The medical aspect of outreach is by far our our biggest as well as most expensive aspect of the program. It also fills the biggest that needs filled for empowering the families to keep and care for their children. We have 2 nurses at the Miriam Center who not only care for the kids at the Miriam Center but also help facilitate outreach children seeing the doctor at the mission, getting lab work done, and providing the medications from our pharmacy. We just recently added a 3rd nurse. She works only with the outreach program children and her entire job is to advocate for there medical needs.
Meet the newest staff member of the Outreach Program, Nurse Marlee.
She started full-time in June thanks to STAND The Haiti Project. STAND has raised the funds to add this much needed position to the outreach program. Many children with special needs have alot of medical problems and are just more fragile. They are also the most misunderstood population in Haiti. One of the areas that we felt we had been failing was in relation to following up with sick kids after they visited the doctor, home-visits, and helping parents navigate the hospital and clinic system. Nurse Marlee’s home base is the STAND building in PdP. She has a multi-faceted role advocating for the outreach children's health in many different ways. She is basically our Community Health Nurse for the Outreach Program. She is responsible for the care of about 150 children right now. Providing the outreach families the following services.
Area 1- Regular Home Visits
Area 2- Advocacy at Hospital and Private Clinics
Area 3- Post-Clinic, Hospital, or Doctor HOMEVISITS
Area 4- REGULAR MULTI-VITAMIN PROGRAM
Area 5- Bow Leg and RICKETS VITAMIN PROGRAM (Calcium and Vitamin D)
Area 6- PARENT EDUCATION focused on Medical Topics affecting there child or family.
Below I will explain in detail each aspect of her job as there are alot of areas. She is still learning everything and I have to give a huge shout out and THANK YOU to Miss Mirlene one of the nurse's from the Miriam Center who has been most active in helping train/orient her. I am so EXCITED about her position.
AREA 1- REGULAR MEDICAL HOMEVISITS
Nurse Marlee’s goal is to do a surprise homevisit every 3 months on all 140 active outreach children. Homevisits are important for multiple reasons. First is it is a big cultural thing to visit families at their home and so it a great way to show our love to that family. Also children’s with disabilities are often considered outcasts and hidden away so when we visit children at their home everyone in the neighborhood is watching and curious and most often you sit outside the house and so the child is brought out where everyone watches while that child is loved on. It starts changing the way the community looks at that child. Thirdly because it is a surprise visit it a chance to see how the child “typically” spends their day. It is a chance to also check on their health as many families wait to long to bring kids to clinic. Our hope is to catch illnesses sooner and thus prevent kids from passing away from curable illnesses and also just getting the child care sooner. Fourthly it is a great chance to do parent education and spend time encouraging the parents. Fifthly it is a chance to check and see if the parent has any concerns, check if they understand their child’s therapy home program, and to see if they are using their child’s adaptive equipment.
Over the last month Marlee has completed many homevisits. She has sent probably half the kids to the doctor catching illnesses sooner. She has found many families not using their child’s equipment because broken and referred them to the building clinic to get it fixed, etc. We are already seeing the great benefits of these visits are and will continue having. And the building relationship aspect is priceless and so important.
AREA 2- ADVOCACY AT HOSPITAL/CLINICS
The 140 Active Outreach kids have full medical benefits. They only pay 100gds (around $2US) per doctor, hospital or private clinic visit. The outreach program pays for the rest of the care medicine, lab/tests, hospital and clinic fees, etc. This is a HUGE benefit of being in the active part of the program and a HUGE gap and need we fill in for these families.
A little background on hospitals and private clinics in our area of Haiti. There are 2hospitals. There is 1 public hospital in PdP about an hour from the mission. Until the last few months the quality of care there was not good at all and it had the reputation that you go there to die. So we did not send children or encourage families to seek help at that hospital. Thankfully there has been some good changes at least in the pediatric ward and so have been sending some kids there and closely monitoring there care and so far so good and alot cheaper. The second is a private hospital in La Pointe about 30 minutes from the mission. La pointe hospital is much more expensive and you have to purchase each medicine, medical equipment (gloves, needle, syringe, etc.), pay for test, etc. before they will help you. This is a big reason why so many people don’t seek medical care till its to late… they wait till they know they have no other option as they can’t afford it and will have to borrow $ from friends and family. Also this hospital and many private clinics around us don’t want to or refuse to treat children with special needs. They think they should be left to die as they are just a burden to the family anyway. They will give them less quality care, not do everything they can to help them, or flat out turn them away. They discocurage parents and families. Over the last few years a few times when they have turned kids away and we have known we will send go down and advocate for them and sometimes we get that child help and others times our advocating didn’t matter but we are able to take the child other places till we find someone who will help. The problem was that many times we didn’t know when families got sent away or the parent were told the child will be find just give them this medicine when really then needed impatient care, and sometimes the child would be kept but given poor quality of care, etc.
