Saludos de Kate

Misc. Photos

2009-07-09T13:04:00.000-07:00

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!

Dibujos! Dibujos!

2009-06-27T14:26:00.000-07:00

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!

....I'm back!

2009-06-17T10:04:00.000-07:00

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!

"Final post"

2008-07-09T09:17:00.000-07:00

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

2008-06-18T07:09:00.000-07:00

[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...

2008-06-07T11:28:00.000-07:00

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

2008-05-28T06:15:00.000-07:00

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

2008-05-27T11:39:00.000-07:00

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

2008-05-20T07:24:00.001-07:00

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

2008-05-08T05:26:00.000-07:00

[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

2008-04-05T13:07:00.000-07:00

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!

2008-04-05T12:58:00.000-07:00

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

2008-03-29T11:40:00.000-07:00

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

2008-03-07T08:34:00.000-08:00

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

2008-03-07T07:56:00.000-08:00

....I´m on a portrait-kick.

El Hogar

2008-02-03T09:04:00.000-08:00

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!

2008-01-12T09:31:00.000-08:00

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!!

House-Keeping

2007-12-10T12:42:00.000-08:00

I wrote the entry below yesterday, meaning to add more today and send out an update email. There's still plenty of things to say! Unfortunately, I got a fever last night that is persisting through today (not too high - don't worry), and I am taking it easy between chills, sweats, and ibuprofen. (There appear to be no blankets for miles around, so I have all my extra sheets and my bath-towels stacked up on my bed to substitute hahaha.)

You know, I thought I might be homesick if I got sick during this year overseas, but it's not all that bad. My family here checks up on me, and my colleagues called as soon as they found out to order me to rest and to come see our unit's doctor tomorrow if the fever keeps up. They've promised to call back this afternoon to check on me again. To me, these are real signs of membership/acceptance in this community. I have real friends who care about my well-being! Yay! Also on the plus side, I may be better able to face a cold shower with a fever....

And now a quick note about mail: I will be moving to a new city in about a month to start work on a different project here in the DR. To those of you who were/are planning to send mail, it can take three or four weeks to get here, even under the 7-10 day airmail plan. (Sometimes it takes less, sometimes not.) So, now's the time to get a-mailin'. And remember if you're sending bulky things to use the small, green Customs Declaration - CN 22 form (must be less than four pounds). My address is in the right-hand column of this page.

And that's it for now! I'm going to go try to take a nap. Have a good week!

Christmastime!

2007-12-09T07:45:00.000-08:00

Advent is here, and we're all busy preparing for Christmas. The weather has cooled down remarkably (finally!) and now we enjoy days of about 84 degrees and nights of about 72. It's become fairly windy here, which Father Guelmi told me is typical of the season. (The winds are called The Christmas Breezes.) Even though we've had our plastic Christmas tree out for weeks, we finally got around to decorating it last week:

It's always fun to decorate a tree, but I felt a little funny doing it in a t-shirt and bare feet! I made a few paper snowflakes with loops of thread to hang on the tree as a decoration contribution. They twist and blow in The Christmas Breezes coming through the open window - a pretty effect.

For supper that night, we had traditional Christmastime food: Pasteles en Ojas (roughly Pies in Leaves). During December, the streets are filled with vendors selling pasteles. Last week, ours came from a batch Grandma made, and they were delicious. The pies are made by mashing plantain with other ingredients like flour to create a semi-gelatinous skin. The inside is stuffed with ground meat, beans, and spices. The whole thing is wrapped in a big plantain leaf, tied with string, and boiled until cooked. Here are some pictures of cooking and eating Grandma's pasteles last week.

Just after boiling - ready to be cut open

Father Guelmi cuts open a pastel

Inside view of the meat and beans... Mmmm.

Advent Calendars are not really done here, so I had my Dad bring a couple in November. Now there's one hanging in our living room and one in the clinic, and everybody seems very pleased with them. It's fun to be able to contribute something different from home, and be able to experience the traditions here in turn. On Christmas Eve (la Buena Noche), we'll have a special meal involving pork (I haven't been able to figure out all the details yet). On both Christmas Eve and Christmas Day, we'll go to special services at church. But big family gatherings and presents are saved for Jan. 6th, El Dia de Reyes, when the three kings arrived bearing gifts. I am so grateful for the wonderful family I live with here - this promises to be a special holiday season!

Catch-Up!

2007-11-24T07:22:00.000-08:00

It's been nearly two weeks since I last posted. I can't believe it! There are so many things I want to share - be prepared for a long post.

So I'll start where I left off: The baby is born! His name is Gerald Enmanuel Rosario Pina, but he goes by Enmanuel. He weighed 9 and 1/4 pounds at birth and is a long baby with chubby cheeks and a lot of dark hair. He'll be two weeks old tomorrow, and I just got the chance to take pictures today. (He sleeps ALL the time!) I call this series: Enmanuel Wakes

Notice the single raised eyebrow in that last shot. This baby is suave.

As an added bonus to Enmanuel's birth, Grandma came to stay last week. Grandma is a riot. She comes up to about my shoulder and loves to talk. Grandma taught me the next step in my cross-stitching embroidery. She monitored my evening shower schedule so I would not get la gripe, a general term for colds/respiratory infections. (FYI: Contrary to popular belief, la gripe is caused by germs, not by getting wet.) Grandma force-fed me all week, which was fine with me, though I had to be especially stealthy to avoid the chicken feet in the soup during second and third servings. And now Grandma has invited me to come stay at her house some weekend. Looking forward to it!

At the end of last week, I took two days to do a little sight-seeing with missionaries one town over. We went to La Romana and saw the caves with indigenous drawings, an Italian-style village built by a very rich man for his wife, and spent a day at a beautiful beach in an exclusive, gated community. Being in such beautiful, exclusive places was a little bit of culture shock after the work I do here in San Pedro. I call this series: Wow Is this Different from Villa Faro or What?

