Growing up Gringo

Odds & Ends

2008-10-05T21:43:00.001-05:00

Ashley and I

Things are chuggin' along here in Montecristi. About a month ago the fall interns arrived, and it was a nice change of pace from the 3 or so weeks when there were less than 5 of us at Orphanage Outreach. These interns are here to teach English classes this fall at our English Institute, where I lived earlier this summer. They spent a couple of weeks renovating the English Institute, transforming it from the dusty shell of a learning environment that it was following its evacuation on July 26th, when the summer program ended, into a veritable rainbow coalition of English eye candy, with posters, figures, tables, etc covering the walls throughout the building. As children walked in for registration they were amazed at the makeover, and certainly seemed excited to begin learning English in such a user-friendly environment.

At the English Institute we offer three levels of English classes, with Level I being offered to 5th graders, and a couple of weeks ago we spent a few days going to the local schools to advertise our program. The local schools here in Montecristi opened at the beginning of September, but it usually takes about a week for attendance to reach normal levels. The Dominican Republic has some serious problems with its educational system. Some statistics: net enrollment at the secondary level is 35%; currently only 1 in 10 Dominicans graduate from high school; the average student receives 2.5 hours/day of instruction; at the secondary level, 50% of students are overage and up to 20% are three or more years behind. From the last few weeks of teaching in the schools, I have become acutely aware of these problems. Montecristi's public education is especially terrible for a number of reasons. MC is one of the poorest provinces in the DR, and there is not one public university in the municipality, thus 'brain drain' is a huge problem. Many kids see no reason to finish high school when they clearly can't afford moving to Santiago to go to college. The closest university is in Dajabon, a 45 minute bus ride, and I know a few Dominicans who are struggling to make it through college there while dealing with rising transportation costs. The ones who do manage to make it out of Montecristi to universities in other cities rarely return. As Father Toni, the town's Catholic priest, told me in a conversation about the state of his city, "Return to what? Say you leave for Santiago to pursue a degree in engineering. What work would you find in Montecristi?" Futher, most of the roads in Montecristi are unpaved, and schoolbuses do not exist, so any day that it rains here school is cancelled. The situation in the bateys surrounding Montecristi is even worse. Most villages have two or three classrooms for all levels of education, forcing teachers to cluster several grades of students into one classroom. In several bateys where I work there is no secondary school classes, so once you graduate from 6th grade you would have to take a 20 minute walk every day to the next village to continue your education. Most kids don't find that worth the trouble, and thus a large percentage of children start working in the fields at age 12 or 13. All these problems have led the World Bank to conclude that the Dominican Republic has one of the worst education systems in Latin America. Needless to say, English education in public schools is not taught by native English speakers, and public health education is a low priority for teachers. Thus Orphanage Outreach has the opportunity to make a huge difference in these two areas.

We ended up going to the schools the second week of September to advertise our English program to the 5th graders. I tagged along because I needed to ask the principals if they would be comfortable with my giving public health lessons this month. As I explained in a previous post, I have been designing a public health curriculum for the schools and bateys here in Montecristi, and my intention was to test all the lessons this fall in order to improve the lessons for this spring, when public health teams will come to teach the curriculum with me. The teachers were very receptive to the idea, and I organized times to come to different schools for my last month here in the Dominican Republic. Schools in Montecristi come in all shapes and sizes, from the large Catholic Colegio and Liceo hosting hundreds and high school students, to Ciudad de Luz, a small school started by a former OO volunteer. We entered the atrium/playground area of Ciudad de Luz to find tons of toddlers enjoying the extended recess times that contribute to the 2.5 hours/day of schooling that the students average here in the DR. The kids, all dressed in red polos and jeans, cheered that all too familiar greeting, "AMERICANOS!" and swarmed us with glee. At the end of the week we had recruited about 80 5th graders to enroll in our Level I classes, and I had a busy schedule planned for teaching health lessons in the schools.

Children at Ciudad de Luz, a local school that was founded by former OO volunteers. Cutest uniforms ever.

The next week I began teaching the curriculum that I had slowly compiled over the past 3 months in the DR. This work was made much easier with the help of Julie, a new program leader at OO who at one point was bound for medical school until she found a passion for teaching in New York. Julie helped me focus my lesson ideas into appropriate modules for the grades that we would be teaching. I now have modules on hygiene, dental health, infectious disease, anatomy, nutrition, and sexual health, with more in the works for drug and alcohol abuse and mental health. Those last few lessons are targeted towards high schoolers, while the rest are appropriate for 5th to 7th graders. The basic model for the lesson plans is to have about 20 minutes of lecture, with an assistant (Julie in my case) writing information on the board. The lectures usually include material to keep the kids engaged ("Who can tell me an example of an infectious disease?", etc.). At the end of the lecture, there is an activity/quiz to reinforce the lesson. The lessons usually take about 30 to 40 minutes to teach.

The first day of teaching we went to Rosa Smestre, a primary school, to teach a lesson on nutrition. I had bought a host of Dominican food items at the local grocery store, Lilo's, so that I could teach the kids how to read nutritional labels and what's necessary for a healthy diet. Julie and I walked into the principal's office to speak with La Jefa, and she quickly ushered us into one of three fifth grade classrooms that we were to teach that morning. I took a deep breath as I looked upon a classroom full of boisterous 5th graders. I was about to teach my first lesson, and I was a little bit nervous. Quite frankly, I'm not sure I would have been able to do it before I arrived here in June. It took me three months of working with the 40 children at the orphanage, along with the hundreds of kids that I had led at the various camps throughout the summer, to be confident enough, both in my Dominican Spanish and in my ability to command the respect of rowdy children, to teach a large group of Dominican children on my own. The children in this first class were especially crazy that day because their teacher had left once Julie and I entered the classroom. Without their Dominican teacher to scare them into submission, they knew they didn't have to listen to a word I was saying about the merits of vitamin C in fruits. Despite a few children who were clearly not going to pay attention no matter what we did, we managed to keep the kids interested by asking them easy questions about nutrition. Julie recommended that we start the classes by raising up two food products and asking which one is a good source of a particular nutrient. The kids like those kind of yes/no voting questions. Understandably children at that age are less inclined to bite on open-ended questions for fear of being embarassed in front of their class. The lesson seemed to be going well until about 15 minutes into the lecture when a few of the boys got out of their seats and decided they wanted to have a wrestling match at the side of the classroom. I tried yelling at them, but they kept fighting, and so I walked over to break up the fight. By the time I had stopped the match the whole classroom was out of their seats, walking around the room, and some walked out of the classroom into the hallway. I was losing control, and I started to panic. Luckily I was saved by the principal who noticed the disruption spilling out into the main hallway. She walked up to the classroom with a look of pure fury, screaming "Desgraciados! and when the children saw her they scrambled back into the classroom. It was a beautiful site, seeing those kids shriek in terror at the site of the all-powerful Jefa. The rest of the lesson continued without many problems. Some of the kids really enjoyed the activity we had planned in which they would record the nutritional information for food items that we handed out. The next two classes went much smoother, each time getting better as I became more comfortable with the lesson. We made a few changes to keep the kids interested in the lesson, but overall I was proud that my initial lesson plan came out quite well.

The next day I expected a similar experience in another middle school, John F. Kennedy (yeah, strange). We walked into the principal's office and told the principal that we were ready to teach lessons that morning in the classrooms. She told us to wait in her office, and she left. I assumed she would come back quickly to bring us to one of the 5th or 6th grade classrooms as the principal of Rosa Smestre had done. I began to wonder what was happening, though, when she was still gone 10 minutes later. How long does it take to let a teacher know we're coming into their class? We had already talked to her the day before about coming. Maybe she got distracted with something else, I thought. Another 10 minutes later she finally returned to her office and told us to follow her. Without thinking about it to much, I noticed that all the students were leaving their classrooms and seemed to be heading to the same room on one side of the building. Oddly enough we were also heading in that direction. We arrived at a salon where all the students were pouring in with their teachers. The principal motioned me to enter the room, and there I stood in front of an entire middle school. She nodded to me and Julie, giving a gesture that seemed to say, "Good luck, you're going to need it." About 250 students were gathered to hear us speak about infectious disease. I was expecting a classroom of 20.

"Uh, so is this your assembly? Or do you want me to give the lesson here?" I stupidly asked. She looked at me funny for a second, then said I would be giving the lesson here, that it will be better this way. I waited a few minutes, pacing and grinning in front of the classroom full of students with a finger to my mouth gesturing the "SHH!" sign. It became clear after a couple of minutes that I was not going to be able to calm down the kids by myself, so the principal swept in with a couple of other teachers and had the kids all sing a song and then she presented us to the group, giving a nice little summary of our organization, Orphanage Outreach. She passed it off to me, and I began in a shouting voice describing some basics of infectious disease. I had designed the lesson to be interactive, having kids answer questions, but I had to improvise a little bit because none of the children wanted to answer a question in front of 250 students. So I started off with some yes/no questions ("Hello guys, I am a student of medicine. Does anyone here wanted to be a doctor?" and a chorus of "SIIIIIIIIIIIIIIIIIIIII!" in response). After I explained the difference between a bacteria and a virus, and went over the basics of TB, rabies, dengue, malaria, the flu, and worms, Julie and I ended with a little patient-doctor skit, partially to test the kids knowledge of the material presented, and partially to give them a very superficial sense of the life of a doctor. Julie was my 'patient' in five different situations where she described the symptoms of the different diseases we covered. I'm glad she was a good sport about it, because I made her look like the most unhygienic person in the world- playing with stray dogs (rabies), playing in the mud and dirty water in the gutters in the city (worms), leaving large containers of untapped water sitting around her house (malaria/dengue, sespools for mosquitos). The kids thought it was pretty funny. We ended the day with "Heads, Shoulders, Knees and Toes" which the 4th, 5th, and 6th graders sang and the 7th and 8th graders decided they were too cool to learn. At the end of the lesson, I began to erase the board where Julie had written all the basic information for the IDs we talked about, until one of the teachers came up to me and stopped me because she wanted to copy the information. It will be exciting to collaborate with the teachers in the spring to make the lessons available for them to teach in their own classrooms, thus making the program sustainable.

