I'm particularly drawn to two regular patients at the clinic; we'll call them Jose and Carlos. We see both these babies often, including today, and I'd like to share their stories with you:
Jose is six-months old and weighs 8 pounds today. Last week when I weighed him he was 9 pounds, and the week before that he weighed 10 pounds - his caregiver told me today that he won't eat. Jose's HIV-positive mother abandoned him as a newborn, and he was taken in by an elderly neighbor woman and an uncle who are both very dedicated to his care. As a newborn, Jose was hospitalized five times in as many months before the public hospital referred him to our clinic. Fortunately, we can provide care (and some baby formula) to the family free of charge. Unfortunately, we don't have a big lab and cannot provide many of the complicated tests the baby needs, which means more expense for the family and lots of lost time waiting for results. We can't even do an HIV test, since the more affordable test we have would detect the mother's antibodies in the baby's system and be an automatic positive, no matter Jose's real status. Jose can't sit-up or grasp objects; he breathes poorly and his skin is covered in old and newer scabies scars. But he is alert, makes strong eye-contact, and loves to visually track moving objects. And he has the most wonderful, rare smile (that he usually reserves for his uncle). Holding this serious, tiny baby is unlike anything I've ever done before; my heart breaks for him. Jose is very, very ill. His failure to thrive is possibly due to a positive HIV status, but we can't start treatment until we get two separate, positive results of the expensive, out-sourced test - weeks of waiting. Today, we decided to put him in the hospital for a few days of IV nutrition. Please keep him in your thoughts and prayers - this baby needs all the help he can get.
Carlos is doing only a little better than Jose. At nine-months he weighs in at 14 pounds. His quiet, timid mother weighs 94 pounds (three pounds less than two days ago). She is HIV-positive, but Carlos has definitively tested negative, to everyone's relief. So why is Carlos' growth plateauing? He is a social and engaging child, with a sweet, elfin face and a quick smile. His mother says he eats a lot (rice, beans and even some meat, but almost no milk, which is too expensive and which we can't provide on the donor-program's technicality that Carlos is not HIV+). Mom hesitates to answer our questions; even when Elena, (with her open, non-judgmental, trustworthy, and caring manner) reaches out to her and gently explains how important it is for the baby to eat, and for Mom to eat, too. When Elena asks how things are at home, and if they have any food, Carlos' mother says yes and does not elaborate. Meanwhile, Carlos is malnourished, has chronic diarrhea, and failure to thrive. But, unlike Jose's failure to thrive, Carlos' seems nearly exclusively related to poverty - to little access to clean, affordable, and nutritious food and water, and to a parent who lacks a support-system and education to help her engage and care for her child, physically, mentally and emotionally. But there are encouraging moments: Carlos' mom returned my smile today. She wants to take care of her child, but doesn't really know how. I believe she is slowly warming up to us, which is the best way for us to care for both of them. Carlos and Mom: another family to keep in your hearts.
Even when I'm not at the clinic, I find these two sweet, small babies in my thoughts often. One baby probably HIV-positive and the other not. One with caring, dedicated, and persistent caregivers and the other with a single caregiver who's just starting to learn. Both families are fighting a difficult and terrible battle to raise their children. For me, both children are reminders of why I want to help and of what I need to do. Again, please keep them both in your thoughts and prayers.
Wednesday, September 26, 2007
Jarabacoa: the adventures continue...
This past long-weekend I went back up to the mountains in Jarabacoa with another woman from the clinic to do some more adventuring. And it was quite the adventure: Several different buses broke down during the weekend; I got on a horse for the third time in my life and ended up on a 20-minute gallop through the country-side with no real saddle and some bumps into trees and fences; I got on a river-raft for the second time in my life - we capsized in a rapid called The Toilet. (I spent a short time floating down-river, but luckily we were all fine.) But perhaps the best adventure came in the form of Manuel and Estrilo, two six-year-old cousins who were daring each other to get closer and closer to our cabin while I was reading. I went out to say hello and the boys and I became fast friends. The next day, more kids showed up at the camp. All of them are very familiar with digital cameras and very excited about photo-shoots. So here are some of our best shots:
Estrilo and Manuel
Part of the group (That fruit that everyone keeps eating is called guayava and is sort of like the Dominican apple)
Girls only!
