Living in Poverty

     Friday morning we drove back to the shores to the countries' capitol of Santo Domingo. I didn't have WiFi at the resort we stayed at so am just now able to type a wrap up.  Before getting to the hotel, we stopped and did some more local shopping downtown Santo Domingo.

We got to spend the rest of Friday afternoon at the beach or pool, as well as on Saturday morning before flying out Saturday afternoon.  We had a lay over in Philly again then landed safely in Detroit.  This man below was one of the many venders on the beach, posed for his picture before cutting the coconut....

     To look back and review what all we did in one week of being in the Dominican is difficult to explain without experiencing it your self.  Most of the country is third world living, which living in poverty there is slightly different than what living in poverty is like in the states.  We had a lot to offer the people of the Dominican Republic, but at the same time, they had much to offer to us as well.  Below are a few observations/lessons about living in poverty in a third world country.

Living in poverty means you don't save money. There are no such things as banks or mortgages.  

Living in poverty means you don't know where your next meal will come from.  

Living in poverty means you don't have public education and education is not guaranteed without paying for it.  

Living in poverty means you don't have an address, or postal service for that matter.   It means sleeping in one room shacks made from material found on the land that 6 other people live and sleep in as well, no privacy.

Living in poverty means no hot water, or maybe no running or clean water at all.

Living in poverty means getting a ride somewhere by jumping on the back of a moving bus, or when you are really lucky, the most affordable transportation is a moped. 

BUT, living in poverty also means you know your neighbors, and look out for your neighbor because one time they looked out for you. It means you may live in a solid concrete structure and your neighbor lives in something made of cans and dirt, but it doesn't matter-they are still your neighbor.  

Living in poverty means you care about your appearance, take pride in sweeping your dirt patio, because most of the time its all you have. 

Living in poverty means even if you have the opportunity to leave the country for good, you don't simply because that means leaving your family and culture. 

Living in poverty means you are generous with what you do have.

Living in poverty means your Walmart is the nearest local market where your friends sell the good you use. 

Living in poverty means you are resourceful and have a strong faith. 

Living in poverty means you are some of the most hard working and intelligent people in the world.

     Most observations were dirt and hopelessness, according to America's standards. But at the same time, those same things were beautiful in the meaning of the tense.  I saw some of the most amazing scenery ever at the same time as the most disgusting living conditions.  This trip really makes you feel blessed for what you do have. If any of you have an opportunity to help your neighbor, whether it be down the road or in another country, do so.  The fact of the matter is we are all a bunch of people of different color and of different backgrounds residing all on the same planet.   

Godspeed,

Elizabeth

Elias Pina

    We did another clinic today in the most poverty stricken barrio we have been to yet.  We set up shop at the only community building located in the area. It consisted of four walls, probably smaller than my bedroom back home.  The Dominicans are very creative when it comes to building with the resources they have available. So needless to say, we crammed five stations into a very small area.  We had an intake station, vital signs and weight, two doctor stations, and the pharmacy.  

    Our lovely doctors: Dr. Lebron

and Dr. Jennifer

  

   I started the morning off with Dr. Jennifer.  She was one of the most patient and compassionate doctors I have ever met.  Families with up to 13 children would come and there seemed to be a lot of grandparents who brought their grandchildren in to be seen at the clinic.  Most complaints consisted of flu-like symptoms, which they call Gripe, abdominal pain, headaches (usually because their blood pressure was 200/100), skin rashes, bug bites, etc.  When something is assessed that can not be addressed at the clinic with the medication and equipment we brought, a referral was made to another resource.  After that, I spent some time at the vitals station. Most individuals I encountered did not even know to close your mouth around a thermometer because most had never seen a digital thermometer.  As the day passed on and more and more people came, our pharmacy was in full work load.  I spent the rest of the afternoon in the pharmacy catching up with filling the necessary medications our lovely doctors prescribed.  Again we passed out vitamins to all ages. We used a little window to the right of the below picture as our consult/education area to help decrease the clutter of people within the small room we were in.  It was extremely hot in this corner today!          

   During a lunch break, I walked behind the small building and sat to look out over the barrio and mountains.  Eventually, these children joined me.  I couldn't tell if they were speaking Spanish or Creole, as we were even closer to the Haiti border than we were yesterday.  But it didn't matter, just company.  They seem just as interested in us being there as we are experiencing their culture and everyday norms.   

 

 

    We are heading to the coast in the morning, back to the country's capitol, Santo Domingo.  Tomorrow night we are staying at a resort on the beach named Barcelo Capella!     