But perhaps my favorite part of the trip was trying to get out of the gated community. We made several turns, and were a little uncertain of how to find the exit. So when we found a guard at an intersection, our driver (one of the missionaries from one town over) rolled down the window to ask. "Exito? Exito! Exito?!" she yelled out the window, trying to get a quick point in the right direction and not block traffic. As it turns out, exito means "success" in Spanish. So here's this car-load of Americans frantically yelling "Success?!" out a car window while a puzzled guard looks on. Hahahaha. Finally, the guard figured out what we wanted, provided the correct word ('salida') and directed us out. I laughed pretty hard for a while.

As soon as I got back from that trip, I went to the capital to see my Dad, who was here for a meeting. I took two HOT showers within twelve hours! And he brought Christmas music, pumpkin pie filling, advent calendars... true "necessities". Haha.

Everybody thought we looked exactly alike (a little scary for me.) What do you think?

He left last Tuesday, and so it was back to the clinic for a very busy few days. We have finally raised enough money to get started on the new roof! (We have about 2/3 of the estimated total cost - which has taken years to get - so we're starting with what we have.) The first phase of this project, and what we attacked this week, is cleaning out the unusable upstairs, where we've been storing medicine, equipment, and other stuff. The upstairs is dangerously filled with bat/rat droppings, so everyone has to wear a mask to avoid getting sick. I call this series: Evidence as to Our Dire Need for a New Roof

And then all of a sudden it was Thanksgiving! After a necessary international call to my mother with some questions, I successfully baked three pumpkin pies (one for the family, one for a Tday meal with Americans, and one for the office)! I got a variety of responses to them, though my favorites are as follows: The fourteen-year-old in my family took one bite and said, "This might be my new favorite pastry!" (There's no word for 'pie' here, so we use 'pastry'.) Then, after tasting the pie, two women I work with independently said, "You may get married." Apparently, that's a very high compliment indicating that my cooking is good enough that I can marry and run my own household. (Phew - What a relief! Heehee.)

Since then, I've been snacking on left-over pie, organizing a Health Promoters training on women's health, investigating merengue dance classes, trying to teach English to Enmanuel, and moving furniture in the clinic. I am avoiding cleaning my room as we speak. To close, I'll leave you with my Lost-in-Translation moment for the weekend: The Spanish words for 'piece' (pedaso) and for 'sin' (pecado) are very similar, and I often confuse them. Yesterday, Claribel asked me if I'd like any ice in my glass, and I said, "Yes, I'd like two or three sins please." Whoops....

Happy (belated) Thanksgiving everyone! Have a wonderful last week of November!

babytodaybabytoday!

2007-11-11T13:01:00.000-08:00

The new baby is coming today!! Today today today!

Reyna was scheduled to have her C-section this coming Thursday, but her water broke early this morning and I woke to loud knocks on my bedroom door and a fast explanation from the family running out the door to go to the capital. They've been there all day.

I feel like some nervous relative in the waiting room. All of my week-long feelings of laziness have been counter-acted. I've fixed breakfast, been to church, washed all the dishes and cleaned the kitchen, visited another family, done two loads of laundry, and I keep returning to fluff our fake Christmas tree (which tends to clump) whenever there's nothing else to do. And so far no news!

Please keep Reyna and the family in your thoughts and prayers as they welcome this new baby into their lives. I am so excited I could explode. I'll try to post some pictures soon!

Seasons are Different

2007-11-11T12:23:00.000-08:00

I have a couple little anecdotes about seasons for your reading enjoyment. Both take place with the fabulous people I work with in the clinic.

Autumn:
We got a new computer in our office! Now we can chart information and sum receipts and print-out signs... lots of good things. During the first days of the new computer, I glanced up and literally gasped out loud when I saw that the desktop background was a picture of autumn in the United States. It's that picture that comes with Windows, you know, the one with the bright red maple leaves overhanging a rustic-looking lane with a wooden fence? Anyway, about a week later the background picture was changed to something else, which made me a little bit sad. I said, "What happened to the picture of autumn?" and one of the girls said, "Oh we can find it again!" She promptly put up a picture of a spring tree with new green leaves. "Autumn, right?" I said, "No... springtime." Next, she put up a picture of yellow tulips. "Autumn?" "No, spring again." At this point I was chuckling and said I could find the picture. I quickly did, and when it was up on the desktop again, she said, "Oh no, that's a picture of a tree with all red blossoms like we have here in the summer." Hahaha. An attempt to explain color-changing leaves and bare winter branches ensued. She couldn't believe that the trees had nothing on them in winter, and I think she mostly chalked up what I was saying to lack of Spanish skills and lunacy. Oh, well - I thought it was pretty funny.

Winter:
We broke out the office Christmas decorations last week. We now have a reindeer in a sweater and holding a pair of skis sitting on the reception desk. There's also purple and gold garlands hung everywhere that remind me more of Mardi Gras than Christmas, but they're festive nonetheless. One slow morning this week, I decided to do my own decoration contribution by cutting a couple snowflakes out of white paper. This has inspired a craze, and now I'm teaching snowflake-cutting to people right and left. Everyone is so pleased when they make a few triangular cuts and out comes a beautifully lacy piece of paper - you gotta admit, that moment of opening a freshly-cut snowflake is pretty thrilling. At the beginning, I took the opportunity to explain that we make these for winter, not necessarily for Christmas, because they represent snow. I went on to say that no two snowflakes are identical, and neither are the ones we make out of paper. Etc. Etc. But then people, and most often the nurse, started asking me why I make them out of white paper, which doesn't contrast enough with the white walls. I reiterated my snow explanation, but after several days of having basically the same conversation I gave up. The nurse wants me to make several extra-big snowflakes out of bright green and red paper and then string them up from their centers and hang them from the ceiling. I think this will have more of a jungle effect than a snow effect... but that's fine! I think I'll call it the Jungle Pointsettia look...

So the moral of the story is: Seasons are different in different parts of the world. I'm having a wonderful time working and learning in a tropical Fall and Christmas season. But please step on a crunchy leaf and eat a falling snowflake for me! xo!

