Global Pediatric Fellow Chris Carpenter, MD reports on work in Haiti.

 

As I opened the iron gate to the pediatric ward, a young mother ran toward me with her bundled baby in her arms. With tears streaming down her face, she screamed, "Please help me! My baby is sick and the nurses won't help me. I have been here for an hour and nothing has been done."

I quickly peaked under the cloth and saw a small, blue, limp body. There were occasional gasps, but within minutes, the baby was dead.

I approached the nursing station and asked, "What happened? Why didn't you do anything for this child? We just let her die."

I was the new doctor and had not yet developed a rapport with the staff. Not surprisingly, my questioning was met with a menacing glare. As I walked away, one nurse retorted in Creole, "Who does he think he is?"

Afterwards, I was terribly upset. The apparent nursing apathy toward the patient was difficult to understand.

Over the following weeks, nothing changed. Frustration and poor communication dominated my interactions with the entire nursing staff. For the first time in my career, I had trouble creating allies. And as a result, patient care suffered.

Finally, after two months of getting nowhere, I tried something new. I invited the entire staff to dinner at the nicest restaurant in town. I hoped filling their stomachs with good food and socializing outside the hospital could change the negative atmosphere.

Prior to arriving at the restaurant, I was nervous. However, once I arrived, things went smoothly. For a while we just mingled. I learned about their families and hobbies, and I told them about my life. The nurses who glared at me before were now interested in learning about my childhood and family. It was a completely different and dynamic atmosphere.

After the small talk concluded, we got to business. I simply said, "I am dedicated to making our ward the best it can be. It is true that we have had our struggles. But now we need to come together as a team to provide better care for our patients. What do you think is the best way for us to do this?"

The response was terrific. They all wanted more resources (namely oxygen, suction, ambu-bags, scales) and consistent education. No one asked for higher pay or additional time off. Every comment was centered on ways to provide better patient care.

The following week my organization bought many of the supplies the nurses requested. Each time we arrived with a new device, the staff was delighted. It was like a birthday party every day.

One week later, we held our first training seminar. As I was giving my first lecture on neonatal resuscitation, I realized something very important: the nurses had minimal training for emergencies. They were not familiar with how to artificially breathe for a baby and had no concept of how to give proper chest compressions. 

In the middle of the lecture, I thought back to the infant dying a few months prior. It became clear to me that the nurses had not been apathetic. They cared about the child but simply didn't have the tools or experience to try to save her life.

In retrospect, I can see that all of our initial difficulties stemmed from poor communication. I had not adequately assessed what their problems and needs were. We were not on the same page. 

Since our dinner meeting, I have had a very good relationship with the nurses. We collaborate on the majority of patient care plans and are working as a team. Finally, after establishing good communication, we are on the road to providing excellent patient care.