Clinica del Cercado

   This morning we drove about 55 miles west of the guesthouse to set up the health fair.  The Solid Rock Organization has funded schools in surrounding areas of San Juan and the building we were at today was affiliated with the organization.  It consisted of a health clinic, a school, and a church building within a small area.  This location was originally chosen by Solid Rock because of a previous lack of education, poor health, and low birth weights.  This area operates off a grant funded by the government to provide milk monthly to children or families who's weights and health statuses are monitored through the program.  Today was the one day a month milk pick-up.  They purposely planned for the health fair to be at this location on this particular day knowing many of the community members would be coming for their milk.

   We had 6 total health topics: CPR/choking, Nutrition, Hand washing, First aid and Umbilical cord care, Dental care, and Hypertension that were presented by us nurses and two pharmacy students. Each project was set up in stations with three activity stations in between.  Some individuals were waiting outside the building before we even arrived.  Once we set up, families piled in and split into groups.  A small paper kept track of each station they visited.  A translator was also placed with each station.  I started off each group by passing out suckers to the children to occupy them while attempting to maintain the attention of the adults.  A first aid kit that I had previously put together was given to each one with an explanation of its contents.  I had a rubber fake wound that we demonstrated simple, yet effective first aid on.  We covered small abrasions, large wounds, control of bleeding, splinter and stinger removal, burns, and removal of glass and debris.  The importance of wearing shoes and protecting their feet, especially in children, was stressed because so many run around bare foot through the dirt roads and patios.  Any pregnant individuals or females of child bearing age received one on one attention regarding umbilical cord care and received an umbilical cord care kit.  Again, something like keeping an area clean and dry seems to be common sense but for the population we were serving, it just simple is not.  Adult interaction with the demonstrations followed with a children's activity made for a successful health promotion! 

 

The remaining nursing groups: 

  The area was only a mountain from the Haiti border, so there were occasions where the translations became difficult, as some spoke Creole.  Following the health fair, the medical group took a walk through El Cercado with our translators, while the engineer group finished their teacher work shop.  The views were amazing.  

    Upon returning to the guesthouse, some of the girls and I took a walk down town in San Juan and took a tour of a cathedral.  It had a tower we climbed up to get a great view of the city and mountains surrounding.

On our way back we met a wonderful 13 year old named Jorge.  He recognized that we were from the states and ran over to us asking where Nicole was.  She is a nurse who lives at the Clinica Christiana year round and collaborates with Solid Rock International.  She had actually just returned to America due to a death in the family, so we explained she would not be back for a few days.  It was obvious what a great relationship he had with her and his relationship with the clinic organization in general.  The bond and trust of the community with Solid Rock International is something we went over on our orientation day.  After talking with Jorge for about 10 mins, it was clear the lasting relationships they are building; one individual at a time.

 

Quite the womanizer....actually, probably more mature than most 23 year Americans.

   The rest of the evening was spent eating out at a safe authentic restaurant downtown.  All 30 of us piled into two trucks (yes, 6-8 sitting and standing in the truck bed, just like the actual culture of the Dominican's). The food was good!  Following dinner, we attended a church service that was ran by the youth pastor of Solid Rock International.  They were nice enough to translate the entire service. Again, we are lucky to have them!  We all piled back into the trucks and returned back to the guesthouse for one more barrio clinic in the morning.
  Excuse the mass quantity of pictures.  But down here, a picture is truly worth 1,000 words.

Los Charcos del Capa

  On our way to today's barrio, we stopped at the local market to do a walk through and experience the culture of a Dominican market.  Comparable to America's Walmart, right? These citizens put in a lot of time and hard work peeling at beans and rice (two of their largest industries).  The second picture below was a meat vender.  The spine and tail of a pig is hanging in the middle.

  Today's clinic was set up much like yesterday's but in a different barrio a little bit further a way.  We were able to use another school house, this time with a few more rooms.  The majority of the children that attended had on light blue uniform-type shirts that were part of a mission to attend school there.  The patients could come and go through intake with their chief complaints and history, get assessed and vital signs taken, see the doctors, and then wait at the pharmacy to get their medication filled if needed.  Again most everyone we see gets vitamins and common over the counter medications as well as anything specific treatable complaint.  Today we saw a few eye infections, fungal infections to nails, parasites, dog bites, and a patient with the highest blood pressure I have ever seen in my five years of nursing, a systolic pressure of 280.  Whenever there is a diagnosis that can not be treated by the clinic doctors, a referral slip is made and help is given to attempt to get that patient the help they need. (ie: an 8 year old needing a large hernia repair) The common child-bearing age in the Dominican is approx. 14 years of age.  Many of the parents to the small children appear young themselves.  I wasn't able to take many pictures today except when someone else had my camera.  I have enjoyed being one of the licensed personnel in the pharmacy, along with the other registered nurses.  It is fast paced and great knowing even if we don't have a specific medication in our kit, we have been able to substitute for others and determining safe drug interactions for the citizens of all ages. We could not do what we do without our lovely translators.  Education regarding proper use of medications and basic understanding of ways to prevent or help current and future symptoms are a main focus.  These were some of our first patients to come through the pharmacy today.  The small girl to my right side of photo below was very friendly and throughout the day I would catch her trying to get our attention through the windows.

