Day Two started out great; we got to the hospital and went on rounds with the doctors. I saw my friend Dimitry, who works on physical therapy with patients. Before I left last time, he asked if we could help get more training for him and his co-worker. The only training they have had has been intermittent through aid workers who come down. No one in our group is a PT. We were unable to find anyone to come down in the two months since our last trip but are hopeful that we will have some come with us in the future. (Note: if you are a physical therapist, or you know one, please leave a comment or contact us. We’d love to meet you!) In the meantime, I was able to find a text book for them. Dimitry beamed when I gave him the book. I also gave him a used phone that no one had any use for in the States and he was incredibly grateful. I think the text book cost me $4.00 US and the phone was free.
After rounds, we attempted to teach an ACLS class with the nurses because that was one of the topics in which they had expressed interest the last time we were here. We began with a few cases from the ACLS curriculum, but it quickly became apparent that there was some disconnect. They began asking questions about CPR; we had specifically chosen cases that did not involve CPR because we knew that it was rarely performed here. We decided to switch gears and give an impromptu CPR class because they had such specific questions.
After the class ended, we spoke with the director of the hospital. He explained that he did not believe the nurses were ready for ACLS, and that he thought the doctors might have trouble with it as well. The primary challenge is that the resources the director has found are in English, not French or Haitian. The director also explained that the nurses in Haiti did not receive training in EKGs like American nurses do, and that he thought ACLS would not be productive or useful for them. He wanted us to work with the nurses and doctors to help them find ways to work together as a team.
This was good news for us because we emphasize the team approach and know how to teach it very well. We decided to use cardiac arrest cases to show how teams work in the U.S. While they may approach cases differently in Haiti, the teamwork was the important part. We simulated a case to show how we organize personnel and how we communicate during a case. We explained the roles and how communication was short but effective. We emphasized how the doctor in the team leader role needs to stand back and oversee the case. We also emphasized proper communication. Initially, it was sort of like watching children playing soccer where everyone mobs the ball. There was a lot of giggling and arguing about how the best way to do things. However, they quickly got the hand of it and started to stay within their roles. The director watched the teams simulate a few cases and was happy with the progress.
It would be easy to become frustrated here with the curve balls that every day brings, but as long as you are willing to be flexible, you can teach here.