Hospital Visit

Today was our hospital visit day. All students and some volunteers loaded up in a bus and traveled one hour to the Ricardo Limardo public hospital in Puerto Plata. We were greeted by the Director of Nurses who happens to be Ramon’s mother (he is one of our interpreters). It was an eye-opening experience to find ourselves in a  world so foreign to ours. Here in the DR this hospital has been undergoing “reconstruction” that is very behind schedule. To us, it was a world of noise, many many people all over the place, narrow hallways, ten patients to a room, some patients lying on bare mattresses without sheets, walls in need of painting, a noticeable absence of hand sanitizer, hard back paper charts med carts for a quarter of a century ago, and last, but not least a separate unit just for those with Dengue fever.

Our American view of orderly processes and systems, air conditioning, patient privacy, private rooms, electronic health records, omni-cells and Pyxis systems were nowhere to be found. Yet the nurses and interns we met were knowledgeable and caring, warm and genuine. Florence Nightingale would have been impressed with the fresh air environment and that so many patients could be cared for under these circumstances. 

We left there truly humbled and will be reflecting on social injustices throughout the world including those within our own country, for a long time. Perhaps some of us will be called to action but all of us will be incorporating this experience into our persona as American nurses and doctors.

On the Road

The day started like every other one here: rising just before daybreak and bustling around with the busy-ness of prepping for today’s clinics. By 7.40 AM breakfast was history and the first wave of trucks was loaded and ready to go. Sixteen of us set out for La Batata, where we were seeing patients coming from the local community and down from the neighboring community of El Brizon.

Along the way, we had to make a sharp 315 degree turn off the semi-paved road onto a very rocky, winding road. We shared the rocky road with cows, mules, pedestrians, motorcycles, chickens and turkeys. At one point, we slowed down to allow a line of seven or eight turkeys to cross the road, when the turkeys abruptly turned and charged toward us!

After a good laugh, we settled into the rest of our ride and enjoyed the gorgeous scenery while taking in views of the simple, laid-back yet hardworking lives here. Shortly after, we moved from quiet observer to active immersion into our care-provider role. By now there is no hesitation and we all just know what to do.

Last Clinic Day

Today was the last day of clinics for PRHDR’s summer 2016 group! The next days will involve a final meeting with our community leaders and a visit to a local hospital. Please find following some thoughts by nursing student Gabi Stojanovic.

“Now it is the time that we prepare for our exit. The last medications are given away. The last patients are seen. Eight clinics ago we were all uncertain, the veterans needed to shake off the cobwebs and the first timers were uncomfortable with their ability to communicate and unsure of their assessment skills. Today, after just eight days’ experience, I looked around at my classmates and felt so privileged to be part of such a quick learning, and confident group of women.

Yes, in this short time we have grown, and we should be proud of what we have gained. I personally feel a slight sadness at this, our greatest milestone of the trip, the last day of clinics. The beginning of the end. Because I feel as at home here, in this culture, and country as I do in my own. The language comes as easy to me as water, and the quiet welcoming acceptance of these people can only be described as distinctly Latino.

We have helped people here, yes. But they have helped us more. Whether through their quiet patience, their gratefulness at our care, or their acceptance of their current reality, whichever that may be.

As in other Latin American countries, I have found that those with the least are the most self-reliant, the most accepting and the happiest of patients. In these final days, we will begin to distance ourselves from the Dominican Republic, and slip slowly toward the Yankee norm, but I find that I don’t want to leave the grace of this society.

I will not soon forget all the wonderful, strong and resilient people that I have met throughout this trip, whether the patients or our wonderful interpreters. Those who could share a less American perspective on life, on health or on happiness. In that way our interpreters were more than just a bridge between two languages, but between two cultures as well. Arguably, their jobs have been the most difficult. Switching between languages and bridging cultures, is a mentally, emotionally and physically exhausting endeavor and I’m so grateful that they are here. Without them, we wouldn’t function and for me, saying goodbye to them and this beautiful country will be the most difficult part of this trip. Yes, saying goodbye is always the most difficult of all.”

– Gabi Stojanovic, Nursing Student, Summer 2016 trip

For more information about PRHDR, please see http://www.prhdr.org.