One lesson that I did not expect to be teaching until Dr. Garcia said it would be a good idea and Coco gave approval was sexually transmitted diseases, which I taught to the 12th grade classes of the local high school. I sat down one Saturday with Dr. Garcia and designed the lesson plan to be appropriate for the age group I was working with, but I must admit I was pretty nervous when we showed up to the Liceo for the first day of teaching the lesson. 12th graders are certainly different from 5th and 6th graders. One glaring difference was that any word that I said with any accent at all they would quickly correct, thus making me insecure about my Spanish as I plowed my way through the lesson for the first time. They were also unafraid to interrupt me at any point to ask a question, which was actually a good thing because it kept me from slipping into a monotonous, preachy lecture on the dangers of STDs in sexually active adolescents. In one of the classrooms my 30 minute lesson quickly extended another 15 minutes as the kids continued to ask me questions about HIV. Many of their questions reflected some of the most common myths commonly about HIV and AIDS ("Don't people with HIV all have rashes on their arms?", etc.). I was surprised by how enjoyable the lesson was. I expected there to be lots of snickering and giggles when I talked about things like the thick discharge associated with gonorrea and the importance of checking your privates regularly if you are sexually active, but the kids actually remained very attentive and were interested in what I had to say. I think that by keeping a confident tone throughout the lessons, which improved as I had done the lesson a couple of times, the kids respected me as someone who knew what he was talking about. I think it probably also helped that I started out the lesson by saying that I was a student of medicine who works with Dr. Miguel Garcia, former director of the Montecristi Hospital. The kids who knew Dr. Garcia, which was most of the class, had a lot of respect for him. Knowing the right people can have a significant impact on the level of respect you get with people in MC. I realized that earlier in the summer when Coco and I stopped by the office of public health (SESPAS) one day to discuss our plans for designing a public health curriculum to be taught in the MC schools. The tone of the conversation with a public health official quickly changed from standoffish (What are these gringos doing here trying to get involved in public health, he was thinking) to warm and cordial when we mentioned the fact that Orphanage Outreach had a long standing relationship with Dr. Garcia. Anyways, by the end of several days of teaching the lesson, we had taught what must have been about 150 12th graders about the most common STDs in Monte Cristi. I'm excited to teach other lessons on sexual health in the spring. Dr. Garcia and I discussed lessons on family planning and reproductive health, but I never got the chance this fall to teach these lessons before I left for the states. I don't think we will have the pre-med volunteers teaching the lessons on sexual health, for a number of reasons. I am wary about the confidence and fluency they have with their Spanish, and I am not sure how they would react in a room full of Dominican 12th graders, who began asking questions about STDs and their prevalence in MC that I was able to answer because of conversations I had with Dr. Garcia but they might not feel equipped to answer. Finally many volunteers will likely just feel uncomfortable teaching that unit. However there are a couple other units I am designing this fall for older students that could be more reasonable for our volunteers to teach- lessons on alcoholism, drug abuse, and mental health. The experiences teaching health lessons in the schools have been extremely rewarding, and I'm excited to revise these lessons for the Spring program when pre-med volunteers from U.S. universities are coming down to teach my curriculum in the rest of the schools.

This past month I began driving the OO Daihatsu pickup truck, which is quite a piece of work. It kind of reminds me of the first car that I learned to drive a stick shift, a 1987 Isuzu Trooper. It even makes the same catlike streeching upon startup, as the belts in the engine beg for an end to their sad, decrepit existence. The Daihatsu also does not have the luxury of power steering, so I'm definitely getting buff as I drive it more often.

Kids singing my handwashing song. The lyrics (to the rhythm of "If you're happy and you know it clap your hands"): "Si tu estas feliz, lava las manos, CH CH CH (x2)

Si tu estas feliz, y no quieres un lombriz

si tu estas feliz, lava las manos"

("If you're happy, wash your hands

if you're happy, and you don't want worms

if you're happy, wash your hands" with the CH CH CH being a handwashing motion)

Here I'm teaching the infectious disease module, talking about the four different methods of transmitting IDs- fecal/oral, direct contact, blood, respiratory. module.
Hygiene lessonSoftly crying while walking back from school after our day got cut short by a MC rainstorm. When rain comes, schools are often ended early here.
"Una foto, Una foto por favor!" Some of the neighborhood kids.

Besides the health lessons in the schools, I also spent a couple of days one week writing a health puppet show for the kids at the orphanage. There were three 'acts' to the puppet show: dental health, hygiene, and nutrition. I'm expecting a Tony this year for my groundbreaking depiction of the young Dominican boy, Maliento (short for mal aliento, bad breath), as he struggled to brush his teeth regularly, contracted several infectious diseases due to poor hygiene, and was humiliated by his younger brother who beat him in sports because he ate a healthy diet. It was a study into the depths of the human condition that rivals Chekhov's greatest works. Seriously though, the kids really enjoyed the puppet show. I unfortunately could not see their faces as I was busy backstage directing the other puppeteers and being the voice of several (male and female) puppets. Let me tell that holding puppets for an hour, moving their mouths for each syllable you say, and making sure when you hold two puppets that you are manipulating the right puppet for the right voice is hard work. By the end of the show I was covered in sweat, my voice shot, especially due to an unexpectedly long exchange on nutrition with the audience. The fact that 20 kids had stayed until the end was a small miracle. We're still preparing our acceptance speech for that Tony.

The main characters

Christina, Julie and I going over my script in the dress rehearsal

A master of puppeteering

Maliento learns to brush his teeth to my Grammy awarding winning "El Cepillo de Dientes" song

Que mas? With the start of the English program in the month of September the fall interns also started a pre-school class for the younger girls who are not old enough for the MC kindergarten programs. The rule in MC is if a child is potty trained he/she can go to school. We've got quite a few kids, all girls, still in diapers, so the volunteers decided to spruce up the education center in the orphanage and turn it into a pre-school area for this fall. I've helped them out a few times with the activities, which include fun things like singing songs about the days of the week, teaching the girls the first letter in their names, and having colors and numbers of the day. Christine prepared the color red to be the color of the day one time, and made a little scavenger hunt all around the room with red items for the girls to find. They retrieved them with some assistance, and brought them over to our color station. We went through each item and asked them what color they were. For each object Jennifer would say, with confidence, "Amarillo", yellow, the color of the day the previous day. It was adorable.

Grandpa Hagan shares a story about a green dragon with his children.

Jennifer and Franchezca getting excited about the color of the day, Red, by wearing Santa Claus hats.

I never mentioned in previous posts that we survived hurricane season in Montecristi without any real problems, despite the fact that other areas of the DR were hit pretty hard, and Haiti was devastated by the storms. Montecristi is surrounded by mountains that tame most of the worst forces of the hurricanes, but we did get a few days with some impressive, dare I say torrential rainfall. For whatever reason most of these storms passed over us during the night, producing a nice cooling effect on the hot and stuffy Montecristi summer nights. What they also produced were large cacatas, or tarantulas. Tarantulas live in holes in the ground, and when it rains hard and their homes are flooded they head for our buildings to take cover. One ominous stormy night I was watching lightning flash in the sky outside my bedroom window, when one of the flashes illuminated a large dark moving creature. I flicked on my lights and was horrified by the sight of two large cacatas casually crawling across the wall in my room. After wetting my pants, I ran out of my room and asked one of the volunteers to kill the spiders for me. I have a visceral fear of spiders, and needless to say I was up all night cycling horrible images of tarantulas crawling all over my sleeping body and eating me alive. I shouldn't have had anything to be worried about, given that tarantulas are not aggressive and their bites are only slightly more serious than a mosquito bite. I wasn't going to let that information stop me from sleeping that night with the lights on in my room. Pathetic, I know.

An uninvited guest in my room

One more thing. In the weeks leading up to my departure, in the wake of hurricane season, an enormous outbreak of conjunctivitis (pink eye) hit the country. I first noticed it when we saw a lady at a colmado (candy shoo) with the infection while preparing ice for a cup of juice without using gloves. Hygiene habits like that certainly contributed to the fact that almost every kid in the orphanage had the disease the following week, but the disease doesn't require such egregious violations of sanitation to spread. It is very contagious, and it was comical to watch how kids one day picking on the first few kids to contract the disease would be moping around the orphanage the next day with a rag over their eye. Some of the kids were excited about the chance to catch the virus so they could miss a guaranteed 5 days of school, until they finally caught it and realized how miserable it is. I thought the disease was somewhat of a joke as well until, 3 days before my departure I finally came down with the symptoms, waking up with one eye crusted shut. It was a nice going away present for my time here.

