"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!

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.

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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).
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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.

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!

Charlas

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!

Misc. Pictures

Mid-final blow in a rooster fight in Villa Faro

Health promoter just home from school

My census assistant in Los Conucos

Health promoters in Villa Faro

These guys sell melon on the road out of Quisqueya

Good advice in the tropics: Carry your shade with you

A cow.

Lost in Translation

My favorite recent ¨Lost in Translation¨ moment for you:



So at the park close to the grocery store there´s a little dance studio run by this family of three. Dad and Mom (stage names: El Fantasma [The Phantom] and La India [India]) are the owners and they teach salsa, merengue, and bachata. Their son, Landry, (who now all-of-a-sudden wants to be called exclusively by his stage name: El Fantasmito [the Little Phantom]) is 11 and a fabulous dancer/teacher. Anyway, this family is really great and I´ve been enjoying getting to know them and learning to dance over the past few months here in San Pedro.

I usually go to class with the daughter of some friends from work, and we´ve become good friends with Landry. But one day, my friend, Natalia, minorly cut her foot on some broken glass and couldn´t come to class for a couple days. When I arrived at class by myself, Landry met me at the door and asked me where Natalia was. I had prepared myself for this moment and thought of a sentence with all the right reflexive pronouns: Ella se cortó a su pie. (¨She cut her foot¨, or, literally: ¨She cut herself at the foot¨.) I smiled broadly and waved my hand to indicate that it was no big deal, all to be met by a gap-mouthed, wide-eyed stare from Landry who suddenly bursts out with: ¨They amputated her foot!?!?¨

Oops.

Confusion ensued as I tried to assure him that no, it was just a small cut on the arch of her foot, she would be fine, etc. I was also laughing pretty hard putting myself in Landry´s shoes, seeing my smiling non-chalance as I announced the amputation of our friend´s foot. (Hahahaha. Still funny.)

Anyway, it all got straightened out, Natalia´s foot healed just fine, and dance class continues to be a joy. But I still don´t know how to properly say, ¨She cut her foot¨.....

Tough Call

[Warning/waiver: Hello, all. I have had to delete the initial opening paragraph to my post, which included general greetings and a brief outline of this last month’s activities, because, as I wrote the post, it didn’t follow that outline at all. Much to my surprise, what follows is an exploration of healthcare on two different levels. Also to my surprise, it has gotten late and I have to go to bed now. But rest assured that I will post more very shortly, and it will be less lengthy and have more pictures! Until then, here you are:]

During the past four weeks or so, we’ve been working on getting our community health program up and running in two new – and very different – communities. In El Brisal, named for its hill-top breezes, we’ve come up against a lot of obstacles. The community is rather new and hasn’t yet developed a well-organized neighborhood council. Our program policies require a strong leadership structure in the community, since a lack of one usually indicates a community unable to take on the responsibility of health promotion and illness prevention themselves. It’s not that people don’t want to be healthier, know more about fever and infection, or learn new water-treatment options – and it certainly doesn’t mean that they don’t deserve these things – it just usually means they are absorbed in the hard work of making their own lives move forward from day to day, and aren’t yet in a place stable enough to take part in an “extracurricular” activity like volunteer work. In El Brisal, we have tried five times to have our initial program-presentation meeting. We have started hours late; we have canceled because no one showed up to our well-publicized meeting; we’ve had people come to ask us to fix the electricity problems, the water problems, the inflation problems, the swamp and mosquito problems…. We have never had more than two people show enough interest or dedication to come to more than one meeting.

This raises a lot of issues I studied in undergrad on a theoretical basis, but turn out to be much more complicated in real life. Big surprise, right? One of these is the issue of healthcare on the individual versus group level. Currently, our healthcare in the United States is focused on the individual – we will pull out all the stops, use whatever tests and resources are available, simply do whatever it takes to see an improvement in the individual patient in front of us, all of which makes for inherently “treatment-focused” care. This kind of care comes with assumptions about unlimited resources, and measures its own efficacy on a case-by-case basis. (This all, of course, really mostly applies to the insured patient who can pay.) On the other hand, a public health approach focuses on the group level. Working under the assumption that there exist limits to healthcare resources, and that these limited resources should be used to achieve the greatest good, this type of care tends to be prevention-focused, and measures its efficacy based on group statistics like a decreased infant mortality rate in a given population.

