First off, Happy Thanksgiving. I have an incredibly blessed life and am thankful for many things—but most relevant to this post is the fact that I’m thankful for the Frist Global Health Leaders Program. Because of it, I have been given this amazing opportunity to come to Cayes and work at HIC. It has been—and I’m sure will continue to be—an incredible experience, and I am so grateful for the Program and for having been selected for it.
I have been with Susan for three weeks and have gotten a feel for how things work around here and the kinds of patients that come through the clinic. On Wednesday patients come in for vaccinations. Susan stores her vaccines at another facility because of lack of electricity and the cost of fuel to run a generator for the refrigerator. That has its costs as well since she has to pay transportation costs to go and retrieve the vaccines. Vaccines are provided free from the government and Susan charges a nominal fee for administering vaccines.
Most days (or I should say nights rather)—I forget I’m working in Haiti. We have normal, beautiful deliveries with happy, healthy moms and babies. I got to catch twins the other day (!!), and the first was breech—which was quite exciting/stressful for me, as breech babies typically are sectioned in the U.S. and so the breech delivery skill-set is a dying art. Sure we have the occasional loss of power, or we run out of gloves, but overall things at the maternity run in a manner pretty similar to how they would back in the U.S.
Haiti—or at least what I’ve seen of it—is a very religious country. Although religion in Haiti may make people think of Voodoo—which is certainly still practiced—I however, have seen it mainly in the Christian incarnation. A significant number of the buses and trucks, as well as the stores around Cayes have Christian Bible verses/words on them/names, and there are churches (of various denominations) all over the city. Women at the maternity often pray and sing through their labor/contractions, and many of the women—immediately after giving birth—say a prayer in thanks to Jesus. Two nights ago—at 3am—one of the laboring women started signing a song talking about “needing God”. Shortly after she started singing other people picked up the song and began to sing as well. For a good 5 minutes I’d say there were 15+ people singing this song (beautifully I might add), and then after the song faded they each started praying their own prayers. I seemed to be the only one who was astonished that everyone seemed to know the song and wanted to sing it, and that no one else thought it an inappropriate time (3am) to belt out a song and then start to pray loudly. I mention this story only because it was—for me—an incredibly unique experience, which gave me a better appreciation for the norms and beliefs of some (most, possibly) of my patients.
Courtney and I had the unique experience of helping a family in Mshenguville relocate their home. Mshenguville is an informal settlement within Munsieville, and the houses there are built on a hill. The houses at the bottom of the hill are in a flood-prone area with poor sewage facilities, and the families in these homes recently got permission from the local municipality to relocate to a different street near Mshenguville and move out of the flooded area. Mshenguville is sometimes referred to as a squatter’s camp because people come to the area to settle, claim an area of land, and build houses out of any available material. Because Mshenguville is an informal settlement, there is no government assistance in providing houses and resources for the community. The government simply gave the families permission to move and would not be providing new houses for the families, so anyone that wanted to move would have to do so on his or her own.
Susan is a RN midwife and like her private clinic colleagues acts more as a family nurse practitioner. She assesses and diagnoses and prescribes medication or other treatments and now refers out for deliveries and more complicated cases.
Last week I started working nights. I work three nights, then have three off. I’ve decided that despite the fact that I’m not a huge fan of the night shift, that this is the way that I can be the most useful to the Maternity staff. During the day there is an overabundance of staff: 3-4 nurses, 1-2 interns, and 6 (or so) nursing students from the nursing school associated with HIC. At night however, there’s one intern and 1-3 nurses. As a result, at night I’m actually able to not only use my skills as a provider, but decrease the patient burden that each provider has—thus (I hope) improving the care those women/infants receive.
Sadly, I am leaving this wonderful island tonight. I cannot imagine how the time has flown by so fast. The last week was intense; activities included inputting and analyzing the data we collected, preparing for the presentation, organizing the workshop for stress management, and saying goodbye to my dear friends on the island.
The past two weeks were full of activities. I conducted a series interviews with the people to obtain a better understanding of the culture and guidelines for my research, including professionals in stress and mental health, as well as people who work at healthy food promotion, obesity control, agriculture, and other various areas. After summarizing my findings, I did a presentation to inform my fellows working at land grant, American Samoa Community College, to get the staff involved with this program. The relation between stress and obesity is a novel concept to most of them. Even in Samoan language, there is not a direct word for stress, and they do not conceive of the tremendous influence of stress on health. Therefore, it is of great significance for land grant to incorporate this stress management program for the American Samoa Community College’s Wellness Center when it officially opens later this year.
Equipped with the knowledge of public health learned from my college and an enthusiastic heart, I came to American Samoa, the southern territory of the USA nearly three weeks ago. There are so much differences here, culture, family structure, work regulations, personal habits, traditional ceremonies, views of the world, just to name a few. Fa’asamoa, which means the Samoan way to do things, influences every corner in this place. In addition, the natural beauty is pristine and fabulous. However, behind the gorgeous attractions, there are tremendous public health problems here.

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