My Life

My latest posts have been a scattered assortment of reflections on aspects of living in the Dominican Republic, but they may have left some of you wondering what exactly I've been doing here. So here's my medical update post.

Right now I am preparing the public health curriculum that will be implemented in the 5 public schools and 10 surrounding bateyes (villages) this fall. What is this curriculum? Well it consists of modules that are roughly 15 to 20 minutes long focusing on different health topics. By the beginning of the school year, which is August 18th here in the province of Montecristi, I hope to have 5 to 6 modules ready for presentation in the schools. Depending on the number of volunteers for weeks in the future, we will go to schools and bateys in groups and present these health lessons to the kids. I also hope that we will have enough donations to be able to distribute items like soap and toothbrushes when we give the lessons. So far I have divided the health topics into dental health, infectious diseases, nutrition, preventative strategies (for example, washing your hands, sneezing into your elbow instead of your hand, avoiding stray animals, wearing mosquillo repellant), what to do when you become sick, and vaccination. These modules are subject to change, and the lesson plans for each one will improve as I see how the kids react to them.

I have already had a number of opportunities to test lesson plans in dental health, because I started bringing donated toothbrushes and toothpaste to the bateys when we go for camps and when I go with Dr. Garcia in the afternoons. At the first summer camp where we distributed toothbrushes, I decided to do a dental health lesson at the closing of camp, when we gather all the kids in the classroom and sing songs. One of the volunteers and I quickly turned "The Wheels on the Bus" song into "El Cepillo de dientes" (toothbrush) song. Here are the lyrics:
"El cepillo de dientes va asi asi asi, asi asi asi, asi asi asi, asi asi asi
El cepillo de dientes va asi asi asi, todos los dias!
Si no lo usas, se cayen los dientes, se cayen los dientes, se cayen los dientes
Si no lo usas, se cayen los dientes, que lastima!"

(Translation: The tooth brush goes like this like this like this (4x)
The tooth brush goes like this every day
If you don't use it, your teeth will fall out (4x)
If you don't use it, your teeth will fall out, what a shame!)

Instead of making the wheels on the bus hand motions, we had Will, one of the interns, brush his teeth during the song, and when we said "Asi asi asi" we made a brushing gesture. I knew I wanted to make a toothbrush song that could be something kids could hum while they brush their teeth, and the wheels on the bus song is an appropriate length of time for brushing your teeth, so it actually worked out perfectly. The lyrics in the second verse are a little crude, but hey, it's true!

The first 15 minutes after we hand out the goods, the kids frantically barter for the coolest looking toothbrush. Unfortunately, for distribution's sake, we have a wide variety of toothbrushes, some much better looking than others, and so the kids who get the more basic ones complain. But what can you do? For the younger kids who get upset I convince them that their plain toothbrush has special brushing powers that the fancy ones wish they had. When they don't buy that, I tell them if they don't want the toothbrush, then give it back. There's plenty of kids in other bateys who'd be happy to have it. That usually works better.
Unbridled enthusiasm (any Seinfeld fans?) for the toothbrushes

We mark the kids hands with sharpees to make sure no one comes back for seconds.

Winner of the Summer 2008 Cutest Camper Award

At the end of camp, we calmed the kids down, and I was standing up front with Will and Susannah. Will was holding the toothbrush, ready to give the demonstration, while Susannah and I started the lesson by asking the kids whether they knew what Will was holding. The children had seen toothbrushes before, but judging by their teeth it was clear that they did not brush regularly, or ever. One interesting cultural aspect of dental health in Montecristi is that paletas, lollipops, are extremely popular with the youth here, and many of the children are constantly sucking on them. You can spot the kids with the biggest sweet tooths, because their front teeth have decayed considerably. It is not high on the priority list of parents in the bateys to buy their children toothbrushes. They are struggling as it is trying to keep their families fed on a daily basis.

