Q & A with Sr. Janet Lehmann, directing a nursing program in Haiti

Sr. Janet Lehmann is the director of the nursing program of the University of Notre Dame Haiti's Jacmel campus on the country's southern coast. Jacmel is a medium-sized city of 40,000 with a strong French colonial heritage.

Lehmann, a member of the Sisters of Charity of St. Elizabeth, first visited Haiti after the 2010 earthquake and felt drawn to the country and its people. In 2013, she was recruited to move from the U.S. to Haiti by Msgr. Content Sauveur, vice rector executive at the Jacmel campus, to build up a relatively new program that began in 2009. Lehmann identified many basic program needs that required attention. It was a bit like "starting from scratch," she said.

With a doctorate from New York University and more than 20 years teaching and chairing the nursing department at the College of St. Elizabeth in Morristown, N.J., Lehmann, 74, speaks knowingly about Haiti's many issues, and is a passionate advocate for nursing, education and improved health care for the country.

The university's program is helping build a foundation for the country, she says, particularly as it recovers from the latest disaster, Hurricane Matthew, which hit Jacmel as it made its way up Haiti's west coast. More than a month after the hurricane made landfall, Jacmel is still facing challenges ranging from cleanup to getting electrical power back in order.

In describing her work, Lehmann says, "I love it. I want the students to be the best they can be."

GSR: What are some of the challenges you see in Haiti right now?

Lehmann: One of the important issues is how social realities affect schooling. People in Haiti have to pay for all schooling including the primary grades. If you don't have a job, or have a low-paying job, which describes most Haitians, you prioritize who goes to school. Boys are still given the priority in Haitian society, but in my limited experience I see girls also being educated. The girls are socialized differently, however. Girls are taught to wash the clothes, clean house, to set the table. Boys are given more freedom to play, perhaps learn the computer, join sports teams. That's one example of a cultural reality that differs from our own and in my view needs some attention and adjustment.

It's also a very hierarchical society and it is male dominated. An issue related to gender is the prevalence of domestic abuse. The extreme poverty with the backdrop of so many men not having decent jobs increases the possibility that abuse will occur — women take the brunt of the effects of poverty. There are organizations which help women, but there aren't enough of them. There are laws against beating your wife, but they're not very effective. When the cases of abuse are brought to trial, men are often not convicted.

Tell us about the university's nursing program.

We have 206 nursing students, nearly all of them women — only eight men. It's a day college, no room or board. Students and their families sacrifice much to pay the tuition — about [US] $1,000 a year. This includes the tuition for all the courses. After four years of study, after graduation, the students will have a hard time finding a job. There is a shortage of nurses — many hospitals need nurses but they can't afford to hire more. After completing their studies, Haiti requires nurses and doctors to give a year of free service to the country. That sounds good, but one problem is that both groups need enough money saved to work a year without pay. It's not exactly fair — but it's one way for the health care needs to be met even if on a short-term basis.

When I first arrived, the challenges were many: a clinical practice laboratory that sorely needed attention; a library that had few current French texts; a lack of computers, projectors and printers for faculty use; and a lack of scholarship monies for students. Friends old and new joined me in addressing these issues. I cannot thank them enough for their support.

The need to find ways to increase the critical thinking of the nursing students was and is great. The rote model of teaching-learning is commonly used in Haiti. In the new curriculum standards, there is emphasis placed on the development of critical-thinking skills. Nursing faculty members are being challenged. Working with case studies, discussion and using simulation models becomes very important. To students used to another way of learning it can be somewhat of a shock at first, but then it's welcomed.

In our case, I thought of two very special nurse educators: Professor Eileen Specchio from the College of Saint Elizabeth and Mary Beth Kelley, dean at Trinitas School of Nursing in Elizabeth, N.J. They agreed to develop a two-week course of study for nursing students coming from Haiti to the U.S. for short-term study using teaching strategies that would encourage critical thinking. The program ran twice: in 2014 and 2016. The simulation laboratory at Trinitas School of Nursing was used effectively. English presentations were done with French or Creole translators. All handouts were in French or Creole. The students were excited about the program and both they and the faculty evaluated the program highly.

Tell us about nursing education in Haiti.

The curriculum, including all the courses, is taught in French. Haiti has recently revised curriculum standards for registered nurse programs. It is an effort to standardize and improve nursing education in Haiti. All programs must follow the requirements.

Faculty in nursing programs must have their bachelor's degree in nursing and clinical practice experience. There are currently no master's degree programs in Haiti. In Jacmel, one of the faculty members is attending a program for her master's degree in nursing education and leadership, a cooperative program between the University of Notre Dame Haiti and Regis College in Boston. It is a step. Other than myself there is no one teaching nursing with a master's or higher degree at the Jacmel campus. This is very common in all schools of nursing. In Jacmel, as is common in other Haitian nursing programs, all of the faculty excluding the director are part time.