So having a nurse that parents call when their child is very sick and heading to hospital was a HUGE NEED that we have been failing in the past few years. To this point there were many times that we didn’t even know a kid was in the hospital till a week or 2 later when the family ran out of money and brought the receipts for us to reimburse their child’s stay at the hospital only to realize the hospital had still not run tests to find out diagnosis and was just keeping them for $, or that the child was getting worse and hospital not doing best care and the worst was when we got the call a child passed away and later found out they went to the hospital but were turned away or sent home but we didn’t know.
So now all the families know if their child is sick and need a hospital or clinic they can call the Medical Emergency phone which Miss Marlee has on her 24/7. They can call and share the problem and the nurse will instruct where to take them. If they are already at a hospital or clinic they let the nurse know so she can come check on them and help advocate for there child. A lot of parents don’t even know how to advocate for their child in the hospital setting…It is intimidating and they don’t know whats wrong with there child or what treatment they should be getting, etc. This is why it is important to have a nurse who knows what the child needs or should get getting done and if it is not happening is there to advocate for them. The nurse is also there to make sure the hospital is taking good care of the child, that they are treating them as they would any other child and not discriminating or giving less quality care because the child is disabled. Another problem is the hospital keeping kids to long to make $ and so the nurse is able to watch and make sure this doesn’t happen to. Or the hospital does not look for the root cause of what is going on and just treats symptoms and thus child doesn’t get better and so the nurse can advocate for the doctors to look for root problem. There have been a few occaison’s where we have moved the child to a different clinic if they would not getting the care they need.
In the last 2 months Miss Marlee has helped advocate for over 10 children at the local hospitals and clinics. This advocacy will save lives, will help encourage/love on parents during a scary and hard time, and will strengthen the quality of care each child gets.
Alot of funding goes towards ensuring we are doing the best we can for these kids medically.
AREA 3- Post-Clinic, Hospital, or Doctor HOMEVISITS
This is another area of Medical Outreach that we were failing in. So when kids come to the mission clinic to see the doctor during week days they often get lab work done and perscriptions filled and are send home with instructions to follow but maybe they didn’t understand the instructions or the child didn’t get better or got worse but we often didn’t find out till they ended up in the hospital or had suffered for weeks before the families brought them back to the clinic. Same goes with kids who were released from the hospital or private clinic after staying overnight for anywhere from a day to a few weeks or even a month. They left with instructions and medicines to finish but there was no follow up to check on them.
Miss Marlee does a Follow-up Post medical follow up visit 1 week after a child either sees the doctor or is released from the hospital/clinic. This visit is to make sure the parents understand the instructions, to check and make sure the child is getting better and not staying the same or getting worse. She will be available to answer questions and also be there to provide some encouragement and prayer for the child and family. This homevisit also shows the family how much we care about there child and how we want them to thrive and make sure the child is getting better.
And like I shared above homevisits are a BIG cultural thing and also is a chance to show the neighbors and watching community how much we value and care about this child with special needs and their family. These visits not only impact the family but the watching community as well.
We have already seen in the last 2 months how important these visits are and the benefits of them.
AREA 4- REGULAR MULTI-VITAMIN PROGRAM
As many of you know children with disabilities often have a difficult time getting needed nutrition this is even more true in Haiti where resources are limited. We are excited that thanks to STAND’s partnership we were able to start a multi-vitamin program for the 140 active outreach children. We do not have the funding or capability to provide this to everyone. We believe these added vitamins/nutrients will make a difference in the kids health.