Muchachos
Group cart-wheel attempt
Group shot
There are several other shots of eating cookies, climbing trees, swinging, and all that good stuff. These kids are enthusiastic about everything and great Spanish teachers! I had an amazing time riding horses, swimming in waterfalls, and rafting this weekend, but sometimes nothing beats some good old-fashioned hangin' around with the kids!
Estrilo and Manuel
Part of the group (That fruit that everyone keeps eating is called guayava and is sort of like the Dominican apple)
Girls only!
Muchachos
Group cart-wheel attempt
Group shotThere are several other shots of eating cookies, climbing trees, swinging, and all that good stuff. These kids are enthusiastic about everything and great Spanish teachers! I had an amazing time riding horses, swimming in waterfalls, and rafting this weekend, but sometimes nothing beats some good old-fashioned hangin' around with the kids!
Saturday, September 15, 2007
Work Update
Two months in the DR so far! We're having a quiet afternoon in the house. There's some dark clouds rolling in from the east - cross your fingers for a big storm to break this heat. Through my window I can see an animal trotting back and forth on the roof of a building in the next block. Is it a dog? A small goat? A large pig? No matter how hard I squint, I just can't tell.
It's been a while since I've written about work at the clinic, but there's still a lot of exciting things going on! I'd like to answer some FAQ's about the clinic and its services. There are four sections of offices: primary care, HIV/AIDS, physical therapy, and vaccinations/pharmacy/lab. Here's a "virtual tour":
Through the front door is a waiting room and long hallway with several primary care examination rooms and offices. The docs here treat injuries and infections, and do a little bit of prenatal care and a fair amount of gynecological care, though they don't deliver babies. A typical exam room is big and clean with open windows, a desk, and an exam table. Unfortunately, the rooms lack practical things like sinks. (A well-meaning charity didn't ask the docs what they needed before re-doing the rooms.) The best bathrooms are down this hall on the left. And if you time it right, you can walk past the door to the one air-conditioned room in the clinic while it's momentarily open. Great doctors and the occasional AC - the place to be!
The primary care/administration section takes up the short leg of the "L"-shaped clinic. The longer leg starts with the HIV/AIDS clinic, called Esperanza y Vida (Hope and Life) - my home base. In three rooms with green curtains and an ocean breeze, we do HIV testing, counseling, medicine distribution, and doctors' visits. Several of us double up as the community health team and also work out of this space, for lack of our own. We do programs like the Health Promoters in Villa Faro, education/support programs for at-risk groups, and regular home visits. Last week, we did a Health Promoters training session on fever and respiratory diseases and met with the neighborhood association to divide the Villa Faro map into promoter regions. I have to say, I think our section of the clinic has the most fun! We get to develop real relationships with our patients since they come regularly. They bring us their babies to play with and bags of limes from their yards, and we swing by their homes to check-in during the week and bring food or medicines. The staff is entirely young women, except the Drs. Dohn, and we trade language lessons during slower afternoons or sit together to plan Elena's wedding (coming up next month! Yay!). It's like a big extended family!
Down the hall is the physical therapy area. The therapists see a lot of people recovering from motorcycle/work accidents and strokes; and also quite a few babies and small children who need treatment for congenital problems. The kids don't like PT much, but, for some reason, they tend to quiet down when I'm around. (I like to think the children are soothed by my charming and magnetic personality, but more likely they're fascinated by my unusual face and the goofy Spanglish I speak to them.) The therapists have begun to call me in whenever there's a particularly fussy kid and I'm not busy, which I enjoy. And, to add to my role as Child-Soother, they're teaching me to do heat treatments and ultrasounds for pain relief on the patients! Time spent in physical therapy is a great way to practice Spanish, and I get to hang out with kids! A full rotation there might be in the works for later this year.
