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Reprinted with permission from
The Academic Nurse
The Journal of the Columbia University School of Nursing
Haiti is one of those forsaken places that enter the American consciousness only when disaster strikes, from bloody coups to epidemics to hurricanes. So, when Mary Lou Larkin was asked if she were interested in doing volunteer work there, her initial reaction was, quite reasonably, “I’d love to, but is it safe?”
Seven years and more than a dozen visits to Haiti later, Ms. Larkin would answer the same query with an emphatic ‘yes.’ “Once you go, there’s something about the country and the people,” she says. “They are wonderful. It’s so upsetting, in the paper all you see is the violence, and you think, ‘What a violent culture!’ But it is not that way.”
Ms. Larkin has become something of an expert on health in Haiti, the poorest nation in the Western hemisphere. Since 1999, she has played a lead role in a volunteer effort to bring basic health care and other services to Jacquesyl, a primitive village of 1,200 on Haiti's northeast coast. Small in size but large in impact, her non-profit group, called Haiti Marycare, Inc., has built an array of clinical services that have profoundly improved the quality of life in this isolated rural outpost.
Remarkably, Ms. Larkin accomplished this without a whiff of prior experience in international health, all the while holding down a full-time job as a nurse practitioner in the pediatric emergency room at Jacobi Medical Center in the Bronx. What Ms. Larkin did have was a wealth of nursing expertise. One could say she had been preparing for this role her entire career.
Fresh out of nursing school, in 1974 she took a position with Kentucky’s storied Frontier Nursing Service, a pioneer in rural public health nursing and nurse-midwifery. The experience was priceless. Working alongside seasoned nurse practitioners, she learned firsthand that advanced-practice nurses were eminently capable of managing patients with little oversight, even in the most challenging settings.
It was a lesson that Ms. Larkin would never forget, although she would wait almost a quarter-century to become a nurse practitioner herself. Simply put, life intervened — a husband, four kids, a mortgage. During those years, the longtime Danbury, Conn., resident worked as a critical care nurse, an emergency room nurse, a staff nurse in a private pediatrics practice, and as a school nurse.
She also found time for community service, volunteering in a free health clinic, Bedford Hills State Prison Children’s Program, and Danbury Federal Correctional Institute, bringing her into contact with women and children from the world over, most struggling at the bottom rung of the socioeconomic ladder.
Through it all, the thought of becoming a pediatric nurse practitioner and practicing with more responsibility and autonomy, never faded. Finally, in the mid-nineties, realizing it was now or never, she enrolled in Columbia’s PNP program. Upon graduating in 1998, she joined the staff at Jacobi, where she oversees the care of children with everything from broken bones to sickle cell anemia to influenza, a range of ailments not uncommon to urban ERs. It’s everything she hoped advanced-practice nursing would be.
Around the same time came the opportunity to volunteer in Haiti. On her first trip to Jacquesyl, she found a village barely removed from the Middle Ages. Infant and maternal mortality rates were sky high. Kids were getting infectious diseases for want of routine vaccinations or suffering from dysentery and dehydration for lack of potable water. Malaria was commonplace.
Inspired by Paul Farmer (the Harvard physician who founded Partners In Health, the international health and social justice organization), Ms. Larkin started a rudimentary primary care clinic in Jacquesyl. Staffed by a doctor, a nurse, and a lab technician, all Haitian, the clinic offers an array of services: vaccinations, infant and maternal care, nutrition and hygiene classes, home visits, and more.
Her husband, Tom, joined the effort as well, equipping the clinic with a simple water filtration system. Soon, the whole town was gathering at the clinic for clean water, overwhelming the supply. A trade-show-display salesman by vocation, Mr. Larkin proceeded to teach himself the basics of wells and water systems and teamed with a Canadian outfit to build two more wells. They also trained a group of men from Jacquesyl to clean old wells and dig new ones, with an eye toward establishing a locally run, self-sustaining well-water business.
Now that the clinic is running smoothly, Ms. Larkin travels to Haiti twice a year, where a good portion of her time is spent making home visits. “When I first went there, I never saw any handicapped kids,” she says. “It turned out their families were either too poor to come to the clinic or they were embarrassed. So, I asked to be taken to their houses. In the home, you see so many problems that you don’t see in the clinic, because everybody comes dressed in their Sunday best.” She also makes home visits for the elderly, who were similarly invisible to the clinic.
In addition, Ms. Larkin takes time each trip to consult with the local health committee. “I've found it is best to ask what the people need, and to take my guidance from them,” she says.
Once crammed into a single room in the village school, the clinic is now located in a building of its own, replete with four exam rooms, an office, and a modest laboratory — thanks to another nongovernmental organization, Plan International and the hard work of the Jacquesyl community.
Haiti Marycare’s services are constantly expanding. One year, she brought along a dental hygienist and another year a physician, who offered hypertension and gynecology clinics. In 2006, the clinic started giving Hemophilus type B influenza vaccinations, supported by a grant from the National Association of Pediatric Nurse Practitioners and Wyeth Pharmaceuticals.
Malaria prevention has become another priority. The clinic has run educational workshops for adults and children, teaching preventive measures such as eliminating standing water and cleaning up garbage. Ms. Larkin also raised funds to buy a bed net for every resident, a venture two years in the making — offering a glimpse of how difficult it is to raise funds for and carry out even the simplest international health project. “Paul Farmer says that the poorest of the poor are the last ones to get anything because they don’t have the infrastructure,” she explains. “The roads here are terrible. We had a truck, but it was stolen by the rebels in the last coup. We borrow one from the bishop when we need to transport something to Jacquesyl.”
Like so many other non-profits, Haiti Marycare struggles to makes ends meet. Back home, Ms. Larkin devotes a good deal of time to fund raising — a necessary evil, in her mind.
Slowly, things are getting better in Jacquesyl. “Our hope is that people will stay and build a life there,” says Ms. Larkin, rather than move to the capitol, Port au Prince, which is wracked by poverty, disease, and violence. “There are no jobs there. A lot of people come back with AIDS. I haven't seen anything good happen when people have left for the city.”
But Ms. Larkin prefers to focus on the positive, a spirit captured in the Haitian proverb she likes to quote: “Lespwa fe‘ viv” — hope makes us live. One of her hopes is that the Jacquesyl clinic will serve as a model for other villages. “As far as primary care goes, there’s nothing except our clinic for miles around,” she says. “People travel hours to get to our clinic. What we do can be duplicated.”
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