Both individual- and group-level healthcare have pros and cons. Doing everything in your power to fix the sick person in front of you feels right (and is what we all want when we picture ourselves as the individual)… besides, what would healthcare really be like if tough, ethical, in fact “god-like,” decisions and judgments had to be made about who deserved what and how, where and when. But similarly: What if we worked to prevent the illness that required these drastic treatments, as we so often can? And as moral, caring, and perhaps religious people, aren’t we obligated to think of others, especially the underprivileged groups that are already experiencing a rationing of healthcare that we just don’t see? Lots to think about. And that was quite a crash course… please feel free to respond to/correct what I just described (especially since I’m not even sure if I still speak English anymore).

So back to the matter at hand: I work in community health, a group-level healthcare approach by definition. I have seen first-hand that there are not unlimited healthcare resources in this world. And I have seen first-hand some of the useless and wasteful effects of the individual-approach in this country, as I have seen incredible benefit from health education and preventative measures. But then there’s Kevin:

Kevin is the 14-month-old son of one of the two people who came to several of our meeting attempts in El Brisal. He is interactive and social, and his mother is a quiet, dedicated woman who believes in contributing her time to the benefit of her greater community. They both represent the many wonderful, deserving children and adults in this neighborhood. But she and Kevin – and the rest of El Brisal – will not benefit from our community health program (at least not yet) because the community doesn’t yet have the infra-structure to support it. On a personal level, it is unlikely that I will ever see them again. Isn’t that sad? Aren’t you feeling frustrated? I am.

But now listen to this: The other community where we have started implementing the program is about 15-minutes away (that’s a lot of gas-money, by the way) and is called Los Conucos. In terms of need, it is certainly in league with El Brisal. In fact, as we have discovered in completing our census, hardly anyone knows where to get a free, confidential HIV test, lots and lots of children simply aren’t vaccinated, most people don’t treat the cooking water they draw from their contaminated wells, and the concept of ever feeding an infant solely breast-milk is almost unheard of, let alone doing that for the recommended first six months. But Los Conucos has a well-organized and hard-working neighborhood council, which immediately understood and agreed with the premises of our program. In one meeting we enlisted the support of the community council. In the next we had 25 people interested in volunteering their time as a health promoter. And in the next, all 25 returned and spent half a day being trained in health promotion and getting their neighborhood assignments. In fact, this community is so organized that they have decided to kill two birds with one stone, and have gotten their high-schoolers interested in and committed to being health promoters, instead of hanging out on street corners and in bars. Isn’t that great?! Aren’t you feeling exhilarated?! I am!

Our first meeting with interested promoter candidates

Some high-schoolers stay after to read our Women´s Health manual

But now imagine that you have to choose between these two communities. In a very real and true-to-life scenario, imagine that the Community Health Program of La Clinica Esperanza y Caridad is low on funds. What am I saying, “imagine”? Haha. We do not have the resources to implement this program in every needy and deserving place. We are constantly making decisions like the hypothetical one before us now. In this situation, of course, the clear choice appears to be Los Conucos, where the community is equipped to become responsible for its health status/care, and you can already see the benefits of the program in effect. El Brisal may be ready at a later date, and perhaps we’ll have the funds by then.

But now imagine that the funds are there – now – to implement the program in both communities. So no one will miss out if you start the program in both places… for now. Is it responsible to expend the money, materials, staff, time, effort, on a community where it will most likely yield no result? Especially when it is likely that you can save the resources and use them on another community like Los Conucos? Again, it seems obvious that the responsible thing is to save the money….until you start thinking about the people like Kevin and his mother who will miss out on the information, and continue at higher risk for illness and even death. Don’t all people deserve a chance to be healthy and shouldn’t we do whatever is in our power to improve that chance?