Despite having conjunctivitis for my last few days in MC I managed to enjoy my final moments, and it was much harder than I expected to say goodbye the kids even knowing that I would be back a few months later. Vounteers generally do not tell the younger kids when they are leaving until the day that they leave to avoid lengthening the pain of the goodbye process, so I had only told a couple of the older boys that I would be leaving the next Saturday. The next day the entire orphanage knew I only had a night left in Montecristi. Pele, one of the girls who had grown attached to me when she first arrived but had been pretending to be in a fight with me in my last few weeks was almost on the verge of tears when she found out, saying, "Pero estamos contentos contigo! No te vayas!" (But we're happy with you, don't leave!).

I don't really have some amazing final reflection about my stay in the DR and how it has changed my life, although I am certain that it has an enormous impact on me. I think I am still figuring out what this experience has meant to me and I will continue to do that for a long time as I begin the readjustment to life in the States. I just can't wait to get back in January.

To be continued...

Dominicanizando

2008-08-24T11:54:00.006-05:00

Things never seem to slow down here.

A package arrived at the beginning of the week from home with a book, Creole Made Easy. There were a couple of bateys that Dr. Garcia and I went to this week with Haitians, and many Haitians come on Tuesdays to our clinic at our office in Jaramillo, right in the middle of a large cluster of banana plantations, so I had some opportunities to practice my Creole. I have been slowly picking up words here and there over the summer (Ou fe mal tet? Do you have a headache? etc.), but before this week my grasp of Haitian grammar was non-existent. The book tersely touches on the finer points of the language's grammar, which is remarkably simple. Verbs are not inflected for person or tense, and there is no gender for nouns. The structure of sentences follows the same SVO pattern as in English. The written language is completely phonetic as well, so it has been less difficult for me to learn to say the words than it has been with French. I brought the book to the clinic on Tuesday, and spoke with the Haitians in the waiting room as I took their blood pressures. I scrambled through the book's dictionary and tried unsuccessfully to carry on a conversation with them. It was mostly my asking simple questions and getting laughter as a first response, then a rapid fire reply that was completely lost on me.

Besides my renewed interest in learning Creole, it was an uneventful first half of the week, until Thursday afternoon. We did not have enough volunteers to host a camp this week, so instead the volunteers organized activities in the mornings and afternoons for the children at the orphanage. Monday through Wednesday the volunteers taught math and English and had reading periods with the kids. But on Thursday, in honor of the Olympics ending this weekend, the volunteers decided to have a mini-Olympics for the kids. I had some good ideas for events for the kids because we hosted an Olympics camp at the English Institute earlier in the summer, and I had the afternoon off from work in the bateys because Dr. Garcia was in Santo Domingo, so I volunteered to lead the mini-Olympics. We split the kids up into four regions: the Americas, Europe, Asia, and Africa. At the Olympics camp earlier in the summer it was easier to manage the activities because the children were all in a certain age range, but the 35 children at the orphanage are everywhere from 1 to 19 years olds. This posed a problem for team events. I'm pretty sure that 17-year-old, 6'1'' Leonel would crush the 40 pounds of 4-year-old Lisy in any event imaginable.

Lisy and Leonel

We decided to have one running event for the group of 10 girls under the age of 8, and then 2 regular events for the older kids. I had the little girls stand in front of me on one side of the field in the orphanage as Cici, a 2-week volunteer, took a bucket of balls over to the other side about 50 yards way. "OK girls!" I said in Spanish, "for this event you have to run to the other side of the field, pick up a ball and bring it back to me." Once I said the word "run", 3 of the girls sprinted past me, unfamiliar with the formality of "1,2,3, Go!" We tried to wrangle them back to my side, but they wouldn't stop until they had a ball in their hand. It was hilarious and adorable. The mini-Olympics were largely a success, except for the America's last place finish and Asia's ironic sweep of the competition. By the end of the afternoon my voice was shot. Keeping a group of 35 kids interested in a group activity will do a number on your vocal chords.

I stole these pictures from Madison. Thanks Madison! Here I'm trying to organize the relay race of the older kids while holding up a globe.

Little girls getting ready to run

False start!

Little girls really ready this time.

Friday morning the short term volunteers left for a flight out of Puerta Plata, and the remaining long term volunteers (LTVs), meaning Jeff and I, took a trip to Santiago for the night. Lisy, the twin sister of Liry, the physical therapist I worked with this summer, was starring in a 2 person play, Cazadoras de Arca Perdida, a Dominican play with no perceivable relation to Raiders of the Lost Arc. We took a bus packed full of 20 of the older kids to see the play. Needless to say it was not a relaxing bus ride. Halfway to Santiago a tire on the bus exploded, and it took us about 20 minutes to put on the spare. An hour later we were in Santiago, where Peguero, the bus driver/handy man at the orphanage, skillfully (read: aggressively) navegated the bus through metro traffic.

Pit Stop

Before the play we took a tour of Liry's university, which has a beautiful campus. On the walk we ran into a group of American exchange students, presumably preparing for the beginning of their semester abroad. It has become bizarre for me to see Americans not wearing Orphanage Outreach t-shirts, and for a moment I eyed them suspiciously, wondering what they were doing in the country. I was walking around with a large group of Dominican teenagers. Surely they were wondering the same thing about me.

We piled into the bus and headed back into the nightmarish traffic of 6 p.m. Santiago to find a place to eat. We decided to explore some of the local Santiago cuisine at a restaurant called "Kentucky Fried Chicken", enticed by the window ads of KFC Famous Bowls that are "Finger Lickin' Good" (To quote comedian Patton Oswalt: "I want a failure pile in a sadness bowl!"). I entered the building and was welcomed by a tall, attractive Dominican girl wearing a miniskirt and high heels. She distracted me from the utter shame I was feeling visiting a KFC in the DR (or anywhere, for that matter). I was later told that American fast food chains here are considered upper class, and they often have good looking 'welcomers' at the door to make you feel right at home before you shovel food into your mouth from the cholesterol juggernaut of a menu. Yuck.

A sad sight

We finished up at KFC and headed over to the theatre to see Lisy's play. When we got out of the bus in front of the theatre, we were met by a swarm of Dominican 20-somethings who used to live in the orphanage in Montecristi, and were now studying and/or working in Santiago. We watched the play, which was very good despite a few production problems, and then we loaded up on the bus to head back to Montecristi, with one small difference from the ride there: we were bringing all of the people living in Santiago back to Montecristi for the weekend. I had not been told this before, but there was a wedding scheduled for the following day in Montecristi between one of the guys who used to live at the orphanage and his Canadian fiance, and all of the people living in Santiago were to witness the nuptials. The bus went from a mildly uncomfortable 30 people to a veritable can of sardines. Tom and Jeff decided we needed to get a taxi because there were still people leftover that couldn't be packed into the bus if you tried- and I wouldn't want to try, as the congealing load of KFC in our bellies was not conducive to an uber-cramped 2 hour bus ride. They took the taxi, and I stayed by my lonely gringo self on a bus full of 40 chattery Dominicans. Certainly an interesting experience.

The next day the orphanage was bustling with activity in preparation for the ceremony. It was definitely a change of pace from a few days before, when there were about 10 American/Canadian volunteers. I walked over to the dining room for breakfast and sat down at a table full of Dominican women relating stories about life in Santiago, and commenting on how different everything looks at the orphanage now, especially the new comedor that we were inhabiting for the meal. It was really fascinating to see how these 20-somethings were interacting with each other, and it was obvious that they considered each other family. When I watch the younger girls at the orphanage play together, I now wonder what those girls will be like when they grow up, and I also try to imagine the dynamics of the orphanage 10 years ago when all these older people ran the show. It has enhanced my understanding of just how close these children are to each other, and how, despite being a somewhat dysfunctional family, they will leave here carrying friendships that will last a lifetime.

At 5:00 p.m. we arrived at the pier, where the event was to be held, and began setting up the simple decorations for the ceremony- 2 50 foot carpets leading out to the cabana at the end of the pier, a few lights here and there, some balloons, and, most Dominicanly, a pickup truck with big, loud speakers to play the wedding music as the newlyweds marched. I had a short conversation with the Dominican security guard 'supervising' the event. I told him that the event was scheduled for 5 p.m. and it looks like where we were going to be a little late. He quipped, "If a wedding is scheduled for 5 here, you can expect people to start showing up at 7." Indeed, we weren't ready to go until 7:30, when the judge leading the ceremony finally arrived. Someone had gone to his house to look for him, and he was apparently sitting in his living room watching television. The rascal.

The boys at the wedding.

The wedding was going smoothly, with Jeff standing at the side of the bride and groom translating into English for the bride's family and everyone in the wedding party all smiles. But then in the moment preceding the all-important ring exchange, one of the bride's maids noticed the strange absence of the ring from the pillow of the ringbearer. Looked like this was going to be a ringless wedding. I watched the horrified expression on the groom's face, and I really felt for him. The ringbearer was too young to know what she had done. The bride's maids frenetically searched for the ring on the planks of the pier, but it seemed that the ring had slipped through one of the cracks and dropped into the water. 3 months pay now swimming in the Carribean! But alas, the show must go on.

Pretty much impossible to be angry at this little bundle of joy for dropping the ring into the water.

