Thursday, July 9, 2009

Misc. Photos

Hi everyone! Sorry to be a little behind in updating this site - things have been pretty busy. I can't believe how the weeks have flown by... I'm getting ready to leave the DR this Saturday. It's been so wonderful to be back, and it's so sad to be getting ready to leave all over again. I couldn't think of a cohesive post about the last 10 days, so here's a collection of pictures and stories about all kinds of things:

This is a blurry, sneaky picture of the rooster who lives right outside my bedroom window - and who is my sworn enemy.  The first night I was here, he crowed twice at dawn.  I thought: He's acting appropriately for a rooster!  Perhaps he has changed his ways since two years ago!  But alas, it was not to be.  Since then he has returned to his unfortunate habit of crowing every twenty minutes, starting at 1:30am and lasting til about 6:30am.  Even with earplugs every night, I've only just gotten used to sleeping through it all again.  'Til we meet again, Rooster, 'til we meet again....

All you can do in the afternoon heat....

This little girl, "Luisa," is one of our youngest HIV patients at the clinic.  On the day this picture was taken, she was in for her five-month check-up, and I was chosen to be the model for her monthly photograph.  At only six pounds, Luisa feels like a newborn in your arms.  She was born several months premature to a mother who did not realize she was pregnant - and also did not realize her own HIV-positive status.  Abandoned at birth, Luisa found her way into the care of a neighbor woman with three grown children.  She has been our patient since then, and with the help of HIV medication, donated formula, and lots and lots of loving attention she has been growing and doing well.  It's wonderful to see the staff interact with her - each visit lasts a few hours because at least 9 different people have to hold and cuddle Luisa.  She is passed from lap to lap and smiles for everyone!  Please keep her in your thoughts and prayers as she continues to grow and develop.

We have recently returned to the poultry farm outside Los Conucos (where we were working a year and a half ago) to re-assess the area's health status and water usage.  At this home, young women came out of the woodwork during the survey, curious about what we were doing.  Everybody was excited to have her picture taken!

Here, a girl walks away from the local Gallera - a big, caged stadium where rooster fights are held.  This neighborhood doesn't have a school or a health clinic, but rest assured you can catch a lively rooster match nearby!

My mini-goodbye party - these are great people.

I was sitting in the jeep with the car door open to catch more breeze when I turned around and there was suddenly a small boy essentially in the car next to me (the one with the toothy grin.)  I shook his hand and asked him how he was doing, but he didn't respond.  I thought he was shy until my co-worker said he couldn't speak at all.  His friend on the right came over and the three of us chatted in a mixture of Spanish and sign language.  I never found out the little boy's name because everyone calls him "Mudo," the Spanish word for "Mute."  As we went about our neighborhood business, Mudo tagged along and made himself clear with a variety of specialized gestures.  Once, he disappeared for a few minutes and later returned to show me a mouth full of chewed-up food, shaking a chicken wing in his hand and beckoning me to follow him and get one myself.  I decided not to, and he scampered off for a bit.  When I asked my co-worker, she said it was unlikely he could attend school, since specialized schools for mute and/or deaf children are expensive and not located in San Pedro.  A terrible thing for any child, including one so bright and full of questions.  I really enjoyed my time with this kid, answering questions and trying to decode Dominican gestures (which are different than US ones).  I'm hoping access to a quality education becomes available to him soon, and to all the kids in his area and the DR.

Well, that's it for now!  I'll be back in the States soon, but am hoping to put another couple posts together with things to share from my stay here.  Thanks for reading - Have a good weekend!

Saturday, June 27, 2009

Dibujos! Dibujos!

Wednesday morning at the clinic, this little girl - we'll call her Maria Elena - snuck up on me and tugged my sleeve, saying, "Dibujos! Dibujos!" She was so familiar, but I couldn't quite place her, nor could I remember what dibujos means, so I asked her her name. "Maria Elena!" she said, and launched into a description of dibujos, which is when I remembered.

