Partnership in Port Au Prince

The chaotic noise was replaced by that of children playing, songs slipping from classroom windows and the busy hum of lunch being prepared. This was the vision of Miquette Denie McMahon ’06 made real – a place where education is changing the course of poor health and poverty in her community.

In 2007, nursing graduate McMahon founded the nonprofit organization TeacHaiti to educate Haitian children. Unlike the free public education offered in the U.S., Haitian families must pay for their children’s schooling, which is often not possible. In response to dismal literacy rates and the destruction from the 2010 earthquake, McMahon raised funds in the U.S. to open a school and primary care clinic in Port-au-Prince, along with a second school in her hometown of SaintMichel. McMahon received the 2016 Sent Forth Award for her transformative work and shared her story at Commencement in May 2017.

Seeking multidisciplinary study abroad opportunities for students, Dr. Per Anderson, associate dean for global learning, traveled to Haiti with nursing faculty Dr. Jean Bokinskie and Dr. Polly Kloster in August 2017 to conduct a risk management assessment. During the visit, McMahon, a former advisee of Kloster’s, expressed TeacHaiti’s desire for child health education on basic hygiene and communicable diseases, along with classroom French language instruction.

In a serendipitous encounter at the compound where they stayed, the Concordia group met Marion Nonglaton, country director for Pure Water for the World in Haiti, which sets up water biofiltration systems and educates residents on waterborne diseases in rural villages. Amid discussing related goals, a partnership began.

Upon return to Minnesota, Kloster enlisted Dr. Gay Rawson, professor of French. The two had traveled together since 2004 – primarily in Vietnam and Cambodia (also Francophone countries), where they facilitated dental and eye exams and health education programs. In light of meeting Nonglaton and an opportunity closer to the U.S., they envisioned students teaching infection control and general health in the same rural Haitian communities where Pure Water provides access to safe drinking water and prevention of waterborne diseases.

“Whatever we were going to do in Haiti, it was going to involve service, which is not to say that we would go in and do for but would go and do with them.” – Dr. Polly Kloster

“It’s not to rescue; it’s standing and working together, helping us understand what’s going on with their culture.”

Kloster and Rawson launched an independent study in spring 2018 with students in the French and nursing programs. Their students developed education modules on health topics requested by TeacHaiti and Pure Water and outlined the time, equipment and staff needed to teach them. They also made isolation precaution signage, translated into French, for their facilities. They developed culturally and age-appropriate curriculum on handwashing, oral and body hygiene, and practiced their lessons with preschoolers at Cobber Kids.

In May 2018, 12 French and nursing students went to Haiti with Kloster, Bokinskie and Rawson to pilot their education program. Using donated materials they brought with (such as a giant toothbrush and model of a mouth), nursing students demonstrated health practices to children and taught hygiene-related games and songs while French students interpreted. Glitter was used in the hand-washing demonstrations as a visual cue of dirt removal and Pure Water for the World staff observed, offering tips on the teaching method.

Meanwhile, Kloster and her students administered immunizations and took vitals at the TeacHaiti clinic where McMahon’s brother, Dr. Isaac Denie, serves as the primary care physician. Brought in by families and nearby orphanages, the young patients were able to establish health records for the first time with the international director of health in Haiti. Sarah Quatier ’18 also provided instructions for CPR and first aid to healthcare providers, using manikins brought from the U.S. and left with TeacHaiti.

“CPR is not widely taught in Haiti or a common skill, so it was interesting to teach a group that was starting with minimal knowledge on the subject,” Quatier says. “It’s rewarding to know that this session has the potential to make a real, lasting impact. The French students gave me firsthand experience in working alongside interpreters, which we use frequently in our Fargo hospital and are an incredibly valuable resource in connecting with people and sharing information.”

Experiences like this opened up questions for the participants: In the U.S., you initiate certain steps until help arrives, but what happens when you are the help – when one ambulance pushes through streets where it’s not a law to make room and arrives only for those who have insurance? What are the ethics involved in care without a defibrillator and advanced life support?

Each night, the Concordia group discussed such questions and kept reflective journals. They learned that their sessions needed adjustments, whether to minimize the water used in hand-washing or to choose a quieter setting than the crowded outdoor area where more Haitian students than they had designed the curriculum for wanted to participate. They also realized they had no trouble communicating with Creole speakers, who understood French when heard but some of whom couldn’t read and write it.

These cultural dimensions added richness and complexity to the team’s efforts. Samantha Smallarz ’19 was thankful for the opportunity to do hands-on work in her field of study and see an immediate impact.

“We tackled obstacles such as limited vocabulary, lack of supplies and short-notice plan changes,” she says. “It was powerful to see our own strengths come together as we overcame language barriers to provide healthcare, education and comradery for the people we worked with.”

The most poignant experiences for the Concordia students involved visiting a market, chapel service and metalworking factory. They shopped with three families of different economic levels, watching as they made choices between coal or food, water or household supplies.

“We didn’t just witness Haitian faith and love but were part of that journey,” Rawson says of attending chapel. “In an open-air structure with no walls, we felt more welcome than we ever have at church.”

The same week, the group walked through a metalworking factory that sells cut oil drums at an art shop in McMahon’s school. Among immense piles of dirt and garbage, shards of glass and metal, tangled extension cords and wandering roosters, barefoot men without protective eyewear cut metal while watching a TV strapped to a tree with bungee cords. When asked to identify visible health hazards, Concordia students suggested proper equipment, but Kloster reminded them that basic needs take precedence over a healthy work environment. After all, why would one care about safety methods or environmental impact when food and water are immediate concerns?

Questions like these stirred in their minds as they returned to campus and began dictating the plan for the academic year. Students in Rawson’s Caribbean/South America perspectives course and Kloster’s Community Health Nursing global perspectives course are preparing to conduct focus groups in Haiti. Instead of developing new curriculum, they are focusing on the significance of Haitian health issues and what can be done to address them. Though in separate classes, the French and nursing students meet regularly and convened for a global health forum at the end of fall semester.

Students will go to Haiti in May 2019 to conduct focus groups, screen Haitians for high blood pressure and diabetes, reteach CPR, conduct more nutrition and health checks, and host a World Hand Hygiene Day with Pure Water for the World at McMahon’s school. Pure Water will offer a course on menstrual health to more than 200 female students at no charge to TeacHaiti in exchange for translated health educational materials created by Concordia students. At the close of World Hand Hygiene Day, Haitian students will come up with a skit, a popular recreation in Haitian culture, to demonstrate their understanding of the objectives.

Kloster and Rawson want their students to see the big picture of public health both in Haiti and the U.S. – to assess the existing problems, the policies in place to deal with them, and the laws that ensure the policies are met and enforced for the greater good.

“We know that we can’t pick up what we do here and put it in their environment,” Kloster says. “Our nursing students know that patients’ inability to follow recommendations is not noncompliance on their part but our own noncompliance as healthcare providers for not understanding their understanding of the issue – that’s the starting point. It’s always about empowering the person.”

^{Published January 2019}