Villa Faro Video

2007-11-11T12:19:00.001-08:00

Drs. Michael and Anita Dohn, who work at Clinica Esperanza and Caridad and are in charge of many things, including the Community Health program, shot this video of the Villa Faro neighborhood where we're currently setting up a new Health Promoters program.

I spend a lot of wonderful time in Villa Faro, and now you can get a live-action glimpse of what it's like! Enjoy! (And be prepared to turn up the volume... the narration is sort of soft.)

Noel in the DR

2007-11-01T10:11:00.000-07:00

Today is the first day with some sun in a week! It looks like Tropical Storm Noel has finally moved on. Thanks to everyone for your notes and check-ups - my area wasn't hit too badly, and my family and I are fine. The storm was an interesting experience, though, and I'd like to tell you a little about it.

It started raining last Friday, a steady rain that reminded me of chilly October days at home. That's pretty unusual here, since most rains are heavy cloud-bursts that clear quickly, but for some reason I took no particular notice. On Saturday, I went to the capital (about an hour away) to visit friends. The roads were fine despite the rain, and I had no trouble getting to the city. Once there, it rained and rained, until we all started commenting on it: "Wow I don't think it's rained like this since I've been here" and "Oh the power's gone out! How unusual for this neighborhood... I wonder why..." For some reason none of us knew about the Noel weather predictions.

After a lovely, though rainy, 24-hours, I headed back to San Pedro Sunday afternoon. The first bus was lashed with rain, and the sea was crashing against the highway as we drove back to the city. The local San Pedro bus (and by 'bus' I mean deteriorating 9-person van with Saran-Wrap for windows) was doing fine until we came to several blocks of the route covered in about 1.5 feet of water. The cobrador (guy who takes your bus money) slid the van's side-door closed (which I've never seen happen before) and we headed into the water. Water splashed against the windows and leaked in under the door. And still I didn't find this much out of the ordinary.

[Side note here: In retrospect, traveling during a tropical storm is not advisable and I don't think I'll do it again. Also, the flooding I just described is not that uncommon here after a big storm - very few streets have adequate drainage. I think my lack of surprise/shock at all these things, though, is for another reason. My threshold for "surprise/shock" has risen tremendously in these last three-months. Everything is so surprising/shocking, really. Now, I think I over-corrected my dial, because there is plenty surprising/shocking about a tropical storm.]

I got home just fine and had a pleasant evening. (We ate nothing but big bowls of rice pudding for supper, and I am A-OK with that.) The family mentioned TS Noel at the table, but I still didn't think about it until the next morning, when I woke up to no power. I headed down to breakfast and then to the clinic, not thinking that maybe we'd be closed, like the schools and stores in the city. But we were open, despite no power and no public transportation.

Now, the clinic desperately needs a new roof before the upstairs can be human-friendly. Right now, the windows don't close and the whole place is covered in bat/pigeon droppings, which can cause serious illness. Nevertheless, this is where the community health office is, and where we store all our HIV meds. On Monday, three of us headed upstairs to find the boxed meds sitting in an inch of water. We pulled tables away from open windows and leaky ceiling-spots and transferred all the meds to new boxes on elevated surfaces. Luckily, the meds are undamaged. (And I'm thinking of providing some plastic storage shelves....)

The clinic eventually did decide to close for the afternoon, so I spent the extra time in the house, listening to the wind literally howl outside. Just as we were lighting candles to settle down for an evening without power, the lights came back on. We were very lucky to be without power for only a day. (For many people, including the clinic, the lack of power also means no running water, since the pipes are powered by an electric pump, so we're also lucky to not need a pump.)

Tuesday and Wednesday passed with more wind and rain, though the clinic was open both days. On Tuesday word was out about another danger in addition to the storm. A barge carrying 50,000 barrels of combustible gasoline had run aground about ten miles out to sea from the city. In the wind and churning water, the hull was being ground against the sea-floor, causing wear and friction. But nobody could do anything because the storm conditions were too dangerous. Locals were fearing an explosion; some even talked about an explosion-caused "tsunami" that would come drench the shore-line, including our clinic/my house. Officials monitored the ship and waited out the storm for the last two days. And while I haven't officially heard it, I bet they were able to get out there today. So far no massive explosions!

We are all relieved that the storm appears over. While damage in my area wasn't too extensive, other parts of the country truly suffered. As of yesterday, there were over forty people reported dead (mostly from mud-slides) and tens of thousands missing. Schools have been closed for most of the week. Entire crops of rice, tomatoes, and plantains were destroyed, ruining many farmers' livelihoods. And prices for these basic foods will rise in the cities. Telephone lines are down, and officials are worried that water reservoirs have been contaminated in many parts of the country. Rivers are swollen and roads and bridges are washed out. Our team has had trouble getting to communities because of a gas shortage and continued flooding. So even though the storm is over, the disaster continues.

I'm truly thankful for the safety of my family and co-workers, as well as my own. And it was wonderful to hear from you all once the electricity returned! This update has gotten longer than I intended, but I hope it helps all of you appreciate Dominican life in a natural disaster; it certainly opened my eyes to be here during this storm. Please keep this country and its people in your thoughts and prayers!

xo!

Great Goings On

2007-10-25T17:07:00.000-07:00

The last ten days have brought many exciting things! Last weekend was the national celebration of the 11oth year of Anglican presence in the DR. I attended Sunday's huge service in the capital - it was a wonderful gathering, with students from all the Episcopal schools, and priests/bishops from the DR, Haiti, Florida, and the Virgin Islands to help celebrate. I'm sorry to say I didn't have my camera, but I might be able to get my hands on some pictures in the near future.

