PAHO/WHO Project in Commonwealth Caribbean

My next project was to assist World Health Organization (WHO) personnel in developing an evaluation of schools of nursing in the 13 countries of the former British Caribbean territories, later named the Commonwealth Caribbean. My title for this Pan American Health Organization/World Health Organization (PAHO/WHO) project was “PAHO/WHO Short Term Consultant”.

I was responsible for the development of the entire project under the general direction of the zone nurse, Janet Thomson. The PAHO/WHO project nurse was Nita Barrow. This project -PAHO/WHO Survey of Schools of Nursing in the Caribbean Area –followed the same methodology I had developed for the PPESN in Canada. The first phase, as in Canada, included visits to all countries and territories to interpret the project to ministers of governments, members of board controlling nursing schools, matrons, teaching staff other nursing personnel and, where requested to do so, the local nurses’ associations, general nursing councils and medical associations. During these one-to two-day preliminary visits, we interpreted and distributed a questionnaire designed to obtain some basic information about each school of nursing, prior to the survey. In this initial phase, it was also necessary, as it was in Canada to have an Advisory Committee, a Board of Review, and Regional Visitors. There were three persons intimately involved in the project: The Project Nurse, Nita Barrow, who was recruited from her post as Principal Nursing Officer in Jamaica. Nita Barrow and WHO had tried to convince me to become the project nurse but I was unable to commit myself to working in the Caribbean for two years. Despite pressure to change my mind, I held firm and recommended Nita as having all the necessary qualifications to become Project Nurse. At that time, WHO had a policy that no national could be employed to carry out a project in his/his own country. In the end, we prevailed and, despite the roadblocks, a national, Nita Barrow, was given permission to be a senior member of the WHO team.

The Zone Nurse, Janet Thomson, was a highly competent American WHO nurse stationed in Caracas. The Short-term Consultant was a position I eventually held for almost 10 years. My original assignment was a two-year appointment but I carried on for an additional seven years. For seven weeks in the summer of 1964 and, again, for six weeks in the summer of 1965, I worked on the project. (See p. 16-19 of the report “Survey of Schools of Nursing in the Caribbean Area” and “Spotlight on Nursing

Education: The Report of the PPESN in Canada” p.13-17.)

Nita Barrow (far right)

As noted earlier, preliminary visits were made to 13 countries and 23 schools of nursing. Later, one week surveys of the 23 schools were carried out to collect data for the final evaluation. Air travel to the 13 Caribbean countries, each on its own island~ was a fascinating adventure. We would “take off” across a wonderful, blue, sparkling sea only to land in a very short period of time on another tropical island. This was my very first trip to the tropics but not by any means, my last.

Many memorable events occurred on various stops. One visit, especially, I shall always remember. It is difficult to forget looking for yourself -for almost an hour! Apparently, Nita Barrow had asked a very efficient Chief Nurse in the Public Health Service to look after me, despite the fact that I didn’t feel I needed “looking after.” After she greeted me warmly at the airport, the Chief Nurse asked if I would help her locate a physician from Canada who had been on my plane. Pleased to assist, I recovered my bags and began checking the passports of deplaning passengers. I approached an elegant man with a Canada passport and asked if he was a doctor on a PAHO/WHO assignment. His response, a very rude “No!” I persevered.

Eventually — there were 100 passengers on the plane — I spotted a very business-like person with the appropriate passport and asked, very politely, if he were coming to St. Lucia for an assignment with WHO. He looked suspiciously at me and proceeded to the baggage claim area. In those days, you could move freely through the terminal, so I followed him only to be told that he was NOT with any organization. I reported back to the Chief Nurse who was still chatting with Nita. I suggested that she ask the airport officials to page the doctor over the public address system, lest our Canadian doctor had slipped through our net. Booming over the loudspeaker came the message, “Would Dr. Mussallem from Canada please identify himself to the station manager.” Well! After almost an hour of looking, we had located the missing Canadian doctor!

In the meantime, Nita had been reclaiming her luggage. Unfortunately, her suitcase was a disaster. It was as full of holes as a grate, and was seemingly held together by a few tattered bits of fabric. A young man, carrying a cardboard box, approached us. He told us that he had left Antigua with 12 reptiles and now there were only two in his box. Had we seen any? An airport official wanted to open Nita’s bag there and then but Nita refused. After all, one doesn’t wish to have one’s personal items exposed to public gaze.