La Playita

Yesterday, PRHDR sent a team to La Playita, a small village that is extremely poor, very isolated and frequently completely cut off from the world. This was only the second time that PRHDR has managed to access this village, as the last time we tried, the road conditions made it completely unattainable.

This time, we were able to get most of the way there by car. We stopped at the top of a hill, where we were met by our community leader, Evelyn, who has recently joined the PRHDR team. Evelyn had hiked all the way up to the meeting point early in the morning to wait for us and then guided us all the way back down to her village. She also got a mule that carried our bags and patient files. The road was a little complicated and involved a total of 12 river crossings – six on the way there and six on the way back.

The clinic was held on the porch of a peaceful house and the owner of the house showed up part way through sweating profusely and carrying a load of bananas he’d brought for us. When we got there, we saw approximately 40 patients. Many patients complained of physical pain – something to be expected in a very agricultural society.

At the end of the clinic, we did a home visit with two patients, a mother and son who are both severely physically disabled. The son is in his forties and has cerebral palsy, while the mother is “about 80 years old” and had her leg amputated five years ago after a wound became gangrenous. The son does not have a wheelchair and it was really hard, particularly as a group that has travelled to see two people whose entire lives are limited to two rooms.

After the home visit, we hiked back – two miles that frequently seemed to just go straight up and was exhausting. At the beginning of the day, Evelyn had informed us that the village children made this hike both ways every day just to get to and from school.

 

Home Visits in Rincones

This was the day of home visits in the village of Rincones. We had expected a number of additional patients that we would be asked to see, however we were also caught off-guard by a long and difficult hike to reach them. Nonetheless, considering how challenging it was for us to traverse the muddy, rocky terrain, we could only imagine how difficult it must be for those living in these most remote areas. In particular, we were seeing very elderly clients with increasing medical needs as they aged.

We discussed why individuals might choose to live in such remote locations (aside from the amazing views) and it was postulated that for some, it was all they knew. For example, one gentleman we saw told us he had been born in that house and lived there his entire life. While potentially difficult for us to wrap our heads around such an existence, that is their norm and although they may had dirt floors, they certainly seemed to have lived rich lives.

The day ended with a visit to an elderly, bedridden lady who had been so for the last five months. The thin mattress and her frail state led us to be very surprised at the excellent condition of her skin, completely devoid of any signs of breakdown. This was attributable to her totally devoted daughter who told us she changes her mother’s sheets and bathes her every single day. We commended her efforts and she replied most matter-of-factly that “that is just what you do for your parents because they did so much for us.” It was a lesson that hit close to home and undoubtedly rings true across all cultures.

Day Five of Clinics

Day Four of Clinics

The following is a contribution from Donna Davis- Rankin, a registered nurse who is volunteering with us.

“My experience in the DR has been both enlightening and humbling. The people fo the DR are proud, resilient and gracious. What they lack in material possessions is balanced with what they offer from the heart. There is a strong sense of family and community in each village. The phrase “It takes a village to raise a child” is very evident here as an infant or young child is often held and cared for by many. The older children demonstrate reverence and respect for elders.

During our clinics the wait time can be long. Our clients are patient, without complaints of how long they must wait to be seen. They are grateful for the attention and care we provide.

The children are outgoing and curious to learn anything we can offer. I held a baby today who was content to be in my arms. Looking at his beautiful brown eyes, all felt right with the world. I am exactly where I was meant to be.

It has been amazing to watch our student nurses blossom, a bit shy and uncertain. They are becoming self confident, learning much about themselves and much about the culture and daily living of the people in the DR. This experience promises to be life changing. As a seasoned nurse, I am humbled, learning from a new generation of nurses. I am humbled to show my knowledge and experience with them as well. I am proud to be supporting incredible young women who will one day be a part of this noble profession we call nursing.”

Donna Davis-Rankin, Registered Nurse, Volunteer

 

Children

The following is a blog post by Susan Clement, one of PRHDR’s volunteers, about her first day with us.

“My first day in clinic. A very proud grandma.”This one, she wants to be a doctor,” Grandma said, describing her six-year-old granddaughter.