Finally, at the very end of the "L," are the vaccination room, the pharmacy, and the lab. I don't actually know much about these offices except that babies are often crying in the vaccination room, just like in the States. The pharmacy is very small - it was hoped that it might be a money-maker to help fund clinic needs, but very few of our patients are in a position to pay the full cost of medicine, so we give families the necessary meds and find our money elsewhere. Otherwise, these offices are a mystery. Maybe I should go explore them....
So that concludes our tour. There is a second floor with some offices and storage, but the roof is so hole-y and full of animals that we can't do any patient care or meetings up there. There's also a big, newer room upstairs for group meetings with a big air conditioner right next to a huge hole in the wall to the outside, which sort of defeats the purpose. That room isn't used much, though it has a pretty view of the ocean.
The clinic is a great place to work, with plenty of interesting things to see and do, and lots of ways to help. The people I work with are all incredibly nice and understanding, and we have a lot of fun together. Last week, we community health people received a big shipment of donated food to make our monthly food bags for patients. We formed an assembly line and loaded rice, sugar, pasta, tomato sauce, canned vegetables, salt, chocolate powder, beans, soup mix, toothpaste, laundry soap, and much more into plastic bags to hand out. It took half the clinic space and nearly a full day to do it, but we had fun! Here are some pictures:
Diana, Ana, and I load food on one side...
Stefanie, Elena, and Greysi load food on the other side...
...and, finally, some of the finished product!
It's been a while since I've written about work at the clinic, but there's still a lot of exciting things going on! I'd like to answer some FAQ's about the clinic and its services. There are four sections of offices: primary care, HIV/AIDS, physical therapy, and vaccinations/pharmacy/lab. Here's a "virtual tour":
Through the front door is a waiting room and long hallway with several primary care examination rooms and offices. The docs here treat injuries and infections, and do a little bit of prenatal care and a fair amount of gynecological care, though they don't deliver babies. A typical exam room is big and clean with open windows, a desk, and an exam table. Unfortunately, the rooms lack practical things like sinks. (A well-meaning charity didn't ask the docs what they needed before re-doing the rooms.) The best bathrooms are down this hall on the left. And if you time it right, you can walk past the door to the one air-conditioned room in the clinic while it's momentarily open. Great doctors and the occasional AC - the place to be!
The primary care/administration section takes up the short leg of the "L"-shaped clinic. The longer leg starts with the HIV/AIDS clinic, called Esperanza y Vida (Hope and Life) - my home base. In three rooms with green curtains and an ocean breeze, we do HIV testing, counseling, medicine distribution, and doctors' visits. Several of us double up as the community health team and also work out of this space, for lack of our own. We do programs like the Health Promoters in Villa Faro, education/support programs for at-risk groups, and regular home visits. Last week, we did a Health Promoters training session on fever and respiratory diseases and met with the neighborhood association to divide the Villa Faro map into promoter regions. I have to say, I think our section of the clinic has the most fun! We get to develop real relationships with our patients since they come regularly. They bring us their babies to play with and bags of limes from their yards, and we swing by their homes to check-in during the week and bring food or medicines. The staff is entirely young women, except the Drs. Dohn, and we trade language lessons during slower afternoons or sit together to plan Elena's wedding (coming up next month! Yay!). It's like a big extended family!
Down the hall is the physical therapy area. The therapists see a lot of people recovering from motorcycle/work accidents and strokes; and also quite a few babies and small children who need treatment for congenital problems. The kids don't like PT much, but, for some reason, they tend to quiet down when I'm around. (I like to think the children are soothed by my charming and magnetic personality, but more likely they're fascinated by my unusual face and the goofy Spanglish I speak to them.) The therapists have begun to call me in whenever there's a particularly fussy kid and I'm not busy, which I enjoy. And, to add to my role as Child-Soother, they're teaching me to do heat treatments and ultrasounds for pain relief on the patients! Time spent in physical therapy is a great way to practice Spanish, and I get to hang out with kids! A full rotation there might be in the works for later this year.