Conveniently, it is part of program policies that we do not start the program and invest the resources in communities without a leadership structure. Phew. Looks like that tough decision has already been made for us. But as I continue in healthcare here and in life, as I engage in the decision-making, in the choosing of who gets and who doesn’t, I just feel pretty unequipped – despite “logic” and “good reasons.” I believe in prevention and community health, but communities are made up of individuals! I know these people. It’s hard.

So this has been long. And there is still so much more to say. I guess the nutshell is this: Life is full of complicated decisions. Healthcare is full of complicated decisions. But it is important that we identify them and think about them, even when there are no clear answers to be found, and even if we are not healthcare providers ourselves. And that’s where I’m stopping for today. I had had great plans for a long, vast post covering many aspects of work and daily life, but this post took a different course of its own. So now I’ll add a warning/waiver to the beginning before I publish it, and call it a night. Happy May everyone - I’ll trade you a mango for a small bouquet of Lilly of the Valley! Enjoy!

Jose Update

Remember Jose? (You can see my September entry about this struggling baby here: http://saludosdekate.blogspot.com/2007/09/two-patient-stories.html) Look at how much better he's doing six months later!


Near-death six months ago, Jose has just turned a year old and he is alert, interactive, and starting to stand. He smiles and claps and reaches and does all kinds of things that are especially encouraging to those of us who met him last September. He is a beloved patient, and we are always excited to see him. He´s still on the small side, weighing about 16 pounds and he´s frequently in the clinic for persistent respiratory and appetite problems, but we´re rooting for him and believe he´ll continue to improve.

I thought this was going be a lengthy, somewhat ¨deep¨post, but really I think I can sum up what I want to say this way: There is nothing like working with a person over a period of months and watching his health improve. I certainly wasn´t Jose´s doctor or anything, but I weighed him, filled his meds and formula, listened to and relayed his parent-figure´s concerns, and just spent some time every week hanging out. And without even realizing it was happening, I got invested! And now every time I see him, I get this bubbly happy feeling inside because he´s holding his head up and smiling. Perhaps cliché, but certainly amazing.

I am thankful for: dedicated healthcare providers, generous neighbors, food donations, anti-retroviral medicines, charitable funds, donated baby bottles, HIV research, and so many other things that make Jose´s care possible. And thank you all for keeping him in your thoughts and prayers.

This really is just unbelievably wonderful.

Look who else I get to hang out with!

Give me a V-A-C-C-I-N-E!

Hello! I’m writing today to tell you about our exciting vaccine workshop we just presented on Thursday. This is the first workshop where I’ve been left in charge of big chunks of the preparation and presentation of the material, so I’m particularly proud of it. (And now I also better appreciate the work that goes into giving a training workshop!) So now, I am pleased to present: The Birth of a Community Health Initiative.

First of all, remember in August and September when I described doing a door-to-door health census and making a map of Villa Faro to inform our newly-trained community health promoters there? Well, since then, these promoters have been visiting neighbors’ houses, checking on the sick and educating the well. We have presented workshops on potable water, HIV/STD’s, dehydration and diarrhea, respiratory illness, women’s health, and other topics. We’ve visited each promoter every other month or so to ask how visits are going and to sometimes accompany them. Overall, the Villa Faro Health Promotion program is in full swing and doing well.

But about three weeks ago it came time to think about giving the vaccine training workshop. We realized that our materials – our manual, posters, etc. – were out of date, and that we’d have to start from scratch in designing the workshop. Somehow the task of compiling a new manual fell to me, and I was left to sort through the government's public health nurse training manual, our old manual, and a medical dictionary…. all in Spanish, of course. I decided what from the public health manual was important to include and what was too technical; I updated the information in our old manual to include the new vaccines available and the new schemes in use; and I distilled the medical dictionary entries on each illness to give a basic overview of exactly what these vaccines are preventing. After I typed it up and the other two members of the team checked it, we were left with a simple, clear, 23-page manual on the importance of vaccines, how they work, special considerations, administration scheme, the preventable illnesses, and how to approach a family about vaccines and verify the children’s vaccine records. Our medical director added images, a cover page, and brought it back from the printer’s bound in shiny plastic and ready to go! Yes!