Clinic work continues to be engaging and challenging. We returned to Batey Esperanza last week to deliver test results. Gracias a Dios, we only had two positives out of the 49 tests - a surprisingly low number. While our two counselors sat inside to give results, I was in charge of maintaining order outside. In other words, the afternoon was a crash course in Batey Spanish mixed with some Creole. Late afternoons are a time for socializing, and I made an intriguing spectacle for everyone in the Batey, not just people waiting for results. At the end of the day I had drawn stick-figures with toddlers in the dirt, been told I had "cat-eyes" several times, and garnered two declarations of love. All in a day's work....

This week, the community health team has been working on making teaching aids for breast exams for our Health Promoters. Old bras, backed with fabric and stuffed with cotton and a single rock "tumor," are great - and affordable - dummies for teaching self-breast exams. Promoters can teach without causing discomfort or embarrassment, and the experience is realistic enough to be a great help! Our sewing machine isn't working, so we spent most of one morning sewing the dummies together by hand. But we're not complaining; it was a chance to just hang out and chat!

Today, the team headed out to Villa Faro to continue training our newest Health Promoters there. With the help of the neighborhood school's faculty, we organized a practice session for assessing infant respiratory rate. Nearly twenty volunteer mothers and babies showed up to give our promoters a chance to practice taking respiratory rates on very young children, since that group is often the hardest to assess. Promoters had a chance to work with several babies - some crying, some with colds, some asleep - and compare their findings. As usual, we passed out crackers and juice. We also had a bottle of children's Tylenol and a bottle of Broncochem (similar to Dimetap) to give each mother as a 'thank you' for her participation. The school was noisy and chaotic with promoters, mothers, babies, and other children, but the event was a huge success. Here are some of my favorite shots of the afternoon:

One way to assess breathing is by touching the baby

Another is to put your ear to the baby's chest

Anita teaches

So that's a quick catch-up on work activities. I'm headed into the capital this weekend to visit friends, see the part of the city Christopher Columbus built, and perhaps go to a ballet performance! It's already Christmas here in the DR, as evidenced by the Christmas lights/decorations appearing everywhere, the carols playing in the buses, and (perhaps) the red and green fireworks visible through my window right now. Pretty funny. I guess that's what happens when there's no Halloween or Thanksgiving.... Hope everyone is having a wonderful week! xo

Operativo: Batey Esperanza

2007-10-14T13:00:00.000-07:00

An exciting operativo afternoon last week! Some definitions before we get started:

Operativo - an event when our HIV team leaves the clinic to give a couple hours of free HIV-testing and counseling in poor and/or rural communities. Interested individuals go through a small-group charla (chat/discussion) about the test and HIV/AIDS before having their blood drawn. People under 18 must be accompanied by a parent/guardian. We give test-takers cookies and pop as an incentive to take the test and as a way to feed hungry people. We take the blood samples back for analysis at our lab, and then return the following week to deliver results.

Batey - a (usually rural) community associated with farming sugarcane. Most residents are Haitian or of Haitian descent, though most speak an accented Spanish. Some speak Creole, which I can't understand, despite years of French class. Bateys are usually very poor communities.

Esperanza - Spanish for 'hope'

Last Thursday, I went with our HIV team to do my first operativo in Batey Esperanza. We set up in the batey's clinic, using their waiting room as our charla space, and the vaccination room as the testing room. I was put in charge of dispensing cookies and pop, which turned out to be trickier than I thought, given the large amount of persuasive kids eying the cookies.

Greysi and I waited for the first few people to show up. We got there at about 3:30 and were expecting 10-20 people before we closed at 5, but had come prepared with a few extra syringes. At first, it was slow-going, but as people left the clinic with cookies in hand, word spread and more and more people came for a charla and a test.

A charla - not all of the people who heard the talks chose to get tested

As time wore on and the news spread, more and more people showed up. We ran out of syringes twice and had to borrow from the clinic! We finally closed up shop around 6:45, after testing 49 people! As dusk fell on the batey, I was happy to finally be able to hand out the few left-over cookies we had.

We loaded up the car and headed home, all talking excitedly about the afternoon. The feeling on the ride home - five of us crammed in the Jeep, bachata music turned up loud, excited conversation in Spanish, night falling over San Pedro - was wonderful. We are all still excited about the number of people we reached through charlas and the number of tests we did.

Delivering results on Thursday will be harder. This diagnosis is life-changing. I am a little comforted to know that we can at least provide free treatment, free transportation, and some food to any people with positive results. And I'm hoping for many negative results. Please keep this vibrant community in your thoughts and prayers.

*all photos taken by our wonderful driver for use by our funding charity organization.

La Boda de Elena

2007-10-14T10:15:00.000-07:00

Last weekend was the very exciting and long-awaited wedding of Elena. There's been a lot of questions about it, so here's a short description with some pictures:

I helped set-up the hall during the day, mopping, moving tables, slicing cake.... I even learned how to tie balloons! After all these years of thinking it was a secret talent of my mom's!

We used a reception hall upstairs in the clinic for the ceremony and reception

The cake - I was shocked when one of the girls pretended to eat some until everyone told me it was a fake cake used as a prop for pictures. They thought it was pretty funny that I had thought it was real....

Ada taught me to tie balloons.

The wedding was scheduled to start at 5:30. We were still decorating in our jeans at 5:50, and nobody had arrived. I rushed home to get ready and was back by 6:20, just in time to see Elena walk down the aisle (for the first time). A stereo blared out the wedding march as Elena went to meet her groom, and they both sat down at a table with a judge. While the three worked out the legal side of marriage, the "congregation" listened to music on the stereo and chatted. After about half an hour, the wedding march played again and Elena walked back down the aisle to a pastor waiting at the other side of the room. Here the bride and groom exchanged vows and had a religious blessing. The congregation tried to listen to music and continue chatting until the pastor glared at everyone to hush. After the final kiss, the congregation clapped and cheered, the wedding party gathered next to the cake for photos, and the reception began!

El novio y la novia

The clinic colleages wait for our photo with the bride and groom

Clinic girls! (None of us caught the bouquet)

A light fare of Dominican appetizers was served during the reception: empanadas, shish kabobs, dumplings... Mmm. The newly married couple socialized while background music played on the stereo. Surprisingly, there was no dancing, and most guests left soon after the food was finished. I had been looking forward to my first try at merengue and bachata, but it was not to be. Now I'm seriously looking into dance classes!