Smiling wide. I agreed with her. Yes, she’s smart enough. The tiny girl sat at the table with a pad of paper, listening and printing names of nursing students, as she heard them. Mine too. Seeing these families, generations living together. The children are loved, well cared for, clean clothes, groomed with barrettes in hair. It’s meaningful to see that. Yes, we are here for a day,in this village. Yet it’s also reassuring that there’s support in place, across the generations, to carry on. In community health nursing, we’re given the privilege of meeting the families of our patients. We’re fortunate to be invited in to see these sweet relationships.

My second day in clinic. A tender moment with an eager boy. “Abre la boca,” I said, ready to apply fluoride to his teeth. The small boy stood in front of me, attentive, posture still and straight as a soldier. Me sitting on the chair, I could look directly at his face. I think he’s probably no more than five. So ready to please. Trusting me as I do this crazy thing, using a paintbrush the size of a toothpick, dipping it into the cup of fluoride, to “paint” onto his teeth. How is it tasting to him? No sign from him that it’s unpleasant. And this moment warmed my heart. Then I notice something, black spots, on many of his teeth.

Cavities? Yes, I know cavities, my kids have had cavities, I’ve had them, but they were caught by the dentist, by X-ray. We didn’t reach the stage of seeing black spots. This endearing boy, who a moment ago was giving me a precious trip down memory lane of my own son when he was this age, now I’m realizing a big difference in how this little boy’s life is different. I finish the painting, announce, “muy bien, hemos terminado”, good job, we’re done. He’s looking at me, we exchange smiles, universal language for happiness. I offer him my sticker selection. He chooses the blue star, and a blue toothbrush to match. I’m grateful to have this experience and I’m grateful to be able to reflect on what I have to be thankful for.

What a privilege to serve him and receive that smile from him. I’m thankful for that too.”

Susan Clement, volunteer, RN.

For more information about PRHDR’s programs, please check out www.prhdr.org.

Second Day

After completing our first clinics today PRHDR is heading to Tinijitas and Yaroa.

This is an entry by voluteer Karen Twidwill about our first day and her experience in the PRHDR clinic at El Treinta.

“Tuesday was our first clinic day. We set up in a concrete pavilion on a Dominican mountainside. The views were just amazing. I was told the pavilion was once a disco spot. Currently, there is a broken down car and a stage where our pharmacy and lab were set up. The sincere faces of the Dominican people were priceless. The love they share for their neighbors leaves me wanting a more loving community that shares meals, smiles and hugs. The student nurses took on a whole new role of what it means to be a nurse.

I am grateful that a program exists to create such a bond of entirely different cultures. Tomorrow will be an exciting continuation of feelings, education and bonds.”

– Karen Twidwill

For more information about our work, check out www.prhdr.org.

First Day of Clinics!

Clinic day 1 with team Rolinda traveled to the small town of El Treinta. In full scrubs and my hiking sneakers, we took off down the bumpy road. It was a beautiful walk and an ample opportunity to get some great pictures of the wildlife, structures, and culture. A few of my favorites were the “coffee shop” which was a small table, two small pitchers of coffee and a couple random pastries, the butcher shop with dried entrails hanging from the ceiling, and the local “ice cream truck,” which was in fact a man carrying a bag of cones, a cooler on his head, all the while ringing a small bell.

Once we got to the clinic and set everything up to get started it was a bit overwhelming. We were able to work through the rough patches no less. I was definitely wishing I spoke Spanish. However, working with an interpreter was a great learning experience. My first patient visit went by slow and steady. I learned with each new patient and began to find a good flow as time went on.

I nearly jumped for joy when I was presented with my third patient of the day, a seven-month-old baby boy with the most adorable dark curly hair. The rainstorm during the clinic offered some cool breezes and a relaxing background noise. I felt that the day went by as well as anyone could have hoped, being the first clinic of the trip.

I loved getting to push myself, interact with such gracious people, and even pick up a few new words to add to my slowly expanding Spanish vocabulary. Working in a foreign place, being so on the go, and seeing so many people coming from so little, you really get a new view on how many things in life you can live without. So many things from my life at home have taken on a new meaning.

Today taught me a lot about the difference between a need and a want, and most importantly to be so thankful for what we have. There is so much need in the world, and so many ways we can make a difference. From measuring heights to taking blood pressures, passing meds to driving supply trucks, today we all came together to help change a lot of lives. So many people with the same mission can be a very powerful force.

– Emily Gold USM Nursing Student

For more information about our work, check out www.prhdr.org.