In April of 2008, Maria Elena appeared at our HIV unit to be seen by a specialist in pediatric infectious disease from the US. This doctor was to come with a team of film-makers working on a documentary about something - I really can't remember what, and we never heard any more about it. But that morning the team was running very late, though Maria Elena and her caregiver had arrived very early and were dressed to the nines. To occupy her, I pulled out a stack of paper and a bag of left-over crayon bits that we save for emergencies. When I handed them to her, she looked puzzled and didn't really know what to do; coloring is not an activity most Dominican children engage in, even in school. So I grabbed a magic marker and sat down with her to make pictures and shape outlines on the paper that she could color in.

I asked her what she wanted in each picture, and the requests got more and more complex as the hours passed. Soon I was scrambling to create images that included a bed AND a window AND a boat AND the moon AND a cat AND three pairs of flip-flops AND an apple tree (whose fruit she later colored orange). We spent hours drawing and coloring and had a very fun time getting to know each other.

When the specialist finally arrived, she invited me to shadow her as part of my medical education, so I did. I had known that Maria Elena was thin, and that her skin was covered with large, dark sores, but I was surprised by our examination findings. Maria Elena was extremely underweight for her age, had a chronic and advanced dermatitis, and chronic respiratory problems that she just couldn't seem to shake. We did a CD4 test, which counts the number of a type of immune cell integral to initiating the body's defense systems in her blood. Her CD4 count was 12. We generally admit and start treatment for adults with a CD4 lower than 350.
Here was a child in full-blown AIDS - with a CD4 count that should have kept her from standing - vivaciously coloring and touring the waiting room.

The specialist decided to start anti-retroviral medication right away, and began to prepare more tests for after the lunch break. As the team left for lunch, I went to give Maria Elena a hug, since I had to do community visits in the afternoon. She immediately kneeled down and wrapped her arms and legs around my left leg, telling me I couldn't leave and laughing as I tried to make my way to the door. Once I disentangled myself, I gave her a quick hug and quickly ducked out to avoid further restraint. I never saw her again.

....until Wednesday! What a wonderful thing to see her more than a year later, doing so much better than before! Maria Elena is at a normal weight, her skin has cleared up, and as far as I could tell, no respiratory infection was keeping her from following me up and down the stairs. A true success story!! We unfortunately didn't get to make any more dibujos (drawings) together on Wednesday, but I'm hoping to run into her again in a couple weeks when the regular pediatrician is back.

Running into Maria Elena again was touching on so many levels: She is an inspiring example of the great combination regular care and antiretrovirals can make in an HIV+ child's life. She is smart and fun and on her way to some great experiences in school. And I must admit I teared up when I realized she remembered our one morning together, and wanted to continue it. It's both immensely satisfying and heart-breaking to be back to see everyone, knowing that I have to leave again so soon. I know I will never forget this place and these people - nor will I ever forget again what dibujos means!

Hope your weekend was restful - have a good week!

Wednesday, June 17, 2009

....I'm back!

The title says it all - I'm back in San Pedro de Macoris, Dominican Republic!

I arrived Saturday night, a few days after finishing exams. The trip had taken shape just in the last couple months of school, as the beginning of the summer opened up to allow some traveling. After months of missing the DR and its people, food, music, etc., I decided to head down here for a few weeks of visiting and volunteering. It's wonderful!

Fortunately for me, my year-long dreams of changed street lay-out, disappearing houses, and increased guagua fare have not come true, and I have arrived to find things comfortingly familiar. I am staying with the Dohns, the missionary family who was so wonderful during my year here, and reveling in mangos, cold showers, very loud merengue music, and portable fans. Today, I hopped on the guagua with Anita and headed to the clinic, where I spent the whole day catching up with my friends and updating the HIV clinic's chart system for lab tests. Tomorrow, we will do some home visits for HIV patients, and plan our workshop on diarrhea for Wednesday. Back in the swing of things - hooray!

But the best part of all is reconnecting with people. I talked for hours today with Santa, Daysi, Rosy, Beljica, Maximinia, and everyone else on the team, showing them current pictures of my friends and family and where I live, and hearing their stories from the year, the new babies in their lives and about the people who have passed away. Even though I'm behind on the news, the relationships feel like I never left. Even the small relationships - patients who remember and greet me, a familiar wave from the security guard - these things warm my heart and make me so happy to be back.

