Severely malnourished, flaccid, and crying weakly, the 15-month-old was barely responsive when his mother carried him into the Port-au-Prince clinic’s triage section where Kelly Williamson met them. Williamson ’16 immediately sensed the urgency of the child’s condition, and ushered the boy and his mother to Sharon Byrne for further evaluation.
“As soon as they walked in, I knew that this was not a good situation,” says Byrne, an assistant professor of nursing and certified nurse practitioner. The boy, Thomas, hadn’t eaten or breastfed for at least a month, and ensuing muscle weakness left him unable to walk. He was having trouble breathing; a wound on his leg had gone untreated, allowing an infection to set in.
It had taken his mother, Marie, four hours to walk to the free, pop-up clinic that day.
“I would classify him as ‘failure to thrive,’” says Byrne. “We had to transport the baby to the emergency room or he wasn’t going to make it. He’s lucky he made it that far.”
Since Haitian ERs require up-front payment before medical staff will provide treatment, Byrne handed over $95 she had on her, then stayed with Marie and Thomas while another TCNJ volunteer bought IV fluids and medication from a nearby pharmacy. “I’d equate the ER there to a dirty utility room in the U.S.,” says Byrne. “The bed the baby was on was an old OB-GYN table, missing its legs and drawers.”
Byrne, Williamson, and six others from TCNJ were in Port-au-Prince in January to volunteer at a clinic run by the Haitian American Caucus, which opens every few months and relies on staffing from a rotation of aid groups. Over the course of five days, the students treated more than 650 patients—triaging, taking vital signs, performing assessments, and maintaining a pharmacy area to fill prescriptions.
“As we were triaging some of the kids, they would say, ‘Oh, my stomach hurts, it has been hurting for a couple of weeks now,’” says Kimberly Hackshaw ’17. “And I would ask them, ‘When was the last time you ate? Are you eating? Are you drinking water?’ The kids would tell us that the meal they have at school was their only meal for the day.”
Though she considers herself a global health “newbie,” Byrne has made five trips to the western half of Hispaniola to volunteer as a health-care provider with Explorers Sans Frontières, a Philadelphia-based NGO. On this most recent one, she brought undergraduate students from her Nursing in Global Health class. Byrne designed the course so that students would gain experience in delivering care in a resource-poor community abroad, while also developing cultural competency—crucial skills for anyone working in medicine today, she says.
“Providers have to be aware of the beliefs, values, and languages of their host community and show respect for cultural differences,” says Byrne.
In that Port-au-Prince hospital, Byrne found the complete lack of communication between nurses and their patients striking. At home and even in the mobile clinic, Byrne says she has the freedom to “assess, diagnose, prescribe, and provide a full treatment plan for my patients.” But in Haiti, she learned, physicians handle all patient interaction inside the hospital, while nurses are essentially relegated to the sideline. After Byrne brought Thomas into the ER that day, the RN on duty immediately took the boy’s vital signs, then waited for a physician to arrive and give her orders to conduct a full assessment.
“It was very frustrating,” says Byrne, “and was compounded by what I perceived as a lack of therapeutic communication of any sort on the part of the provider or nurse with the child’s mother.”
Byrne stayed with Marie and Thomas throughout the ER ordeal, and checked back with the family later in the week before returning to the U.S. says Byrne.
Ultimately, the triage evaluation and intervention performed by TCNJ’s cohort at the mobile clinic was a life-saving one. Explorers Sans Frontières wired funds to pay the rest of Thomas’ bills for his three-day stay in the hospital. He was then transferred to a Catholic children’s hospital on a charity basis. Says Byrne, “He continues to receive treatment and grow stronger every day.”
—Emily W. Dodd ’03, with additional reporting by Mary Jo Patterson and Tony Marchetti ’96, MA ’02