Every month the families will have the chance to receive a months worth of vitamins from Nurse Marlee. To receive the vitamins then must come with their child which will get weighed each month. Our hope it by tracking the kids weight we will be able to catch sooner if a kid starts losing weight. This also ensures we see each kid 1x per month to do a quick check on their health. Since therapy is 10 weeks per year there were months at a time that would go by that we would not see the kids. Where the family picks up vitamins changes based on where the month and what other activities the family has scheduled for the outreach program.
We were able to ship in 9 month of multi-vitamins from the states to get the program started but the plan to make this program more sustainable is to start making vitamins from a superfood leaf that grows all over haiti. Our plan is to make our own nutritional vitamin supplement from Moringa powder. We will only bring the capsules in from the USA. The plan currently is that we will hire a few of the outreach mothers to go out and gather the leaves, dry them and make the powder. Then hire a few other mothers to make the capsules (putting the powder into the pill capsules). Moringa powder actually has more nutrients in it than most multi-vitamins.
We are excited for this new aspect of the program. For the chance to provide better nutrition. The ability to track the children’s weight and another chance to improve the quality of care we provide these children and their families.
AREA 5- Bow Leg and RICKETS VITAMIN PROGRAM (Calcium and Vitamin D)
2 years ago we started a special vitamin program for a very specific group of kids kids with Bow legs. In Haiti we don’t have the technology to determine which children with Bow Legs can be corrected with vitamins versus ones who can’t be. This is why any child that comes to us with Bow Legs we start in the vitamin program. This vitamin program was started after we had about 40 children with bow legs that we did not know how to help. I hated that there was not way to help. There are few therapy options to help these children outside of surgery later in life but the most effective treatment if it is Rickets is Vitamins (calcium and Vitamin D). If anyone knows any treatments outside of vitamins and surgery later in life I would love to talk. I am doing my best but realize this is not an area of specialty or alot of knowledge for me.
We started the program but families were not being very consistent and it was hard to keep track of who was coming and who was not. Sometimes I would give out vitamins, sometimes the MC nurses, sometimes other therapy staff, etc. Also the families could come any day when they ran out to get vitamins so never knew when they would come.
Thankfully Now that we have Nurse Marlee there are 3 specific days per month that the family and child can come and get their vitamins. We have established a strict attendance policy since if the child is not taking vitamins daily they will not be effective. We want to help the families who are dedicated and want to fully participate.
We hope starting early next year that all of these children will also receive a multivitamin along with their Calcium and Vitamin D. Since bow legs have alot to do with malnutrition and many of the children we serve with Bow Legs have nutrition deficits we want to be able to help fill this gap in a small way.
AREA 6- PARENT EDUCATION
An aspect of outreach we added about 3 years ago was mandatory Parent Education every first Friday of the month. We are excited that Nurse Marlee will be able to really add to this time in a great way.
Since Miss Marlee will be spending alot of time in the families homes during home-visits as well as advocating for kids in the hospital/clinics she will gain a good understanding of what the parents/families need further edcuation on in relation to health and medical for themselves, their special needs child or their normally developing children. Nurse Marlee will be preparing a 45 minute education each first Friday of the Month with a handout that the families will be able to take home to refer back to and to share with other family members. We are excited to take parent education to the next level.
Yesterday was her first week of doing an education and we had a record breaking number of families in attendance 95 out of the 150 families. I am really EXCITED to see the attendance policy working and I think the home visits and greater relationship building is helping this. So these families received a 45 minute education on something health related and then 45 minutes on something therapy related, devotion on the sovereign goodness of God, and at the end a meal.
So as you can see Miss Marlee’s addition to our outreach staff has taken outreach to the next level of providing holistic and quality care to the kids. Her position would not be possible without the Support of STAND The Haiti Project who has partnered with the outreach program and hired Miss Marlee. In the past few months we have seen the benefits of this position already. So many illnesses were caught before they got worse. 20+ kids have been advocated for in the hospital, etc. We are really excited to see God work through her and all the ways she will impact the children and families.
Please join me in lifting her up in prayer as this job requires ALOT of....
~travel (pray for safety), being in the community
~ being around sick children and traveling in the heat alot (pray for protection of health)
~Time-management- which does not come naturally to Haitians (pray for ability to learn this quickly)
~New information all at once-very challenging (pray for her to learn quickly & not get frustrated)
Then also pray for WISDOM, KNOWLEDGE, and GUIDANCE in finding the support she needs, someone to train her in the information she does not know, etc.
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