The wedding finished, and everyone headed over to Hostal San Fernando, the nice local hotel, for the reception. We signed the guest book and took our seats. The menu for the dinner included fried rice, chicken, beef, and goat. Goat is quite common in Montecristi. One walk through town will make you realize that. They run freely through the city, munching on grass in parks, defecating where they please, and just generally being a nuisance. Somehow their owners keep track of them. The way goat is prepared here in the Dominican Republic leaves many small, elusive bones in the meat, and it can be irritating trying to pick your way through them. If you aren't vigilant, it turns out it can also be quite dangerous.

About 10 minutes into the dinner, right after our table had gone to fill up at the buffet, and I was negotiating my first piece of goat meat, I heard a scream from behind me around the pool area. I turned around to see several bride's maids surrounding one of their sisters coughing violently. She was stumbling around the pool area, avoiding the assistance of the bride's maids, whose shrieks of terror could not be ignored by anyone at the reception. It took me a few moments to realize what was happening, and then one of her sisters confirmed what I was thinking. "She's choking on a goat bone!" she cried. People from the reception hurried over to the pool to see what was happening. After 30 seconds of her coughing without success, one of guys in the reception began giving blows to her upper back. 30 seconds more of this, and no change in status. It was difficult to assess how serious the situation was. She was breathing, although with difficulty, and she even took the lead in stopping the banging on her back. "Eso no sirve!" (that's not working) she feebly informed us. "IS ANYONE A DOCTOR HERE?" Pastor Ramon asked in Spanish. A large knot developed in my stomach. My quick inner monologue went something like this: "No, of course there are no doctors here at the reception. Tom would have introduced me to them already. So the closest thing we have is me, a pre-med student who seems to be constantly mistaken for an MD. What did we learn in first aid freshman year about the Heimlich maneuver? Thrusts to the lower diaphragm. Isn't that a last resort? Are we are at last resort? How many do I do? These people are expecting me to do something, and I should be doing something." Indeed, people were eyeing me, and I heard someone mumble, "Isn't he the doctor?"

I shuddered. It certainly makes me feel good that people think I'm a doctor, until a situation arises when an actual doctor is needed. I have not gone to medical school yet, but I know what "First do no harm" means. No medical training + "First do no harm" = Scott should not be giving medical advice or treating patients.

Then Liry, the physical therapist, says, "She could asphyxiate if we don't do something." She did look like she was getting worse, whether it was because she was out of energy from coughing so much, or she was in need of air. I decided to do the Heimlich maneuver, and I motioned the maneuver to the Pastor, and everyone nodded in approval. "Si, él es muy fuerte! Debe hacerlo!" (He's very strong, he should do it!) someone said. I was much more comfortable with that justification than with the "Isn't he the doctor?" one. I did four or five thrusts, and each time she let out a miserable heave. "Is this working?" I worried. In first aid we never learned what to do when the Heimlich does not work. Such is your typical first aid class. Basic interventions and nothing about what happens when those don't help the situation. There was no A Ha! moment where the bone flies out of the subject's mouth and everything is hunky dory, like in a children's cartoon. After several thrusts she tells me to wait a second. "I think it worked!" someone shouted prematurely. No, it did not work. At least not completely. She was still coughing on the bone, although she said she was "un poco mejor". Meanwhile her sisters were standing around her crying hysterically, never having seen their sister in such a fragile condition. "Take them away, let them sit down somewhere, she's fine!" I shouted, perhaps with less tact than I should have had considering they are her family. But I didn't want screaming family members to disorient her more than she already was. Someone ushered them away. I think that the Heimlich did move the bone to a new place in her throat, because she was breathing better. But after a few more thrusts, she was still coughing a lot, and was now softly crying from the pain. The Pastor said we should take her to the hospital now, and we all agreed. There was not much more that we could do for her. I climbed into the backseat of the car, with Giselle, the girl choking on the bone, sitting next to me, and two other family members sitting on either side of us. We raced off to the hospital. The car ride was mostly silent, besides the coughing of the victim, the sporadic crying of the various passengers, and my feeble advice. "Try to control your breathing if you can," I told her. I didn't know much else to say. She looked absolutely miserable, but she certainly wasn't in danger of asphyxiating.

We arrived at the hospital, but unfortunately it was 10:30 p.m. on a Saturday night, and the one doctor working there was busy with a trauma victim. We had brought a water bottle for Giselle, and when I got out of the car, I put it on the roof before I carried her into the hospital, and Victor, the Pastor's son, drove the car away to park it, and there went the waterbottle. It was a boneheaded move on my part, especially because there was no water in the emergency area of the hospital. There was only saline solution, which the nurse tried to pour into her mouth, but Giselle spit it right out. We sat for 10 minutes in a room with a nurse who didn't know what else they could do for us. She told us to go to the private clinic, maybe there was a doctor there. We rushed back out to the car, and headed over. "Pastor, I can't pay for the private clinic!" Giselle said in tears. It was a moment you could see some politician exploiting for their health care proposal. He told her not to worry about it.

Much to our dismay there was also no available doctor in the private clinic, but the nurse on duty did seem to know a thing or two about airway obstructions. She inspected her throat with a tongue depressor and asked her a few questions about her condition. The treatment that followed was a marvelous display of modern medicine. "Do any of you have 5 pesos? Go to the hot dog stand outside the clinic and buy a hot dog bun" she said (in retrospect, I wondered why I did not think of having her eat something solid earlier. Duh! Lesson learned.). 5 minutes later, Victor returned with a bun and a (new) bottle of water. Giselle took a big chunk of bread and began chewing on it with intense displeasure. She washed down the bread with the water, and then looked up at us for a second, and her face changed from a dismal expression to a faint smile. And then that all important moment arrived: she began to laugh. And we all followed suit, finally knowing that everything was going to be OK. The bone had passed to her stomach, and she quickly returned to her cheerful demeanor that I had remembered from when I first met her. The nurse suggested a radiography for the following morning, and we headed back to the reception, a full hour after the initial bone swallowing attempt.

We were met by riotous applause upon returning to the reception, and it was clear that everyone had been waiting nervously for the last hour to see that Giselle was OK (Pastor Ramon had been on the phone continuously with Tom throughout the extravaganza). They let out a communal sigh of relief upon seeing a laughing Giselle walking up to them. But it was not the last sigh of relief that would be had that night. Apparently during the fiasco, another OO volunteer had gone to the pier with a flashlight and a mask to hunt for the ring, and in a stroke of extraordinary luck that you would only find on a day like the one we were having, the volunteer saw a flash in the water (only 3 or 4 feet deep at the end of the pier), and jumped in to grab the ring. Five minutes after we had returned to the wedding reception, this second party returned, and one of the Dominican teenagers ran into the room with the ring raised in the air. Another thunderous round of applause ensued.

So in the end the wedding was an enormous success, despite some less than optimal circumstances, and with my medical escapades I gained the respect of the new people that I had met. The groom walked up to me and shook my hand, saying "Hey so you're a doctor right?" I laughed and tried to explain to him my pre-med year off situation, but stopped and just said it was a team effort that night. Giselle gave me a hug and said in a thick Dominican accent "Thank you very much." And then a group of Dominican guys came up and harassed me, chanting "Ecoy" (the final evolution of my name here. Scott, Escott, Esco, Eco, Ecoy!), shaking my hand, patting me on the back, and laughing at the night's insanity. The gringo moments seem to come at regular intervals here, and after a few weeks without too many embarassments, I managed to hit one out of the park that night, as a wedding party of 50 Dominicans witnessed me embrace a bride's maid and induce horrendous artificial coughing. It was a moment you could find in a Chevy Chase National Lampoon's Vacation movie. I've been slowly integrating into the Montecristi community, but it took an over-the-top Dominican wedding for me to truly feel at home here. I'll never forget that night.

My Life

2008-08-10T10:42:00.000-05:00

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

Boy From School

2008-08-09T15:09:00.000-05:00

Changes

2008-08-02T06:46:00.000-05:00

So my computer crashed a few weeks ago, and the new/refurbished one that I got shipped here is not compatible with the wireless network (I should be getting a new card that is compatible), so I have only had access to the communal computer here. That is my feeble excuse for not blogging in awhile. I'm also not able to compress images on the communal computer, so I won't be able to post pictures until next week.

A lot has happened in the past month. The summer intern program at the English Institute ended on July 26th, and all the interns that I became good friends with over this summer have safely made it home. I can honestly say that they were some of the most wonderful people I have ever met, and I wish them all the best in their endeavors.

With the finish of the program, the English Institute has been closed down until the fall interns arrive on September 4th. That means I am now living at the orphanage, in one of the ramadas (pictures soon). I will stay here the rest of my time this fall until I return to the States in October.