The wedding was one of the first social events here where I felt like I really belonged. I knew the bride and groom and was able to congratulate them, and I had all my colleagues to hang out with. Despite the lack of dancing, I had a great time and feel so fortunate to have been invited. Yay! Felicidades, Elena!

The Social Life

2007-10-07T17:27:00.000-07:00

Saludos everyone! After weeks of settling in - and it's an ongoing process - I had a fun, social afternoon and thought I'd share it with you. I think it's a good glimpse of DR culture and my experience living in a different country. So, in terrible detail, here's the story:

Today, the house phone rang and it was for me, which never happens. I picked up and someone started speaking Spanish - it took me a few minutes to realize it was my new friend, Paola. We met at the retreat weekend in Jarabacoa and have run into each other a couple times since then, each time saying we needed to get together at some point. I warned Paola then that it is close to impossible for me to understand native Spanish speakers on the phone - much more difficult than face-to-face. In fact, the first time Paola called a couple weeks ago, she had to repeat everything twice at an incredibly slow pace, and I was still startled when the phone went dead and I realized the conversation had ended and she'd hung up!

So this time, I listened very carefully and she spoke very clearly and we had an entire conversation making plans for the late afternoon. Thrilled that I actually knew when the conversation was over, I hung up and ran upstairs before I stopped to think about what I'd said. As far as I could tell, I had agreed to meet Paola at an ice cream shop an hour later to....watch people dance salsa together on top of a wooden table while on bicycles. What? I figured there was nothing for it but to go, so I asked my family how to get to this ice cream shop and changed clothes.

Then I started to get nervous. I was going to be walking by myself (granted, only about five blocks) to a busy ice cream store on the ocean-front boulevard, which is famous for loud music, large crowds, and general confusion. And it was getting closer to dusk. I asked my family if it seemed safe to walk there and they said it was. Even though I trust their judgment and know they care a lot about me, I was hesitant. And then there was the question of time: If Paola said 5pm, did she mean right at 5 or did she mean a more Dominican 5 a la 5:20? I didn't want to be waiting at the ice cream shop alone for 20 minutes.... The more time passed, the more nervous I got, until even I could recognize that it was probably out of proportion to the event at hand.

Knowing that in all likelihood this was going to be fun and I would be fine, I got ready and decided to leave the house at 5, hoping Paola would already be there. Even though the day was cloudy, I donned my big sunglasses (I find I get less attention on the street this way - I think because people can't see where I'm looking and can't tell that my eyes are blue) and struck out with a confident walk. I reached the ice cream shop with no problem and looked around for Paola.

She was nowhere to be seen. Still nervous, I leaned against a column and tried to blend in. A little girl, about five, stood on a chair to be eye-level with me, leaned in to my face, and started chatting in pristine Spanish. Between scampers over to her grandparents, she pointed out all her family members, including a description of how unimpressed she was by her five-year-old boy cousin. Then she proudly counted to five in English. I hadn't wanted to attract any attention, but I was so grateful to have this uninhibited little girl for company. Sure enough, at about 5:20, Paola walked in and we did the Dominican cheek-kiss greeting.

This was the first time Paola and I had successfully met up, so our conversation was of the basic get-to-know-you type, which, thankfully, is usually in present tense. Paola asked if I wanted ice cream and I said, sure. Dominican ice cream is served in really squat waffle cones and, regardless of the flavor, covered in a thick strawberry syrup and often sprinkled with that Fruity Pebbles cereal from the States. There was a little confusion when I ordered only a single scoop of sherbet (chinola - my favorite Dominican flavor) without any of the toppings. (Hey, if I saw a girl walk in at 5:30 on a cloudy day wearing sunglasses and then proceed to refuse the strawberry syrup, I'd be confused too.) Paola insisted on paying, since she had invited me - another cultural custom.

Finally, with ice in hand, we headed out to see the salsa-ing bicyclists. It turns out it was a performance of bicycle tricks on a huge wooden ramp in the middle of the street. (So I had correctly caught the words bicycle, wooden, and tricks, though I still don't know how I got salsa...) As it turned out, Paola and I were both too short to see over the crowd, so we ended up sitting by the water's edge and chatting. She was very patient with my Spanish and we had a great conversation. Paola has also just moved to this city, and we shared our feelings of bewilderment in how to get around, what it was like looking for friends, and how we missed an active social life. It turns out she is really interested in learning to salsa, so we might take classes together once I've learned merengue and bachata. Exciting!

After about an hour, while it was still light, we said good-bye and I walked back to the house, nerves replaced by confidence. Even now, I am still absurdly proud of executing my first "friend-date" by myself - phone call, plan, walk, conversation, return... all of it! It's funny to me how things so simple in the US become such a challenge for me here, and then such an achievement! And now I have wonderful friends in the clinic, someone outside the clinic, and a lovely Dominican family to spend time with.

As Vonnegut writes, "Do one thing everyday that scares you." ....no matter how small! xoxo

Two Patient Stories

2007-09-26T16:36:00.000-07:00

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.

Jarabacoa: the adventures continue...

2007-09-26T10:11:00.001-07:00

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!

Work Update

2007-09-15T10:27:00.000-07:00

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!

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?

The Retreat

2007-09-09T15:08:00.000-07:00

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 the Fly

2007-08-31T08:08:00.000-07:00

Hi everyone! I'm sorry I haven't updated in a while - and that this update must be short and business-like.

House-keeping:
Some people have said that they are not getting the update emails I send out. It seems that the mass emails (at least for people using gmail) are sometimes getting directed to the Spam box, instead of the regular inbox. If you have not been receiving update emails with a link to this log, and suspect you should be, try checking your trash or spam boxes. You should be able to approve my emails and receive them in your regular inbox. If that still doesn't work, just let me know and I'll double-check that your email is included in the list.
Also, in response to some emails: I'm sad to admit that I don't know how the boy from the last entry was rescued. I just saw the aftermath. Sorry to leave you with such a mystery!