Classes are large — that's normal in Haiti. Last year we had about 44 students in one classroom, and 75 students in another classroom. It's crowded! It's not impossible. Thankfully, we have a good computer lab at the university. Twenty-four laptops were donated last year and added to the computers already present. In Haiti, as in other countries but more so here, computers are necessary for teaching to remain current. With a shortage of current books, and a lack of mail service for nursing journals, information from reliable web sites is becoming an essential part of the learning here at Jacmel. Most students don't have laptops at home — the students would have to have both money to afford a laptop and the availability of electricity. Most Haitian families don't have either. Electricity is kept on at the university through the evening hours to provide light and electricity for students to study.

Let's go more broadly and ask what the challenges are facing health care in Haiti?

Where do you begin? There's no national health insurance, no Medicare, Medicaid, or social security. You name it, it's not there. If you need an operation and you don't have the money, you don't have the operation. That happens in the U.S., too, but here it happens on a large scale. What may surprise many is that when you come to a hospital in Haiti, you or your family bring the linens — and the family has to clean them! You want food? Your family must provide this. There is little privacy in the wards.

The population at large is very poor. Access to drinking water is limited for many. There is a food crisis in Haiti now that has become more intense since Hurricane Matthew. Lack of food and malnutrition affect health. Trucks with food going to regions outside of Port-au-Prince are being hijacked. People are desperate. After work there are generally three to five children outside where I live who are requesting something to eat. They are hungry.  

There is one major food store in Jacmel. Much of the population cannot afford to shop there.  Food is expensive. The local outdoor market, the mache, where most buy their food, is crowded with vendors and buyers. Providing adequate nutrition for the family is difficult.  

Most people cannot afford a stove or a refrigerator. The people rely on charcoal for cooking. They cook enough for the day. Meal planning becomes difficult. Buying food which requires refrigeration -- yogurt, cheese, meat, margarine, some vegetables, lettuce etc., — limits buying choices. Nutrition is affected. Health is affected.

Major health problems — stroke, hypertension and diabetes — are not easy for people to manage. It is difficult to advocate for a change in diet or lifestyle when such poverty exists. Paying for medication is a problem, making it difficult for people to continue with the ordered medication. Dietary changes may not be possible. Although rice with beans is the main diet for many, some cannot afford even the beans. Malnutrition is common. Health is affected.

Voodoo medical practitioners may be called on to provide service because they are less expensive, and many people believe in their powers. Other recognized healers in a village may be the first ones called on for help. Doctors and nurses must be cognizant and respectfully ask information about treatments the patients are taking from non-traditional health care providers.  

Increasing the availability of health-care workers, physicians, nurses, radiologists, pharmacists and others is a must. Increasing training programs for local midwives to provide excellent maternal care will do much to decrease the maternal and infant death rate. Including a way for medical groups that come on a yearly basis to provide care, to network with others in the community so that care can be sustained between visits, is vital.  

Cholera is beginning to show its face again; it is the rainy season right now and the recent hurricane and rains have caused many of the waters to overflow. Sanitary conditions are not available for many. Education to prevent cholera needs to be provided on a regular basis.

What are the implications of Hurricane Matthew in a country just now getting back on its feet after the 2010 earthquake?

Haiti is very vulnerable to any major disaster. One of the major implications from Hurricane Matthew is the urgent need for government planning for future hurricanes or earthquakes. My knowledge of political life in Haiti is very limited. But it would seem logical that help in developing this comprehensive plan would be both desirable and helpful for the people. 

Many people are fearful that money sent to help will not get to where it is most needed. They believe fraud is so rampant they refuse to give. Haiti needs to rectify this situation. Acknowledging the past, and drawing plans for donated monies to include fiscal accountability and transparency, is essential.

The press gave minimal coverage to Haiti for the first several days of the hurricane. Only then did news reach the United States on the effects of the hurricane. News from Haiti centers on the vast destruction in several areas of Haiti. This coverage is essential. Help from respected humanitarian agencies can do much to help. The poor in other areas of Haiti are somewhat neglected in the process. Plans for the distribution of monies should include these areas as well.  Distribution could be done by people working in the area who know the poor, who can verify the need, and who are willing and want to help the people.

What sustains you in your spiritual life?

Jesus Christ. He cared for the poorest, for the outcasts. He was and is calling me here. I'm a poor representative of Jesus' love, but I believe in the idea of a preferential option for the poor. I think Jesus believed it — Jesus loved the poor and I and others here are doing his work, and that's a privilege. There are some inconveniences being in Haiti. They are not insurmountable. So your refrigerator loses power. So what? It is the way it is for all of the people here. When I go home to New Jersey, people say, "Oh, you're brave, you're strong." That's crazy. I don't believe that. Jesus calls me here and I can only follow what I believe he wants for me.

[Chris Herlinger is GSR international correspondent. His email address is cherlinger@ncronline.org.]