Four nurse educators went to Haiti after the 2012 earthquake to help rebuild the School of Nursing in Port-au-Prince.  They were alarmed by the low level of health care in Haiti.  Most people have no care, and those that do are treated by nurses who are not trained to do so.  This article details the steps the nurses went through to start a family nurse practitioner program in Haiti to address the need for primary care and discusses how they created the partnerships necessary to start such an innovative program at the University of Haiti

Roye, Carol, EdD, RN

Sonenberg, Andrea, PhD, WHNP, CNM-BC

English

DigitalCommons@Pace

Pace UniversityDigitalCommons@PaceWilson Center for Social Entrepreneurship Academic, Policy and Research Centers2017It Takes an Instigator, Vision and Passion,Promoting Health In Haiti: Developing aPartnership Between an Impoverished Nation andan NGO to Develop Advanced Practice NursingEducation, A Case StudyCarol Roye EdD, RNPace University, croye@pace.eduAndrea Sonenberg PhD, WHNP, CNM-BCPace University, asonenberg@pace.eduFollow this and additional works at: https://digitalcommons.pace.edu/wilsonPart of the Business Administration, Management, and Operations Commons, Entrepreneurialand Small Business Operations Commons, Other Medicine and Health Sciences Commons, OtherPublic Health Commons, Public Health Education and Promotion Commons, and the Women'sHealth CommonsThis Article is brought to you for free and open access by the Academic, Policy and Research Centers at DigitalCommons@Pace. It has been acceptedfor inclusion in Wilson Center for Social Entrepreneurship by an authorized administrator of DigitalCommons@Pace. For more information, pleasecontact rracelis@pace.edu.Recommended CitationRoye, Carol EdD, RN and Sonenberg, Andrea PhD, WHNP, CNM-BC, "It Takes an Instigator, Vision and Passion, Promoting HealthIn Haiti: Developing a Partnership Between an Impoverished Nation and an NGO to Develop Advanced Practice Nursing Education,A Case Study" (2017). Wilson Center for Social Entrepreneurship. 36.https://digitalcommons.pace.edu/wilson/361  It Takes an Instigator, Vision and Passion Promoting Health In Haiti:  Developing a Partnership Between an Impoverished Nation and an NGO to Develop Advanced Practice Nursing Education, A Case Study   PI:  Carol Roye, EdD, RN, Professor and Associate Dean, College of Health Professions, Lienhard School of Nursing  This project was an investigation examining how a small non-profit organization, Promoting Health in Haiti (PHH),  founded by a group of nurse faculty after the catastrophic Haitian earthquake on January 12, 2010,  established partnerships with key entities in Haiti and created a sea of change in nursing education.  However, the barriers faced by the investigator in completing this case study exemplify the difficulties of working in a resource-poor country with a fragile government and enormous health needs.  During the course of this project Haiti’s government essentially fell apart.  The President’s term ran out without an election.  There were riots in the streets and demands for an election.   Presidential elections were held in Haiti on 25 October 2015.  The incumbent, President Michel Martelly was barred by the constitution from running.  No candidate received a majority so a runoff was scheduled.  However, for various reasons – largely having to do with rioting and violence, it was postponed indefinitely.  This left the country without a functioning government.  The Senate appointed an interim president.  As of this writing, there is still no permanent government.  There are riots in many areas.    Our organization, Promoting Health In Haiti (PHH) is concerned. We have Memoranda of Understanding (MOU) with the Ministry of Health (MSPP) and the University of Haiti (UEH) establishing the role of the family nurse practitioner (FNP) in Haiti.  However, the signatories of those MOUs are no longer in the government.  Whether and how that will affect our students’ ability to work as FNPs when they graduate is yet to be seen.  This situation has had an influence on this project.  First, when the interim President was appointed he dismissed many key government officials including the Minister of Health and others, with whom we had a working relationship.  New cabinet members were appointed, but they are likely to be temporary as well, and will be replaced if and when a new President is elected.    Furthermore, students staged a months-long sit-in to keep the Recteur (Chancellor) of the University of Haiti (UEH) out of his office.  During the disorder, the Recteur’s term ran out.  After many months, a new Recteur was elected; the man who had been the Assistant to the Recteur.  Still, however, it appears that the Recteur does not have access to his limited funds or to his office. 2   This project was undertaken despite this environment.  However, we were not able to interview everyone we had hoped to.  Haiti Nursing Foundation One question we wanted to answer is:  What are the factors involved in making change in a resource poor country?  