Orphanage life is certainly different. At the English Institute we lived in the middle of Montecristi and we were well connected to the community. There is a park right outside the Institute where we would play with kids of all ages, and we eventually got to know their families who lived in the neighborhood. There was one piece of land inhabited by around 20 people from a patchwork of families. In this neighborhood, if someone is not your parent or your sibling, they are your aunt/uncle/niece/nephew or, perhaps the most notorious, the primo (cousin). Anyone can be your primo. When I ask who a boy is running across the street, I get a response like "Oh he's my primo... Yeah, he's the son of the sister of my best friend growing up" and so on. The blurred line between family and friends seems to be a common circumstance in Latino cultures, as I remember the same use of primo for close friends when I lived in Mexico. It's much more than just a superficial gesture of affection; you can really see how the people of this pueblo take care of each other. I really enjoy how they infuse that sense of family into community life. Anyways, although it was never clear how related the people were who lived on that property, they certainly have that familial rapport. Walking in from the street, there is one big dining room/kitchen/living room space where we spent a fair amount eating delicious Dominican food and chatting with the Dominican families. Past this room is the backyard/courtyard area as well as the sleeping quarters. These housing accomodations remind me of the so-called 'shotgun' houses in the poor neighborhoods of New Orleans, where the buildings are one room wide with one hallway, and as families grow they add on rooms in one direction (thus you could shoot a shotgun through the house and find the fragments on the other side). We spent several afternoons and nights in this backyard, and one night the moms tried to give us a bachata/merengue lesson, which was pretty hilarious. The bachata dance is a three-step, but I opted for the one-step-on-toes-two-hobble-awkwardly-step. Needless to say my dance moves are not up to par with the Dominicans.

One other story about the backyard. There is a special guest living behind the garden that Tito, one of the teenage guys, showed me one day. "Escot, come here my friend, I have something for you to see" he said giggingly, giddy to show me his pet. He grabbed the garden house buried in some bushes and motioned me to follow him back to a shack at the end of the yard. As we approached it he waved his hand in front of his nose, preparing me for the hellish stench emanating from the shanty. Before I could see what was inside, Tito began spraying water through a crack in the wall, and an animal began squealing with delight. A prize pig was getting his afternoon bath. I took a look inside, which was difficult considering the strong odor (odors seem to be a theme in my posts), and the hog was caked in mud, with a big grin across its face, elated from the cool spray in the hot afternoon. He must have weighed 300 pounds. Apparently a common source of incomes for families in the DR is selling the piglets of a mother pig, and then sacrificing the mother at the local butcher shop.

I have now been at the orphanage for several weeks, and it has been a very different experience from the Institute. We are somewhat isolated from city life, but I try to walk every day into the city to visit my friends in town. On the journey I get waves from kids and their families, who spend their summer afternoons sitting in the shade of their patios. The kids yell, "Americano!" and I yell back, "Dominicanos!". They give a confused look and then start laughing. One day a little boy, probably around 3 years old, was following me down the road, skipping with glee beside me, completely naked except for a pair of shoes. At least he was keeping his feet protected. Walking towards the city is one of the best parts of my day because of these random encounters. It's clear that the people of Montecristi are glad that we are here, and have a good view of Americans. Gracias a Dios.

The orphanage is walled in and we are not supposed to go outside at night, so almost all of our interaction during our downtime is with the orphans. There is so much to write about these kids I don't even know where to begin. I guess the first thing I should say is that I have never felt such an intense love for a group of people I just met in my entire life. It is clear that they have had an incredibly difficult childhood, and the behavioral problems that they have are a reflection of that bad environment, but despite their faults, in the moments where they let their guard down to me I have realized just how wonderful all of them are.

A new girl, Maria, was dropped off at the orphanage about 3 weeks ago, her parents effectively abandoning her. Many of the orphans here do have parents, but they decided that it was best to leave the kids at the orphanage, whether due to financial hardships or some other difficult domestic situation. Only a few of the parents come to visit the children during the visitor's hours on the weekends. Some of the children have been abused, others were brought when they were only babies. Maria was brought in at age 6, and has not seen her parents since they dropped her off. When I arrived her she immediately grew attached to me. The kids like me because I'm not embarassed to act like a goofball around them. I have become an expert tickler here, and the little kids love me for that. Out of the handful of English words that the little tots know, many of them now know the world tickle, which they pronounce "chickuhr". Maria runs up to me laughing devilishly and screams "Chickurh!". I start tickling her and she cackles wildly, and after 10 seconds or so says "Ahh no mas! no mas" (no more), and I stop and her laughter slowly subsides. She stares at me with a grin, her adult teeth fighting each other for space in her little mouth, and after a second of silence screams "Chickurh!", and the process starts all over again. Her energy is endless, and after 30 minutes of playing with her and the other younger orphans I am drenched in sweat. I'm still adjusting to this climate.

One night we were playing with the orphans outside their dormitory, and 9 p.m. rolled around, which means it was time for the volunteers and the orphans to separate for the night. I was sitting by Maria and I said goodbye to her, and she gave me a hug and reluctantly walked away. Another one of the younger girls, Joanni, came up to me and asked me for "terremoto" (earthquake. The little kids sit on my knee and I bounce them around, and they moan "Whoahoahoahoahoah!"). I agreed to one terremoto, and in the middle of our game Maria spots me playing with Joanni, runs up to her and slaps her in the face. I grabbed Maria by the arm and scolded her, and told her to go inside. Both girls were crying hysterically. It took me a minute to calm down Joanni, and we said goodnight. But as I watched her run into the dormitory rec room, I saw Maria sitting in a corner, still crying from me scolding her. I walked up to her and sat beside her, trying to console her, but as I saw the utter despair in her countenance, I realized that there was nothing I could do to cheer her up. She ran off to her room, and that was the abrupt end to my night with the orphans.
I sat in my room for a long time thinking about what had happened that night. The image of Maria's face haunted me. I wondered what was going through her head. I came to two conclusions about that sequence of events. One, children are just little people. That might not sound like an astute analysis, but hear me out. Maria was clearly jealous that I was playing with another girl, and her visceral response was to slap her. Children are so transparent in that way. Adults have those same feelings of jealousy, along with the gamut of other ugly emotions, but the only difference is that they are better at hiding them, or more skilled in subtly expressing them. Skins grow thicker, but instincts remain the same.
The other thing I realized was that how painful and damaging it must be for these kids to grow up without a stable father figure. Maria had grown attached to me, and was likely upset when she realized that I was not going to give her special attention over the other orphans. The memory of her parents dropping her off three weeks ago was surely fresh on her mind, although she likely did not understand what exactly was happening to her. It makes me a little worried that some of the kids could get attached to me in that way, because I know that a year from now I will be gone, and I will likely never see these kids again. I don't want to be another one of those people who abandon these children, but I cannot stay here forever. It's been difficult for me to try to find that balance here, trying to act like a role model but avoiding assuming the role of a father figure.
I expressed these thoughts to Liry, 23, who was dropped off at the orphanage when she was 1 and had spent the rest of her youth there. Liry is a physical therapist, studying in Santiago, and I spend several mornings a week in the Rehab center with her working with patients. I will describe that in more detail some other day. Liry is worshipped by her patients, and is one of the most caring, mature people I have ever met. I can definitely say that I have learned more about bedside manner interacting with her and our patients than in any other shadowing experience. I told her that I was concerned about how I was impacting the kids knowing that I would leave them eventually. In a long talk with her she explained to me that is was certainly hard growing up without a real family, and it was difficult, especially for long-term volunteers, when they left the orphans, but in the end it is better for them to have something than nothing. Our presence here has an indelible impact on their development, whether it be teaching them phrases in English, reading with them, or simply playing with them and letting them know that they are loved. It is hard to notice how much impact you have on these kids lives when you cannot be with them as they grow older, but even in the little moments when I share a smile with a kid, I know that they are happy we are here. I have really loved getting to know them, and I am excited about spending a whole year with them.
So things here at the orphanage have been different, but I am really loving my time here. I miss the summer interns a lot, but getting to know the orphans has been one of the most rewarding experiences in my life.

I have a post coming about my clinical work here. Sorry for the delay. I should get some more pictures up soon.
Paz fuera

Hispaniola

2008-07-09T18:21:00.000-05:00

As mentioned in the first post, the relationship between Haiti and the Dominican Republic is a turbulent one. There are many Haitians who work in western provinces of the DR, Monte Cristi included, and they are willing to work for lower wages than their Dominican counterparts. Over half of the 14 bateys that I travel to with Dr. Garcia are populated completely by Haitian workers. In this sense, the relationship between Haitians and Dominicans is similar to that of Mexicans immigrants and Americans. Many lower class Dominicans resent the influx of cheap Haitian labor. Although this economic situation explains some of the tensions on the border provinces, the long and bloody history of Hispaniola has been rife with antihaitianismo, and the racial prejudice that you currently find in the DR represents the confluence of a number of different historical factors. Here's a good article explaining some of this history. Here are some of the key moments:

