¡Bienvenidos!

Hello everyone and thanks for visiting my blog!  Due to the lack of technology on my trip everything in this blog is a bit after-the-fact, but I thought it would be a great way to share my experience in the Dominican Republic with my family and friends.  Below you will find pictures and captions detailing my adventures in the DR.  If you would like any background information about me, ILAC, or the Summer Program, please see the links to the side.  Enjoy!

PS- I apologize for all the dates being incorrect.  I wanted you to be able to read about my experience in order instead of starting from the end.
PPS- Thanks to my assistant coordinator Bri for providing most of the photos for this blog!

Arrival: The First Week in Santiago

(June 19-June 23, 2012)
After a long day of traveling beginning at 6 am, we arrived in Santiago around 8:30 pm and took a shuttle to the ILAC Center.  Total, there were 40-50 participants and 12 coordinators/assistant coordinators.  The ILAC Center is beautiful and peaceful.  There are many larger rooms with bunk beds and smaller houses called casitas for other guests.  Here are some pictures of the center (you can click on them to make them bigger):

Before leaving for the campos, we spent 4 jam-packed days in Santiago.  Each morning we had 2 hours of Spanish class and a meeting with our professional group (so, nurses for me) before lunch.  After lunch we did various tours around the city. Unfortunately, I was not allowed to take pictures on all of my tours.

The first day I went to Cabral y Baez, the national public hospital.  Much of it was under construction so it was hard to get a clear idea of the nature of the hospital, but it is definitely very different from the hospitals we are used to in the US.  Most of the hospital is not air-conditioned and several parts are open to the outside.  I saw many patients sitting in waiting rooms or in hallways with IV bags.  In addition, the hospital is primarily run by residents and medical students.  During the weekdays in the mornings, physicians will come to the hospital to do their public service before returning to their own private practices.  The hospital is packed during this time; most physicians see 50-60 patients in the short amount of time that they are there.  During the afternoons and evenings, residents and medical students are responsible for patients.  Most patient rooms are 4-bed rooms, and several family members are usually in there at a time.  Needless to say, they get rather crowded.  I asked about nurse-patient ratio, and most nurses have 2 of these rooms they are responsible, as many as 8 patients!  I also learned the DR does not have a pharmacy degree, so the pharmacists there do not have much knowledge of drugs and mostly just fill orders.  Outside of the hospital, you do not need a prescription for medication, so anyone can go to a pharmacy at any time and get whatever drugs they want. (No pictures were allowed here, sorry!)

On day 2 I traveled to a museum in Santiago where we learned a little about the history of the country and a lot about the use of brooms in the DR (there was a special exhibit, it was a bit too extensive).  After that we were sent on a scavenger hunt around the city.  A primary form of public transportation in the DR is guagua (pronounced gwah-gwah), which is usually a 15 passenger van that never actually seats 15 people.  The saying is: How many people can you fit in a guagua?  1 more!  The most I counted in one of my guaguas was 25 people--it was cramped!  We took a guagua down into the city and walked around, visiting a park, a market, El Monumento (a large monument in the center of the city).  The Monument's official name is Monumento a los Héroes de la Restauración.  It was built in 1944 during the reign of the dictator Trujillo.  Here are some pictures of downtown Santiago and the Monument:

The last tour I had in Santiago was of an area called Cien Fuegos, which means 100 Fires.  Essentially, it is the slum of Santiago.  It covers a vast area of land which includes the area at the base of the city dump. Trash is abundant here, as is poverty.  Most people live in small shanty homes of wood and tin roofs.  People who come to Santiago hoping to find work often end up here.  Unemployment is a huge issue in this part of the city; many people search through the dump to find something to sell as a source of income.  Forgive me for the poor photography, I had to take all of my pictures here through a bus window.  I did steal a real photograph of someone in the dump so you can have a better idea of how the people in Cien Fuegos live life.

That wraps up my first few days in Santiago!

