Pictured above right is Bette J. Gebrian, UConn School of Nursing Lecturer and Primary Health Coordinator of The Haitian Health Foundation.
Haitian Relief – If you didn’t know about the School of Nursing’s involvement with the Haitian Health Foundation (HHF) please read on…
Dr. Bette Gebrian ’77 (Nursing), ’93 (Medical Anthropology), is a lecturer at the SON and the Primary Health Coordinator at HHF.
For many years, she has hosted nursing, medical, dental and public health students/residents from UConn. Recipient of a Global Health Award (for Expert on Maternal and Child Health in Haiti – Best Practices in Global Health 2008), Bette continues to receive recognition from the World Health Organization and others in the global health community for her clinical research and outreach programs.
Dr. Gebrian was the recipient of the 2008 Global Health Award for Expert on Maternal and Child Health in Haiti – Best Practices in Global Health. [view pdf]
Making Haiti a Healthier Nation:
Public Health Outreach Program of the Haitian Health Foundation Recognized for Best Practices by GHO
The Haitian Health Foundation, Inc. (HHF), began as a volunteer effort of health professionals and has grown into an outpatient health care facility supported by a nondenominational foundation based in Norwich, CT. In 1985, HHF moved its outreach to Jeremie, in rural southern Haiti, based on a suggestion of Mother Teresa of Calcutta. Mother Teresa’s idea to bring health care, hope, and opportunity to this especially poor and remote area resulted in HHF’s mission and the delivery of service to over 200,000 (total population 600,000) of the poorest people in Haiti (percapita income $325 with an unemployment rate of 70%).
With funding by USAID/Haiti in 1989, the Public Health Outreach Program of HHF began child survival activities. All Outreach Program staff are Haitian except Dr. Bette Gebrian ’77 (UConn Nursing), ’93 (Medical Anthropology), Primary Health Care Coordinator. Dr. Gebrian, faculty member at the School of Nursing since 1983, has resided in Haiti for the last thirteen years and is dedicated to her work serving the mission of HHF. Dr. Gebrian and Dr. Jeremiah J. Lowney, Jr. ’86 (Public Health), HHF’s founder and President, have received recognition in Connecticut and beyond for their work with HHF. Both alumni feel fortunate that their passion to serve HHF has attracted other alumni and friends to enthusiastically volunteer and support the organization.
Outreach Program and Clinic
Serving as the major outpatient health care facility for the area, HHF places emphasis on preventive, prenatal and pediatric care, provision of health education, and immunizations. The “Klinik Pep Bondye-a”, HHF’s clinic and headquarters, also provides nutritional, dental, medical (including the only eye care for 100 miles) and emergency services. Daily, health care to 350-400 patients is provided using mostly donated equipment and supplies. The 27,000 square foot clinic is outfitted with a pharmacy, clinical laboratory, dental operatory, medical examination suites, outpatient surgical suite, medical laboratory, medical and dental radiology equipment, and sonogram. The Outreach Program utilizes resident village health agents who receive technical supervision from medical staff to provide preventive and basic health care. Dr. Gebrian and the HHF medical director, Dr. Royneld Bourdeau, have trained health agents, who on average have a seventh-grade education, in nonformal teaching and community participation approaches. Health agents, nominated for the position by a group of village leaders, are currently employed in 104 villages surrounding Jeremie and are extraordinary in their commitment to serve their communities.Agents see measurable declines in morbidity and mortality and the appreciation of their communities. They participate in continuing education and enjoy a healthy sense of inter-agent competition. They enjoy feedback they receive on their performance. Due to the effectiveness of Dr. Gebrian, her Haitian staff, and Dr. Royneld Bourdeau, each project launched – including acute respiratory infection, vaccination campaigns, and exclusive breastfeeding – has succeeded beyond expectation.
Since a new respiratory intervention was added, the health agents’ work has become more demanding, since agents can be called on to diagnose acute respiratory infection at their homes any day of the year. Agents may keep children in their homes for observation if the child lives far away and has been diagnosed with severe diarrhea or pneumonia. On occasion, agents have walked hours to transfer vaccines when vaccine refrigerators broke down. During several periods of HHF lay-offs, agents have worked without pay until they could be re-hired.
Many believe that the demand for curative care precedes that for preventive care, but HHF has shown that a demand for preventive care can emerge where none previously existed.
In 1993, HHF trained the health agents using the World Health Organization algorithm for Acute Respiratory Infection (ARI) diagnosis and treatment, and began computerizing data from case record forms. Dr. Gebrian’s commitment to computerizing programmatic information and allowing others to analyze these data has set an example for all who work in global health. During the first five years of the ARI intervention, Dr. Gebrian personally reviewed each case record form and entered the data into a database. As a result, she now has a high quality database containing data from more than 17,000 cases which have been used for evaluation and research purposes.