I just wanted to let you all know to expect an update on clinic goings-on, with some pictures of changes and growth accomplished in the past year. Let me know if you have any particular questions you want answered! I hope you all are enjoying the beginning of summer - saludos de la Republica Dominicana!

Wednesday, July 9, 2008

"Final post"

Well, I've been home for 2.5 weeks now. And I still feel like I don't know what to make of it all.

I've been meaning to write this final post literally every day since I returned, but some good reason to postpone it always comes up. I've found the task daunting because I have somehow convinced myself that I need to include profound, all-encompassing thoughts and details, summarize my experience in its totality, and otherwise neatly wrap up the year in a few paragraphs. But that's impossible. So I'll just start with the trip home and see what comes out.

Leaving the DR was a hard thing to do - emotionally and physically. I spent days trying to fit everything into the three suitcases I started the year with, leaving boxes of clothes and lotions and books and toys and shoes in the clinic, with my family, and in the church conference center. Who knew you could collect so much stuff in a year? My friends - who happen to also be my colleagues - had a lovely goodbye party for me, which I described briefly in my last post. My family took me out for a special goodbye supper (at McDonalds! Haha!) on my last night. And my surrogate American family, the Dohns, shared many meals and helped me get ready throughout the week. Every moment in the clinic and at my dance class was in slow-motion and felt special and precious. The night before I left, I was up til 4 a.m. saying goodbye to friends and packing.

Then, I got up at 6:30, and headed to the airport with four of my closest friends who had insisted on riding with me to say goodbye. They helped me haul luggage, charmed the flight check-in lady to not charge me for an extra-heavy bag, and waved to me until I was out of sight in the departure area. We all cried.

Three flights and four cities later, after many customs and immigration desks, canceled flights and close connections, I made it to Chicago, where my family was waiting for me! More crying ensued. My luggage did not make it, which felt like a nice book-end to my trip last July when my luggage didn't make it to the DR at first. But the car was stocked with blueberries, raspberries, and drinkable tap water - all the things I'd been desperately missing. And, when I went to straighten out the baggage issue, I got to do it in English!

So now I am home, my destroyed suitcases are in the trash, and I'm busy moving into my apartment for medical school, which starts August 1. The transition is strange, and overall pretty difficult. The "cultural stutters" range from comical (I have the hardest time flushing toilet paper and insane impulses to speak to small children exclusively in Spanish) to stressful (I was extremely nervous taking a late-night train into Chicago the other night, even though I intellectually knew that this solo nighttime public transportation was safe, or on the plane from Miami to Atlanta, when I felt incredibly guilty for not sharing my sandwich with my seat-mate, which in the DR would be very rude, even though I knew the American next to me would feel strange if I offered him half. And then on the next plane to Chicago when I felt slightly offended that my seat-mate didn't offer me part of her sandwich!) It is strange to walk around and see light-skinned people... it is strange that no one gawks at me when I walk around the grocery store. I feel flustered when I am standing with a group of people in the sun, instead of promptly searching for shade as we do in the DR. I am overwhelmed by the sheer size of everything. It feels like I stepped into a science fiction futuristic movie: The size and efficiency of construction scaffolding, the running water I use to brush my teeth, the mail that punctually arrives every day - I am suddenly noticing and marveling over these things.

And at least 240 times a day, I think What would my Dominican friends think of this?? Wanda the seven-year-old would just be beside herself with fireflies and the hail we had the other day. Santa would probably faint over the selection of apples, her favorite fruit, in the store. Nelson would be speechless to taste Lake Michigan, since he kept trying to tell me Chicago was on an ocean coast, even though I kept telling him it's a lake that looks like an ocean. Everyone would be astounded by my house. Everyday I look around and things that were regular are amazing and remind me of my Dominican friends.

And then, beside the wonder, is a deep uneasiness when I notice with what wild abandon we use paper towels and gasoline. I am overwhelmed by all the brands of pickles in the grocery store. And I'm simply out-of-sync with every reference to a movie, hit song, political campaign, or fashion trend. It's exhausting.