Leaving for the Campo

(June 24, 2012)
After 4 busy days at the ILAC center, it was time to leave for the campo!  (In case you're wondering it's not pronounced camp-o, it sounds like kahmpoh).  I was fortunate to spend a short amount of time with Colin before we left...he arrived at ILAC the night before.  He spent almost two weeks in the DR working on psychology research (so you should ask him about his experience there).  Anyway, we said farewell to our friends and then packed up the bus and headed out.  My campo's name was El Rodeo, located close to Haiti.  Unlike most groups, our campo was not in the mountains.  It was affectionately referred to as "the hot campo."  In case you want a sense of location, here's a couple of maps:

This is where the DR is located...only short swim to Cuba!

(Excuse my paint skills) This is a map of the DR.  The green oval in the middle is Santiago, where the ILAC center is located.  My campo, El Rodeo (drawn in) is on the left.  As I'm sure you will notice, it is rather close to Haiti.  It is approximately a 45 minute drive to the border.  Just for reference, the capital of the DR is Santo Domingo, located on the southern border of the country.

My group had 12 students throughout the 4 weeks.  We also had 5 professionals who stayed with us from 1 week to 2 weeks: 3 physicians, 1 dentist, and 1 pharmacist.  Here's the group before departure!

Back Row: Bri, Assistant Coordinator
Chris, Dentist
Kevin, Pharmacist
John, Auydante
Patrick, Dental Student
Dr. Longo, Physician
Tim, Auydante
Front Row: Rachel, Coordinator
Ruth, Pharmacy Student
Lori, Nursing Student
Sam, Medical Student (4th year)
Alex, Medical Student (1st year)
Brittney, Dental Student
Not Pictured: Ashley, Pharmacy Student

Loading up the bus!

After a little less than 2 1/2 hours of bumpy driving, we finally made it to Rodeo.  At first glance, you can see there is poverty in the campo, but it is not as blatant as it was in Cien Fuegos.  The poorer families have houses made out of wood with concrete floors and tin roofs.  They have latrines and outdoor showers.  There are also nicer homes which are made of concrete, often have tiled floors, and have bathrooms inside.  Rodeo is one of the larger campos (160 families) and it is rather spread out.  There are essentially two halves to the campo separated by a main road.  We visited the other side of the campo a few times, but mostly stuck to the side where we lived and had clinic.

Upon arriving we went to our cooperadora's home.  Each campo affiliated with ILAC has a cooperador(a) assigned to the community.  The cooperador's job is to be a leader for the people in the campo and supply them with resources for healthy living.  They have some very basic health education (such as taking blood pressure, giving shots, etc.) and try to promote wellness in the community. They also do much, much more, but I never got the run-down of all of their responsibilities.  Our community actually had 2 cooperadoras because of its large size.  The cooperadora we worked most closely with was Nereida.  We ate all of our meals at her house and spent many of our afternoons hanging out and playing cards.

Nereida, in her kitchen

We then went to meet all of our families and get settled in.  Most of the girls and some of the boys were paired up with someone else in the group.  My room mate was Ruth, one of the pharmacy students.  Meeting the family was a bit overwhelming, as neither Ruth nor I spoke very much Spanish.  It was a small, simple home made of wood with 2 bedrooms, a small living room, a kitchen under a pavilion outside, and most exciting, a bathroom!  We were very fortunate to have a bathroom in our home because most people in Rodeo still use latrines.  Our bathroom had running water as well (a huge plus) so we were able to use a sink, flush the toilet and take a shower.  (Not quite like a shower in the US, there was no shower head so it was just like a faucet from the ceiling.  It was still great though, most of my group took bucket showers). Ruth and I each had our own bed too.