How do effective programs gestate and develop?  What is the genesis of successful programs?  To answer this question, we interviewed Marcia Lane, the CEO of the Haiti Nursing Foundation (HNF).  Their school, Faculte des Science Infirmieres de Leogane (FSIL) is the site where PHH taught its first cohort of students.  The HNF was founded in 2005.  The impetus was the recognition by a Haitian Doctor, at Hospital St Croix in the Haitian town of Leogane, who recognized the need for a nursing school.*   Members of the Ann Arbor (MI) Presbyterian Church became involved, and a nurse who had recently retired from the University of Michigan was asked to lead this effort.  This leader was firm that she wanted the school to offer a Baccalaureate degree in nursing.  Nursing education in Haiti was (and remains) primarily at the Diploma level.  With the help of the funding orgaizations, the school was built.  The members of HNF identified a Haitian-American nurse who did not  have a history in academia, but had a strong background in clinical nursing.  She became (and remains) the Dean of the school.  The HNF attributes their success to the vision and passion of their founder.   Barriers :  However, when asked about barriers to the founding of HNF – the three top responses were :  money, money, money.  The original donations which allowed the building of the school were only for the building.  There were no operational funds, no money for such academic needs as qualified faculty.    _____  * It bears mentioning that there are many, many nursing schools in Haiti.  They are not accredited, and essentially anybody (whether or not they are nurses) can open one.  However, the doctor’s request here was for a rigorous nursing school.      Facilitators :  Facilitators for developing a nursing school in Haiti include the lack of regulation.  While this is a detriment overall, it did allow the HNF Board to do what they wanted to establish 3  the school.  They gathered together American and Haitian American nursing faculty – people with talent and passion, in order to get a critical mass to support the students’ education.    Moreover, HNF believes it would not have been successful without deep roots in the church, which enabled them to raise tens of thousands of dollars.  Suggestions to improve the function of non-governmental organizations (NGOs) in the future include :    1)  Stop the silos.  There is no coordination of NGO activities in Haiti.  Therefore there is a lot of duplication.  Organizations should collaborate, and share administrative activities and costs.  This is especially true for organizations that work in the same general area – in our case that is health.  Ideally, there could be an official office that helps NGOs collaborate in the various civic areas, including santitation, water safety, health etc.  The admonition to « stop the silos » was foundational to the success of PHH.  Early in its development, PHH hosted a conference in April 2011, and invited fifteen Haitian nurse leaders and physicians to New York City to join over 50 representatives of North American schools of nursing.  The conference served as a starting point to begin serious, detailed, collaborative discussions about enhancing nursing education in Haiti. To this day, PHH is collaborating with Regis College’s Haiti Program, the leaders of which they met at the conference.  PHH and Regis offer core Master’s Degree courses together.  The Director of the Regis program notes that a key to success is collaboration with Haitian colleagues.  While it can be somewhat daunting to overcome cultural differences, both PHH and Regis have been successful at collaborating with Haitian colleagues in academia and the government to pursue their goals.  Interviews With Haitian Officials  Several of the officials whom we intended to interview lost their jobs in the government chaos.  We were, therefore, unable to interview them.  However, officials who kept their jobs did respond to email queries.  These include Irma Bois, The Director of Nursing at the Ministry of Health (MSPP) and Nelson Sylvestre, the Director of Graduate Programs at UEH.  Mrs.Irma Bois, the Director of Nursing at the Ministry of Health told us, first and foremost that she is very grateful for the program.  From her perspective, it was not difficult to get the program started, in conjunction with the University of Haiti (UEH).  She has long understood the need for the program.  However, despite that, she acknowledged that it took PHH 5 years to implement the program in the public sector, owing to “red tape”.   4   According to Mrs. Bois, the program “reaches and responds to our needs in training for our nursing executives...”   She recognizes that “this program fills a void that has plagued our system for the training of our nurses .... this is a program that is essential to the advancement of Nursing in Haiti and to the improvement of services offered to the population Haitian ...”  She considers it a “vital program, essential for any health system.”   