Lessons Learned Leah Wolfe

For those of you still interested in going or returning to Haiti, I have documented my lessons learned. I'm not speaking for Team Montana. This is just perspective that I'm offering based on my experience in Haiti.

1. My public health teachers were right: Key informants from the community you wish to serve are vital for successful and appropriate mutual aid. Nothing we did would have been possible without Odson. He grew up in Haiti and would accompany us to the town he grew up in where he still held many social connections. He offered us a place to stay, helped us with transportation and communication, took us to the police station in Saint Marc so that they would know we were there and make sure we were OK, translated til he had laryngitis, coached us in Kreyol slang, introduced us to other active community members, and kept us all laughing when we needed it most. He was also very good about teaching us Haitian culture so that we didn't make too many mistakes. He helped us transition into the hospital so that we didn't just work well with the American nurses and doctors, but also worked well with the Haitian nurses and doctors. I believe that we were very lucky. I can't thank MADR enough for passing along his phone number. It was the only thing we needed from MADR to make this happen.

2. Security protocol will decrease negative outcomes. Although nothing went terribly wrong, I can't tell you how many times it occurred to me that one thing or another could have gone terribly wrong. What this will look will depend on each team, but consider having alternative plans for everything. In some ways we were over-prepared for this trip and in others, under-prepared. As an example, we ended up going from Petion-ville to Saint Marc in two trucks. I don't know if we are certain that the two drivers knew each other well. After getting through a mess of traffic, we got separated. Communication via cell phones was not reliable. We had two-way radios that worked great for a while, which actually allowed the drivers to come up with a meeting space. But then we went out of range. Luckily, the two trucks met up and we continued on to Saint Marc. I'll let you imagine all the ways this could have gone wrong.

3. Team recruitment should have guidelines. Our team was approached three times. One person wanted to go and their only qualification was that they had access to bulk tofu. A second wanted to tag along so that they could study how people use communication tools during a disaster. The third person's qualifications were much better. Registered nurse with experience in trauma and hospice, speaks Creole, has access to supplies, food, and pharmaceuticals and OTCs. I can't say that I speak for everyone on the team, but a few will agree, that the last person sounded great, but it didn't work out. I don't want to get into details, but "my friend's friend of a friend" is not enough of a vouch for being on a team. For the activists on the list, putting together one of these teams should be much like how an affinity group comes together. I don't know how the first two teams came together, so they might disagree. This is just my perspective.

4. Cultural competence begins at home, not in a foreign country. I understand that cultural competence is extremely important when entering a community that is not my own. It doesn't matter whether that community is in Haiti or the Lutheran community I live in. I also understand that some people are unwilling to work with certain communities based on their beliefs (i.e., those in MADR who expressed unwillingness to work with CDR). I feel that this had a negative impact/impression on those involved with MADR. There was no clarity on what exactly CDR was doing wrong and there was an assumption that everyone associated with MADR held the same opinions about working with Christian groups. Further, there is confusion when one Christian group is touted as being problematic because they are conservative and believe in prayer as a form of healing while Herbs for Orphans asks for "support in the form of monetary donations, prayer and supplies." Team Montana worked for a couple of days with people from Touch Ministries, who believe in praying over patients before performing skin grafts and other important treatments. They weren't the most culturally competent people but they were getting the work done in a place that would otherwise be without. I don't believe the same things that they do but I'm not going to let that influence my willingness to work with them if it's not going to cause harm. Praying for someone in this way is a lot different than proselytizing, oppressing, or stealing babies (as some religious folks got caught doing).

Making assumptions in general about a person's ability to accomplish something without asking them about experience/education/background. The discussions of cultural competence, disaster tourism, and ego, though not irrelevant were heavy handed enough to wedge division into our team before we even left home. The reason I am bringing this to the table is because it had a negative impact on my experience in Haiti - primarily because one of our team members was told by another that I was not allowed to use 3 of our 5 communication tools because the person didn't want to send reports to MADR. I also witnessed this person suddenly retrieving a phone from Charles when he mentioned that he was going to call Jeff with it. This greatly hampered our ability to communicate with our stateside support. I think that this person was wrong as far as how they chose to deal with the problem, but I also understand the frustration that person had with MADR because I felt it, too.

5. Have a plan to overcome the language barrier. I agree wholeheartedly with Roger and others from previous teams. None of what we did would have been possible without people who spoke different languages. Much of our travel and border crossings would have been much more difficult without having two Spanish speakers on the team. We had one French speaker on the team and a dedicated Kreyol speaker who traveled with us to outlying communities. The hospital we were at had at least a dozen translators of varying skill levels while many of the nurses and doctors there had a rudimentary or better understanding of English. Ideally I would recommend one translator for two health workers depending on the situation. Sometimes a patient would require 4 or more providers and only one translator was necessary. In the field, more translators were required. Also, keep in mind that many Haitian doctors are Cuban trained, thus, also speak Spanish.

6. Consider having team roles. There were times when we had problems because we didn't have clearly defined roles. Too many people got involved in finding trucks to Saint Marc and an argument started between potential drivers. We didn't have coffee (not important for all of us, but very important for some of us) the first two days because we didn't have someone bottomlining the meals. We had a particularly embarrassing moment when too many people got involved with a controversial patient transfer and too much information was given to the wrong people.

7. Retain high ethical standards even though the laws of that country don't require it. Patient privacy was often impossible because of the public nature of being in the hospital, but we learned a few things. The family is more involved with the patient than what is allowed in the U.S. The families get to know each other. And when someone dies the cries will start in the room but will soon ripple out into the courtyards and the streets so that everyone can know that this person has passed. This is a very different hospital atmosphere from all of the places I've visited and worked. But as outsiders looking in, we have a responsibility to remember the protocol we are taught in the U.S. regarding privacy and informed consent. This is a response to what I saw exhibited by other teams at the hospital and by mistakes that our team made. There were times when patients were taken away without an interpreter to explain where they were going. Pictures were taken of patients and their wounds without asking permission, and some of these pictures have been posted to the internet.

A few days after the Boston team left Saint Marc we learned that the Haitian hospital staff has a higher standard of sterility for wound cleanings and dressing changes. The only reason we learned of this was because of the rapport we developed with the Haitian nurses who told us that they use sterile gloves A LOT more often than the we or the Boston team were. Part of this was because there is a different perception of what sterile means and partly because some of the U.S. practices are not as stringent. What this came down to is asking them how they prefer things to be done. This mistake was ours, but in our defense, we stepped into it based on what the Boston team was doing and didn't question whether they were doing it by Haitian standards. But when we learned, we changed what we were doing.

8. Get to know the community. I suspect that most people involved with MADR would make this a primary goal, however, this is not what Haitians have come to expect. American doctors have been visiting the hospital in Saint Marc for a long, long time. Most of them drive from hotels to the hospital without stopping, bring bottled water, and bring all of their own food and beverages. We stayed in the neighborhood, walked to the hospital once or twice a day, flew kites with the children on the beach, went out for meals and drinks with Haitians, watched them make medicines and tools from plant materials, and some of us even danced for them. For this they enjoyed having us there, and that is what made our experience rich and meaningful.

9. Trust the universe. This is the most important part of what I experienced there. I have to say that I can't tell you how many times I heard someone from our team say that God/the universe/or some other mysterious collective consciousness was watching out for us. It truly felt that we were guided during a leap of blind faith.

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