Monday
Weighing station
I spent most of the day observing the nursing area with Jillian. During a time when there were no patients, I had a really uncomfortable talk with one of the nurses, Altagracia, about religion and creationism/evolution. She went through disbelief (Her Spanish isn’t perfect, maybe she didn’t understand the question) then shock (How could she not believe?), followed by indignation and some anger, before finally coming to an agree-to-disagree conclusion with the help of the other nurse there, Sandra, who was much more understanding and helped calm Altagracia down. I tried to walk the very fine line between not lying about my beliefs and being culturally insensitive, and in the end it worked out okay–Altagracia doesn’t hold it against me–but I do wonder whether I should just lie. As an activist, I’ve been trained to encourage people not to keep their differentness or controversial opinions to themselves (unless it would put them in danger), with the understanding that visibility is the first step toward tolerance, which can then lead to acceptance. This is the argument for “coming out” in places/social environments where LGBT issues are other people’s issues, and where “normal” means heterosexual and cis-gender, and not feeling the need to “come out” in social environments where queerness is accepted as normal human diversity, like skin pigmentation or singing ability. So, naturally, in a place where Christianity is assumed and those who are not Christian are marginalized, I do not want to pretend to be Catholic. It is important that people recognize that not all “good”/normal people live in the same way they do, and this is part of the “cultural exchange” aspect of volunteer work, traveling, and living abroad. Though the unexpected difference is surprising, things like vegetarianism, support for gay rights, and atheism (by way of cultural/secular Judaism) are now associated with someone they respect and relate to, rather than being “Other” and subject to judgment. I don’t bring up touchy subjects, but when asked straightforwardly I will explain as much as I think the other person can accept, in the mildest words possible.
Tuesday
From left to right: Abdias (Haitian med student), Teresa (Project HOPE Country Director), Don Cesar (aka Mr. Monte Plata), me, Derek, Jillian, Dana (visiting former volunteer & mentor)
Teresa came up to visit for a couple of days with Dana Fitz-Simmons, a pharmacist who volunteered here as part of his MPH coursework five years ago. Since Jillian and Derek are pharmacy students on rotation, but don’t really have a preceptor here to guide them, Dana came to help them think of how they will spend their month and develop some project ideas. Teresa ran into Don Cesar outside, and so he spent some time talking to us as well. As I mentioned in a previous post, Don Cesar is the man who donated the land for the clinic. As it turns out, he is “Mr. Monte Plata.” He has lived here all his life, raised his six children here, and is responsible for funding many other social-good and beautification projects in the town. He explained that while many people wait until they die to donate money, set up foundations, etc., he prefers to do so while living so that he can see the fruits of his labor/philanthropy. He also has a large farm, where he grows a wide variety of crops, including several fruits that have vanished from the province. I plan to take him up on his offer to visit the farm, which is just down the road.
Wednesday
Learning about Project HOPE’s Gifts In Kind program
Medications are donated to the clinics, as well as to the Dominican Republic’s Ministry of Health on a much larger scale, through Project HOPE’s gifts-in-kind program. A brief overview of the program was included in the Project HOPE online volunteer orientation I had to complete as preparation for this trip, but Teresa explained it in much greater detail—and with more personal anecdotes—during a multi-hour session in the storeroom on Wednesday. This was my first experience translating for more than a few minutes at a time, and I enjoyed it. Teresa is from Ecuador and speaks very clearly, so it’s very easy to understand her. With the Gifts-In-Kind explanation, I developed a deeper understanding of Project HOPE’s role in the DR, its relationship with the Ministry of Public Health, and how the clinics’ storerooms come to be filled with so many medicines and supplies labelled in English (and often approaching their expiration dates).
Thursday
Teresa wanted us to look natural and for a couple candids. We did well.
We left Monte Plata Thursday morning, and went straight through Santo Domingo to Haina, where construction on the third Project HOPE clinic is (finally!) underway. Haina is about an hour from Santo Domingo, and is most known for its industrial parks and extremely high incidence of elevated levels of lead in the blood of its residents. The clinic will look and function almost identically to the existing two clinics, but I wonder how it will be specially adapted to the industrial environment/industry-specific health issues and lead poisoning. The groundbreaking was set for the beginning of August, but as of this morning (July 16th) it has been postponed to September. I’m sad that I’ll be missing it, but relieved that I won’t have to translate lots of very formal Spanish into equally formal English for the Project HOPE President and other guests who do not understand Spanish.