Before we began our survey in each country, we attended an elegant reception complete with government officials, clergy, PAHO/WHO personnel, staff, from hospitals, schools of nursing, press, etc. St. Lucia was no exception. This was a very formal occasion with many speeches. After the formalities, the Zone Nurse and Project Nurse spoke outlining the project and, finally, I contributed a few words about my role. I always tried to have “a little special something” in each presentation. On our flight into St. Lucia, I had spotted a rainbow which made a complete circle. Wow! It was so spectacular that I thought it merited waking Nita to see it. (Nita always sat by the window and went into a deep sleep before the plane took off. When we landed, she awoke fresh and rested.) At my prodding, she opened her beautiful, dark eyes and took a good look at the rainbow and then promptly fell into a deep sleep again. I jotted down a few notes thinking that I could use this extraordinary sight in my speech. Eloquently, I likened the rainbow circle to the value of nursing in the Caribbean –encompassing the whole spectrum of society and its commitment to prevention of disease, the maintenance of health, and the education of nurses to meet health goals.

At our welcoming reception, dignitaries spoke, the Zone Nurse spoke, and then Nita spoke. Imagine my surprise when she gave a moving speech based on the circular rainbow she had seen from the plane. There went my speech, although I did manage to scrounge a few snippets out of what I had prepared. Nita Barrow, I should mention, was, and is, one of the most gifted speakers I have ever heard. Although many Caribbeans seem to have a talent for public speaking, Nita is head and shoulders above the rest.

With the Minister of Health, Barbados

At the time of our surveys, Nita’s brother was Premier of Barbados and one of the most outstanding dignitaries in the entire Caribbean. Nita, however, never took advantage of her illustrious brother’s position.” Well, perhaps on one occasion, and that was when a companion stepped on some sea urchins. Nita asked a police constable to get help and, when he did not obey, she “let him have it”. For such a dignified, calm person, she could “fight like mad” whenthe occasion demanded it.

I recall the extraordinary preparations made for us prior to and during our survey visits. Every effort was made to have all documents and schedules ready and waiting for us. What a wide range of quality and ingenuity we encountered! I remember, with some amusement, the diagrams of the female genitourinary tract presented to us at one school of nursing. Before us were drawings, in color, of all anatomical parts -but with a new twist! Around the uterus, kidneys, bladder, etc. was pasted exquisite lace. Never before or since have I seen those organs looking so festive!

The curriculum in most of the Caribbean schools of nursing was an exact copy of the syllabus in the U.K. These were former British colonies and senior staff were expatriates or recruits from the U.K. Additionally, nurses graduating from Caribbean schools wished to have reciprocity with the U.K. and this could be accomplished only if the U.K. syllabus was followed. When I asked in school after school for a copy of their curriculum, I became very discouraged when all that was produced was a copy of “The Syllabus”. It was music to my ears when I heard, at the 1972 Seminar for Tutors, the Director of one of these schools ask, “When are we going to produce nurses who are qualified to meet the needs of the Caribbean people?”

The one-week survey visit to each school of nursing was an intensive process, usually planned as follows:

Monday was devoted to studying the information provided in the Preliminary Information Schedule and the 21 additional items of written materials describing the program, requested at the time of the survey. Tuesday, Wednesday and Thursday were spent in visiting the school, the hospital and one affiliating agency, and in interviewing individuals and groups directly connected with the educational program. Each evening and all day Friday were spent writing the report, and Saturday morning the report was read back to the faculty and other interested members of the hospital staff. A total of approximately 65 hours was spent by each visitor on the survey and the writing of the report.

Helen K. Mussallem and chauffeur

Rule No. 1 was that absolutely no evenings were to be spent in other than writing of the report, discussions, etc. related to the relevant survey. One week, when we were in Antigua, the country where the Project Director was headquartered, I noticed some unusual activity. Maids and porters were kept busy delivering small and large packages which Nita put on top of the fridge. By Thursday, I was becoming really suspicious. I said to Nita, “I hope we are not having guests before we finish on Saturday.” No reply. You didn’t push Nita, no matter what your authority. All day Friday, while we were writing the report at Nita’s place in Sugar Hill Flats, activity increased and Nita divided her time between receiving parcels and writing her share of the report. At 7 p.m., I was still busy writing when guests started to arrive. Nita had recruited the assistance of maids and waiters of friends and, together, they whipped up the best party ever–about 60 people came. After putting the report together in my flat next to Nita’s, I joined in the fun. The main focus was a BBQ with a pig’s head rotated on a spit and cooked to a turn. As Nita’s flat became the main venue for the party, one maid, Valentino, was assigned to wash dishes in my flat. Dear Valentino was so pregnant but, as everything was set up for her there, she managed just fine.

Despite my misgivings, I enjoyed the party immensely. Nita had prepared some absolutely luscious Caribbean dishes and her friends and brought others. Rum and other spiritus frumenti were in ample supply but there was no sign of any intoxication. I had consumed very little myself, as I knew I had more work to do that night on the survey report. Food was laid out buffet style but, from somewhere, Nita had recruited two waiters so everyone was well looked after. We were a friendly, happy group which included most of the Island officials and doctors and their wives from all over the island.

