Tuesday, January 26, 2010

Care in a catastrophe

“Nothing in my life prepared me for what I saw,” says Debbie Abraham of Haiti’s earthquake destruction, seen here in a previous trip to Haiti, assisting an orthopedic patient.

When you land in a third world country to assist with nursing care, you might expect to be surprised here and there. You don’t expect a surprise of a 7.0 magnitude. That is what happened to Debbie Abraham, ’95 MSN, RN five hours after landing in Haiti on Tuesday, January 12, 2010 for what she thought would be another routine service trip to Hôpital Albert Schweitzer (HAS) in Deschappelles, 70 km north of the capital city of Port-au-Prince.

Abraham, a former critical care nurse and nurse educator in the Philadelphia region, resides in Havertown, Pa. with her husband and two children who are in college and high school. She recently returned to Villanova University College of Nursing to earn a post-master’s certificate as an adult nurse practitioner (NP)—she already held a master’s degree from the College in nursing education. Since finishing her preparation as an NP she has been readying for this trip to Haiti before studying for her NP certification exam and seeking a new NP position.

In 2002, Abraham learned of an opportunity to teach CPR to staff at HAS, which serves 300,000 impoverished people in the Artibonite Valley in central rural Haiti. Within days of her arrival seven years ago, she knew she would return. She has done so once or twice a year to do staff education on nursing and health issues as well as assist with patient care in the hospital and its more remote clinics. She is self-taught in Kreyol, the native language, but also uses a translator when teaching. This January trip was to be a two-week stay, involving more teaching and patient care, her first as a new advanced practice nurse. She did not know she would be delivering care and utilizing her fresh skills in the midst of the worst humanitarian crisis in recent memory in the poorest country of the western hemisphere.

Abraham first traveled to the house of friend Zulta, a midwife, in Tabarre, 10 minutes outside the capital, for a two-day visit. She describes the onset of the quake while standing in the kitchen talking about dinner, “I recall hearing a very loud boom, like an explosion, and then literally shaking…as the amplitude got worse, we got the kids and ran out.” Initially unsure of what was happening, she stood outside with her friend and her husband and two small children as people were running, screaming, looking to the sky and singing, praying or chanting. “It was chaotic,” she says. Miraculously, Zulta’s house did not collapse. Abraham became concerned, realizing she was far from family and essential services were wiped out, “The total isolation for me was pretty incredible.” The car radio was operational so they got confirmation from French radio that it was a significant earthquake. They lived through “tremendous aftershocks,” trying to sleep in the car for safety. It is estimated that the earthquake affected approximate three million people and that the dead will number in the hundreds of thousands.

At the request of another friend, Zulta and Abraham set out the following morning to deliver a few supplies from the home to a neighboring area, Delmar, a section of Port-au-Prince that was nearly razed. They brought gauze, sterile gloves, suture material, betadine, ampicillin, ibuprofen, Benadryl, and some food. “The first injury we saw was a partially amputated foot…then a spinal cord injury and a skull fracture,” notes Abraham. Not being equipped for the more serious cases, they began treating abrasions and other wounds, soon reprioritizing how to treat certain injuries and improvising with their quickly diminishing supplies, for instance using the paper from gauze packaging to wipe a wound instead of the gauze itself. After two hours they returned home. As she reflects on that experience, Abraham notes “In 30 years of nursing I never felt so helpless.”

On Thursday, Abraham saw firsthand the situation in Port-au-Prince as they sought members of Zulta’s family. “It was absolutely unbelievable to see the destruction of the buildings, people staking out areas to sleep, and thousands and thousands in the road, walking,” she recalls vividly, along with the odor from the countless dead bodies covered in the street. Later that day she made the long journey to HAS in Deschapelles as scheduled. Largely unscathed, the town had more operational services than the capital and she was able to make an Internet call to her husband following up on a simple one-way text message she sent from Zulta’s house earlier that said “I am ok.”

At HAS, Abraham again pulled on her NP knowledge and skills to triage patients for two days. While the hospital had more resources than most, she still had to be judicious in ordering x-rays and other tests. She would admit patients and write their orders, or prescribe needed medications and discharge them. She estimates 90% of the cases were orthopedic or trauma, especially among those who had arrived from Port-au-Prince. Essentially this was her “first day on the job” she notes, saying she felt confident in her assessment skills but still unsure about some of her decisions since she was unfamiliar with the paperwork and protocols. She did have physicians to call on for consultation, though stuck with her assessment of one woman whom she thought had a collapsed lung, a situation which can quickly become dire. The staff disagreed. Abraham’s suspicions were confirmed by a chest x-ray and the patient was treated appropriately.

Abraham discusses how nursing knowledge and education translate into various situations. “I certainly felt prepared as I had been given the appropriate information (at Villanova) to use; I used my physical assessment course, no doubt about it!” She acknowledges that setting priorities and assessing patients is part of all nursing. She delivered care and medications on the wards to about 150 people a day in her second week in Haiti though she fears she lost count. Abraham recalls it being difficult having people pull on the hem of her scrub pants for help as she stepped around them on the floor to get to someone else. “I went back to them,” she offers. She remains affected by the people “We can’t fathom their daily life…Despite the horrible living conditions and ineffective leadership in Haiti, to see the grace, dignity and resolve with which they live their lives is overwhelming….everyone had someone in their family who was dead.”

With her two weeks completed, Abraham was able to depart Haiti and fly home from the Dominican Republic. She has great respect for the endeavors of HAS and is acutely aware of their need for funding. This is why she tells her story even before getting much rest since her return to the United States just over 36 hours ago. “I felt conflicted about leaving,” she admits. Determined to return to HAS and Haiti, Abraham says firmly “It is my privilege to be able to work there and it will continue. This will not stop me.”

To learn more about Hôpital Albert Schweitzer and its critical needs, visit http://www.hashaiti.org/.

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