We returned from the Haina site for a tour of the Herrera clinic. I had been shown around when I first visited with the nurse practitioner students, but took advantage of this second tour to ask some more specific questions about people’s roles and explore differences between how the two clinics function. An important difference was that the community health office is run by a licensed nurse in Herrera, while in Monte Plata it is run by staff with less formal training, and breastfeeding support is provided in the community health office as well as in the nursing area. In theory, this should also happen in Monte Plata, but it definitely does not. The Herrera clinic is also much busier than the Monte Plata clinic, and people expect greater efficiency, which was explained to us as being due to the fact that people have to take time off work to come to the clinic, and need to return by a certain time. In Monte Plata, almost none of the women work outside the home, though some are students.
During an impromptu meeting with the senior staff of the clinic and Teresa, all crammed into Teresa’s office, Lucrecia, the nurse in charge of community health, took great interest in my mHealth project and would very much like to implement it ASAP at the Herrera clinic. Though I had initially thought to pilot the program at the Monte Plata clinic, and had conducted the initial set of surveys here, I am now thinking that with Lucrecia’s support we should survey women at the Herrera clinic, and pilot it there (either instead of or in addition to the Monte Plata clinic). Teresa and I agree that a sample size of about 100 women would be a good amount for the survey, and if I am in Monte Plata semi-permanently I can have Lucrecia or a young female med student volunteer conduct the survey at the Herrera clinic. Ideally, I would be able to train my Herrera counterpart such that she administers the interview the same way I do, so as not to skew the results.
We had a very late lunch with Teresa and Dana at a restaurant on the Malecon (along the ocean), and spent the early evening drinking Presidente and enjoying the AC in our hostel room. We then rejoined Dana, whose hotel was a block away from our hostel, for a stroll. Since it was July 4th, we ended up in the most American spot in Santo Domingo: the Hard Rock Cafe. Over a rather unfortunate plate of nachos, we discussed potential projects, the role of volunteers, health literacy, and a variety of other relevant topics.
Friday
Orlando picked us up at 8 for the “8am meeting at the Ministry of Public Health.” It turned out that the meeting was actually at a high school, and most of the attendees were community health workers. The subject of the meeting seemed to be dengue prevention in Sector 7 (the health district of Santo Domingo in which the Herrera clinic is located). We had some adventures finding the entrance to the school, which resulted in the day’s entertainment for the residents of the dead end street above the school. At the meeting, we were introduced to several hospital directors, a representative from the Ministry of Public Health who is the district liaison, and a representative from the Ministry of Women. It still hadn’t started at 10:30, since the Minister of Public Health was at another meeting in another part of town, so we left. I had my “10am” Watson site visit via Skype around 11:30, in which Teresa called half the clinic staff into the office to introduce themselves and say something nice about the clinic. Later that afternoon, we met Anel and Ruben, who both had connections to Project HOPE and now run a small nonprofit a couple hours away that does sustainable development work. All of us–Teresa, Dana, Ruben, Anel, me, Derek and Jillian–had dinner at El Conuco, which serves food typical in the Dominican countryside and has traditional dancing–merengue, salsa and bachata. We left around 11:15, sweaty, full and happy. We all said goodbye to Dana, who was leaving in the morning. When we got back to the hostel, Derek went inside to sleep and Jillian and I sat outside in Parque Duarte, which was filled with small groups of people talking, listening to music and/or drinking (angry article about the park’s queerness here, excellent counterpoint here). We mostly people-watched, but spoke for awhile with a group of friends (some of whom are in a government-sponsored English language immersion program and spoke excellent English) and two friends who initially came over to hit on us but seemed ok just talking when we said we had BFs (one was more persistant than the other, but his friend helped keep him in check). We turned in at 1:30, and the park was still quite full.
Saturday
We spent Saturday sightseeing. Abdias joined us to visit the first catedral of the New World and the Casa Real (a really great historical museum).
Old medicine chest in the museum. The center area with the extra small drawers is for herbs. We noted that there were drawers on the right side for two different kinds of cannabis.
Sunday
We began the day with lots of walking, including a few minutes walking on the beach, and visiting monuments.
The orchid exhibit had already closed…So Derek hopped the fence, took a look around, and showed us pictures.
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