Professor Nelson Sylvestre, the Director of Graduate Programs at UEH pointed to a key concern, one which few people have alluded to.  Admitting that UEH was very slow in formalizing the relationship between PHH and UEH, he  attributed the delay as follows: “there have been difficulties  on the stigmatizing perception that people in general and the  health professionals (doctors, even teachers and leaders training in Medicine) have of nursing: a training which should be only 1 cycle!”  He means that there is a belief that nurses do not need graduate (or even baccalaureate) education.  It should be mentioned that Professor Sylvestre was educated outside of Haiti, which may account for his more enlightened view of nursing.  Professor Sylvestre pointed out an unanticipated benefit of the FNP program, saying that,  “An interesting advantage is the improvement of the Bachelor (Licence) training given to the nurses in Haiti, and mostly the care given to the patients by the graduates in a more organized and sustained way. We hope that many situations that were be hard to deal with will now be handled with more ease.”   He stressed that programs of this kind must be “in partnership with the structures and institutions (public in particular), but on the basis of an independent, automatic, academic and administrative management engaging, of course, an academic and administrative staff on site and budgeted a project which is separate from its management by a national institution.               He continued, saying that these programs should be in partnership with existing structures and institutions (public in particular), and should have an independent automatic academic and administrative management, engaging of course an academic and administrative staff on site and budgeted as a separate project to the management by a national institution.  Lessons Learned  Although we were not able to interview everyone we had originally hoped to speak with, several themes emerged, as we worked to understand barriers and facilitators of efforts to improve life in a developing nation: 5  1)  Collaboration with Haitian officials, from the beginning, was critical.  The idea of collaboration and partnership is key to success for many reasons.  First, we acknowledge and respect Haitian professionals, who live and work in Haiti. Although, none of our Haitian colleagues mentioned this specifically, we can certainly understand that it must feel very demeaning for Haitian professionals, administrators and academics to have outside “experts” come in and tell them what they need.  Secondly, who knows better what the needs are – in terms of health care, education, water, sanitation and other infrastructure needs than the Haitians who are living with and addressing the problems.   Moreover, there is also a sense among some Haitians that foreigners rush in during a crisis; but do not return.  Yolande Nazaire, who was  Dean of the National School of Nursing in Port-au-Prince when the earthquake occurred, told us on our first trip 5 months after the earthquake,  that people who come to help, do not come back.  PHH pledged to remain, and we have done so.  That brings us credibility in the eyes of Haitians. 2)  Collaboration among organizations – both foreign and Haitian is also critical.  Clearly, the conference that PHH held in New York, in April 2011 was key to the success of the FNP program.  By bringing together Haitian nursing and Ministry of Health leaders, with American and Canadian Schools of Nursing that were working in, or had an interest in Haiti, we were able to establish key relationships.  The outcome of that conference was the commitment to work towards two goals:  1) Baccalaureate nursing education as an entry level requirement to the profession of nursing; and 2) the need to educate Family Nurse Practitioners for Haiti to meet the huge, unmet need for health care.  As happens, many of the North American schools who attended the conference did not follow up afterwards.  However, Regis College and PHH did persist in working together.  Regis educates nurses at the Master’s degree level to become nurse leaders and educators.  PHH educates FNPs at the Master’s degree level.  Today, Regis and PHH share core Master’s courses, with some courses taught by Regis faculty and some by PHH faculty. 3)  Persistence.  The narratives speak to the difficulty of getting things done in Haiti.  It would be so easy to just give up.  However, the steely determination to continue, despite the difficulties, is what makes the FNP program a success.     

It Takes an Instigator, Vision and Passion, Promoting Health In Haiti:  Developing a Partnership Between an Impoverished Nation and an NGO to Develop Advanced Practice Nursing Education, A Case Study

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It Takes an Instigator, Vision and Passion, Promoting Health In Haiti: Developing a Partnership Between an Impoverished Nation and an NGO to Develop Advanced Practice Nursing Education, A Case Study

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