In 1990, the World Health Organization selected HHF as one of four sites for a focused ethnographic study examining the cultural perceptions and health-seeking behaviors related to pneumonia. A significant finding was that few mothers were able to recognize rapid breathing, the key diagnostic sign for diagnosing pneumonia. In 1995, Anne Pope ’96 (Public Health), analyzed 1994 data and produced a descriptive analysis, including an analysis of multiple cases of pneumonia in the same child. The ARI intervention was evaluated by two CDC epidemiologists in late 1997, who estimated that the pneumonia-specific mortality rate in children under five had been reduced by 50%.
In 1998, a World Health Organization epidemiologist returned to Haiti to conduct a case-control study of children who had three or more diagnoses of pneumonia before the age of five. Tremendous logistical challenges were overcome to bring affected families to Jeremie for a chest x-ray and to bring both cases and controls to one of the vehicle-accessible meeting points for interview and physical exam. Although HHF received funds to pay some expenses, no funds were provided to cover the numerous labor hours contributed by HHF staff to this study. Researchers found that the only statistically significant factor predicting recurrent pneumonia was a history of wheezing. Thus, they learned that asthma may be an important contributor to recurrent pneumonia and/or may be misclassified as pneumonia by the WHO criteria.
Lasting Impact on Nursing Graduate Students: Work and Life Changed Forever
June McClure ’97, ’99, Cathy Narcavage-Bradley ’99, and Juliette Shellman ’99, were master’s students in UConn’s Community Health Nursing program when they went to Haiti with Dr. Gebrian. Juliette Shellman, a former clinical faculty member and doctoral student at the School of Nursing, says her primary reason for going to Haiti was “to gain international community health experience with Dr. Gebrian.” During her visit Juliette conducted a qualitative study of reminiscence experience with Haitian elders to determine common characteristics of Haitians’ experiences of attaining old age. Common themes emerged and Juliette has presented her findings at ENRS and the Transcultural Nursing Society’s Annual Conference. Juliette’s current grant, funded by the American Nurses Foundation, is a direct result of her Haiti experience. She intends to use reminiscence with African American elders to compare and contrast themes from both populations. “The most profound part of the experience was talking with the elders and hearing their stories. While themes were similar to those of American white elders, the Haitian themes were powerful and moving because of the poverty and destitution that surround the lives of the Haitian elders.” Juliette was struck by how at peace the Haitians were with themselves and says, “the people of Haiti and their stories made my research experience remarkable.”
June McClure ’97, ’99, Clinical Nurse Specialist, is working with HHF on her fourth and most extensive trip to Haiti to help make a privately funded Maternal Waiting Home a reality. June was prompted to return to HHF because “despite all the tremendous health projects and improvements in child survival, the maternal mortality rate remained very high.” The new Maternal Waiting Home, the outcome of a study using the Safe Motherhood Framework, will build upon the strong foundation of prenatal care and education that HHF delivers. June says, “because many pregnant women with identified high risks live in the remote mountainous area, frequently 2-14 hours walking distance from vital services, many die unnecessarily.” The Maternal Waiting Home will provide a facility adjacent to the hospital for at-risk pregnant women not only to live, but to receive education and health training for the 2-3 weeks prior to delivery. One of the strongest elements of HHF’s success is the trust and spirit of community participation that has developed. During focus group sessions, community members not only identified problems when at-risk women leave the village, but also agreed to work together to resolve key issues such as providing temporary care for children left behind. June says, “I encourage more students, alumni, and individuals involved with the School of Nursing to come to Haiti and experience the possibilities of such an effective participatory community model.”
June remarked that although the interdisciplinary pieces are necessary, “community health projects need nurses, like Dr. Gebrian, who, with both passion and a practical focus, drive almost impossible challenges into a caring, life-giving reality.”
In addition to serving on faculty of the School of Nursing since 1983, over the last 12 years Dr. Gebrian has collaborated with UConn School of Medicine, department of Community Medicine, and with Dr. Judy Lewis to provide educational experiences for students. More than 30 students have received academic credit in Medicine, Anthropology, Public Health and Nursing. Gebrian has a long history of providing educational experiences to students and invites nursing alumni and all students to visit her and HHF in Haiti. Currently, Gebrian is exploring a collaborative relationship with UConn’s Department of Medical Geography in Storrs to map the health care services HHF is providing in remote villages.
Donors and Volunteers
HHF relies heavily on the generosity of donors and the many volunteers who donate their time and talents. Volunteers travel to Jeremie, at their own expense, from America, Canada, and Europe. They include health care providers, electricians, plumbers, teachers, clergy, and students. The Klinik Pep Bondye-a houses up to 20 full-time and visiting volunteers and a 3-bedroom hospitality house serves long-term volunteers.
Margaret Sweetland Patricelli, a former member of the UConn School of Nursing Advisory Board, was so inspired she has been to Jeremie twice since 1998 as a volunteer.
“It is a life-changing ‘count your blessings’ experience. Seeing is believing,” says Patricelli. “HHF’s public health, outreach, and education programs are run very cost effectively. Its computerized health education system is one of the best in the world. Each year more village health agents become (and stay!) involved in HHF’s education programs. The work they do in their own communities is producing measurable and lasting improvements in their families’ and neighbors’ health status.”