This year in the DR was so different from my regular life that it felt like time stopped. But it has gone on without me. People have graduated; they have gotten engaged. New babies have been born. And other loved ones are no longer with us. To come back and experience a changed and different home is challenging. I try to catch up as best I can; I talk and cry and laugh with my family and friends, but it's hard work.

Scanning back over this post, I realize I describe doing a lot of crying. It's true! I currently do cry often! But I also want to stress how wonderfully happy I am - grateful for the indescribable opportunity to live in the DR, to work and eat and do laundry and make friends and dance. I wouldn't miss it this much if it hadn't been so incredible! And it's equally wonderful to see my family and friends, and even do silly things like take hot showers and eat turkey with whole grain mustard.

The year has changed me! People have been wondering how the year has affected my career goals. I don't really know how to answer that except to say that I am all the more sure that I want to pursue medicine. A year working hard in the medical field and seeing health improvements has given me an extra oomph of motivation to go through the next two years of hard-core science lectures and labs. I already know that that hard work will pay off in a wonderfully rewarding way, and I think I'm luckier than most first-year med students in that knowledge. And I am grateful for the rigorous medical education we receive in the US, especially after seeing the limited medical educational opportunities available to Dominican doctors. Also, I am excited by diverse healthcare fields and opportunities! I am facing a career path in which I can choose to speak Spanish, work outside in communities, participate in education and prevention, get to know patients and families and communities... yes! And I am deeply committed to culturally competent care, to a better understanding of social determinants of health, to the end of ethnic/racial health disparities, and particularly to the world-wide HIV epidemic. Phew. Do I have some causes cut out for me or what.

So, in short, it appears I am forever changed. There is just so much to say - in writing this, I feel as if I have only touched the very tip of the iceberg. And my mind is already racing with more thoughts about the friendships I made, the experience of working in another culture, the thrill of being even a small help to a community that became like another family to me. Clearly, though the year may be over, the experience is not. Writing a "final post" for this blog feels silly, though I know I can't continue to update it forever. Please feel free to contact me with questions or thoughts you have, or if you want more information about YASC to share with another young person. As I'm sure you can see, I'm more than happy to talk about this year.

And thank you all so very very much for your continued support before, during, and after this year. The experience was made possible - and enjoyable - by you all, and I really appreciate every message, donation, blog comment, and letter that came my way. I don't think this is the end of my DR experience, so I hope we will be in contact in the future, especially as I better gather my thoughts and photos. Thank you Thank you Thank you! And please do keep in touch!

Wednesday, June 18, 2008

The Last Week

[I started this post early during my last week in the DR, tried to finish it up and post it mid-week at work, and then was interrupted, as you will see, before the power/internet went out. Sorry to be posting it so late after it was written.]

It’s getting toward bedtime, and I’m sitting here listening to salsa music float in from the street and feeling semi-teary about facing my last week here in the DR. In mid-April, I remember looking at the calendar and feeling fairly certain this week would never come. At the time, I was feeling a little homesick, though I knew that deep-down I didn’t want the year to end any earlier than was already planned. What I didn’t expect was how hard it is to leave now that the time has come.

What an unbelievable year I’ve had! I really do find myself at a loss for words to describe it – but that doesn’t mean I don’t want to talk about it! In fact, I want to go ahead and put out a formal request, in writing, to all of you friends and family: Whenever our paths next cross, please do ask me about this year. I have so many anecdotes, reactions, feelings, and observations I want to share! If you find yourself wanting to ask something beyond “How was your year?”, here is a list of subjects I’ve recently been wishing I had written postings on:

  • The livestock and poultry farm where many of our Los Conucos families live and work, and where we spent a harrowing day doing our door-to-door health census.

  • Wanda, the seven-year-old I currently live with, who likes to dance in the kitchen with me, leaves surprises like finger-paintings and eye-ball-shaped candy on my bed, and is currently engaged in a lively effort to convince me that the frost build-up in the freezer must be snow.

  • Modes of transport ranging from feet and the occasional Jeep to gua-guas, backs of flat-bed trucks, motorcycles, and rafts.

  • Anything relating to my fabulous dance class.