When the party ended at about 11 p.m., there were no words of protest from me. Nita knew I had enjoyed the festivities. The waiters cleaned the flat and Valentino was washing dishes in my quarters. When I returned to my flat -the kitchen was the first room you entered –Valentino said something like, “Dotah mam des a moh n yo ba”. Perplexed, I replied, “I can’t understand you Valentino. Please speak more slowly”. Again, I failed to understand her. Not wanting to be insistent but now very curious. I again asked, “Valentino, please speak more slowly –one word at a time”. Still no luck. By this time, I was so tired that all I wanted to do was to get to bed. The report could be finished in the morning. Slowly, she enunciated, “Dotah ma’m des a man in yo bed”. Comprehension slowly dawned but I still thought I must have misunderstood something. By now, I was screeching at poor Valentino who became so frightened that she turned the small garbage pail upside down, sat on it, and began to cry uncontrollably. I proceeded, hesitant1y to my darkened bedroom and, sure enough, there was a man asleep on my bed. I stepped back, yelling at him to get out of my bed and house. Not a move. I shouted louder; still no movement. Creeping closer to the bed, it became obvious that he was completely unconscious from indulging too free1y at OUR party. I dashed over and got Nita but, even with her assistance, it was impossible to rouse our intruder. I returned to Nita’s flat where we argued for a while as she wanted me to sleep in her bed but I won and slept on the couch. As we readied for bed I rehearsed how I was going to severely reprimand that impossible man who had stolen my bed.

I woke early and walked outside where I could peer in through my bedroom window. The lifeless figure was still there. I returned at intervals but when he hadn’t awakened by 7 a.m., I rapped on the window waking him with a start. I dashed inside and confronted the dazed man, “telling him off” in no uncertain terms. He tried to get in a word of explanation and, finally, I listened. After showing me his identification, he explained that he was from NASA and had been working steadily for 48 hours on the launch of GEMINI. Full of compassion, I invited him to Nita’s flat for breakfast. Nita looked puzzled as I led him in.

I’m sure she was wondering what had happened to the fierce speech I had prepared. After working so many hours, he explained, when his relief finally arrived, he dragged himself to his room at the Sugar Mill Motel–just down the hill from our flats. Too tired to sleep, he heard the noise and music from our party and walked up the hill to see what was going on. Next thing he knew, someone handed him a drink and he was swept into the party. When lack of sleep and fatigue finally caught up with him, instead of going back to his room, he thought he would rest for a bit in my flat before returning to the party. My bed looked just right for a quick nap and that was the last thing he remembered until I banged on the window. Why Valentino let him into my bedroom is something I still don’t know but I presume she thought he was one of our party.

Unexpectedly, Nita and I found out something about the tracking of satellites and, to this day, when a space ship is launched, I remember –and chuckle.

The Board of Review, composed of eight well-qualified senior nurses from eight of the 23 countries had the onerous responsibility of evaluating, in the light of factual information presented to them, the 23 nursing schools. I recall so well their August 1964 meeting held in the open garage of the Barrymore Hotel. Voting on every aspect of every report was awesome –a soul-searching process. Two of the group stood out head and shoulders above the rest and led the evaluation to a credible conclusion. I reflected back on the PPESN Board of Review meetings in Canada and felt sure that the commitment and quality of the two groups was not that far apart. The process was a Canadian one and I was fascinated to note how readily it was accepted by these exceptional nurses in the Caribbean.

The contrast in the settings of our meetings was remarkable. In Canada, we had a suite at the Chateau Laurier. In Antigua, we met in the open garage. Each time there was a tropical downpour –and there were many –we had to recess the meeting, so loud was the noise from the rain. Despite all this, the quality of both groups was, in my opinion, equal.

It was during this first sitting of the Board of Review in Antigua, while I was accompanying Mrs. Chagas (Chief Nurse, PAHO/WHO, in Washington), that I had an unusual experience. As Nita, and her car, were already engaged, I volunteered to accompany Mrs. Chagas, by taxi, to the meeting at the Barrymore. On arrival, I insisted on paying for the taxi. Much to my chagrin, when I opened my wallet, I didn’t have any BIWI dollars. The night before, I had visited the bar at the Sugar Mill Flats expressly to exchange Canadian travellers cheques for local currency. The bar was full but I managed to complete my transaction and returned immediately to my suite. That night there was a most horrendous storm which I had hoped would relieve the debilitating humidity. There was a ceiling fan in my room but it offered little respite so, as was my custom in the tropics, I lay on top of the bed without my nightdress. When I attempted to pay our taxi fare, I realized that I had been relieved of my BIWI currency, but said nothing. With alacrity, Mrs. Chagas paid the tab. I was disturbed, however. Why were there Canadian travellers cheques and Canadian dollars in my wallet, but no BIWI dollars.