Then we decided to base our presentation on the manual, using the same topic order. We split the manual into four sections and each of us was responsible for organizing and presenting our chunk. Channeling middle school, I made a big chart showing all the vaccine information together for the presentation:
That poster earned me much admiration from the team and before I knew it I was making everyone’s posters, tracing pictures of babies, coloring with crayons, and block-printing definitions and lists. (Kids here don’t get much practice/play with construction paper, markers, rulers, and glue in school, so everyone is consistently impressed with my ability to print and color. It’s a reminder of the privilege I had even in elementary school – how sad that children miss out on that.)

The night before the presentation, I stood in front of the mirror and practiced my five-minute chunk over and over. It went something like this: Ah! I forgot the indirect object pronoun! My tongue catches on double “r” sounds! I can’t say “domiciliaria” and sound like a human! Ah! Ah! I could hardly sleep I was so nervous. In retrospect, it’s pretty funny. After years of presentations and performances, memorization and improvisation, I flip out over five minutes of common sense and spend an evening staring at my flip-flopping tongue in the mirror. Haha!

But the next day, I felt ready and excited. The day of passing out my lovely manual, showing off the beautiful posters, and doing my first chunk of group training in Spanish had arrived! My chunk was last, so I took pictures, prepared the snack, and helped with small-group activities until then.

In small groups, promoters brainstormed common reasons parents give for not vaccinating their children. These can include:

• The last vaccine made my baby sick and gave him a fever, so we’re not going again.
• All vaccines cause allergic reactions.
• Grandma and I were never vaccinated and we’re still around, so why should I vaccinate my baby?
• My baby has/had a cold/fever/spots in his mouth/diarrhea/etc.
• It’s been too long since his last vaccine, so we shouldn’t finish them.

Groups presented their ideas and we talked about ways to address these concerns, and clarified questions about contraindications to vaccines. Did you know that a baby can be vaccinated even if he is sick, is taking medicine, is recuperating, is malnourished, has allergies, or is very behind on the vaccination scheme? Many people in our workshop didn’t.

During the afternoon, promoters learned vaccination methods, practiced reading various hypothetical vaccine records and identifying missing vaccines, and enjoyed a break:

Ten minutes before our scheduled ending time, it was my turn to present. I stood up and talked about how to interact with families during a home visit about vaccines. My favorite part, where I got to do some acting, was showing that it’s better to encourage rather than criticize. For example, it’s not a good idea to say: “Look! Your child is missing vaccines! You’re a terrible mother!!” (Here, the audience graciously chuckled – score one for Kate!) Rather, it’s better to say: “OK, here is evidence of part of the scheme; let’s talk about your plan for completing it.” I also emphasized that every home visit, whether it’s just a check-in or a requested visit to assess an illness, is a chance to talk about vaccines or to check a child’s vaccination record. When I asked at the end if everyone had understood me, they all smiled in an encouraging way and said, “Yes!” Wahoo!

We thanked people for coming, packed up the jeep, and headed back to the clinic. That evening, I reflected on all the hard work I’d put in to the presentation, and thought about all the work the rest of the team had done, delivering invitations, reserving the church space, organizing activities and buying supplies, and doing the majority of the presenting, in addition to all their regular clinic duties. Truly, I am so proud to be a part of this capable and dedicated team.

Next, we will start training promoters in new communities to follow the path of the Villa Faro group. We are currently gathering volunteers, doing our preliminary census, and making maps, but soon the program will begin in two new communities. And I’ve already been assigned a big chunk of the next presentation, most likely on how to be a health promoter. Here we go again!

I hope everyone had a peaceful Easter. Enjoy spring, and if you see a crocus, please say hello for me!

A Whirlwind Week

Hello! After some time away from the internet, I’m back and vowing to post more regularly.

