenge of applying their skills and practices in a very different environment. As Lydie Presnar, one of the four nurses, pointed out, “In order to enable us to use all that we have learned here, we will need more materials and more resources than we currently have in Haiti.”

The nurses from Cange should soon have these, as PIH and ZL will be renovating a building that holds the two operating rooms at Hopital Bon Sauveur in Cange in the coming year. ZL is also hoping to raise funds to build a larger operating room, complete with more of the most modern equipment.

The success of Marie and her classmates is a good sign for the future of an academic collaboration that is creating a means for health professionals in Haiti to bring much-needed expertise and resources from Boston to patients in the Central Plateau.

Jeanne said that the nurses plan to continue collaborating, wherever the road ahead leads them. The prospect of helping those in need, she said, is well worth the bumpy two-hour stretch between Belladère and Cange that they will travel to meet each other every couple weeks.

PIH Note: Enormous thanks to our partners at Regis College, Lawrence Memorial Hospital, Boston Medical Center and all the individuals who worked on translation, transportation and other logistics. This was an amazing collaboration and shows how well institutions can work together to improve patients’ lives in far-away places.

[posted June 2008]