HAITIAN HEALTH FOUNDATION, NORWICH
501(c)(3) – Tax Exempt Organization
Contact Person: Marilyn Lowney
97 Sherman Street
Norwich, CT 06360
phone (860) 886-4357
For more information via email from Haiti
contact Bette Gebrian (509) 284-5242
Nursing in Honduras Program
In the summer of 2000, Dr. Arthur Engler spent a month working in a small village on the north coast of Honduras. Sponsored by the Episcopal Diocese of Honduras, village people and volunteers rebuilt the village destroyed by Hurricane Mitch in November ‘98.
As the result of poor health care and sanitation, villagers suffer from many chronic and acute health problems. Engler treated many skin infections in children, advised mothers on breastfeeding, and administered parasite medications to 40 children.
The College of Continuing Studies and the School of Nursing were pleased to offer Community Nursing in Honduras, in the summer of 2001.
Integrating clinical experience with an enhanced sense of cultural awareness, this program was open to qualified UConn School of Nursing students, nursing students from other colleges and universities, and practicing nurses seeking to expand their knowledge of health care practices in an international setting. Students earned four academic credits; CEUs were available for practicing nurses. The four-week summer session was directed by Professor Engler, who accompanied the group.
- 66% of children under six months of age were exclusively breastfed. (In comparison, the 1994/5 DHS survey found that nationally only 0.6% of children 4-6 months of age were exclusively breastfed).
- 98% of children aged 9-59 months had the level of measles vaccination appropriate for their age and 85% had all immunizations complete for age.
- 72% of children were weighed twice or more and in 90% of cases where a child had weight loss the caretaker received appropriate counseling.
- 82% of pregnant women received three or more prenatal visits.
- Construction on a donated 5-acre site near the clinic and the local government hospital.
- The Kwash Center, 12-15 bed inpatient facility, to treat children with deadly Kwashiorkor – severe malnutrition.
- The Lying In Center (Maternal Waiting Home), an inpatient facility for 12-15 high-risk pregnant women.
- A Food Distribution Pavilion, used to store and distribute food to over 2,500 children and prenatal women 3 times per week, and to deliver nutrition and preventive health care education. $300 can feed a child for one year.
Over 1,000 Haitian families matched with individual sponsors who donate $25.00 per month for their needs, are provided with shelter, food, education, and “cottage” self-supporting businesses. (This entirely volunteer-driven program allows 100% of donations to support a family.)
Visiting volunteer physicians and dentists:
Offering specialized treatment to patients with the latest procedures and technology. Over 125 patients with cleft lip/palate were treated through our liaison with the University of Connecticut Health Center and maxillofacial surgeons from New England.
Adopt a Health Agent:
Over 200,000 people receive care for about $3 per person per year because of the Health Agent program. There are villages that do not have agents and others that share an agent with a neighboring village. Each agent provides health care to 2,000-3,000 people. Your gift will provide a trained Health Agent for a village that is now lacking health services.
For over eight years HHF has provided access to school (1,250 students presently attend) because education is neither free nor mandatory in Haiti. Save-a-Family Program pays for tuition, books, uniforms, and shoes which prevent a source of malnutrition by reducing parasites’ entrance into children’s bodies.
Latrine Building Program:
Building latrines encourages sanitation helping to curtail the spread of disease related to lack of proper waste disposal. To date, over 800 latrines have been built in Jeremie and surrounding villages. With a gift of $175 more latrines can be built to continue the advancement in proper waste disposal.
Recipients participate in building houses to replace small, rickety shacks of cardboard, tin, and straw. Since 1997, over 130 “Happy Houses” (made of concrete, tin roof, doors, and windows) have been built or renovated for approximately $500 each. Donated by benefactors at $5,000 each, 5 duplex houses were also built for the use of the elderly, orphaned, and destitute. •Adopt a Village: The villagers are committed to self-help, cooperation and hardwork for the health of the residents. Mothers, Fathers, and Youth groups have been created, Community Banks begun, Haitian volunteers organize Health Fairs and build roads for visitors to have more easy access. A $5,000 gift can help to support their needs.
The Creole Pig Replacement Program:
Reintroduction of over 7,500 Creole sows, a historic staple of the peasant economy, destroyed by a Swine Flu epidemic in the ‘80s.
Layer Hen Project:
Distributing layer hens provides means of support and nourishment to local families.
Purchase and distribution of 1,000 goats to rural families. Each goat (cost $150 – including delivery, labor, feed, immunization) is bred, bartered, milked, or used as a source of animal protein for people on meager diets.
Peace Corps volunteers:
In 1998, 2 full-time volunteers were assigned to serve in local villages.
Aid to Artisans:
In 2000, Jeremie was selected as one of three Aid to Artisans sites in Haiti, which advances self-support through sale of local crafts and training of craft workers.
“Come down and see for yourself what advanced nursing practice in international public health nursing and anthro looks like!”
– Dr. Gebrian