As a team, we focused our first sessions with each year (Years 1-4) on a basic needs assessment for training, the normal stress response and exercises for managing stress. The students specifically requested information on stress including etiology, presentation, signs/ symptoms and treatment for both themselves and their patients. They also requested information on clinical diagnoses such as PTSD. We split the students into small groups. The students shared experiences of their patients and themselves. Many of the students were first responders to the earthquake at the school providing emergency care to anyone who showed up at the school. As both an individual and as a first responder, the students were affected by the trauma of the earthquake.
We established a clinic in two rooms of the school’s dormitory which also housed the hospital’s pharmacy. We provided individual consultations to nursing students and clinic patients. We also offered opportunities for nursing students to interview and assess clinic patients while a provider was also present. The clinic patients spoke both French and Creole. In the case of Creole only speaking patients, Alexa Tarter translated for Drs. Muhr and Smyth. We saw some patients more than once. Most patients had one clinic visit.
Patients often presented with somatic complaints that had been ruled out medically by the hospital medical staff. Our consultations often included supportive therapy, CBT, psychoeducation and, on rare occasions, medication. We offered follow-up visits to all of our patients.
Logistically, it was difficult to get a significant volume of hospital patients. The clinic providers did refer us patients. The location of our clinic was not on hospital grounds which meant we lost a lot of patients in the process of referral. Therefore, we set up our clinic across the field and through a closed gate in the nursing school’s dormitory.
All of the dormitory students are currently living in Dean Hilda Alcindor’s front yard in tents. Despite no damage to the dormitory from the earthquake, many of them are afraid of returning to the dormitory due to their fear of being under concrete or near concrete during another earthquake. They are also audibly and visibly fearful of sitting in the classroom. Some of the students preferred to be living in a tent. Many of the students preferred to have class outside in the courtyard.
Some of the students have specifically requested to return to the dorm rooms. We offered to work more closely with the students regarding their fears. Since Dean Alcindor requested that all students return together, we did not have the opportunity to provide therapeutic support for their anticipated return to the dorm. In sum, there were logistical obstacles to assisting the students in their return to the dorms.
On Friday of the first week, a memorial service had been planned for the three nursing students who lost their lives in the earthquake. We made ourselves available to students before and after the memorial service/ mass. We also helped prepare some of the nursing students for the memorial service. Additionally, we made ourselves available to nursing students, if individually requested, outside of clinic hours.
Week 2: In the second week, we continued to offer clinics and small group teaching to the first through fourth year students. Our teaching priorities the second week included mental health history taking, exam, and differential diagnosis specifically of anxiety disorders including phobia and PTSD. We focused on clinical presentation, signs/ symptoms, co-morbidities and treatment of depression. We also reviewed the stages of grief and responses to grief. We included a discussion of the use of cognitive behavioral exercises. In all groups, we included role plays specific to their clinical encounters.
As the week progressed, the students started to implement their interviewing, assessment and supportive therapeutic techniques in role plays and in the clinic. Additionally, there was a shift in interest, comfort and rapport with the team. In fact, there were more nursing students willing to participate in clinic and to seek private consultation.
During the second week we experienced at least two aftershocks which exarcerbated students level of stress temporarily. We made ourselves available for support with visits to their temporarily living quarters in Dean Alcindor's yard.
Our last day of teaching was a full day. We had a morning of teaching with the first year students. Similar to the first week, the students rotated through three stations with topics including grief, depression, PTSD, mental health history taking and assessment, patient/ nurse role plays, building self-esteem and cognitive behavioral techniques.
It was on our final clinic day that many nursing students decided they wanted to be seen. Thus our final day was a busiest clinic day, particularly for Dr. Rachelle Rene.
In sum, we saw patients with anxiety, PTSD, depression, grief, insomnia, conversion disorder, pseudocyesis and normal reactions to trauma and stress. We provided supportive therapy, cognitive behavioral techniques, relaxation and breathing techniques. The nursing student patients were very interested in any hands-on, concrete approaches to addressing their mental health. Two students were open to using medications. Most students stated that they were not interested in medications. In fact, some students requested Dr. Rachelle for at least one reason. “ I don’t want any medication.” Only one patient acknowledged having seen a psychiatrist in Port au Prince.
The nursing students were open, spontaneous, flexible, eager and curious. FSIL, Leogane and the surrounding communities would greatly benefit from at least one mental health provider. We spoke with a Haitian pediatrician who has a private practice (on hold) and currently works for Save the Children (a NGO) as an administrator. The pediatrician stated that if a child has any mental health needs the only option is to offer a mental health referral to Port au Prince (private pay psychiatrists) which is not feasible or accessible to almost all patients. There is a definite need for the mental health training of nurses committed to working as mental health providers in Leogane.