Christopher Columbus lands on December 5th, 1492, and comes back for a second voyage in 1494. It is on this second trip that he instituted a policy of genocide towards the Tainos, the native people. He seizes 1,200 Tainos from the island and takes them back to Spain. Hundreds die on the journey, the rest are sold as slaves in Seville. All the Taino people on the island are then enslaved and ordered to bring gold to the Spaniards. Those who resisted were killed. In 2 1/2 years after his arrival, 250,000 Tainos are killed. Within 60 years the indigenous population is extinct. (Source, Source, Source). Why do we have a Columbus Day? Anyways, Santo Domingo is officially founded in 1898. Slaves were imported from Africa, and the white elite ruled over the slaves and creoles in the plantations.
The French arrive in the 18th century and establish Saint-Domingue in the west. They import half a million African slaves and quickly begin expanding on the island. The first steps in Dominican nationalism occur, orchestrated by Spanish colonists worried about losing control of their territory.
Hispanic elites lose control in 1795 when the island is officially ceded to the French. A cultural clash occurs between the nascent Hispanic nationalism and the French/African influence.
Haiti declares independence from France in 1804, becoming the world's first black republic. Spain regains control of Santo Domingo in 1808. Haitian leaders set their eyes on gaining control of Santo Domingo, but not before the Dominicans declared independence from Spain in 1821. 9 weeks later Jean-Pierre Boyer, president of Haiti, invades the DR. He promptly strips Hispanic elites of much of their property and privileges. Many of these leaders were disgusted by the fact that Haitians of a darker skin color, many of whom were ex-slaves, were now ruling over them.
As part of the independence movement, Hispanic elites and intellectuals, still with networks of power in the east, stirred up anti-Haitian sentiments, separating themselves from Haitians based upon cultural and racial lines. They venerated their Iberian Catholic heritage and rejected the conspicuous African roots in Haitian culture, most notably the voudou practices.
Dominicans declared independence from Haitian rule in 1844. Hispanic elites take over government, and the intellectual culture within this class conditions a classification of Dominicans as white and Haitians as black. Race defines nationality. A slew of nationalist literature follows.
It seemed that tensions between Haiti and the DR cooled in the post-independence period, especially after the Haitian government support Dominican revolutionaries when Spain gained control of the government in 1861. In 1865 the Dominicans re-gained independence, and the new president, General Ulises Heureaux, was actually of Haitian descent.
Antihaitianismo resurged during the dictatorship of Rafael Trujillo, beginning in 1931. In 1937 Trujillo ordered the execution of 17,000 to 35,000 Haitians in what became known as the Parsley Massacre. The motivations for this massacre are a good starting point for talking about the modern DR/Haiti conflict. Trujillo wanted to establish a clearly defined border with Haiti. Citing widespread theft of cattle and crops in the borderlands, Trujillo mobilized his army to the border and began the slaughter. While theft likely did occur, Trujillo used this reason as a cover for a different problem. Haiti was and still is densely populated (currently 758 ppl/sq mile), with little arable land (above 90% now deforested). In order to survive many Haitians on the border migrated to the western provinces of the DR. Without adequate infrastructure connecting rural lands on the border with the larger cities in the DR, borderland Dominicans survived on trade with Haitians. Trujillo feared that the rising population of Haitians in the western provinces along with the increased trade would allow Haitian leaders to claim the provinces as their own. This would not be good for Trujillo's dictatorship, given the incredible wealth produced by the agriculture in these regions, a wealth that ironically was augmented by the cheap Haitian labor Trujillo attempted to exterminate. In the wake of the Parsley massacre Trujillo recruited writers like Joaquín Balaguer to reinforce the party line of antihaitianismo. Trujillo also crafted manuals for rural mayors in the borderlands where he cautioned them to prevent the corruptiing influence of Haitians in their cities.

(Check out the book Why the Cocks Fight: Dominicans, Haitians, and the Struggle for Hispaniola by Michele Wucker for more information. We have a copy here at the Institute that I have glanced through, it's got some good information on the conflict.)

In the wake of Trujillo, antihaitianismo still exists in the DR. I notice it in some (not all) of the youth here in the way they talk about Haitians. For example I was sitting in the park outside the Institute yesterday reading Mountains beyond Mountains by Tracy Kidder, a great book on the life of Paul Farmer, a doctor who has worked extensively in Haiti and other third world countries. The little girls asked me what I was reading and I told them about Farmer, and when I said he worked in Haiti one of them says, "Eww Haiti, why would he work in Haiti?" I tried to tell her that the people there are very poor and they need help, but at age 8 I don't think she cares too much about economic situation in Haiti (not that the situation in Montecristi is that great either), and she lost interest in the conversation. I'm not sure if the discrimination against Haitians is getting better or worse here. Certainly the immigration of Haitian workers fans the flames of resentment in some areas of the country, but I wonder if the prejudice is as strong in the eastern provinces.
Learning about the history of antihaitianismo has helped to deflate my romanticized perception of the Dominican people. I think it's easy, for me at least, to glorify a culture that is full of such welcoming people. But there is a dark side to the Dominican culture, just like with any culture, and it's important to recognize that. No culture is perfect, and it is in the cultural intercambio (exchange) that we can refine and evolve our set of ethics. I think this is what Alasdair Macyntire, a famous Notre Dame philosopher, is getting at in his magnum opus, After Virtue. People from different cultures should approach each other with an open-minded attitude towards learning about others and in the process themselves.
--

Okay, done with my rambling, back to the reason for this post.
Last friday, as well as the first Friday I was here, we went to Dajabon, a border city (and province) about 45 minutes away from Montecristi. Every Monday and Friday the Dominican government, with lots of help from U.N. forces, opens the border with Haiti and allows the Haitians to come purchase goods in an enormous market which seems to take up about half of the city. Many of the goods can't be purchased in Haiti, and even if they can they are much more expensive, so people cross the border to buy products both for themselves and to sell them to other Haitians at a profit. The market is very chaotic and can be quite a jarring experience if you are not prepared for it.

The first time we entered the market I was immediately overwhelmed by the noxious combination of what smelled like burnt garbage, urine, and a city in serious need of deodorant. I was already feeling a bit rumbly in my tumbly from some food I had eaten the day before at a dodgy restaurant in Montecristi, so my mood then went from sour to downright rotten. On top of the odor, I was surrounded by what felt an angry mob of Haitians, all yelling at me in Haitian Creole to get out of the way. You are liable to get run over if you stand in the middle of the main street, as an endless line of Haitians moves towards the bridge of the city with sacks and sacks of basic goods loaded into wheelbarrows and a smorgasbord of other wheeled contraptions. If you don't get lucky enough to be run over, then maybe you'll just get burnt by one of the tailpipes of the motorcycles pushing through the crowd, with drivers abusing the horn (by the way, Dominicans love using the horn, and in the time it just took to write this parenthetical remark I have heard several honks from outside the Institute), outraged that other people might need to use the street. The most dangerous part of walking through Dajabon though has to be the pickpockets. On my first trip I brought my camera, wallet, and a small notepad, and I had them all zipped up in the pockets of my cargo shorts. The pickpockets must have seen this tactic before, because it took all of about 10 seconds in the crowded market before my pockets became unzipped. I was amazed. How did they do that so sneakily? Luckily nothing was stolen, but I still had another 30 minutes of walking through the Haitian market, and the entire time I kept my hands on my zippers, crouching over awkwardly as I hobbled through the main street. 10 minutes later we were at the bridge, which is protected by U.N. peacekeepers, mostly from Uruguay. It was a nice break from the chaos. We stood on the sides of the bridge watching the gauntlet of sweaty bodies pass furiously in both directions. This market is only open 2 days a week, from 9 to 2ish, and in this span of time many of these traders make most of their money for the week. There is no dawdling in Dajabon.

The bridge was a break from walking, but in no way is it a break from the exercise on the senses. Besides the traders rushing back and forth on the bridge, on the banks of the river below there are Haitian settlements all over the place, and hundreds of Haitians use the river as their washing machine. The cities in the distance look overpopulated and extremely impoverished. A truly forsaken land. The only real reflection I had while on the bridge was that I was standing between the developing world and the so-called Fourth World. The DR has patches of destitution, in places like the bateys and some of the slums in cities, but in Haiti the cities seem to be made up of slums. Everything is poor.

We spent 5 minutes on the bridge and then we were off again, back through the market but this time by another route, a side street that was basically a food market. We worked our way through a maze of blue tarps, tall enough for most Dominicans and Haitians but not quite my height. Right around the time I began worrying about the fact that I was getting free samples of the hair parasites of a town full of people, I had one of the most disgusting experiences of my life. A young boy ran past me and in the process pushed me into this gutter in the middle of the street. My sneaker went into a gooey, black liquid. I couldn't imagine a more bloodcurdling substance. I shuddered at the thought of the hodgepodge of infectious diseases cruising through that evil gutter water. I was just reading the previous day about schistosomiasis, a nasty flatworm parasite. Was I being attacked by a disease I still cannot pronounce? Yuck. To put into perspective how disgusting this water was, when I took my foot out of the gutter and kept walking, the women who sat on the ground tending their stands pushed my leg away from their items, scared I might infect them and their products. The only thing on my mind was, where is some hand sanitizer when you really need it. I rushed to the bus and took off my shoe and sock and began cleaning my leg with heaps of that Purell goodness. We sat in the bus for about 10 minutes, and a group of Haitian boys were tapping at my window offering me Haitian coins in exchange for Dominican pesos. $1= 39 Haitian gourde. Sorry kids, not a good deal for me. They persisted. By the end it shifted from soliciting to demanding. "Deme dinero, ahora!" (give me money, now!). I was ready to get the hell out of Dajabon.

The bus ride back was the first time for me to really think on everything I had seen. It was clear that the others who had come on the trip were having the same moment of reflection; the bus ride was silent, and as I looked around I saw the blank stares of the volunteers, all lost in thought. What were we feeling? First, shock. I had never seen anything like that before. It was truly awesome. Also, sadness. These people live like this every day of their lives. That's truly depressing. Confusion. How did this happen? Was Haiti always like this? What a nightmare. And ultimately regret. By taking a turn to negative town at the beginning I prevented myself from really experiencing the market. I remembered very little of what I actually saw in the market because I was too busy focused on getting out of there. It took a second trip two weeks later, when I was much better prepared to deal with the sights and sounds of Dajabon, for me to really appreciate the experience. And in that second trip I took these pictures. Enjoy. I have written too much already. I'm sure I'll post on Dajabon again.