I want to say a big THANK YOU to everyone for your notes, emails, blog comments, etc. Even if it seems I am uninterested (or I don't reply quickly, etc.), I am so thankful for these communications from home. I'm starting to feel more and more settled here, but it's lovely to have some connection back home, too.

The last two weeks have been busy and engaging. We continue to work on our Health Promoters program in the clinic and it's picking up speed! I am currently running out the door to go to a retreat weekend up in the mountains for people ages 20-35. It's supposed to be cool and beautiful, with waterfalls, hiking, and horse-back riding at the diocesan camp. It should be a good chance to get to know people my age. But - I'll be honest - I'm sort of nervous. At home, meeting new people, making friends, and visiting new places are all pretty easy for me. But here, where I stand out and it's a struggle to communicate, that stuff takes a lot more work. It still surprises me how much mental preparation I have to do to feel ready for any event outside of the clinic. So, this weekend is me taking a deep breath and plunging in. It will be beautiful and a chance to see and do things I've never done before (and a great way to practice Spanish!), but it's still work and effort. I'm looking forward to that great feeling of accomplishment that comes only after trying something new and intimidating! I know going to this retreat is certainly not something I will regret. Here I go!

So, I will be sure to update you all with stories and pictures from the weekend. And, lest that last paragraph make you worry, let me assure you that I'm happily settling in and enjoying this adventurous year. In fact, there's a lot of things about settling in that make me inordinately happy. Some examples from this week include correct usage of the subjunctive and the word "Supongo," successful washing and line-drying of my clothes and sheets, and an invitation from my co-worker, Ana, to hang out next weekend! I go ahead and let myself be pretty thrilled with these small events - life is good! So now I'll close with a description of the pictures (above) from last Sunday, when the whole church went to the other side of the country for a day at a stunning beach. I was nervous about that day too, but came through it with new acquaintances (and a slight sunburn): a success to be sure.

[For some reason, I can't get the pictures to appear anywhere but on the top of my entry.... It doesn't help that this entire site is also in Spanish now that I'm in a Spanish network. Oh, well. Any advice is welcome.]

Love to all! Have a wonderful Labor Day weekend!

A Saturday with Hurricane Dean

2007-08-18T13:11:00.000-07:00

A typical house in Villa Faro

A combination of trash and the beautiful ocean (Villa Faro)

Clothes drying on barbed wire outside a half-constructed home (Villa Faro)

My family, from left to right:
Father Guelmy, Jayza (14-yo), Reyna, Claribel (19-yo)
Just before Jayza's graduation!

An entry written on Saturday, August 18 (posted later due to internet issues):

I'm hunkered down in my dim room, waiting for today's weather to pass. It looks like Hurricane Dean is blowing away from San Pedro, and we're just getting the edges. But there's a lot of rain beating on our aluminum shutters and the wind is literally howling! Surprisingly, the weather has made for a really fun day, since everyone's holed up in the house. We made homemade pizza for lunch, with onions, mushrooms, corn, ham, and oregano. Delicious! Jayza, the fourteen-year-old, has the equivalent of her junior high graduation today, so she is running around the house in curlers and hoping for less rain by the time of the ceremonies this evening. Tonight will be the first wearing of her new dress and shoes, which she proudly modeled two nights ago - gotta love an excuse to get dressed up!

Earlier this afternoon, Fr. Gulemy yelled to me that there was a rescue going on at the beach two blocks away, where two boys had been surfing and one was now stranded clinging to a buoy. The waves are too high for boats to be on the water, and everyone from the neighborhood was gathering at the shore to see how the boy would be retrieved. Half an hour later, Fr. Gulemy called me onto the porch to witness what he called a "Dominican tradition" - the streets chock-full of people leaving the beach after a successful rescue. He laughingly said, "A Dominican custom: where there is danger, go find it!" Nobody is working today because of the weather, but everyone will make it to the beach to see a daring water rescue. What an eventful day....

And now, The Week in Work:

The clinic has a great public health program that works to place local people in healthcare roles right in the community. Well-liked, responsible, and interested community members are recruited and taught basic healthcare and water usage information and how to make effective home visits. These volunteer "Health Promoters" serve as educators, sources of advice, and advocates for their local community. They are trusted by and accessible to their neighbors - and they know first-hand what it's like to live in the neighborhood - which makes them an invaluable bridge between the clinic and the community. The most recently trained Health Promoters are to be assigned regions of Villa Faro and given the results from our health census, including information on population, illness, pregnancies, etc. We did a workshop training for these H.P.'s two weeks ago, and finished the census this past week, so I thought this week would bring assignments and the start of the Villa Faro program!

Then I found out that there is no map of Villa Faro. Suddenly, assigning regions and giving meaningful geographic census information was really out of the question. So, there was nothing to do but make our own map! Compasses, addresses, pavement, streets with names, grids....oh, the things I have taken for granted! Dr. Dohn and I were lucky enough to start with (only slightly outdated) Google satellite pictures of the city, zoomed in extra close, printed, and taped together into a large scroll. Clutching those fuzzy pictures and a blank scroll, we drove and walked the southern half of the neighborhood, drawing solid lines for driveable roads and dotted lines for winding footpaths and impassable roads. We noted important landmarks: a church, a school, every "Colmado" convenience store, and a big abandoned hotel-type building. This week, we will hopefully finish with the north half of the neighorhood. Even though it's a long, hot process, it's fun (like a puzzle) and a great chance to talk to people in Villa Faro.