I’ve just moved back to San Pedro and am finally moved in and into full swing in the HIV unit and with the community health team. Before the move, I was working in the rural town of Santana Bani (about two and a half hours away) preparing for and then translating for a visiting short-term medical team from western North Carolina. No amount of words can describe the experience, but I’ll give it my best shot and throw in some pictures for flavor.

Part I of my work, preparing for the team, proved a bigger job than I’d anticipated. I started simply by making nametags in Spanish for the Americans: Jim became Jaime, Ray à Raymundo, Joan à Joana, etc. In the days that followed I worked with two others to plan the clinic flow through the church and school building available to us: waiting room to intake to waiting room to exam room to pharmacy to parasite station to exit. We trained community volunteers, picked up meds, strung up sheets for examination areas, made signs, scrubbed bathrooms, and had countless conversations with willing and wonderful locals on how to ensure water, electricity, and working fans and toilets. Lesson learned: Always make friends with security guards and maintenance people.

Part II began when the team arrived to provide four days of free medical care. We had an ophthalmologist, three doctors doing general medicine, one physician’s assistant, one nurse practitioner, one paramedic, two nurses, a med student, a marketing analyst, a priest, a dance teacher, and an organist. Phew. Only two or three of those spoke Spanish, so I spent most of each day jumping from room to room translating. (I snuck some picture-taking in too.)

We saw about 180 patients each day and there still wasn’t time to see everyone. Our “waiting room” in the church sanctuary was full most of the time, as families gave their medical history to a volunteer or waited to be weighed.

These three kids waited patiently all morning - when I took this picture – but by the time I was translating for them and Mom at 11:30 they could no longer curb their curiosity over tongue depressors and stethoscopes. My pictures of them then all turned out blurry with movement, though I had a great time during that session.

We did exam after exam, until some things became so common the providers turned over explanation to me. Kate, please find out what they’re eating and do The Diet Spiel… Could you please do the Diabetic Foot Care Explanation? …. I need a Scabies Cream Tutorial over here! etc. OK, so maybe they didn’t use those exact words, but pretty close! In truth, I was lucky to be with a team of experienced providers who were excited to teach me new skills and talk through their diagnostic approach with me. For every patient I helped, I was helped in return, since everyone was willing to let me take a second listen to the lungs, watch an exam, or re-palpate a lymph node. A big thanks to all our providers and patients!

On February 27th, in the middle of our clinic week, the country celebrated Independence Day, so we spent the day watching parades and hanging out with the neighborhood folks.

I inadvertently ended up part of the parade, marching and waving a flag, and got a good view of family onlookers:


Now that the hubbub is over, reflections are starting to percolate through my brain. I can’t get over the huge amount of preventable or easily treatable illness, left un-checked, that we encountered every day. I saw adult after adult with hypertension and/or diabetes, and all the heart/foot/eye/body problems that go with them. I saw child after child with iron-deficient anemia and skin/digestive tract parasites. And then facing our own limitations to help as a short-term group: It’s hard to provide the necessary follow-up care for these chronic conditions. And what does it mean to give every child anti-parasite treatment when they’ll be back playing in the contaminated dirt and water next week?

When your advice is to drink less Coke, but drinkable water costs as much or more…. When you recommend monthly doctor check-ups but the nearest free clinic is often un-manned or out of meds…. When your instructions are to stay out of the dirt, but there’s nowhere else to play…. How can you help?

Sometimes I am overwhelmed by the incredible need in this country. The short-term clinic and my work here in San Pedro provide wonderful ways to concretely help people in these communities, even when it is the service of simply being with the people. Every time a child gets an iron supplement, a parent physical therapy, or an infant a vaccine, it is an important contribution. But I can’t help but feel the pull for infrastructural change, for running water, clean streets, health education, sewage systems, etc. These are big issues in a big picture, and I don’t have the background or skills to fairly address them, but I think it´s worth thinking about.