This guy's a big Alabama fan. In the emotional rollercoaster than is the Dajabon experience, one way my spirits stayed afloat was by the irony of the messages on Haitian t-shirts. A few of my favorites:
"Ask me about the new Blackberry!"
On a skinny older gentleman, an oversized shirt saying "Love is 100% fat friendly."
"I believe in small group education."
"Born in the U.S.A."

The arch you must walk under to cross the bridge

I decided to pass on the head of lettuce in the Haitian market. Tempting, I know.

Notice the blue tarps.

The view from the bridge. On the left, Haiti; on the right, DR. You can see Haitians washing clothes in the river.

The age of some of these men hauling these heavy carts is both impressive and depressing.

These carts haul some serious loads.

Haitian village

Paz fuera.

Stuck Between Stations

2008-07-03T01:00:00.000-05:00

"I woke up as the sun was reddening; and that was the one distinct time in my life, the strangest moment of all, when I didn't know who I was-- I was far away from home, haunted and tired with travel, in a cheap hotel room I'd never seen, hearing the hiss of steam outside, and the creak of the old wood of the hotel, and footsteps upstairs, and all the sad sounds, and I looked at the cracked high ceiling and really didn't know who I was for about fifteen strange seconds. I wasn't scared; I was just somebody else, some stranger, and my whole life was a haunted life, the life of a ghost. I was halfway across America, at the dividing line between the East of my youth and the West of my future, and maybe that's why it happened right there and then, that strange red afternoon."

-Jack Kerouac, On the Road

I read these lines for the first time today. Sweet serendipity. I understand what he means when he says "I didn't know who I was", because I've shared those very same thoughts as a lie in bed at night here in MC, with thoughts interrupted by the whir of scrappy mopeds, tossing and turning in bed as I try to endure the Dominican heat. The roosters start crowing at around 3 a.m. here, giving us more than enough to prepare for an 8 a.m. breakfast. How thoughtful. We're advised to wear earplugs, which don't do much good, so one guy, Will, has gone a step farther, designing a helmet contraption consisting of earplugs, a pillow wrapped horizontally by a bedsheet wrapped vertically around his noggin. It looks hilarious.
Strangely enough I'm living in what used to be a hotel (called "Coconuts"). We have an oscillating fan in our room that fields the needs of 2 bunkbeds, 4 bodies. Because of the layout our bunk gets roughly 1 of 10 seconds of wind in each cycle. I can't decide whether it'd be better to have no fan at all. For a few nights I had gotten in the habit of just sleeping in the hammock outside our room, because there's usually a nice breeze at night. But I eventually adjusted to the heat, I think through a combination of growing a tolerance for the climate and getting so tired at night that I just fall asleep once I lie down.

Back to the point though. The sites and sounds of a new environment, while educational in themselves, can be more profound when they catalyze a reflection on changes in our lives. So right now in the midst of the sensory overload that is OO and the DR, I have a lot of moments where I get that feeling of not knowing exactly who I am. I have reached that crossroads between Youth and Young Manhood, to continue the indie music allusions (for those readers not 'hip with the jive', "Stuck Between Stations" is a song by The Hold Steady, with a direct quote from On The Road in the first verse: "Boys and girls in America have such a sad time together." Youth and Young Manhood is the debut album of Kings of Leon. I was told by one reader that my blog is not 'indie' enough, so I thought I'd spruce it up with some pretentious references.), and much of the way I define myself right now is by what I am not.

I am not a college student, unlike all of the other summer interns here who will leave for home within a month from now. When they talk about their plans for going back to school next month I get all nostalgic for my college years, then I feel old when I realize I now refer to them as "my college years."

I am not a Dominican. I'm reminded of this by the daily cries of "Americanos!" when we walk through the streets of Montecristi. There are more embarassing examples, though, like when I got into Dr. Garcia's car on the first day of going to the bateys with him and said "Hola, como 'ta la vaina?" which I thought meant "how are things." He looked at me funny, and then starting laughing when he realized I didn't know how offensive that the word vaina is to say in a conversation with adults. I had heard it used constantly by teenagers over the first week of being here, but didn't catch on to its profane character. Whoops. Trying to learn a new dialect is hard.

Also, I am not a doctor. I don't know what it means to endure the trials and tribulations of medical school, residency, and beyond, and outside of diabetes, I have a limited knowledge of most medical problems. Science classes in college do not teach you things like differential diagnosis. Diseases and conditions are studied almost exclusively at the scientific level. I have learned what I thought was a good amount about many different fields in my clinical work, but a quick glance through my copy of Harrison's Principles of Internal Medicine reminds me just how little a college student can really know about any field of medicine. I have been reading a lot about infectious disease in Harrison's, and it's frustrating yet exciting to realize how much I have to learn.
It is sometimes difficult to explain exactly what stage I am at in my education. The Dominican schooling track for physicians is quite different than ours. They go directly from high school to medical school, so there's really no such thing as pre-medicine. I try to explain that I am taking a year off before medical school, but that's confusing for the health care professionals I work with, because I'm 22 years old. I should be in my last year of medical school right now. Also for the past 2 weeks we have had a group of high school girls from Baltimore work with us at the Institute, and some of them called me "the doctor", which was a nice ego massage. Coco told them that I was a medical student, because it's easier than saying a pre-med taking a year off before medical school, and some assumed I would know everything about their health problems. Apparently I am a dermatologist, because several times last week different girls came up to me and asked about rashes, bumps, or bruises. I told them I didn't know, if it hurts take ibuprofen, if it's really bothering you you could go to the local clinic and get it checked out. They were disappointed, and promptly stopped calling me doctor.

I'm in a new place, and it's helped me to distance myself from my college experience, and at the same time it's giving me a taste of things to come as a physician. I miss my college years, I really do, but it's time to move on, and I'm in the right place for that. Sometimes I feel like I am stuck between stations, no longer in my youth, but not quite an adult; graduated from college, but years away from entering the professional world. But I'm not scared, and I look forward to the new experiences, sometimes uncomfortable but always interesting, that each day here offers.

Dajabon and Batey Isabel posts coming soon.

Paz fuera.

More visuals

2008-06-24T19:53:00.000-05:00

The park you see in the background of these pictures is adjacent to the English Institute, and is the place that we spend most of our free time. These two little buggers are sisters, and their names are Yolani and Mary Isabela. They like climbing on top of me and pretending that I am their chauffeur, yelling "Con toda tu fuerza, caballo!" (with all your strength, horse).

Another public health sign, this one sponsored by the Dominican government. Bleach is commonly used to sterilize water containers in the bateys. If diluted by 1/5 and left to sit for more than 20 minutes, it will kill pretty much any organism that is an ID threat.

This is a transport line to a banana packaging factory in the batey called Jaramillo, the closest batey to Montecristi.

Here we have the first step in the banana packaging process. The bananas are being cleaned in sterilized water.

Here's Doctor Miguel Garcia, my mentor here in the Dominican Republic. He is an epidemiologist and adolescent psychologist who counsels pregnant teenagers. He spends every afternoon working for Banelino, a cooperative that owns the banana factory I just showed you. Banelino was founded by a Dutch woman who came to the DR around 10 years ago and organized a group of 5 banana plantations to form a cooperative which participates in fair trade practices with European nations. The profits from these plantations are all spent on public health programs for 14 bateys around Monte Cristi. It's a fascinating program because it shows how Dominicans are producing more than enough wealth to build sustainable social programs.

Here's the health clinic next to the packaging factory. The doctors and nurses who collaborate with Banelino keep many of their medical supplies here along with 2 other buildings, one in Montecristi and one in Mao. There is a batey right outside of this packaging facility, and it is one of the bateys that is part of the public health program. For that specific one, Dr. Garcia and his associates will go there on a monthly basis and set up a free clinic, and all the villagers with health problems come to the clinic to get checked out. In each of the 14 bateys they have trained at least 1 community health worker, who works as a liason for Banelino, keeping them updated on patient's conditions and notifying their communities with Banelino comes for the monthly clinic. In addition to holding free clinics for general health concerns, Banelino has instituted a robust vaccination program in all of the bateys. This vaccination program has dramatically reduced the incidence of measles in these communities, as well as a host of other IDs. I'll get more pictures up in a later post of the free clinics.

Afternoon shower in the banana fields.

Another pic of the packaging center

Dominicanos vs. Gringos baseball game. Guess who won this one.

This is a picture from the Jaramillo batey behind the banana factory. This tree must be pushing 100 years old. Beautiful.

As you can see, the housing in the bateys is pretty miserable. I'm sorry I could not get pictures of people in these, I will try to get more next week. Most of the bateys that we work with are inhabited exclusively by Haitians, who are often willing to work for much lower pay than Dominicans, at the cost of living in horrific poverty. I will describe in greater detail my feelings and thoughts about the bateys, but I am just beginning to understand how these people live. My emotions certainly run the gamut- shock, dismay, and sadness at the physical conditions of their existence, contrasted by laughter, happiness, and hope when I am within the presence of these people. They live in such poverty, yet are so thankful for the work we are doing, so happy that we are there. In the face of such profound material destitution, I see in them an incredible richness of spirit. It's certainly made me reconsider what exactly poverty is, and who is really poor in this world.
One note about photographs- some Haitians are extremely superstitious, and believe that when a photograph is taken of them, you are stealing part of their soul. Thus I am a little cautious to begin taking photographs of the people until I get to know them a little better.
And how will I get to know them better? By learning Haitian Creole, of course. I've already picked up many phrases, and I hope to be conversational by October. I certainly get enough interaction with Haitians in the bateys, on average 8 hours a week, so that I have plenty of opportunities to learn it. They love teaching it too.
Again, another public health sign that has been put up next to the latrine in Jaramillo. The problem with this sign? It's in Spanish. All the families in this communities are Haitians. The vast majority of them speak no Spanish, which can be a pain when we try to deliver health care there, because no one at Banelino speaks good Creole (this gives me another good reason to get good at Creole). There is usually 1 or 2 good Spanish speakers in each village, who are almost invariable the community health workers that Banelino has trained.