Before, I wouldn't have thought to link maps and medical care, even though maps are used everyday in healthcare in the US (e.g. ambulances, satellite healthcare sites, hospital transfers, even bills!). When you think about it, healthcare, governments, social services, religious communities...all of these are inextricably connected. A lot goes into quality healthcare! And I like the idea of a healthcare provider who can use many different skills, in addition to scientific and technical training, to care for his patients. What a wonderful challenge, to think outside the box, to tap into different talents and resources! We need a map. So we're making one. It's so far been an exercise in patience and creativity, but it will hopefully contribute to the improved health status of an entire community - plus, we're making a copy for the city as well.

This week has certainly flown past; today marks my first month in the DR! I really can't believe it - I still feel like I just got here. I'm happy and healthy and learning new things everyday! And now it's really started pouring again, so I should finish up in case we lose power. Love to all!

Villa Faro

2007-08-10T10:24:00.001-07:00

I promised weeks ago to include a description of the nearby neighborhood where we're conducting our health census. Soooo, without further ado, here it is, in brief:

Named for a non-functional lighthouse on the shore, Villa Faro ("Lighthouse Village") is a neighborhood that stretches north from the Caribbean Sea toward the center of the city of San Pedro - only a sixty-second drive on a paved street from my house. There's a huge jolt when the Jeep we drive leaves pavement to drive on Villa Faro's muddy/dusty streets, bouncing on top of the reefs of dead coral that make up the ground beneath this neighborhood. There are no sidewalks, gutters, or drains; no running water, and only improvised electric lines strung from tree to tree. Homes mostly made of salvaged boards and corrugated tin line tributary paths that branch off the road. There can be 2-5 houses stacked unseen behind the house facing the street.

Yesterday, while working on a presentation about water access in Villa Faro, we stopped to get a picture of a water system belonging to a woman named Maria. Dr. Dohn's profession became apparent, and, suddenly, we were ushered into the house to check Maria's father, Melvin, who had undergone abdominal surgery for a hernia in April. We entered through a typical homemade fence of rusted tin and barbed wire, strung with drying clothes. Maria's family, like most, has a "well" - a hole dug through the coral to the (salt) water table below. Inside the house, there are holes in the tin roof and the concrete floors. Maria and her seven-year-old daughter and three-year-old son live in two rooms at the front of the "lot." Melvin lives in a third room off the back. He is lucky to have his own mattress and mosquito netting; most people in this neighborhood have to share. Fortunately, even though his surgical wound has opened up and not yet healed itself, Melvin is doing fine, with no signs of infection and plenty of antibiotics and dressings. He is in pain, though; we brought some Tylenol today to help.

After dropping off the Tylenol, we continued our health census, walking from house to house in Villa Faro and asking questions about water access/uses, family size, and incidence of child/infant diarrhea, cough, and respiratory infection. On afternoons like this, I work with Ana, a woman about my age and height, which makes us an approachable pair to kids running around the neighborhood. We often have a small entourage of kids in tow, curious about what we're doing. Today, we rounded a corner and were met by a group of about six 8- to 12-year-old boys playing baseball in the street. With no families in sight, one of the older boys volunteered to answer our questions for his household. We must've made quite the spectacle, because soon we were surrounded by jostling and laughing boys. And then came the questions about diarrhea. Already fairly giggly, that just sent the boys over the edge. And what can you do when you're up to your eyeballs in 10-year-old boys in hysterics about diarrhea? Nothing but join in! Needless to say, the suvey was over. But we all had a great time!

Afternoons spent in Villa Faro are simultaneously enjoyable and heart-breaking. I struggle to describe the complex relationships among love, poverty, laughter, illness, beauty, struggle, and hope. (I sat in front of a blank computer screen for days thinking through different descriptions and stories before I could write anything.) Despite - or maybe because of - this complexity, census afternoons have become a favorite part of my week. I know that when we're finished with the census (we're nearing the end now), I'll miss it, but the lessons I've learned and the experiences I've had will be with me forever. And, with our newfound information, we will begin a local preventative healthcare program! Vive Villa Faro! - and may better times soon come your way!

Dominican Life.... So Far

2007-07-31T09:11:00.000-07:00

The view from my bedroom window this morning

Clinic hallway - after hours

The "Dryer"

Our ambulance:
a gift from Spain - unusable since the repair parts are unavailable here

Today marks my tenth day in the DR! In honor of this milestone, I'd like to take this post to describe day-to-day life here as I experience it, and save clinic work for another time.

I'll begin by answering a FAQ: Why is it so loud at night?
I live close to the Malacon (sp?), which is the popular seaside boulevard with ice cream shops, cafes, bars, music, etc. This certainly accounts for some of the noise, since it is a popular place to go any night of the week. However, I think most of the noise I experience is caused by the following chain reaction: Many, many cars and trucks have several huge (maybe 3ft. tall) speakers installed in the trunk or on top of the vehicle. They blast music up and down the streets, creating both incredible sound and tangible vibrations in the ground. This, in turn, sets off every very loud car alarm in the surrounding area. And this sets off another alarm: a very excitable and friendly chocolate-colored dog who lives in the yard next door. Between this speaker-alarm-dog chain, the Malacon, and the passing motorcycles (the major mode of transport here), it can be pretty loud. I like the dog; he fights fire with fire!

Another FAQ: What is my host family like?
My host family is lovely. Father Guelmy is outgoing and talkative. Every night at dinner, he starts speaking loudly and slowly (that's how I know he's talking to me - and it's helpful!) and asks me to describe what I did today and what I will do tomorrow. He knows that I'm really trying to practice my verb tenses. AND he's already fixed my computer twice!
Father Guelmy's wife, Reina, is much quieter but equally kind. She's a fabulous cook and is always singing around the house. Reina is pregnant, due in early November. Yesterday she had the ultrasound that told us that the baby is a boy! We jokingly started thinking about names last night. I think I like "Oscar"....
Fr. Guelmy and Reina's daughter, Yaisa (sp?), is fourteen and speaks a little English. She has a good sense of humor and is not afraid to correct my Spanish or help me translate, which I appreciate. The family gets along really well, though I'm pretty sure that Yaisa's pretty sure that she's right all the time - Some things about being fourteen are the same everywhere!
Reina's sister, Claribel, is also staying with us. She's nineteen and will begin the equivalent of college in January. She's planning to study either tourism or French/English. I think the tentative plan is for her to stay here to help Reina in her last trimester and with the new baby.

