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

Challenges of the Campo

While life in the campo was "easy" in the sense that there weren't any of my normal stressors present, it was definitely challenging in many aspects.  I enjoyed my time in the DR immensely, but it was not without struggles.  The thing that challenged me far more than anything on this trip was the language barrier.  3 years ago when I graduated from high school I considered myself relatively proficient in Spanish.  As I quickly found out, the saying "use it or lose it" is entirely too true.  It was incredibly frustrating for me to not be able to communicate adequately with people.  The hardest part was that my ability to understand was still there--unless a Dominican was speaking.  I found that whenever more fluent members of my group would speak, I would understand about 95% of what they were saying.  However, when a Dominican tried to talk with me I would swear they weren't even speaking Spanish.  Dominicans talk extremely fast and they also use words and phrases that are not common things taught in the US.  It was a miracle if I could actually figure out what they were saying and then formulate a coherent response.  It was most troublesome with my family because I really wanted to be able to have a conversation with them, but with 2 Americans who speak little Spanish and no Dominican kids around to help re-phrase things, I was at a loss.  My padre was pretty good about slowing down and rephrasing things, but my madre would simply repeat things louder and louder until she was practically screaming...and I still had to say "no entiendo" (I don't understand).  Being unable to properly communicate was a large barrier in my experience.  I am hoping to re-learn Spanish in the near future, although I have yet to decide which way I want to go about it.

Another thing that I surprisingly found challenging was the amount of free time.  At home, I'm so used to being busy all the time and never really having a break.  In the DR, there was nothing but time.  Sometimes the afternoons and weekends when we did not have clinic seemed to last an eternity.  It also didn't help that my role at clinic wasn't very time consuming, so I also had abundant free time then.  Time is sort of relative in the DR; we call it "Dominican time" because there is no hurry to get anywhere, and if you're late, it really doesn't matter.  At some points this was nice, but at others I was just itching to get going and start whatever it was we were going to do.  It was during these long periods of not doing much that I would get most homesick, which just made things more difficult.  I eventually adapted to the more relaxed lifestyle of the campo and I learned to enjoy the time to just sit and think or spend time with other people.

As expected, not having all of the comforts of home presented a challenge.  This was more difficult in the first few days, but I adjusted quickly because I had to.  As I mentioned earlier, food was different. I didn't realize how much I would miss American food, but I spent a good 15% of my time imagining all the food I was going to eat when I got home.  When you're in a completely different environment it's nice to have a little reminder of home, so things like peanut butter or candy that people brought was always a nice treat.  I'm not trying to be whiny, but here's the things that bothered me in the campo:
-Bugs (mosquitos, cockroaches, huge spiders, etc.)
-Heat (man was it hot...although not quite as hot as it was in the Midwest I hear)
-Poop (seriously, there was animal poop everywhere and whenever the wind blew you got a nice whiff of it)
-Roosters (quickly became my least favorite animal ever because they do not in fact only crow at dawn, they crow all night long)

Anyway, those are my complaints and challenges of the campo.  I tried not to focus on these while I was there, but they were a part of my experience and I wanted to share with everyone my triumphs and my struggles.