Living room

Kitchen (there is a stove on the other side of the blue door)

My bed

Parent's bedroom

Bathroom

The road leading to our house

Our family was small: we only had parents living with us.  Our padre's name is Epifano; he is 83 and a very sweet old man.  Our madre is Sylvia; she is somewhere in her 60s.  They have 5 children together, 3 of which live in Santo Domingo, 1 in Santiago, and 1 in Rodeo.  The daughter that lives in the campo is Lucia and she has several children of her own.  We met some of her younger children, but I had a hard time keeping all of their name's straight.

My madre, Sylvia

One of the several grandchildren

It's a little blurry, but here's a picture of my family.  On the right is Ruth and in the middle are our parents.  On the left is the random neighbor/possible grandchild that was always around but I could never remember his name.

Click on Older Posts at the bottom of the page to keep reading.

Time for Clinic!

Our primary purpose for being in the campo was to provide the people of the area with a free clinic.  For many people in the campos, health care is difficult to come by, either because there are no resources nearby or because they simply can't afford it.  We had clinic 4 days a week for 4 weeks and were rather busy most days.  We had both a medical and a dental clinic.  Total, we saw over 400 patients in the medical clinic and over 200 patients in the dental clinic.  This includes a day we only had for women, in which we did 56 pap smears (I only assisted by handing the physician supplies).  That was a busy day!  Our clinic was located in the community's school.  We had one room for the medical clinic, one room for the pharmacy, and a pavilion out back for the dentists.

The school/clinic

Medical clinic

A view of the mountains in the distance on our walk to clinic

Prayer before clinic

My main role in the clinic was doing intake for patients in the medical clinic.  This was very difficult at first because Spanish in the DR is very different from the Spanish that I learned in high school.  They use words that I'm not used to hearing, have an accent, and they talk incredibly fast.  For the first few days I had a "translator" help me out.  I say "translator" because they were actually 2 Dominican teenagers from Rodeo who didn't speak English.  However, they were incredibly helpful.  They would repeat what I said faster and then simplify whatever the person said back to me.  Besides intake, there was not a ton of nursing-like things to do.  This was the thing that frustrated me the most at first because I felt like I was not able to practice anything that I learned in school.  The fact was that many of patients that came in did not require any nursing care.  We saw a lot of headaches, low back pain, urinary tract infections, hypertension, joint pain, and cold/flu (also known as the gripe--pronounced greepay). Everyone in the DR had the gripe.  In Spanish, gripe technically means flu, but in the DR it can mean anything from a sniffle to a fever and vomiting.  Everyone wanted a pill for the gripe which was frustrating because there was really nothing we could give them to get rid of their cold.  The biggest problem we saw was dehydration.  Rodeo was very hot, and most of the Dominicans would only drink 4 small glasses of water a day or less.  I think the thing the doctors prescribed most was drinking more water! So, I did not do very many nursing tasks.  I did get the chance to clean a couple of fairly large wounds, do a couple of ear irrigations, and obtain many, many urine samples.  Lori (the other nursing student) and I also tried to do patient education whenever we could.

Our dental clinic was always packed.  Dental care is not high on the priority list for many Dominicans, so many people have mouths full of rotting teeth.  Our dentists were busy doing many fillings and lots of extractions during our 4 weeks.

We also had a pharmacy for dispensing medications, although it was extremely limited on resources.  Because so many people don't have regular access to medical care, they are all looking for a pill to fix themselves. We could give them 1 to 2 months supply of drugs, but after that they would need to go to a pharmacy and buy more.  For many people we did not have the required medication, so the pharmacy dispensed a lot of ibuprofen, tylenol, and vitamins just so the patients would feel better about taking some medication home with them.

The unfortunate part about clinic is that we saw a lot of people with chronic diseases that we did not have the resources to treat or properly diagnose.  Luckily, ILAC has a referral system in place.  For those that we thought needed further follow up for a newly diagnosed disease we would refer them to one of ILAC's physicians stationed in Santiago.  ILAC also has several surgical teams that come to Santiago during the year, so we were able to refer many people that needed some type of surgery.