The last FAQ for the day: Say more about the food!
The food is delicious, more sweet and savory than hot and spicy. In the DR, the big meal of the day is at noon, and we always have rice and beans, some meat, fruit/veggies, and lots of juice (since the tap water is not drinkable). It's great, but pretty hot for such a big meal! I like breakfasts and suppers, especially this sweet cream-of-wheat-type dish and these cheese-stuffed fried dough things. We eat avocado with vinegar at nearly every meal - wahoo! Occasionally, there's some food I recognize from home, but always with a surprising twist. For example, the other day we had hamburgers, which were tiny pads of meat wrapped in a bun three times as big. Or, when we made meatballs a couple days ago, Reina taught me to add garlic, onions, salt, pepper, breadcrumbs, oregano...and then the juice of two limes! Mmmm. I can't identify the majority of fruits and vegetables we eat, but when it tastes this great - who cares?!

In other news, I have a mailing address! It's the equivalent of a PO Box, so it can take mail about four weeks to arrive from the States - not good for time sensitive stuff. It's also not such a good idea to send anything fragile or valuable, since things get tossed around and/or opened. Life is surprisingly different without homework, and I have already torn through all the books in English that I brought. If you are interested in sending any second-hand books that you're finished with, I'll take them! Once read, I will donate them to the new Books-in-English collection we're starting at the conference center. My mailing address (green box), along with a list of books I already have here (tan box), can be found in the right-hand column of this webpage. Also, be sure to check out the listed websites of other YASC'ers in their time abroad! Love and thanks to everyone - I will write again soon!

P.S. More pictures (of people!) to come soon, once I get a feel for it.

Arrival

2007-07-24T08:30:00.000-07:00

Saludos de la Republica Dominicana! I have arrived - safe and sound - in the Dominican Republic! My bags followed me only a few days after (missing two zippers, one lock, and with some damage) and I am now in fresh clothes, a good feeling. I understand that it's a small miracle that my bags took only a few days to get here, and estoy muy agradecida - I am very grateful.

Currently, I am staying with the family of the assistant priest of the Episcopal parish nearest the clinic, San Esteban. In many ways, I am very lucky, with shower access, my own room, screens on the windows, and, since Father Guelmy happens to be a computer whiz, very fast wireless internet access! Father Guelmy, his wife and daughter, are all welcoming, though we struggle to communicate sometimes. Humor is the best way to cope I think - we all laughed yesterday when I asked if I could please help the phone, instead of use it....

Yesterday, I was given a tour of La Clinica Esperanza y Caridad (Clinic of Hope and Charity), a building converted from an old school. Dr. Dohn showed me the new lab, a small, kitchen-type room with one microscope and a dorm-room-size fridge as its main attractions. We saw the laundry - the single washer and the "dryer," as Dr. Dohn calls the open courtyard where line after line of sheets and towels hang. One overstretched generator powers this entire compound, including the church, the clinic, two priests' homes and the conference center. We lose power frequently, but not for very long. I saw a new wall and fresh hallway paint donated by an American charity. One staff member said, "It almost looks too nice; we might lose funding." In many ways, the clinic is so different from a healthcare building in the States, it's beyond description. However, many things are familiar and inspiring: a dedicated and friendly staff, hopeful families waiting in the hallway - and evidence of everyone trying his hardest. I look forward to joining this community in the coming year.

This afternoon, Dr. Dohn and I will travel to a city neighborhood not far from the clinic to continue the clinic's community health census. Though it is not geographically far, few of the city's services reach this neighborhood, and there is little access to clean water. We will ask questions about family size, access to/uses of water, and frequency of illness. I saw some of the neighborhood yesterday, and will have to save description for another post since it will take some space. I'm excited to take part in this important work, but am a little nervous about what I might see.

So that's it for now! Thank you all so much for your support - both for the financial contributions and the wonderful farewell messages - I appreciate it more than I can say. And now, I say goodbye with a few random thoughts: It is so hot here; the food is wonderful; it's incredibly loud at night; and verb conjugation is very important in Spanish. Adios for now!

Getting ready

2007-07-14T17:34:00.000-07:00

Welcome! You've reached the website where I will share reflections, stories, and pictures from my upcoming year as a member of the Young Adult Service Corps (YASC) in the Dominican Republic. My service work will be in healthcare in several communities along the southern coast of the country - working in an AIDS/HIV clinic, a public health program, a residential home for the elderly, and a new clinic along the Haitian border. I'll be learning Spanish, teaching music, working with kids, and (probably) living with a family while I'm there; I can't wait to get started!

Fundraising update: I have reached my fundraising goal and will soon be on my way. Thanks to all for your support and generosity!

I leave for the city of San Pedro de Macoris in the Dominican Republic the morning of Saturday, July 21st (That's one week from today!). I started work on the logistics for leaving several weeks ago and now, after many To-Do Lists, am feeling ready to depart. For those who asked: I do not yet have a mailing address in the Dominican Republic (which I think I'll start calling the DR for short). If you'd like to know the address when available, just send me an email.

There is some internet access in San Pedro, so I will be reachable via email. (This site doesn't show my email address, but you can find it on my fundraising letter or you can feel free to contact my family.) This website will also be updated regularly. If you'd like to receive an email whenever this site is updated, please send me an email (or click on the "comment" option below this posting and type a comment) and include your email address.

To close, a word about the title of this site: Saludos! "Saludos" means "greetings!" in Spanish, so the direct translation of the title is "Greetings from Kate!" Something I like especially about sharing this greeting in Spanish is that the first part of the word, "salud," is the Spanish word for "health." I like to think of "Saludos!" as both greeting and a wish for good health. In one week, I will embark on a new adventure in service, love, and grace. To my Dominican hosts and to my supporters at home: Saludos!