Establishing an American Heart Association International Training Center in Port-au-Prince, Haiti

Saturday, 29 July 2017

Becky M. Baird, MS, RN-BC, CMSRN, CNE
College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
Ellen L. Palmer, PhD, RN
International Child Care USA, Kalamazoo, MI, USA
Marie Jocelyne Arnoux, MS
Grace Children's Hospital, Port-au-Prince, Haiti

For more than fifteen years several nurse educators from the Dallas-Fort Worth, Texas area have participated in educational activities for health care promoters at Grace Children’s Hospital (GCH). GCH was founded in 1967 and has been serving the lower Delmas area of Port-au-Prince since that time, providing outpatient care for both pediatric and adult patients as well as inpatient care for pediatrics. GCH is supported by International Child Care USA, which is a Christian health development organization that supports health programs in Haiti and the Dominican Republic. A collaborative effort began when the U.S.A. nurse educators first developed a trusting relationship with their colleagues at GCH upon realizing a shared vision. Collaborative tasks such as defining how the work gets done, mentoring, identifying what could be accomplished at GCH and following through with commitments has been key to the success of the activities. Through the years, the nurse leaders of GCH have become more and more proficient in many aspects of developing educational programs. These include all elements of activity planning, marketing, conducting learning needs assessments, evaluation of activities, and budget development to include expenses for AV equipment, handouts, electricity costs (in some situations), refreshments, lunches and translators.

In 2015, a simulation laboratory was established at GCH. Although the sim lab has started out modestly, it occupies a large dedicated space in the education division of the hospital. At this time, the director of nurses is responsible for the management of the simulation laboratory. Primarily funded by a grant from the United Methodist Women and anonymous donations, the simulation laboratory features several types of manikins. Resuscitation training is now possible with eight sets of infant, child and adult CPR manikins, and eight French language automatic external defibrillator trainers. Other manikins are used for core pediatric and adult in-hospital clinical skills training, insertion of pediatric IV catheters and the simulation of normal or complex birthing deliveries.

The simulation laboratory has been the site of several trainings thus far. In November 2015, the first course of Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) was taught to 12 traditional birth attendants with both mother and newborn responsibilities. Students were selected by senior nursing staff at GCH. Instructors for the course included two HBB/ECEB Master Trainers (volunteer pediatricians from the U.S.A.) and two pediatric residents trained in HBB and ECEB, assisted by several U.S.A. nurse educators. Course work was taught over a two day period. Tools to facilitate learning included a newborn resuscitation algorithm, learner workbooks, facilitator flip-charts, neonatal simulators and equipment. All written material was available in French. Knowledge checks (written exams) were conducted at the end of the course, which are standardized Helping Babies Survive course material. The second course conducted in February 2016 was a half-day review course and included hands-on practice sessions, and re-administration of the knowledge checks. Nine of the 12 students participated in the second course. The knowledge check exams were provided in both English and French and translators assisted with all teaching as well as assisting with hands-on skills.

Resuscitation training held in June 2016 at the simulation laboratory includes five classes focusing on the 2015 guidelines of the American Heart Association (AHA) for basic life support (BLS). The total number of students included 20 health care promoters and 17 lay persons. The classes were conducted by the U.S.A. nurse educators, one of whom is an AHA BLS instructor. The health care promoter students were nursing staff members of GCH and the Kings Organization Hospital and clinical instructors at several local Port-au-Prince nursing schools. The U.S.A. nurse educators returned in November 2016 to conduct BLS classes to 14 more health care promoters from the Port-au-Prince area. Introduction to electrocardiography classes were provided to the same audience during this time period.

The large death rate numbers from cardiovascular disease in low income countries such as Haiti is a concern. This is a global phenomenon, and in 2011, the United Nations addressed the issue by setting a target of reducing the risk of premature noncommunicable disease deaths by 25% by 2025. Known as the 25 by 25 target, this goal will focus on the reduction of risk factors for cardiovascular disease and the Global Cardiovascular Disease Taskforce will be the disseminator of information and approaches to reach the 2025 targets. With the increase in the numbers of persons with cardiovascular disease, the implication for nurse educators is to work with the AHA to provide the opportunity to teach lifesaving CPR training to both laypersons and health care promoters in low-income countries such as Haiti.

Resuscitation training is a highly requested educational activity for the Haitian health care promoters. However, there are no American Heart Association Training Centers in Port-au-Prince through which an AHA Instructor could request support for training. The process by which American Heart Association Instructors can conduct courses and issue AHA cards is in the country of incorporation. Permission to provide training may be obtained through the approval of the AHA’s Global Training department. Approval is not automatic, and the application must have a letter of support from the Instructor’s Training Center. Unfortunately, the Training Center in which one of the U.S. Instructors is aligned does not support training outside the Instructor’s state.

Through a review of the Grace Children’s Hospital simulation laboratory, staff and equipment, the decision has been made to participate in the American Heart Association’s International Training Center (ITC) Selection Criteria and Accreditation Process. An ITC is an educational, health-related organization outside the United States that signs an agreement with the AHA to provide the AHA’s Emergency Cardiovascular Care programs and issue AHA cards. There are many requirements to become an ITC including legal, administrative, general liability insurance, instructors, facilities, equipment, commitment, territory and number of people trained. The process of evaluation and approval of new International Training Centers takes several steps. There is the presentation of a letter of intent and application form, assessment process, information verification and preliminary approval. The application has to gain legal approval through the AHA International Operations department. Upon approval, the ITC will appoint a Training Center Coordinator, and will be responsible for submitting reports to the AHA twice a year. A quality assurance plan will need to written as well.