by Abby Motz MSc, RRT-NPS

Abby Motz, RRT performing mouth care on an intubated post-traumatic brain injury pediatric patient

What started out as a medical mission trip quickly became about reinforcing the respiratory care education and skills that several respiratory care volunteers for the past year have worked so hard at achieving at Hôpital Sacre Couré in Milot, Haiti. Building upon the vision of improving respiratory care in Haiti, as illustrated by Daniel Rowley, MSc, RRT-ACCS, FAARC in the December 2013 edition of AARC Times, Brandy Seger, MSc, RRT-NPS and I traveled to Milot this past December to not only provide medical assistance, but to reiterate the importance of continuing respiratory care education.

During our one-week visit, we provided respiratory care education to the majority of the Haitian medical staff, as well as numerous nursing students from two different schools in Haiti. Our focus centered on invasive and non-invasive mechanical ventilation at the request of the medical chief of staff at Hôpital Sacre Couré.

Starting back in August of 2013, on-going dialog between U.S. based medical physicians (Dr. Michael Canarie, Dr. Robert Freishtat, and Dr. Ian Goodman), Natalie Napolitano, MPH, RRT-NPS, FAARC, Brandy Seger, MSc, RRT-NPS, and myself identified that is was abundantly clear that a standardized and easy to use bubble CPAP setup was urgently needed in Milot. At this time, there is limited piped in oxygen at Hôpital Sacre Couré. Most of the oxygen needs are either met with H-tanks or by oxygen concentrators. We pulled our resources together and modeled our bubble setup after a system that originated from Seattle Children’s. We sent three of these bubble CPAP setups to Milot in October 2013 with a US medical team, led by Dr. Michael Canarie. We also knew for our trip, we needed to take additional setups; consequentially, this ended up being six extra bubble CPAP setups.

Infant boy on the RAM cannula bubble CPAP setup.

Upon our first day at the Hôpital we were happy to see that the Haitian neonatal nurses were actively using the bubble CPAP setup. Though the Haitian medical team needed some remedial education on the importance of setting the correct liter flows to produce the desired CPAP level, overall, the bubble CPAP setup appears to be a sustaining and successful mode of therapy for the neonatal patient population.

As the week progressed, I gave a grand rounds lecture on the basic principles and indications for invasive and non-invasive ventilation to the majority of the Haitian medical team. On the heels of this lecture, we quickly intubated two neonatal patients, one pediatric patient, and adult patient. This provided a great learning opportunity for the Haitian medical team in which it provided an avenue for them to continue to experience using invasive mechanical ventilation in the clinical setting.

In December of 2012, Daniel Rowley and Natalie Napolitano developed and distributed two simple ventilator weaning protocols that the Haitian medical team could use to wean patients off of the ventilator. Knowing that Hôpital Sacre Couré had limited blood gas sampling capacities, we knew that getting an ETCO2 monitoring device was also a high priority. Thankfully, for our current trip we were able to secure, via donation, an invasive/non-invasive ETCO2 monitoring device along with all of the appropriate equipment that goes along with it, to take down to Milot with us. Not only were we able to educate several of the key medical team members on this device, the Haitian medical team got to use the device numerous times to wean patients off of the ventilator and to help detect when patients were respiratory compromised.

Dr. Kristen Breslin teaching Haitian nursing students how to manually ventilate a baby with an artificial airway

By day four of our trip, Brandy and I were regularly being called upon by both the US and Haitian teams for assistance with non-invasive ventilation (NIV). Considering this wasn’t our first trip to Milot, we were thrilled to see that Haitian cardiologist Dr. Nadine had been regularly using NIV CPAP with her adult patients. Not only was she using CPAP regularly, she was also teaching Haitian residents how to properly apply and manage patients while they were connected to the interface. You can only imagine the joy this brought us; to know that our efforts in bringing this life-saving therapy to this part of the world over the past year was actually being utilized with some degree of success.

Looking back I can’t tell you how many treatments we gave, bubble CPAP’s we setup, equipment fishing expeditions we went on, or the number of hours of sleep we lost, but what I can tell you is that we departed from Milot Haiti with pride knowing that we were making a difference in advancing medical knowledge and care for the Haitian peoples.