  • What it’s like to work in an office that offers free HIV testing. I’ve found that simply being the check-in person for people asking for the test – and then waiting with them for their results a few days later – has been one of the hardest and most compelling experiences for me.

  • Cultural stuff: Dominican Time, manners, personal space, sayings and beliefs around illness...

  • My new identities as amazing chef (taught somebody to make scrambled eggs yesterday and am already famous for making Betty Crocker cake mixes), computer whiz, master of visual aids, typing genius, and – yes, ETHS folk – even video game aficionado.

  • My (limited but memorable) encounters with politics, elections, and police.

  • "How to Be a Responsible Donor": what I'm jokingly calling a collection of experiences, observations, and advice I've gathered this year about what's really helpful to donate to places like our clinic in the DR.

Just as I was getting ready to post this on the work computer, friends from Boca Chica and the capital arrived and I was ushered upstairs to a surprise Despedida (goodbye party).

Well, here I am full-out tearful and touched after my goodbye party at the clinic. We all sat in a circle (true Dominican party style) and took turns saying a few things. I was really touched by the wonderful things my Dominican colleagues and fellow Americans said about my work here - I feel truly accepted and appreciated! I was presented with certificates and a beautiful Dominican painting.... there were empanadas and cake and two flavors of ice cream.... and when I got up to say something I was about two sentences in before the tears started. Even though crying and speaking in Spanish are a particularly hard combination for me, I think I managed to tell everyone how dearly I love and appreciate them. San Pedro, the clinic, and particularly this group of people are another hogar y familia (home and family) for me. I just can't emphasize enough how incredible this has been and how much I will miss them all.

And now that I've re-triggered the tears by writing about it, I'm gonna stop here and just post what I have. The next few days will be incredibly busy, and I won't be in the office much with internet access, but I will try to post this weekend when I'm back in the States. (...still an unbelievable concept.) My love to everyone.

Saturday, June 7, 2008

Coming to a close...

Just a heads-up (as much for me as for you): I head home two weeks from today.

I arrived here in the DR July 2007 with plans to return to the US in July 2008. (My med school just adopted a new curriculum and class now starts two months earlier on August 1, so I had to scoot my departure date up to June.)

I wanted to write about all the contradictory feelings I'm having right now, about my favorite things about the DR, about the things I'm most looking foward to back at home.... but as soon as I write a sentence, I look it over and throw it out as not accurately capturing what I want to convey. So, I'm gonna sleep on it. Hopefully tomorrow will bring a little more clarity! My love to everyone.... see you soon!

Wednesday, May 28, 2008


About a month ago, a school called and asked us to do HIV education presentations for all of its seventh- and eighth-graders, so two weeks ago, we went and spent a whole day repeating our VIH Charla presentation for various groups. The room was dark (no electricity) and way over-crowded with about 65 students for each presentation. (I tried to get a couple pictures, but it was just too dark.) We were hot and crowded, but we pressed on and gave five presentations to the (mostly) well-behaved and engaged middle schoolers.

In this picture, Anita is prepping a volunteer skit group. The signs they are wearing are different illnesses (Tos = cough and Fiebre = fever, though there are others signs for diarrhea and itchy rash too) and the skit compares what happens when these illnesses attack a healthy person´s immune system with what happens when they attack an HIV-infected person´s immune system. Kids get really into this skit, and it´s a good, simple illustration of how HIV works in the body.

Here, Anita uses colored water in different bottles to indicate what happens when a group of young men (in a land far, far away) visit an HIV-infected promiscuous woman in ¨the big city¨ and then marry and are loyal to different women later in life. At the end, the bottles are unveiled as the kids predict which ones are infected with red-colored HIV-water and which are not. Only the boy who did not go with his friends to visit the promiscuous woman - and consequently, his wife - are uninfected.

These skits pepper a (battery-powered) power-point presentation with information on HIV symptoms, how it´s spread, how it´s not spread, how to protect yourself, etc. It´s hard information to present to groups as young as seventh- and eighth-graders, who get antsy and somewhat hysterical around any topic related to sex, but I think these groups learned a lot, and it really is important to educate earlier rather than later.

I also got to spend some time outside during recess:

That´s it for now! Love to everyone!