 
   Sometimes they just want to talk, even though you don't have a clue what they are saying besides responses to "Como se llama?" and "Quantos anos tienes?"

   
   And the ONU nurses with the kids as we wrapped up for the day...

 

   We passed two separate boy and girl orphanages on our way home as well as got to see a typical cemetery of the DR and the country dump.  After dinner, a tailor, named Herman came to the guesthouse with a variety of cloth swatches.  He makes anything and everything you could want.  If you have a picture, he sews it up this week.  So, I went through a book he had and picked our this dress below.  Then, he takes your measurements and later in the week drops the items off for sizing and makes adjustments if needed.  He had pictures of anything from purses, dresses, skirts, to blazers.  He looked really talented in his craft.  So later this week we will see what this looks like in person tailored to me!

  Tonight was a free night where we had a meeting regarding our health fair we are holding at a different barrio.  Some of the traditional ONU students will be assisting in each of our individual projects of health promotion that we have prepared.  Time to put almost 200 first aid and umbilical cord care kits to use! Education...Education...Education.....because well, knowledge is power!

Good night!





 

Las Carreras/Sosa

  Today was our first clinic held at a small school house in a barrio called Las Carreras/Sosa, which was approx. 30 mins from the guesthouse.  We piled our supplies into the buses and trailers, and along with our translators, doctors, and pastor we arrived safely! We did pass a parade of citizens cheering for the man who won their presidential election because that meant the current president was not in office for a consecutive term.    Because of the election, today was considered a holiday.  The school house did not have students in school,   and instead opened their doors to us.  It was obvious we were further from a main city and the even greater lack of resources that were present.
   The school house was a one room building with a small basketball court to one side, an outhouse, and an open kitchen-type nook area all in a fenced in area.  We had an intake station where citizens of the barrios gave their basic info: name, age, known allergies and medications, and what their chief complaint was.  They moved on to the next station where weights and vital signs were taken.  We had two physicians that saw each patient, diagnosed, and prescribed medications if needed.  Many of the diagnosis consisted of parasites, fungal infections, bacterial infections, vitamin deficiencies, pain to generalized areas, gastritis, high blood pressure, etc.  We were told for some of the patients, today would be their only chance to see a doctor for at least a year.  After seeing one of the doctors, the patients came and waited at the set-up pharmacy to get their prescribed medications filled. The most common medications that were prescribed were vitamins and an anti-parasite tablet.  One of us licensed nurses have to be in the pharmacy at all times.  Today happened to be my day to work in the pharmacy!  It was busy and an organized chaos at times, but eventually everyone got what they needed!  The translators became your best friend!  Education on each medication prescribed and reviewing instructions on how to take the medication and why was huge for this population.  It was a perfect time to individually preach some of our health promotion too.  It was extremely interesting to see the prescribed medications when compared to the way things are prescribed in America.  There were some patients who came strictly for a headache that occurred last week but they wanted Tylenol anyway.  If there weren't any current complaints then the patients really didn't see the doctor, however, that patient's headache from last week suddenly returned.  But hey, we have a whole other type of drug seeking behavior back in America!  We passed out tooth brushes and toothpaste to each patient and any children.  While not in line waiting to be seen or at the pharmacy the barrio children got to enjoy our company by playing with bubbles, balls, and many of the toys we brought along.  Occasionally there were patients who appeared to impatient with any type of wait but for the most part the citizens are extremely appreciative of your presence alone, not to mention assisting to relieve their complaints at that time.  Some of today's barrio clinic...  
Just set up the make shift pharmacy along these counter tops, table, and surrounding suitcases.                  

Intake...with the bathroom and all in the background :)

 The one room school house they allowed us to use with stations awaiting to be seen by the physician....

Extra time during our lunch break to play volleyball with some of the locals! These kids were extremely coordinated for their age... Which is one thing I can fluently ask: Quantos anos tienes?

Our favorite translators...

