Projects.

I think it is generally true that hospitals breed projects at astonishing rates. Mission hospitals, like HAH, are no exception. Here, besides normal wear and tear, we work with heat, humidity, dirty air/water/fuel, and wide fluctuations in power; serving up conditions seemingly bent upon destroying or disabling machinery of any type. Pipes break, filters clog, the part is out of stock and so forth. It has become even more clear to me that for medical work to be efficient and effective, whole systems are required. 

If you know Tim, you know that Tim loves projects. Let me rephrase-Tim needs projects. I did not quite comprehend the depth of this need when I married him, but this truth was revealed to me one day, early in our marriage, when I came home to find a partially build cornhole set on our coffee table. In any home I think this would have been arresting, but we lived in under 1000 square feet. And he’d been sanding. We didn’t have a garage at the time (and it was cold outside, what, oh lovely wife, was he supposed to do?), so we got him a membership to a maker space so that he could have a place to go and work on “stuff”. After that there was less sanding in the living room, more cornhole sets, and a steady stream of cutting boards, boxes, and other things. He dreamt of building us a house out of shipping containers-one Sabbath we spent a happy afternoon laying out the hypothetical floor plan. What do you think, oh wife, about us buying a house to fix up? Wouldn’t that be fun?

In Haiti, we’ve been oh-so-excited to set up an Orthotics and Prosthetics (O&P) clinic. It is going to be so good and I will write lots more about it-but in order to be able to build prosthetic legs and braces, Tim needs some large, bulky equipment and supplies (think industrial oven and bags of plaster). The best way to get those to Haiti is via a container, and Haiti Adventist Hospital (HAH) has been planning to ship one down. In August 2020, the purchased O&P equipment and supplies were loaded onto said container, and Tim and I loaded onto a plane. We hoped to see the container by Christmas. In reality (2020), it’s nearly February and the container is still not in country, let alone through customs. So after Tim set up all that he could for the O&P clinic, he dove into project work. 

The projects themselves have been quite varied. Tim learned (thank you youtube) how to rekey locks and has rekeyed the hospital. Seems like a small thing, but it has decreased all sorts of frustration and increased efficiency. He’s fixed a fair number of small engines (pressure washer, lawnmowers, chain saw) for the maintenance crew, cut down a few big trees, supervised the planting of others, and has facilitated a lot of trench digging and block laying. He’s happily working on remodeling two 20 ft containers into nice living spaces. Imagine the excitement! Dr. Scott Nelson loves (needs?) projects too and there are hours spent discussing the details. Mostly confined to campus, we’ve built a wellness trail. We’re building a swimming pool. To be sure, Tim is looking forward to starting an O&P clinic, but with that pending, he has immersed himself in fixing and building, figuratively and sometimes literally greasing the wheels that help the hospital run.

Admittedly, I have a soft spot for projects myself, but mine usually don’t involved brick and mortar. I have been working with the team at HAH on process improvement in a variety of ways. The eventual goal is to build up the hospital so that it could support the opening of an intensive care unit. This will be difficult-a 2019 survey noted “124 reported ICU beds” (Losonczy et al., 2019, p. 5) in Haiti and cites the familiar barriers of lack of supplies, training, and so forth. For HAH, overcoming those challenges will require many of our systems to become more efficient-in fact, that is one of drivers for undertaking such an endeavor. In broad strokes, we are examining and implementing new ways to facilitate more timely patient care and waste less (supplies, equipment, and money). We’ve done a couple of things over the last bit:

-Charge Sheet Implementation. We did a QI project around how medications and supplies arrive to the bedside, and then how patients are billed. We made and submitted a nice poster about that, which I’ve attached here for your viewing pleasure. The poster is neat and tidy (thank you Dr. Jeff Cho), but the reality involved cleaning out some terribly dirty storerooms to make space for supplies to be stored closer to patients, and explaining the ideas and steps with our clumsy creole and lots of hand motions. 

-Supplies inventory. We did a physical inventory of supplies at HAH. We sorted through, among other things, cubic feet of ETTs, several years supply of speculums, and PPE left over from Ebola scares. This first step is groundwork for changes to our supply acquisition process.

-Biomedical inventory. Similar to supplies, we needed to know what we have (and what works) in order to inform our purchasing and requests down the road.