I asked the kids why we use toothbrushes, and then talked a little bit about plaque and cavities, and how all that sugar that they eat in the paletas is bad for their teeth. When I was doing research on dental health I found that having sugar in your mouth over a long period of time, for example by licking lollipops, is much more damaging to your teeth than eating sweets during a meal, even if you ingest more sugar during the meal, because the saliva induced by eating will help to send the sugars packing to the stomach. So I told the kids if they want a smile like mine, showing them my (somewhat) pearly whites, then they should cut back on the lollipops. We then proceeded to sing the toothbrush song. Susannah and I were the only ones singing while the kids giggled at Will brushing his teeth in front of them. Finally we ended camp by giving all of the kids toothbrushes and toothpaste. There were around 50 kids at the camp. I knew the lesson had gone well when one little guy ran up to me with his toothbrush and sang "Asi asi asi!" while doing the brushing motion. Maybe those kids will remember that song.


So the dental health part module has already been battle tested in the bateys, and I am hoping the other lesson plans will have some fun activities like songs and games to keep the kids interested. There were several summer camps at the English Institute where we had a health station, and we had some good activities for the kids that will be used in the other modules I'm designing.

Will and I used this dry erase board to give the children an anatomy lesson.

Besides crafting this public health curriculum, I also spend my mornings in the hospital and in a physical therapy rehabilitation center, and I spend my afternoons working with Dr. Garcia in the bateys. Lately I have spent more of my mornings at the physical therapy center than the hospital. While I enjoy the work at the hospital, I really like the opportunity to build relationships with patients in physical therapy. I see the same people coming in every morning, and instead of just shadowing a doctor, I actually help the patients do their exercises. This week was especially good at the rehab center.

On Monday morning Liry and I went to physical therapy, and I realized that almost all the patients we see know my name now, and that made me feel pretty good. That day we saw many of my favorite patients. There is Rigo, a guy in his 20s who was a victim of gang violence and worked his way from almost complete paralysis a year ago to using a walker now. He spent some time in the United States when he was younger, and when I see him in the mornings he says, "Hey man! How are you?" He's always got a smile on his face, and has shown unrelenting patience throughout the painfully slow course of his recovery. Most of the patients holler when I help them with their flexibility exercises, but Rigo remains tranquil the entire time, living by the slogan "No pain, no gain".


After Rigo we saw another long term patient, Maria, an elderly lady who is a mother of 9. Last year one of her children died, also of gang violence, and after his death she was so devastated that she stayed in bed for literally an entire year. Her joints became so tense and her muscles so atrophied that she couldn't move her legs anymore. Fortunately, her children recently coaxed her into getting out of bed and coming to physical therapy. We have been doing PT on her for weeks now, and every day she's gaining more movement in her legs. It is difficult working with her because she complains mightily as we do the exercises with her, groaning constantly and screeching, "Ay! No me hagas eso! No mas!" (Don't do that! No more!). Liry, being the rockstar physical therapist that she is, convinces her in the most delicate tone imaginable that we would never do anything to hurt her, and she must continue coming to physical therapy to get better. Her family reinforces that message to her throughout the session. They are the reason that she has the strength to keep coming, and it is rare for less than 4 of her children/grandchildren to come with her to the clinic. For that matter, it is rare for any of our patients to come to the clinic without 1 or 2 family members. As I have been saying in previous posts, one of the defining aspects of Dominican culture is close-knit families. With the support of her family and our help at the clinic, I know that one day Maria will walk again.


So that's how I have been spending my mornings. Onto the afternoons...

Last Monday was one of the most productive days ever at the batey with Doctor Garcia. We went to La Recta, which is about an hour away from Montecristi. La Recta is in Palo Verde, a southeastern district of the MC that is home to many rice fields, and thus many Haitians (most rice field workers in Montecristi are Haitian, while banana and plantain workers are mostly Dominican). We used a road that goes right through the middle of an enormous rice field, and I looked out into an endless, picturesque landscape of rice paddies, with Haitian bodies silhouetted against the leaves dancing in the warm summer breeze. It was a scene straight out of a Jean-Francois Millet painting.

Haitians harvesting in the rice fields of Palo Verde

The Gleaners, Jean-Francois Millet. Yes, I am not afraid to reference 19th century French art, thus feigning a knowledge of art from my memory of AP Art History. I believe that's what the French call being un dilettante. The only reason I remember Millet is because I always loved this painting.