Finally, at the very end of the "L," are the vaccination room, the pharmacy, and the lab. I don't actually know much about these offices except that babies are often crying in the vaccination room, just like in the States. The pharmacy is very small - it was hoped that it might be a money-maker to help fund clinic needs, but very few of our patients are in a position to pay the full cost of medicine, so we give families the necessary meds and find our money elsewhere. Otherwise, these offices are a mystery. Maybe I should go explore them....
So that concludes our tour. There is a second floor with some offices and storage, but the roof is so hole-y and full of animals that we can't do any patient care or meetings up there. There's also a big, newer room upstairs for group meetings with a big air conditioner right next to a huge hole in the wall to the outside, which sort of defeats the purpose. That room isn't used much, though it has a pretty view of the ocean.
The clinic is a great place to work, with plenty of interesting things to see and do, and lots of ways to help. The people I work with are all incredibly nice and understanding, and we have a lot of fun together. Last week, we community health people received a big shipment of donated food to make our monthly food bags for patients. We formed an assembly line and loaded rice, sugar, pasta, tomato sauce, canned vegetables, salt, chocolate powder, beans, soup mix, toothpaste, laundry soap, and much more into plastic bags to hand out. It took half the clinic space and nearly a full day to do it, but we had fun! Here are some pictures:
Diana, Ana, and I load food on one side...
Stefanie, Elena, and Greysi load food on the other side...
...and, finally, some of the finished product!Have a good week everyone!
P.S. To answer a question from last week: My camera stayed dry on the river hike because one of the leaders brought a big waterproof bag and carefully carried everyone's cameras/phones in it. Lucky, huh?
P.S. To answer a question from last week: My camera stayed dry on the river hike because one of the leaders brought a big waterproof bag and carefully carried everyone's cameras/phones in it. Lucky, huh?
Sunday, September 9, 2007
The Retreat
So, after a week of sleeping nine hours a night, doing laundry, and cleaning my room, I feel back on track after last weekend's retreat. The weekend was one of extremes; lots of ups and downs. The diocesan camp is beautiful, and there were many lovely new people to meet, but it was frustrating not to understand conversations, plans and instructions... and, I'll admit, I was struck with a little birthday homesickness when people kindly offered me fried plantain instead of cake last Saturday. And I had always thought cake wasn't all that important to me - it's funny to suddenly miss things like that!
On Saturday, we spent most of the day hiking in this beautiful mountain river, to finish with a swim at a big waterfall. Being unable to understand the plan, I first saw the river and thought, Well this is just a glorified Indiana creek! We started wading in and out of the water, moving upstream. Almost imperceptibly, the current grew faster and more and more rocks and rapids began to appear.
People began to slip in the water and grab each other for support. We passed a beautiful waterfall, cascading down the mountainside and into the river. Birthday photo-op: Here's to 23!
We hiked on and on; the water grew rougher with each step. As we alternated between fast rapids and water up to our chests, it became clear that the only way to get through would be to form chains. I learned the Spanish verb for grab right then and there, as everyone yelled at me to grab onto them and reached out their hands to link with me. We were in hysterics fighting our way upstream, clinging to rocks and to each other, and sometimes just waiting to get lifted from one spot to the next by the bigger guys in the group. I, still not understanding the plan, asked in awkward Spanish, "Are we going to return by the same route?" and was met with an uproar of laughter. In retrospect, that is a pretty funny idea!
