When you land in a Third World country to assist with nursing care, you might expect to be surprised here and there. You don't expect a 7.0 magnitude surprise. That is what happened to Debbie Abraham, MSN, RN, 5 hours after landing in Haiti Jan. 12.

Abraham, a 1995 graduate of Villanova University School of Nursing, was in Haiti for what she thought would be another routine service trip to Hôpital Albert Schweitzer (HAS) in Deschappelles, 70 km north of the capital city of Port-au-Prince.

A former critical care nurse and nurse educator, Abraham lives in Havertown, PA, with her husband and two children. She had recently returned to Villanova University College of Nursing to earn a postmaster's certificate as an adult nurse practitioner (NP). Since finishing her NP education she planned this trip to Haiti before studying for her certification exam and seeking a new NP position.

First Haiti Trip

ON PREVIOUS HAITI VISIT: "Nothing in my life prepared me for what I saw," said Debbie Abraham of Haiti's earthquake destruction, seen here during a previous trip to Haiti, assisting an orthopedic patient.

Seven years ago Abraham learned of an opportunity to teach CPR to staff at HAS, which serves 300,000 impoverished people in the Artibonite Valley in central rural Haiti. Within days of her arrival in 2002, she knew she would return.

She has done so once or twice a year to educate staff on nursing and health issues as well as assist with patient care in the hospital and its more remote clinics.

Self-taught in Kreyol, the native language, Abraham also uses a translator when teaching. This January trip was to be a 2-week stay, involving more teaching and patient care, her first as a new advanced practice nurse.

She did not know she would be delivering care and utilizing her fresh skills in the midst of the worst humanitarian crisis in recent memory in the poorest country of the Western Hemisphere.

The Earth Shook

On this 2010 trip, Abraham first traveled for a 2-day visit to the house of friend Zulta, a midwife in Tabarre, 10 minutes outside the capital.

While standing in Zulta's kitchen talking about dinner, the quake occurred. "I recall hearing a very loud boom, like an explosion, and then literally shaking. As the amplitude got worse, we got the kids and ran out."

Unsure of what was happening, they all stood outside as people were running, screaming, looking to the sky and singing, praying or chanting. "It was chaotic," she said. Miraculously, Zulta's house did not collapse.

Soon Abraham was concerned, realizing she was far from family and essential services were wiped out. "The total isolation for me was pretty incredible," she remembered. The car radio was operational; through it they learned from French radio that it was a significant earthquake. They lived through "tremendous aftershocks," trying to sleep in the car for safety. It is estimated the earthquake affected approximate 3 million people and the dead will number in the hundreds of thousands.

Providing Help Where Needed

At the request of another friend, Zulta and Abraham set out the next morning to deliver a few supplies from the home to a neighboring area, Delmar, a section of Port-au-Prince that was nearly razed. They brought gauze, sterile gloves, suture material, betadine, ampicillin, ibuprofen, Benadryl and food.

"The first injury we saw was a partially amputated foot.then a spinal cord injury and a skull fracture," Abraham said. Since they weren't equipped for the more serious cases, they began treating abrasions and other wounds, reprioritizing how to treat certain injuries and improvising with their quickly diminishing supplies, for example, using the paper from gauze packaging to wipe a wound instead of the gauze itself.

As she reflects on that experience, Abraham noted "In 30 years of nursing I never felt so helpless."

Assessing the Damage

Thursday, Abraham saw firsthand the situation in Port-au-Prince as they sought members of Zulta's family. "It was absolutely unbelievable to see the destruction, people staking out areas to sleep, and thousands and thousands walking in the road," she recalled vividly, along with the odor from countless dead bodies in the street.

Later that day she was able to make the long journey to HAS in Deschapelles as scheduled. Largely unscathed, the town had more operational services than the capital and she was able to make an Internet call to her husband following up on an earlier text message: "I am ok."

At HAS, Abraham utilized her NP knowledge and skills to triage patients for 2 days. While the hospital had more resources than most, she still had to be judicious in ordering X-rays and other tests.

She would admit patients and write orders, or prescribe needed medications and discharge them. She estimates 90 percent of the cases were orthopedic or trauma, especially among those who had arrived from Port-au-Prince.

Using Her NP Skills

Essentially this was her "first day on the job" as an NP, she noted. She said she felt confident in her assessment skills but still unsure about some of her decisions since she was unfamiliar with the paperwork and protocols.

She did have physicians to call on for consultation, though stuck with her assessment of one woman she thought had a collapsed lung. Staff disagreed. Abraham's suspicions were confirmed by a chest X-ray and the patient was treated appropriately.

Abraham noted how nursing knowledge and education translate into various situations. "I certainly felt prepared as I had been given the appropriate information to use at Villanova; I used my physical assessment course, no doubt about it!"

Setting priorities and assessing patients is part of all nursing, she acknowledged. Abraham estimates she delivered care and medications on the wards to about 150 people a day in her second week in Haiti though she said she may have lost count.

The Hardest Things

One of the most difficult things of providing care in post-earthquake Hait, was having people pull on the hem of her scrub pants for help as she stepped around them on the floor to get to someone else. "We can't fathom their daily life.Despite the horrible living conditions and ineffective leadership in Haiti, to see the grace, dignity and resolve with which they live their lives is overwhelming..everyone had someone in their family who had died."

Two weeks after her arrival, Abraham was able to depart Haiti and fly home from the Dominican Republic. She has great respect for the endeavors of HAS and is acutely aware of their need for funding. This is why she tells her story even before getting much rest since her return to the U.S. just over 36 hours ago.

"I felt conflicted about leaving," she admits. Determined to return to HAS and Haiti, Abraham said: "It is my privilege to be able to work there and it will continue. This will not stop me."

To learn more about Hôpital Albert Schweitzer and its critical needs, visit www.hashaiti.org.

Ann Barrow McKenzie is coordinator of college relations at Villanova University College of Nursing, Villanova, PA.