I'll get some more posts up soon. I have a bunch of odds and ends that I've written down, and I have about 4 posts pending right now, but I just haven't had the time to finish them.

"Tranquilo, mi amor"

2008-06-23T12:26:00.000-05:00

This morning was only my second time in the hospital, and it was perhaps my most memorable experience yet here in Monte Cristi. Last week I toured the hospital on Tuesday with Coco, the next day with Dr. Garcia, and the next day I shadowed the diabetologist. On Friday I went to Dajabon, which I will blog about soon (that was quite an experience as well). So I came to the hospital today expecting to shadow the same diabetologist from last week. I went to the morning meeting of the doctors, and we went over the case of a pregnant woman, 29 weeks in (LMP), predicted to have a premature birth within the next week. Again I picked up bits and pieces, but my knowledge of embryology terms in Spanish is limited. So I sat in the back and quietly scrambled through my Spanish medical dictionary trying to keep up. It doesn't make it any easier when many of the doctors in the hospital are Cuban, speaking one of the most difficult dialects of Spanish. But it's certainly a good thing that I get to learn two new dialects at once, so I can't really complain.
Dr. Garcia, the doctor that I shadow in the afternoons in the bateys, had not shown up to the meeting in the morning, so I figured he decided to forgo the meeting to begin seeing patients. He walked me to the diabetologist's office the previous week, and so naturally I paid no attention to the number on her door (the doors just say Medicine Interna 1, 2, 3, etc.). So when the meeting got out at 9 a.m (I think the meetings are meant to last about an hour long, although they seem to end abruptly when the director of the hospital feels the residents have been hounded enough for the day), I started walking towards the area of the hospital where the diabetologist's office is when I realized that I had no idea which room to go into. I had a decision to make. Should I pick one of the doors and knock on it, risking the embarrassment of walking into the wrong room? Or wait in front of all 5 potential doors, and when one opens peek in to see whether la doctora is inside? This sounded pretty attractive, except for the fact that the lobby was full of Dominicans who had already noticed a goofy gringo in their presence and would wonder what I was doing pacing in front of the salas. I decided that best option was to just walk over to Dr. Garcia's room and ask him what number the room was. His office was just a few doors down anyways, and I hadn't seen him for a few days so I wanted to stop by and see how he was doing. Having seen a patient just walk into his office, I stood outside the door and waited to catch him between patients.
After waiting 5 minutes, a younger doctor walked up to me and says, "Ey doctor, we're about to do a hernia surgery, come with me" (verbatim in Spanish).
"OK!" I blurted out, and we walked up the ramp to the second floor to the surgery rooms. As we walked into the prep area outside the operating room, he ordered one of the residents to grab some scrubs for me. At that point I started to wonder whether he knew that I did not have any medical training. Did he call me doctor in a kidding sort of way? I had seen him in the meetings before. Maybe he knew I was just shadowing in the hospital. Before I had the chance to tell him my situation he left to scrub into surgery. Yikes. The resident brought me the clothes, and I changed in their locker room. It reminded me of the good old days in the Division of Surgical Research at Vanderbilt, where I'd scrub in for animal catheterizations 3 days a week. They made me wash my hands in the prep room, so I knew I'd be helping at the table in some capacity. I came into the operating room, and they had me put on a gown and surgical gloves. The entire time the only thing running through my head was the one time in high school when I watched a surgeon at Vanderbilt perform heart surgery on an infant. Standing on a stool to watch the surgery, I felt my face start tingling right around the time when they began cauterizing the vessels after the first incision. The smell was insufferable, and when I first registered that what I was smelling was burnt flesh I dropped to the floor, but only after taking down a couple of machines on my way. I was thoroughly humiliated. I've had a good amount clinical experience since then, and spent a lot of time in the animal OR, but I hadn't returned to the human OR since then.
After I put my gloves on I reluctantly walked up to the table. The nurses had administered spinal anesthesia, meaning the patient would be awake for the entire surgery, and free to moan and give a nice little flail of the arms when compelled. "Tranquilo, mi amor," (relax, dear) the nurse whispered to the nervous patient. The room felt like it was around 85 degrees, and I was in full panic mode. Then the doctor made the first incision, and turned to me and asked for the clamp, insinuating that I would be his surgical caddy for this operation. "Remember when you pass me the instruments, hold on to them tightly so you don't drop them," he told me with his Cuban accent. It was at that point, in the middle of the clamp exchange, when I looked down at the incision, and had that familiar sequence of feelings. Tingly face, seeing stars. If I held out any longer I'd be a goner.
"Would it be okay if I sat down?" I asked nervously.
"Of course", he said, and the nurses brought a stool over. I sat down and the nurse pulled down my mask and unbuttoned the top of my gown.
"Look at how pale he is!" another nurse cried, and burst out in laughter (The Irish don't get much sun, it's in my genes, I should have said). The other nurses followed suit. Luckily Dr. Valdez came to my rescue.
"It's quite normal. When I watched my first surgery I hit the floor. Don't worry about it," he reassured me. But this time I felt different about the experience. For one, I did not feel humiliated. I was somewhat embarrassed, but it was more funny than anything else, like any of my gringo moments here. I also didn't want to leave the room. After 5 minutes I was ready to keep watching, and I witnessed my first (human) surgical procedure in its entirety. Although it was a basic operation, I still found it fascinating. I know right now I am interested in endocrinology, but I have not been exposed to enough branches of medicine to say with certainty that I will be an endocrinologist. Surgery is certainly still on the table, no pun intended.

In thinking about the experience now, it shows a lot about how I've grown up since high school. Just like when I listen to a record I haven't heard in many years and it evokes vivid memories of a distant but specific time and place, my second experience in the operating room conjured up images of that first surgery years ago, yet the experience was much different this time around. Certainly my scientific knowledge is much broader these days. From animal surgeries and anatomy labs I knew quite well the geography of the abdomen. Partly because of this knowledge, and partly because I'm much more confident in general now, I wasn't afraid to ask the surgeon questions about the operation. But I think most importantly I wasn't discouraged by an embarrassing moment. In high school I sat in the nurses' lounge while the cardiologist finished the surgery, too scared to go back into the OR. This time around I waited a few minutes to regain control of my faculties, and returned to watch the rest of the operation. In the words of Vince Vaughn as Trent Walker from Swingers, "Our little boy's all grows up, cause you grows up, and you grows up, and you grows up, and you grows up!"

N.B.: I've gotten some complaints about the title of the blog, "I'm So Bored with the U.S.A.". Let me explain myself. It's a song by The Clash that I like. And it doesn't mean I hate America. It's just a joke. I might change it though, to prevent future readers from thinking I'm done with the U.S. of A. I'm just taking a break from a long tumultuous relationship.

Visuals

2008-06-21T11:49:00.000-05:00

I have started compressing images so that I can post them on the website. Not sure how great the quality looks compressed. I'll fiddle around with it when I have more time.

Had an hilarious experience in the hospital this morning. More on that later.

This is the garden behind house where Jose Marti and Maximo Gomez wrote the Manifiesto de Montecristi, declaring Cuban independence from Spain on March 25, 1895

Muela de cangrejo (Crab claw). Delicioso.

Playa del Morro

These kids loved the photo op.

Beth teaching the kids English.

Here's the view from the 3rd floor of the Institute. There's a great park right across the street. Since the summer OO interns arrived, the park's been bustling with activity. It's perfectly situated for the volunteers to get connected with the youth here in town. The mothers bring the kids to the playground in the afternoon and we play soccer, duck duck goose, and other games. One little tyke, Francisco, has taken a liking to me, and runs up to me whenever I come to the park and says, "RAAAAAAH, SOY MAS FUERTE QUE TU!" (I'm stronger than you). He then tries to tackle me unsuccessfully, and I begin tickling him without mercy in the ribs, and he screams "Aha, Escot, estopit! Escot! Ahaha!" (his English is decent for a 10 year old). It's possible that he has passed me in maturity level at this point, because I get just as much fun if not more out of this little game than he does.

These sanitation signs were distributed to the restaurants in town by the Red Cross. Unfortunately I think the Red Cross here is slightly underfunded. Why do I say that? Last March when a group of doctors came on a medical mission, they wanted to see the Red Cross building in town. Coco took them there, and when she tried to open front door, the door came off its hinges and fell to the ground. Whoops. An interesting sign, nonetheless. Sanitation will be one of the core components of the public health program I will try to build. There's a good chance that we'll be designing a sign similar to this one.

The Catholic Church in Monte Cristi- I'll have a funny story about this in my next diary

The Salt Flats near the coast- they've been using these flats since the 15th century

An Ominous Statue

Sunset thwarted by summer showers

The English Institute

Landed

2008-06-16T19:49:00.000-05:00

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.