The purpose of the program was for U.S. based healthcare providers to manage Haitian patients’ hypertension through bimonthly clinics and community health workers to monitor blood pressures weekly. Approximately 27% of Haitian adults have raised blood pressures; cardiovascular diseases account for 24% of the total deaths in Haiti and stroke is the leading cause of death (WHO,2012). Community health workers (CHW) have been effective globally in multiple education activities. In Haiti, CHW have been instrumental in providing education on cholera prevention and control (CDC, n.d.) as well as education and preventive services to people with HIV.
Methods:
Potential health promoters were recruited from churches to receive training in general health promotion and disease prevention, basic anatomy and physiology of the circulatory system, proper techniques for assessing blood pressure, documentation of blood pressure, and when to refer those with elevated blood pressure for additional assessment and hypertension management. Stethoscopes and blood pressure cuffs were provided to the health promoters who passed their blood pressure validation. The education was provided by a nurse practitioner with vast experience in delivering health care in developing countries.
A general medical clinic was conducted in the West Region of Haiti by U.S. healthcare providers and persons with systolic blood pressures over 140 mm/Hg and diastolic blood pressures over 90 mm/Hg were eligible to participate in an ongoing hypertension management clinic. Patients were given a sufficient quantity of medication to last until their scheduled appointment at the hypertension management clinic approximately 2 months from the initial date of service. Guidelines for prescribing anti-hypertensive medication were evidenced based and developed in collaboration with a nephrologist based on drug effectiveness in the Haitian population and not requiring electrolyte monitoring (Roehm, 2010; Weber et al., 2014).
Results:
At the general medical clinic 115 patients were started on medication to treat hypertension. At the first follow-up clinic 22 patients returned; 10 of the 22 returned for the second follow-up; and 7 of the 10 patients were also seen at the third follow-up clinic. Amlodipine and hydrochlorothiazide were the primary medications prescribed. Of the 31 patients seen at least twice, blood pressures were controlled for 10 patients.
Conclusion:
Additional strategies need to be developed to promote lifestyle modifications to decrease the risk for hypertension, increase adequate blood pressure monitoring, and increase medication adherence in the Haitian population. Nurse practitioners are prepared to provide both training for CHW and hypertension management for patients.