We hiked this way for two hours. It would suddenly hit me, as I pushed through water, gripped huge boulders, or clambered through jungle plants: I, Kate, am fighting my way through a mountain river and the jungle of the Dominican Republic! Amaaaaaazing! It sounds corny, but there really are no words to describe that feeling of doing the unbelievable. After a while, the current grew so fast that we had to stay to the very edges of the river, where the sides of the mountain had crept in. Here, the river had carved out room for only itself. We pressed ourselves against the rock and inched forward for this final stretch (overhead view):
And after that last hurdle: The waterfall!
We met up with everyone's kids (who, needless to say, had not been part of the hike), and started to swim. Beautiful!
After another hour at the waterfall, we climbed a path up the side of the mountain and had a late lunch before going back to the camp to clean up and rest. I was exhausted, but happy!
The river hike was the ideal ice-breaker. And shrieking and laughing and helping were all things I could do without speaking Spanish! I noticed (and appreciated) how firmly people reached out to help me through the rough parts, even when I didn't ask. I noticed that when I said, "thank you," no one responded with the usual "you're welcome." And I noticed that when I helped people no one said "thank you" to me. It dawned on me that helping each other through the water wasn't a special favor, needing a thank you - rather, it was just what you did. I was touched to be a part of this, and relaxed into its reliability. What a wonderful way to usher in a new year!
Now, a week later, I have just run into two of my newfound friends at church. Even though the retreat was filled with both struggle and joy, it looks like it laid the way for many great new beginnings. Wahoo! Here's to rivers!
Have a great week, everyone!
On Saturday, we spent most of the day hiking in this beautiful mountain river, to finish with a swim at a big waterfall. Being unable to understand the plan, I first saw the river and thought, Well this is just a glorified Indiana creek! We started wading in and out of the water, moving upstream. Almost imperceptibly, the current grew faster and more and more rocks and rapids began to appear.
People began to slip in the water and grab each other for support. We passed a beautiful waterfall, cascading down the mountainside and into the river. Birthday photo-op: Here's to 23!
We hiked on and on; the water grew rougher with each step. As we alternated between fast rapids and water up to our chests, it became clear that the only way to get through would be to form chains. I learned the Spanish verb for grab right then and there, as everyone yelled at me to grab onto them and reached out their hands to link with me. We were in hysterics fighting our way upstream, clinging to rocks and to each other, and sometimes just waiting to get lifted from one spot to the next by the bigger guys in the group. I, still not understanding the plan, asked in awkward Spanish, "Are we going to return by the same route?" and was met with an uproar of laughter. In retrospect, that is a pretty funny idea!
We hiked this way for two hours. It would suddenly hit me, as I pushed through water, gripped huge boulders, or clambered through jungle plants: I, Kate, am fighting my way through a mountain river and the jungle of the Dominican Republic! Amaaaaaazing! It sounds corny, but there really are no words to describe that feeling of doing the unbelievable. After a while, the current grew so fast that we had to stay to the very edges of the river, where the sides of the mountain had crept in. Here, the river had carved out room for only itself. We pressed ourselves against the rock and inched forward for this final stretch (overhead view):
And after that last hurdle: The waterfall!
We met up with everyone's kids (who, needless to say, had not been part of the hike), and started to swim. Beautiful!
After another hour at the waterfall, we climbed a path up the side of the mountain and had a late lunch before going back to the camp to clean up and rest. I was exhausted, but happy!
The river hike was the ideal ice-breaker. And shrieking and laughing and helping were all things I could do without speaking Spanish! I noticed (and appreciated) how firmly people reached out to help me through the rough parts, even when I didn't ask. I noticed that when I said, "thank you," no one responded with the usual "you're welcome." And I noticed that when I helped people no one said "thank you" to me. It dawned on me that helping each other through the water wasn't a special favor, needing a thank you - rather, it was just what you did. I was touched to be a part of this, and relaxed into its reliability. What a wonderful way to usher in a new year!
Now, a week later, I have just run into two of my newfound friends at church. Even though the retreat was filled with both struggle and joy, it looks like it laid the way for many great new beginnings. Wahoo! Here's to rivers!
Have a great week, everyone!
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