In the midst of our deliberations at the Board of Review meeting, I suddenly realized what had probably happened. During that unbelievably noisy storm, someone had entered my room, opened my purse, and removed my BIWI dollars. Foolishly, I had opened my purse in the bar that night and, presumably, all could see the contents. The next day, after the meetings, I told Nita about my “robbery”. My news so disturbed her that she had what seemed to me to be an asthmatic attack. On our return to Antigua, Nita reported what had happened to the hotel and, believe it or not, I was put in the Honeymoon Suite –three rooms and three locks! In addition, Nita had two police officers on duty outside my room- very reassuring except that the policemen’s voices kept me awake all night.

Relaxing in Barbados

Another evening that remains indelibly etched in my memory is the night a hurricane was headed for Antigua. That day, we had completed the survey of the Antigua School of Nursing. (This was done in 1964 as a model for the surveys to be carried out in the remaining 22 schools when I was back in Canada.) The hurricane watch was a devastating experience. I know the Matron of the school believed she had a good school of nursing-but that was far from reality.

The survey was conducted according to plan and, on Saturday morning, the report was to be presented to the faculty of the school of nursing and other interested members of the hospital staff. When I arrived in the room where the report was to be read, I realized we had an exceptionally large audience. I took my place at the podium with Nita on one side and the Regional Visitor (a religious sister) on the other. The Matron, despite my urging. chose to sit behind me. By this time, the room was full to overflowing. On one side of the room were about 20 nursing sisters, dressed in white with their blue belts and stiffly-starched veils; on the other side were 15 or more doctors also dressed in white suits. What an imposing sight! I could detect great tension in the room so I started out by saying a few pleasant words, attempting to put the group at ease. The report sat squarely in front of me … but I did not start reading until I told a small, whimsical story which was received with polite laughter. Finally, I opened the report and, as I began to read, a strong gust of wind burst through the window and howled across the room to the windows on the other side taking with it almost all of the report except for the few pages I managed to hold down. Almost all of the doctors– some of whom were cricketers (I found out later) and many of the young nurses dashed outside to rescue my sheets. Nurses and doctors brought back page after page -some pages had gone into the sea and the tall doctors had waded in and rescued them. They handed them proudly to me saying, “I has page 82 and 19 ma’m, and the Chief of Surgery has four sheets.” I collated the tattered report, keeping my hand steadily on the pile which was still being battered by gusts of wind. Nothing could have put the group more at ease than this calamity. When Nita and I completed reading the report, we went back to our Sugar Hill Flats to correct the report and put it in order for the typist.

I spent most of that afternoon working on the report as Nita had to do some other work for PAHO/WHO. When I was satisfied that it was in proper shape, I wondered how it could be protected should the rumoured hurricane become a reality. As I recalled seeing pictures of a hurricane’s aftermath when all that was left was a stove and refrigerator, I wrapped the survey report carefully –it was the only copy in Antigua and these were the days before photocopiers ~-and put it in the oven. About an hour later, Nita asked, “What is that peculiar smell7” I told her that I had put our survey in the oven in case a hurricane struck Sugar Mill Flats. For the first and only, time, Nita screamed at me. “What’s the matter with you!! Don’t you know there is a gas pilot light in the stove???” Rescuing our treasured document, we put the slightly-singed report in the refrigerator.

Dame Nita Barrow

As the afternoon wore on, the winds grew stronger and the radio kept blasting out reports of thehurricane heading for Antigua. Nita’s friends and relatives came to our flats, high atop the mounds by the sea, and, one after the other, begged Nita to leave our flats and stay with them  for the night. Nita refused to go but pleaded with me to leave. Stubbornly, I said, “I won’t go if you are staying.” I did, however, move into Nita’s flat.

We telephoned constantly for hurricane updates until all electricity went out and we were left without communication of any kind. I stretched out on the couch and watched as huge trees bent over to touch the ground in the eerie light that preceded the hurricane. Nita sat up all night trying to make contact – with anyone. Impossible. I have never, in all my years of knowing Nita,  seen her so fragile. About 10 p.m., a jeep made it halfway up the hill to our dwelling only to find the road washed out. Junie walked the rest of the way and tried, for the last time, to get Nita and I to leave. We stayed. Finally, at about 6 a.m., there was a beautiful, quiet sky. The devastation was awful but we were fortunate that the hurricane had veered away from Antigua and struck Guadeloupe where it hit very hard. Guadeloupe suffered many deaths and massive destruction so we were fortunate after all.