Office of the Vice President for Global Communications

Tuesday, January 19, 2010

Nursing foundation leader discusses health care challenges in Haiti

Potholes as large as buildings. Hospitals that don’t provide sheets, meals or medication on site. Treeless hills that enable massive flooding, and garbage filled drainage systems. These were all health care problems before the 7.0-magnitude earthquake struck Haiti.

Rosemarie Rowney can only imagine what’s to come. A 1977 graduate of the School of Public Health and an emeritus faculty member of SPH and the School of Nursing, Rowney is president of the Haiti Nursing Foundation. She also serves on the board of directors of the Faculty of Nursing Science of the Episcopal University of Haiti (FSIL).

Health crisis
According to information posted on UNICEF, Haiti has the highest rates of infant, under-age-5 and maternal mortality in the Western Hemisphere. Diarrhea, respiratory infections, malaria, tuberculosis and HIV/AIDS are the leading causes of death, the site says. For more vital statistics on Haiti go to www.unicef.org/infobycountry/haiti.htm.

Vital indicators on child health are infant mortality, under-age-5 mortality and maternal mortality, and in Haiti all are grim. The infant mortality rate was halved from 105 per 1,000 in 1990 to 57 per thousand in 2007, but still is high when compared with the CDC’s latest number from 2006, which shows 6.7 deaths per 1,000 in the United States.

Consider that 21 per 1,000 Haitian children younger than 5 will die annually, compared with 8 per 1,000 in the U.S. Maternal mortality is 523 deaths per 100,000 births in Haiti, compared with 13 per 100,000 in U.S., according to Pan American Health Organization, the latest figures from 2004.

Statistics came from UNICEF, United Nations Population Division and United Nations Statistics Division.

Rowney of Ann Arbor gave her observations on why health care is almost nonexistent in Haiti, and what the earthquake could mean for the country’s only four-year, baccalaureate nursing school.

Haiti’s tumultuous political history has resulted in living conditions that, among other things, do not lend themselves to a healthy population, says Rowney, who became involved with the school four years ago.

“You don’t have the social, economic or political infrastructure to support health within the country,” says Rowney, who was mentored by Ruth Barnard, an associate professor emerita of the nursing program at U-M and co-founder of the Haitian nursing school. Both women became involved through first Presbyterian Church of Ann Arbor.

Haiti is the poorest country in the Western Hemisphere. Infrastructure was virtually nonexistent before the earthquake — no electricity, sanitation system, trash pickup, public school system or source of safe water, Rowney says. The literacy rate is about 50 percent and the average Haitian earns about $1 a day.

There are approximately 11 nurses for every 100,000 people, compared to about 860 per 100,000 in the United States. Traditionally, Haitian nurses are trained — an outmoded method and term abandoned here 50 years ago. Now nurses are highly educated, and that makes a huge difference, Rowney says. The FSIL teaches a curriculum similar to one found at U-M or any great, modern nursing school. The conditions in which they work would be unrecognizable to the majority of nurses at U-M.

The U-M Student Nurses' Association will hold its Third Annual Charity Ball at the Michigan League on Feb. 20 to benefit the Haitian nursing school.

“In the hospitals there are no sheets for the beds so the family must bring the sheets. There is no food on site for patients and the family must bring food. If the physician prescribes medications, the family must go to the pharmacy and bring the medications to the hospital,” Rowney says. “The care and comfort and expertise of a well-trained nurse who can care for the family and the patient is so much appreciated.”

Rowney sees nurses as critical to shoring up the Haitian health care system, and many argue that nurses are more important than doctors when it comes to patient education and averting and managing chronic disease, not just in developing countries, but everywhere.

“If you had an infrastructure where you can teach how to prevent the development of chronic disease and complication of chronic disease, or nurses who could teach simple things like hand washing, this would make such a difference,” Rowney says. “If you had nurses (in Haiti) who could teach people how to recognize the early symptoms of disease before they got really bad or who could counsel the patient and the family at the hospital, that kind of care is paramount to this country.”

The school has graduated two classes, a total of 26 nurses, and 120 are enrolled at all levels, Rowney says. On Thursday, Rowney finally got word that the Dean Hilda Alcindor and the school were OK.

According to the Haiti Nurses Foundation Web site, Alcindor, students and a visiting nursing faculty volunteer were mobilized within a half hour after the first quake. They’re operating 10 first aid stations in and around Leogane and caring for 5,000 townspeople in the schoolyard.

“What I foresee is that these students will be part of medical teams. They know the languages, French and Creole, and learn English as part of the curriculum,” Rowney says.

It’s still too soon to know how the earthquake will impact the nursing school. On Friday Rowney and the board met to discuss some of the logistical problems. Since there’s no electricity in Haiti, fuel-run generators power the school, but obtaining that fuel will be even tougher now, Rowney predicted. The same goes for medical and surgical supplies, water and food.

Despite the horrible problems, which are compounded immensely by the earthquake, Rowney has seen progress in Haiti during the last four years.

“It seems to have become less violent, there seems to be more social order,” says Rowney, who visits the country twice a year. “Just small things, like there are traffic lights in the center of town now and people actually stop at them. This is a signal of more stability.” During her last visit in September, she says, she saw workers cleaning the drainage ditches, also a sign of improvement.

“People think they have to go to Africa or China to do their work,” Rowney says. “No way. Go to Haiti.”