But for now I´ll close with a lighter anecdote: On Independence Day, after a morning of watching and marching in parades, two of us settled down under a tree with books. Suddenly I heard the clanging of spoons on pots and pans and turned to see about fifteen kids in all type of dress – though most with their underwear on their heads – yelling and marching our way. They swarmed around us jumping and laughing and yelling something about chicken, celebrating Independence and a day off school in their own unique way. Pretty soon, as spoons were dropped and participants´ underwear-hats became askew, we were all in hysterics. And then just as quickly, the kids waved and went back the way they came. Interactions like that, where language isn´t necessary and everyone is having a good time, are simply some of the most enjoyable. I still smile to think of Santana Bani´s Impromptu Parade.

That´s it for now, though there´s more on the way! Happy March, and have a great weekend!

Faces of Santana Bani

....I´m on a portrait-kick.

El Hogar

Hello! I'm still here! Thanks to everyone for your notes and messages - I really appreciate it. I'm currently living in the diocese's nursing home, Hogar Obispo Isaac. I've been here for nearly a month, but haven't been able to update since we hardly ever have electricity and when we do, the internet is sketchy and slow. Here's some description:

The Hogar opened last March with space for 32 residents, a kitchen, three balconies, a porch with a dominoes table, and other lovely spaces. Unfortunately, residents have not rushed in as hoped, so now we are working on advertising, brochures, announcements, etc. to get the word out about this great place.

We currently have three residents. This is a picture of Teresa and Titi (L to R), our most mobile residents. They are two of the sweetest grown-ups I know. Teresa has a beautiful smile and occasionally treats us to a merengue dance with the Sunday afternoon music program on TV. She won't go to sleep at night unless I brush off her "dirty" feet - and she smiles and chuckles at me while I go through the motions of feet-washing. I think it's pretty entertaining for her (and for me) to go through this ritual at night.

Part of the Hogar's mission is to provide housing for seniors regardless of their ability to pay. Titi has been with us since the home opened, but pays a nominal fee since his family can't afford much. He is friendly and talkative and engaging; I can't understand a word he says. He's from a very poor, rural community and his accent is unlike anything I've encountered so far. When he moved here at 77 he had his first-ever birthday party, with 100 people filling the Hogar from the neighborhood and church communities. He still sits me down occasionally and tells me about this fabulous party he had with tons of people there to help him celebrate. It's really touching to hear him describe it.... at least, when I can understand what he's saying. Titi is the biggest fan of my cooking at the Hogar, telling me how much he likes the pancakes and deep-dish pizza I made for the residents. A great guy!

Albania, seen here with a visiting physical therapist and one of the staff, is our third resident, though I don't know her as well as the others. She is blind from brain surgery for epilepsy done years ago, and she prefers to spend most of her time in bed. Albania, unlike Titi, has beautiful diction and I can understand every word she says. She has an incredible sweet tooth and really enjoyed the pancakes I served her with grape jelly.

Life in the Hogar has been very interesting for me in terms of culture-mixing. The building is the newest I've been in here and so has things like cable TV, a real washer and dryer, my own room and bathroom, etc. But on the other hand, we don't have electricity the majority of every day, our night watchman guards the place armed with an aluminum baseball bat and a machete, and there's a moth the size of my face (not kidding) called the Fever Butterfly that lives downstairs and, apparently, causes fever. (Similarly, I spotted two giant, hairy spiders each the size of my hand in the kitchen one night, but when I showed them to our cook the next day, she said, "Kate, I thought you said big spiders..." Yikes.) So every evening after the residents are asleep, I watch the night watchman set up his "weapons," stumble around in the dark with a candle, encounter strange, enormous insects, and then sit down and watch Law and Order (in English!) on the battery-powered cable television. Strange mix, no?