 
   We had a successful first barrio day!  We returned to the guesthouse for dinner and a few local venders came offering paintings, jewelry, & baskets.  After dinner we had some time to shop and then some of us went and played a game of softball at a university located within the San Juan against some of the locals.  The Dominican's take their softball serious!! We had intermixed teams and really didn't even keep score but it was still fun and dirty!  

Another barrio clinic planned for tomorrow while the engineer group works with teaching their teacher workshops!  There is so much going on and things you see really are almost impossible to describe! (and i am not spell checking so pardon my mistypes!)

With love...

San Juan de la Maguana

   We drove early this morning through the island into San Juan.  We took mostly main roads and went through little towns where a lot of people were out and about.  Some school buildings had crowds of citizens  surrounding awaiting to vote in their presidential election.  The mountains were a nice view along the ride....

We arrived at the guest house which is connected directly to the Clinica Christiana.  We were told almost 80% of surgeries that take place in the Dominican Republic are done here.  (Chistiana Clinic of Integral Health)

We got our room assignments and ate a fantastic breakfast. All the food has been really good so far actually.   The guest house hosts do a nice job! The group started out with an orientation and review of house rules (ie: you can not flush any paper down the toilets and not to feed the dogs human scraps). There are two guest house dogs here that belong to the hosts and the directors from the US.  Other dogs in the city and villages are not pets to anyone, just roaming wild dogs.
   Our first duty was to start sorting back through all the luggage and organize medication from supplies and donations.  The engineer group did their supplies and made kits for their teacher workshops.  All the medical people sorted pills into 30 day supply bags with labels.  Every patient we see will get at least a 30 day supply of vitamins, adults and children, along with any other prescribed medication if needed.  We were able to bring with us thousands and thousands of tabs that needed sorting.  There were hundreds of bags made with toothpaste and toothbrushes to pass out as well.

 
Throughout the week we will set up clinics at different barrios (similar to a village or city) each day.  Some are the poorest within the country.  We have certain supplies and medication that we stock and bring with us  to each of the clinics.  The nurses organized a triage bag.  The pharmacy at Clinica Christiana looks like this...

   Once all the organizing was completed for the day we were able to walk into the city and through different villages.  It is hard to even put into words what you observe.  There is a lot of trash laying around and people drive wild on the roads and through the villages.  There are random cows tied to trees along as you walk.  We took small stickers along with us as we were walking to pass out to any kids we saw.  As some of us started walking towards a village a little girl screams "Americana"!  You get greeted like celebrities down here!  My Spanish skills are getting refreshed too! The smallest thing like a sticker lightens these kids eyes.  Many would follow along with our group as we kept walking.  Here are a few views from San Juan village life in the Dominican.

The kids loved getting their picture taken too!
There is a big day ahead tomorrow and sounds extremely busy! It is hot and humid here similar to how it sounds back in Ohio!  Stay cool and to all have a great week!

Elizabeth

Destination

 We landed in the Dominican safe and sound!  We had a short lay over in Philly after leaving Detroit....here are us registered nurses awaiting to board...

    The flight was about 4 hours from Philly (which we learned was one of the top 3 terminals for US Airways) but there was pizza waiting for us once we arrived in the Dominican!  The guesthouse representatives picked us up at the airport and we piled into two buses after making it through customs.  There is just under 30 people in our group and behind each bus was a small trailer to put all our luggage.

   It is a complete overcast day and pouring down rain.  They mentioned the country gets most of the year's rain in May but one of the representatives compared today's on and off rain to a northern blizzard.  So the original plan was to drive the approx. 3 hours in land tonight straight to the guesthouse, however, that plan has already changed!  The roads are mostly dirt roads as we start heading into the mountains, so instead of trying to drive on that in the rain, we stopped at a hotel called Barcelo's.  It is an extremely nice hotel in the middle of a not so nice part of the city. Despite the rain, there were people outside along the streets everywhere! and if any of you have ever driven in Mexico, or most foreign countries for that matter, the drivers drive no different here in the Dominican!  (Close calls and constant honking!) 

The plan is to get up and out of here about 5 a.m. in order to get to the guesthouse by 8 a.m. and beat traffic. Tomorrow is the Dominican Republic's presidential election.  Originally, they didn't want us driving on the roads on this particular day, but now the plan is to get up early enough to beat any potential friction that could bring with it.  Tomorrow is a big day of orientation to the guesthouse, reoganize all of our supplies and donations, and get set for the week ahead! Hope for a little less rain and safe travels along these roads!  For tonight we will enjoy air conditioning and a shower! Good night to all...