Meet a Leader Transforming Nursing in Haiti

Since she was a girl, Beatrice Romela dreamed of being a nurse. Today, she’s changing what that means.

Romela is the chief nursing officer for Zanmi Lasante, as Partners In Health is known in Haiti. The role is a culmination of her two decades of experience in nursing, more than 13 of them working for PIH. In this position, created through an initiative to strengthen nursing in the Haitian health care system, Romela travels to all PIH-supported hospitals and clinics in Haiti, working with the nurses and administrative officials to resolve problems, identify training needs, and improve care.

This month, Romela wraps up her master’s degree in nursing education and leadership through a partnership among Regis College, the University of Haiti, and PIH. We sat down with her recently to learn about her story and her work.

Where are you from?

I’m from Baradères, a rural community in the south of Haiti. I grew up and went to primary school there. After that, I left to attend high school in Port-au-Prince. My dad wanted me to leave because there wasn’t a good high school in my hometown. I left my house and my mom, and I lived with my aunt, my father’s sister, in Port-au-Prince. It was hard because I was very young— just 12 years old.

Why did you go into nursing?

When I was 9 years old, I was sick and my mom took me to a health center. I wasn’t hospitalized, but I met with the doctor, who gave me medicine. My mom took me home that same day. But what I remember most is the nurses. They were wearing white uniforms, and they were talking to the patients. I really liked how they looked and how they talked to the patients. I told my mom that when I grew up I would be a nurse like them.

What role do nurses play in the health care system in Haiti?

I’ve worked as a nurse for 20 years in Haiti. In my personal experience, decisions about the health care system in Haiti are made only by doctors, rather than nurses. Nurses aren’t empowered to be part of decisions about the treatment of a patient or the way the health care system operates. In Haiti, the doctor orders the treatment, and it’s the nurse who is responsible for caring for the patient, delivering the treatment, and talking with the patient.

Sometimes, a nurse’s role is to work in places that are remote, where there is no doctor. In those cases, nurses don’t just care for patients but also treat them with medicine, following the guidelines of the Haitian Ministry of Health. If the nurse can’t help, he or she sends the patient to a facility where they have more doctors and nurses.

Nurses are also responsible for educating patients about their health, checking vital signs, providing care in hospitals, and delivering babies where there is no midwife or obstetrician. Nurses also teach in the nursing school.

What do you like about working in rural areas?

I’m a better nurse because I’ve worked in remote areas. I can relate to people and better help them. When you only work in Port-au-Prince, you don’t know the problems of the countryside. When I go to a new health facility, I like to walk to the farthest community that the clinic serves, the place that takes you four hours to get to on foot. It helps me appreciate how far people are walking to reach the health center, and that they need priority because they came from so far away.

Where have you worked with PIH?

Starting in June 2003, I worked in Cange for almost three years in internal medicine. Cange is always in my heart. I had a good experience there, with a lot of HIV and tuberculosis patients. It was the first time I worked with patients who were very sick, many near death. After we began treatment for those patients, they would recover and leave their sick beds. I saw the transformation. In April 2007, PIH moved me to be charge nurse in Thomonde health center. In January 2009, PIH moved me to Lascahobas, where I spent two years working as charge nurse.

What is your role now?

I go to all the sites to see how the nurses are doing. I see what I can do to support the charge nurse, who oversees the other nurses. I identify needs for further training and work with leadership to fix problems that the nurses and patients are facing. I have also some administrative and human resources responsibilities. But my big responsibility is the supervision of nurses in all sites.

Along with Sheila Davis, PIH’s chief nursing officer, we’re forming a nursing leadership team so that we discuss nursing problems. What has to do with nursing, we decide as nurses. It gives us more liberty.

How does it feel to be the first person in this new position of chief nursing officer for PIH in Haiti?

To visit all the sites, all the hospitals and health centers, is hard. I’ve met with other nurses that have a lot of experience in the system to ask for their help. We know that improving nursing is a big job, and I can’t do it alone, so I need the whole team. I tell them, I need your suggestions and your advice. I need your support and your experience. I need your help, so that together we’re a team that can make a change in nursing.

What change do you hope to see?

All decisions about nursing have to be made by nurses, not doctors.  It’s the nurse who knows the patient the best, better than the doctor. That’s why nurses can give their input on what’s best for the patient, and for the entire health system. In hospitals in Haiti, the chief nursing officer is under the chief medical officer. These two professionals should work side-by-side, rather than one above the other.

We have to start to change nursing education in Haiti. We would like all the courses in the schools of nursing to be taught by nurses, but unfortunately some classes are taught by doctors. Regis College in Boston has been working with the University of Haiti to grant the first master’s degrees in nursing. We need more professors of nursing who have master’s degrees so that we don’t need doctors teaching these classes.  

Also, the government has to think about nurses’ salaries. The basic salary for a nurse in Haiti working in the public sector is the equivalent of $377 each month. Only nurses working for international organizations earn more, perhaps $545 each month. In Haiti, the cost of products and services such as food, clothing, health care, and schooling are very expensive. That’s why a lot of nurses leave the country.  After a post-graduate training, the nurses should have a better salary and a better position, but unfortunately they continue to work with the basic salary and the same position.

We need change. I know it is a long process, but we can make it if we nurses put our heads together and work together—not for personal interests, but for the common good. I believe in that.