Landed

So I've made it safely to the Dominican Republic. For those of you who haven't heard my plan, I'm applying to medical school right now while taking a year off to do some service work. I'll be returning to the United States in October for interviews, and then I'll come back to the DR in February until next summer. Debe ser una experiencia inolvidable....

The organization I am working for/collaborating with is called Orphanage Outreach (OO). They have been working in Monte Cristi for the past 13 years with, as the name implies, an orphanage. The orphanage hosts around 40 kids, from toddlers to late teenagers. I have only spent around 2 hours at the actual orphanage, because I do not live there, I live at their English Institute about 3/4 mile away. The English Institute is a 4 story building consisting of classrooms, a basement kitchen, and enough beds to staff about 40 volunteers (forgive me for not posting pictures, I am having a little trouble with the internet right now). Most of the volunteers at the English Institute are here for 2 months to do a new summer program called Teach Corps. The volunteers in the program work with children at various levels of English comprehension and teach them basic school lessons in English. So for example this week the volunteers have Science Camp at the Institute. As I am typing this I can hear the chant "Sunny is the best!" coming from a choir of 8-10 year old Dominicans downstairs; the volunteers have set up stations, and each group has a science-related team name. It's really amazing how fast these children learn English.

I arrived last Saturday and have spent most of the week getting oriented to my new environment, including my residence, the Dominican culture, the volunteers, and my program. I'll be doing a number of different things while I'm down here. First and foremost I will be working with Coco Barrett, the Country Director for OO, to design a public health curriculum for the local schools, the English classes at the Institute, and the rural bateyes which I will describe in greater detail in a minute. The goal is to have a curriculum set that the teachers in the DR can use to improve health awareness in the youth. The most important topics are sanitation and nutrition, from what I have gathered. Being a developing country, the DR has some serious problems with infectious disease and malnutrition.

I have started working in the local hospital, which is staffed by 37 physicians and has enough beds for about 150 patients, although their main focus is clinical work. There is a national health care program in the DR but it is seriously underfunded, and thus you have under-trained physicians and insufficient medical supplies. The hospital is not much to look at in comparison to Vanderbilt Hospital, where I've worked the past two summers, but they do seem to make the most out of what they have. Patients are bussed in from the surrounding areas, and they grab a ticket at a counter at the entrance (again, pictures will be coming soon), and wait in line to be seen. The first day I walked in there must have been around 200 patients waiting in the lobby to be seen. Very chaotic, but interesting nonetheless. The people don't seem to mind waiting long periods of time to see a doctor, because apparently in Monte Cristi everybody knows everyone, and the lobby was drowned in the chatter and laughter of Dominican voices. It's a delightful reflection on the culture here. People are highly social, very relational. I am excited to become a part of their community. Already I have already gotten to know the children who play frequently in the park outside of our building. They yell to me "Ey, Escot!" as a walk home from the hospital.

I have only worked two days so far in the hospital. The first day was orientation with Dr. Garcia, where I saw some interesting sights, like the Ultrasound/Registration room. I tried to hold back my laughter as we walked into the room, where a pregnant lady lay on her side by the machine as a nurse showed her her baby on the screen, and beyond them a secretary was tending to a patient trying to figure out whether his records had been lost. Speaking of records, I have been told that a big problem in the Dominican Republic is the growing number of births that go undocumented. With a birth certificate, babies grow up to have no form of identification, they can not receive social security, health care, etc. Further you can not register the birth of your own children unless you are documented, so the cycle continues indefinitely. There is considerable resistance to having a comprehensive registration plan for undocumented persons because of the influx of Haitian workers, synonomous to Mexican immigrants in the United States, who come illegally and perform cheap labor in the campos. Opening up a registration plan would introduce the possibility of incidental 'amnesty' for Haitian immigrants. The relationship with Haiti is incredibly complex and I'm just beginning to understand it. It seems that there is a substantial amount of racism by the lighter skinned Dominicans towards the Haitians.