I found a drawer of brand-new puzzles in the Hogar and have been working on those (with a flashlight) after Law and Order. (It's a loooong night when all the residents go to bed at 7:30.) I just finished a second 500-piece puzzle last night. Various members of the staff come up and look quizzically at what the strange American girl is doing, since most have never seen a puzzle before. All are invariable impressed with the progress I make each day, but it's obvious everyone thinks it's a little crazy to want to make work for yourself like that. The word for "puzzle" in Spanish is "rompe-cabeza," which directly translates to something like "Broken Head" or "Head-Breaker." In this place where life is so tricky and challenging itself, I think people look at me and wonder why my culture likes to make up tricky and challenging past-times to fill our spare time. Haha - it is a little funny when you think about it. But, hey, it's something to do!

During the day I've been working on a variety of tasks. I just got a pretty, shiny, full-color, in-Spanish brochure finished and off to the printers this week. (I'm ridiculously proud of that thing.) We plan to distribute it at the diocesan convention next weekend to raise awareness of the Hogar. I've planted a bed of wild flowers, including sunflowers, purple cone-flowers, and snap-dragons, next to the Hogar (we'll see how these do in the tropics...), wall-papered a border in our doctor's consulation room, and labeled sack after sack of donated clothes and shoes with prices for our garage sale coming up in two weeks.

On Sundays, I've been helping out with Sunday School lesson-plans at the church. Three weeks ago the gospel was about the Lamb of God, so I surveyed our craft materials and decided on brown paper-bag lamb puppets, with cotton balls pasted on for wool. Here's a slightly blurry picture of me with my proud students and their puppets:


Today the gospel was the story of the Transfiguration. In a nod to my childhood Sunday School teacher, I thought that no lesson better called for glitter than this one, so we broke out the shiny silver-white glitter and decorated pictures I traced of the scene. The kids really have a great time with these crafts at the end of the lesson part of Sunday School - there isn't much in the way of art classes in their schools. Today's craft was another success. Thanks, Glitter Queen.

So overall, this month in the Hogar has been a chance to see and do different things in a really wonderful environment. This weekend will be the diocesan convention in San Pedro (where I was living before), after which I will move to a new city closer to the Haitian border to work on a potable water project and help translate for a visiting American medical team. I don't know what internet will be like in the next several weeks, but I'll do my best to keep this site updated. (And don't worry, I haven't forgotten about my promises to describe bus-rides and work in the HIV clinic!)

In case it's a couple weeks before I write again, Happy Fat Tuesday and Valentine's Day - my love to everyone!

My family came to visit!

After many hours of travel, my family arrived in the DR around noon on New Year's Day. The following week-long visit was wonderful, and certainly a new experience for me in travel, translating, and cooking. In short, I think the week can be summed up in these terms: adventures with seafood, beautiful sites, and public transport. Here's a brief photo-journal of some of our activities:
On the first full day, my mother insisted on buying these live crabs from a man off the side of the highway. The next day, my Dominican sister Jayza reported having heard screams from the conference center where we were staying the night before. I told her not to worry, it was my sisters and me wrestling twelve feisty Dominican crabs into a pot to rinse, two other pots to sit, and then into boiling water (believe me, they didn't like that). Simply terrifying and hysterical. Let me just put it this way: Dreams of crab pinchers creeping over pot-rims and pots rocking on the counter of their own accord haunted me for days.

We took a day to visit the Colonial City that Christopher Columbus built upon his arrival here. This is a view of one of the defense forts used to protect the mouth of the river.

This is the oldest cathedral still in use in the New World.
(By the way, this square is one of my favorite places in the country.)

Inside

During a day at the beach:
My mother proudly cradles the eight-pound fish she just bought off a fisherman in the bay

Later, the fish makes another appearance

We opted to spend our last day together back at the beach, looking for sea urchins.

It was wonderful to have my family here, and I invite them to share some memories in the comments section of this entry! Some of the highlights for me include backrubs from my mom, sharing lime slushies with my sisters, seeing my dad ride the little public van/buses, introducing my family to my friends and co-workers, and meanwhile watching everyone try to speak Spanish. What a great time!

Now, I'm about to move to a nearby town to help out in a nursing home there. Though I don't know what internet access will be like there, I'll do my best to keep all of you updated!

Happy New Year!!