Melissa Agrimanakis has a passion for working in developing countries, which is why the 2010 DPT graduate has returned to the IHP for a nurse practitioner degree.
In all the times Melissa Agrimanakis has gone to Haiti to treat patients in the ravaged Caribbean nation, there’s one question the 2010 Doctor of Physical Therapy graduate keeps returning to: “How can I do more?”
She recently found her answer. Starting this fall, she returned to the MGH Institute as a student in the Master of Science in Nursing program to become a nurse practitioner.
“If I want to go to other countries and help build these rehab clinics, if Physical Therapy is not a recognized profession, it's going to be very hard to gain the trust of the community to help build these clinics,” says Agrimanakis, who is in her first semester in the Master of Science in Nursing program. “A nursing degree is an international degree. Everyone knows what a nurse is. Everyone understands what a nurse does.”
During her 10 trips to Haiti, Agrimanakis has been making an impact – first by winning the trust of the locals, then winning their confidence by helping them move in ways they couldn’t before.
“I treat anyone that comes in with a neuro diagnosis,” says the neuro physical therapist. “It might be someone who can’t chew their food, or they're having a really hard time moving their foot, or suddenly, they’re paralyzed. They come to see me.”
Agrimanakis also handles wounds of all kinds including those from gunshots and stabbings, burns, bug bites, scabies, rashes, and pressure injuries. You name it and Agrimanakis has probably seen it and fixed it.
“You feel good after you've treated someone,” says the 12-year physical therapy veteran. “I love seeing people feeling better. You get lots of hugs, lots of kisses, from people just excited that they can get therapy and feel better.”
The native of Greece has seeing people get better in Port-de-Paix ever since she began visiting there in 2015. The first few trips were with Spaulding Rehabilitation Hospital, where she works in the spinal cord unit. But over the past few years, she has spent weeks at a time in Haiti with the non-profit Sustainable Therapy and New Development (STAND), whose mission is to bring sustainable therapy to the Caribbean country. Agrimanakis typically visits Haiti with a team of 20 nurses, physical therapists, occupational therapists, and nutritionists from the United States, Canada, Australia, and New Zealand. The mission is two-fold: 1) provide treatment from sunrise to sunset and 2) train Haitian citizens to work in the clinic year-round.
“The goal is to make the clinic sustainable,” says Agrimanakis, “so they don't have to rely on people coming in from other countries to get the care they need.”
At least twice a year, the STAND team meets in Miami then flies into the Haitian capital of Port-au-Prince. From there, it’s an arduous and lengthy bus ride through the mountains and dirt roads to get to the home in Port-de-Paix that houses the clinic.
“It’s an adventure. The bus breaks down. You get stuck, but then you get to meet lots of people, so it's fun,” laughs Agrimanakis. “I think the shortest bus ride was 12 hours, and the longest one was probably 18 or 20 hours. But you get a chance to meet all the people that you're going to be working with.”
Because the team brings their own supplies, members are limited in what they can use – and what kind of service they can provide.
“My rule is not necessarily to give patients a diagnosis. It’s to help improve their function so they can try to do what they need to do,” she says. “We don’t have the tools to be diagnosing illnesses. We don't have CTs. We don't have blood labs. We don't have MRI machines. We don't have X-rays. Nothing like that. It’s ‘What are their symptoms and how can we help?’”
Medical limitations aside, Haitians still flock to the clinic, lining up outside the clinic at 4:00 a.m. every day. Some days the clinic sees between 120 and 170 patients.
While the clinic some days is more crowded than others, every day is a time to be culturally sensitive.
“If someone comes and tells me they have a wound because they're cursed, I can't tell them ‘No, that's not why you have the wound. There's a histological reason why your skin is breaking down.’. There was a steep learning curve with that when I first started treating there.”
It’s the treatment and education that has made Agrimanakis a humanitarian hero in Haiti.
“We've had people come year after year after year, and they recognize me,” she says. “If I see them in the community, they wave to me, so that's nice. In addition to the care, I also go into the community and do education about basic hygiene, food prep, purifying water, that sort of thing as well.”
Progress in the community has extended to working with Haitian practitioners, as the STAND team hired a local physical therapist and occupational therapist just before the start of COVID.
“The clinic is now truly being run by Haitians, which was our goal,” Agrimanakis says. “It's great to see the education and your advice spreading beyond the clinic. I think that's one of the biggest things for me. I get so excited when I see our education expanding, because then you can, by default, help more people than we can in just the clinic.”
Just as Agrimanakis and her team were making progress, factors outside their control took hold. First there was COVID, followed by a gas shortage and economic strife, all of which was compounded by a political vacuum created when Haiti’s president was assassinated.
“Currently gangs control the country,” says Agrimanakis. “Anyone that has gone to Haiti runs a very high risk of getting kidnapped. Initially, they were just kidnapping people that were not Haitian, but now even Haitians aren't safe and there are roadblocks everywhere. There's gang violence. It’s just a very unsafe environment.”
Genesis for Humanitarian Help
The healthcare eyes of Agrimanakis were opened when, as a 10-year-old, she visited her grandmother’s home in Crete, which had an outhouse but no running water. She went to a local clinic for care after hurting her foot, but it quickly became infected. After receiving proper care in Athens, she realized not all medical care in the world was created equal. In college, mission trips to Ecuador and Nicaragua only added to her drive to help those less fortunate.
“That just kind of reinforced the ideas that I love doing this and there is a real need to do work internationally and help people who do not have the same privileges that you do,” says Agrimanakis. “But you need to do it in a way that’s consistent with their culture and not force your own culture on theirs.”
The Need for a Nursing Degree
But while she has treated hundreds of Haitians, it became clear she would need a nursing degree to accomplish even more. While the team waits for a safe time to travel, STAND is keeping the clinic functional with fundraising and online trainings with the Haitian staff that’s there, but with spotty internet connection, it’s been a challenge.
In the meantime, Agrimanakis has returned to the IHP so she can do more. As a nurse, she’ll be able to treat people in a more wholistic way “In any developing country that doesn't have access to good, consistent health care, people are too sick to deal with their aches and pains,” says Agrimanakis. “If you can treat the medical side of things and the disease part of things, you can be a more effective PT or OT.”
It’s this global approach she plans to use in a developing country – and her own.
“The more I know about the body, the more effective I can be,” said Agrimanakis. “I want to work with refugees and immigrants, and a lot of these people don't have access to good health care even though they live in the United States. I might be one of the few providers that they see, so if I can help them with both their medical concerns as well as their rehab concerns, I can do a lot more for them.”
Clinical placements, along with faculty expertise and attentiveness, were the critical factors in her decision to return to for her NP degree.
“The education you're getting is top notch, but even more so than that, the clinical placements I had really helped prepare and educate me as to what a role of a PT is,” says Agrimanakis, who was a professional dancer before initially enrolling at the IHP in 2007. “The didactic part of your education obviously is important - you need to know the theories behind everything - but it's really the hands-on practice that is the most important part of learning. I think that's really what makes IHP students stand out when they eventually get into the working world.
The working world at Spaulding will see Agrimanakis on a part-time basis as she pursues a nursing degree. “I love the hands-on work,” she says. “I love working with patients, and I didn't want to give that up for three years.”
In the meantime, Agrimanakis is hopeful for a safer Haiti so she and her STAND colleagues can make an in-person return.
“We're staying in Haiti, and for as long as we have the funds and the resources, we're going to keep our clinic open,” she says. “Ideally, I want to stay in Haiti but if I can't go back - - and international work is my passion - I will find other places. And then as soon as Haiti opens back up again, I'll be back.”