When we got to La Recta we met Cucha, one of the community health workers that works with Banelino. These community health workers notify the villages when we come for our monthly clinics, and they also come to the Banelino office on Wednesdays to fill prescriptions that Dr. Garcia writes for the villagers. We were chatting with Cucha and waiting for people to show up to the clinic, until we realized after 10 minutes that almost no one was coming. So Irmina (the nurse who works with Dr. Garcia) and I decided we needed to do some recruiting. We went through the village knocking on doors and talking to people sitting in the shade outside, saying hey, come get toothbrushes! And vaccines! And consulta with the doctor! And hear a talk on TB! It was around 3 in the afternoon, the perfect time for the toddlers to cool off in the irrigation canals running through the village. One group of boys got out of the canal and strutted up to us proudly, completely naked, and promised us they were coming to our clinic. Not naked though, we said.


After around 20 minutes of advertising in the village, we made our way back to the community center, where within another 10 minutes we went from having the 10 people who originally had come to about 100 people. It was going to be a long afternoon, I thought. Dr. Garcia gave his presentation on tuberculosis that he has been giving in all of the bateys we visit. TB is a major public health problem in the provinces near the border of Haiti, and the people living in the bateys are especially vulnerable because their weakened immuned systems from their poor living environment allow the latent mycobacteria to become activated. One third of the world (more than 2 billion people) test positive for tuberculosis, but 90% of infections are asymptomatic. Weak immune systems, whether from malnutrition or other infections (most notoriously, HIV), are an important catalyst for activating latent TB strains. Check out this CDC page for more info.

Dr. Garcia giving a talk on TB

Dr. Garcia visiting patients

Irmina and Cucha giving vaccines

Me acting doctory. Patient seems unimpressed.

Dr. Garcia finished his lecture on TB, and we got to work. Our table was at the front of the community center, with Dr. Garcia fielding patients stage left, the nurses giving vaccines stage right, and me right smack in the middle, keeping the vaccine and consulting lines organized, loading vaccines into syringes for Irmina, holding the legs of terrified babies as they got the vaccines, giving families toothbrushes once they got vaccinated, giving impromptu dental health lessons to groups of children around me, and taking the blood pressure of the patients Dr. Garcia was seeing. We were trying to keep everyone calm, but it was particularly difficult today because half of our patients were Dominican, half Haitian, and that racism that I posted about previously began rearing its ugly head. Dominicans fought with the Haitians over who would get vaccines first. Then Haitians starting fighting with Haitians, Dominicans with Dominicans, everyone with everything. It was one of the most challenging 3 hours of my entire life, and I almost didn’t make it out alive. I was suffocating by the stench of 150 deodorant-less bodies, and overwhelmed by the sounds of Haitian Creole, batey-style Dominican Spanish, Dr. Garcia speaking French to Haitians and both parties barely understanding each other, the crescendo of crying that runs its course as kids realize they're getting their shots, start hyperventilating when they approach the nurses, and let out bloodcurdling screams after a momentary bout of silence as she pushes in the vaccine. Babies crying, mothers consoling, kids complaining about the color of their toothbrush. Dr. Garcia letting out a funny sneeze after a fly gets close to his nose, grumbling “Coño!” (Damn!), and then yelling “Wuey! Silencio por favor!” as he wipes his sweaty forehead with a handkerchief. And amidst it all, the occasional laughter of Dr. Garcia, Irmina, and Cucha, seasoned veterans amused by the great turnout we were getting. These noises produced an hilarious cacophony that likely could be appreciated from the other side of the village.




I was completely exhausted by the end of the day, my nerves shot from the stressful afternoon. But then I looked at my backpack, and saw how it was completely empty, and remembered that I had counted 150 toothbrushes packed in that sucker. And Irmina counted up the vaccines and proudly stated that we had vaccinated 80 kids. And Dr. Garcia let out a big Santa-Claus chuckle and gleefully shouted, “40 patients!". In 3 hours, the four of us had managed to round up a village full of people, hand out 150 toothbrushes, give 80 vaccines, and consult with 40 patients. I’ve done stuff on service trips before that I was really proud of, but that was probably the most content I’ve ever been with a day of service work.


So there you have it folks. That's what I've been doing here in the Dominican Republic.

Paz fuera