We also have a nice education room set up and in use-which brings me great joy. All in all, it has been busy, rewarding, and we look forward to more projects over the next months! 

Losonczy, L. I., Barnes, S. L., Liu, S., Williams, S. R., McCurdy, M. T., Lemos, V., Chandler, J., Colas, L. N., Augustin, M. E., and Papali, A. (2019). Critical care capacity in Haiti: A nationwide cross-sectional survey. PLOS ONE, 14(6), e0218141. https://doi.org/10.1371/journal.pone.0218141

How the Clevelands Came to Haiti Adventist Hospital

It has been over 8 years since I returned from Guyana and mothballed this blog. A lot has changed in 8 years! And yet much remains the same. I am writing now from another “mission field”, from the campus of Haiti Adventist Hospital (HAH) where my husband Tim and I have been living and working for the last 5 months. In future posts I will share more about here, and our current work, but I am often asked how we ended in Haiti and so here is our little narrative:

From Guyana, I returned to Paradise, CA, briefly, then to Loma Linda University (LLU) for a nursing degree. While at LLU, Tim and I reconnected through mutual friends (we’d first met as freshmen at Walla Walla University) and started dating. At the time, Tim was a student in LLU’s Orthotics and Prosthetics (O&P) program and had also served as a student missionary from WWU. While we were dating we discussed a dream of living abroad for a year or two, serving an underserved population together, then making that site a continued part of our private and professional lives and the lives of our hypothetical children. We jokingly called our little dream "Vision 2020"-the name ripped off the posters for LLU’s “Vision 2020" campaign (fundraising for LLU Medical Center building project) that were plastered all over campus at that time. At that time it was a dream and a goal, but lacked much more substance than that. We moved to Albuquerque, NM for Tim's residency with Hanger Clinic and I started work at the Medical ICU at the University of New Mexico Hospital. We got married and, after Tim completed residency and passed O&P boards, I started to work on my MSN, concentrating on nursing education. We both continued working. Through those years of work and study Vision 2020 smoldered; we prayed and perused the websites of aid organizations, dreaming. We had a few loose criteria-we wanted to work in our fields. We wanted to serve people who needed us-we were not interested in making money, duplicating services, or putting local people out of work. We wanted to form an initial relationship with an organization that would be the foundation for an ongoing relationship-so we needed someplace that was stable enough that we would be able to return to it. We wrote lots of emails, but without exception the answers came back "no". No, you don't have enough experience, no, we don't have or particularly want O&P, no, you'd need to commit for a longer stay, no, you will need to be at separate locations and so on. It was a little disheartening, but with the benefit of hindsight, it was a good thing. In March 2018 we reached out to Dr. Hart and the LLU O&P department asking if LLU/Adventist Health International (AHI) might have a place. The response came within hours-yes, we need you in Haiti-maybe Africa, but probably Haiti-and we would really like to have some O&P! In August 2019 we were able to visit Haiti Adventist Hospital (HAH) on a week long survey trip, accompanied by Michael Moore, one of Tim's professors from the LLU school of O&P. In conversations with Michael, Jere Crispins (CEO at HAH) and Dr. Scott Nelson (Medical Director at HAH) we heard another vision-to improve the services that HAH could offer to their patients in Haiti while building an O&P program that will continue to serve the people of Haiti and O&P students. The dreams dovetailed beautifully. Better than we could have planned. We returned to Albuquerque delighted and encouraged and began to stage “Vision 2020” in earnest-fundraising, planning, and purchasing. In August 2020, amid a smallest lull in the chaos of the pandemic, we cleaned out our workspaces, packed our bags, said our goodbyes, and headed to HAH.

Looking back, we see the quiet, but consistent workings of God. At the outset, the vision was fuzzy. As time went on there was still no road of Damascus moments, no glowing pillars in the night sky-but at each step there was a pocket of confirmation or the nudge of a no. Details became sharper, and things just fell into place despite odds to the contrary. It has been a busy 8 years, filled with challenge, change, and transition, but I continue to be encouraged by the peaceful pull of a loving God. We are grateful to be at HAH, grateful to have had the experiences that have prepared, and are preparing us, to serve people in new and exciting ways.