Life in the Campo

Life in the DR is very different from life in the US.  Here in America I feel like I have every minute of my life scheduled, but in the DR there was ample amounts of free time.  Many Dominicans are content with simply sitting with each other for hours.  Life was easy.  I felt the most relaxed I have felt since I started college 3 years ago.  It was wonderful and difficult at the same (see my later post on challenges).  Here's a sample schedule of what our days were like:

6:00 am--Wake up
7:00-8:00 am-- Breakfast and walk to clinic
8:00am-1:30pm--Clinic
1:30-2:30 pm--Lunch
2:30-6:00pm--Free time
6:00-7:00 pm--Shower
7:00-9:00 pm--Dinner and group chats
9:00 or 10:00 pm-- Bed time

Rinse and repeat.

Now that's a pretty generic schedule, but most clinic days looked like that.  During the "free time" in the afternoon, our activities varied.  We went on a few home visits to elderly members of the community who were unable to make the journey to clinic.  We went the river (río) a lot because it was only a 5 minute walk from my house.  Plus, it was always incredibly hot in the afternoon so we just wanted to cool off.  Sometimes we just sat around and played cards or dominoes, and I often took naps.  I got really good at napping in weird spots/positions because there wasn't always a conventional place to lay down.  Other afternoons we would disperse after lunch and go home to spend time with our families or nap in an actual bed.  Afternoon naps were always great, but there was no way to take a nap without waking up entirely drenched in sweat.  So if you took a nap in the campo, you had to plan on taking a shower right after as well.  Afternoons were a good time read and journal as well, which I did quite a bit of both.

That's me jumping in!

This waterfall was at another part of the river about 45 minutes away

Nap time!

Most nights we went to bed relatively early because we were all exhausted.  Also, electricity in the campo is rather sporadic.  There were many nights where there was no electricity, so we would eat by lamp light (it gets dark around 7-7:30).  When the electricity goes out, the saying is "se fue la luz," which simply means, "there went the light."  Imagine if you never knew when your electricity would be on here in the States.  Wouldn't it be difficult to get almost anything done?  This is what people in the campo deal with everyday, except they are not quite as reliant on technology as we are, so they don't need electricity for as many things (but that's mostly because they can't afford the technology we are so used to). Sorry, I went on a little tangent there.  On nights where there was electricity and we could stay up a little later, we would have bailes (dances) with the community.  Bailes were one of my favorite things about life in the campo.  The 2 main styles of dance in the DR are merengue and bachata.  Merengue is usually a bit faster and more energetic than bachata.  I also learned how to salsa from one of the medical students in my group which was a lot of fun.  They also dance regatone, which is really more a free style of dance and most similar to the way we (well, we college kids) dance in the US.

Lastly, I want to talk a little about the food there.  You don't realize how much you love the food you eat until you don't have it anymore.  I missed US food a lot.  Food in the campo was relatively good, but I am a somewhat picky eater, so that made things difficult.  We ate starch, starch, and more starch.  I really just missed a balanced diet.  However, eating the food that we ate was a way of living in solidarity with the people in the campo because our diet was representative of theirs.  We ate a lot of plantains cooked a variety of ways, yucca (a type of root), potatoes, yams, eggs, salami, rice, and beans.  Other foods that made appearances were tuna (which I avoided), eggplant, tomatoes, cucumbers, cabbage, and cornbread patties.  We ate very little meat, so it was a real treat the few times we got chicken.  If nothing else, there was always peanut butter and bread available, so we never went hungry.  I liked about half the food and did not like the other half, but I ate most of it regardless.  (Except for this one time when we visited someone's house and they served us pig intestines...that one I couldn't quite stomach.)  The one thing that I will sorely miss about campo food is mangos.  Our campo had an abundance of mangos and we had them almost everyday fresh off the trees.  Yum!

Mango eating contest

Mangu, mashed plantains...probably my least favorite food in the DR