In the hospital I am shadowing two diabetologists, doctors who specialize in diabetes. They don't have endocrinologists in the hospital, but they do have these diabetologists. I found that interesting. Diabetes is a big problem in Monte Cristi, and in the Dominican Republic. I don't have the statistics yet on that, but it seems that the Dominican diet of rice and fried foods is responsible. The doctora that I worked with today saw around 20 patients, all with Type II. Checkups are usually uneventful- checking blood pressure, examining feet, asking patient about sugar levels, and writing a prescription. I did see a few patients with pretty advanced neuropathy in the feet. I hadn't seen this before in my previous diabetes clinical work but the doctor checks the pulse of patients in their feet, because a diminished pulse in the feet is a key indicator of decreased circulation to the extremities. One patient had a running, infected sore.

I'm not sure how long I will work with the diabetologists as a shadower. I will probably rotate with other doctors. I'd like to shadow some pediatricians, and general internists. In a hospital that draws from such a diverse area of people, from the Haitian bateys near the border to the nicer parts of Monte Cristi, I'm sure that the experience will be rewarding at the clinical and cultural level.

One other anecdote about the hospital. Every morning I am to arrive at 8:15 to meet with the doctors in the conference room. 10 residents on rotation in Monte Cristi present interesting cases from the previous day, and the senior doctors grill them on etiology, diagnosis, treatment, etc. Half of it goes right over my head, both for lack of knowledge about medicine and a limited Spanish medical vocabulary. I should learn a lot there at the hospital.

On Sunday afternoon I went for a drive with Tom Eklund, director of the Orphanage, to discuss plans about the public health program and to drive to two bateyes to announce that English camps would be hosted there. Bateyes refer to the small communities for the workers of various plantations, including plantains, bananas, and rice (the big three of the agriculture here. I didn't know this, but bananas grow up from the stems, and plaintains grow down from the stems). Most live in abject poverty, with shacks for homes and without clean water and properly functioning latrines. A big push for the public health part of my work here will be to educate these communities on the merits of sanitation, the biggest hurdle to reducing the spread of infectious disease. I'll put up a few pictures in my next post of the kids in these communities. They're adorable. A group of kids ran up to us at the first batey screaming "Americanos!". I felt quite welcome. One little guy, about 3 years old, walked up to me and grabbed my hand and didn't let go as we walked around the village. I was a little taken aback at first, partly 'cos I've never worked with children before, and partly because I was surprised that we'd be welcomed so warmly. It was pretty cool.

So that paragraph was pretty pretentious. Sorry about that. I don't want to give the impression that I'm saving the world here (I'd be quite deluded if I thought that), or even that I'm coming here with purely altruistic interests. Actually many of the underlying motivations for this gap year were quite selfish. I wanted to learn more about medicine through more direct exposure than I got in my clinical work in college. I want to perfect a new dialect of Spanish (hopefully I can spend extended time in Cuba and Puerto Rico, to round out the top 4 Latino groups in the U.S.). And finally I wanted a cultural experience far apart from my own WASP upbringing. Thus I came to the DR.

One more thing about the batey trip. In the second batey there was a big baseball tournament with 5 teams from surrounding bateyes. There was a pickup truck with a mountain of speakers in the bed playing Dominican music, and Tom noticed that one of the guys sitting on top of the speakers was sporting a microphone. Being the crafty, marketing-savvy Americans that we are, Tom and I walked up to the guys and asked them if we could make a little PSA about the camp opening up the next day in the community. The guys cut the music, and there we stood, two blonde hair, blued eyed gringos, grinning like idiots as a village of Dominicans stared at us wondering what could be important enough to pause the merengue. I had a moment of panic as the Dominican with the microphone explained the camp, but much to my surprise the Dominicans were happy to hear it, and began to smile at us. I'll have plenty more gringo moments during my stay here. But that was a pretty good way to kick it off.

That's all for now. I'll try to post more in the future. This has been orientation week and now that I'm settled I'll be able to blog frequently. Paz fuera.