A picture is worth a thousand words, and a video is worth a million bigillion. For this week’s blog post I would like to share with you a 15-minute video called “Faces and Voices of Health Horizons International” that was produced by Dr. Michael Good, one of HHI’s board members and a family practice physician in Connecticut. I had the pleasure of meeting Dr Good when he came to the Dominican Republic to treat patients during HHI’s May 2012 Operativo. In his video, the history and mission of Health Horizons International are told by its founding physicians and community health workers. Watch Dr. Good’s video on HHI’s website here.
After two weeks of devoting all of my free time to writing essays and researching medical schools, on Tuesday I happily submitted my AMCAS, the primary application for medical school. Now I am free to spend my evenings and weekends playing tennis in Puerto Plata and updating my blog!
HHI has 18 wonderful community health workers. They are leaders in their communities whom we have trained in first aid and the management of chronic illnesses, and their hard work and dedication keeps our Chronic Care Program running smoothly. Each community health worker is assigned a caseload of 5-10 patients who need treatment for hypertension, diabetes, asthma or epilepsy. Every month our community health workers visit all their patients to measure vitals and answer questions about medications, and every other month they deliver a new two-month supply of medications. So every two months, on Pill Counting Day, our staff has to fill all the prescriptions for the 100-odd patients in our Chronic Care Program. Last Thursday was my first Pill Counting Day. After 8 hours of counting pills and filling baggies, the medication names that used to give me trouble now roll easily off my tongue: hydrochlorothiazide, metoprolol, acetylsalicylic acid and salbutamol. In addition to helping on Pill Counting Day, I spent much of last week on my laptop entering information from our patients’ paper charts into our electronic medical record (EMR) and cross-checking their current medication regimens with the instructions written by our physicians during HHI’s May Operativo.
Staying safe in Montellano is not easy. The town seems to have been cleverly booby-trapped to injure all but the wariest of passers-by. A few examples from my two months of living in Montellano:
Despite these booby traps and against all odds, I am alive and well. Last week community health workers Mercedes and Corina took their kids and me to their favorite swimming hole in Arroyo de Leche. It was absolutely gorgeous. We swung across the river on vines, I taught swim lessons to a couple of the little tots (I used to teach swim lessons as a lifeguard), and we jumped off high rocks into the swimming hole below. Definitely one of the most fun things I’ve done here.
HHI works in four rural communities, and Arroyo de Leche (River of Milk) is one of the most remote. I go there every Thursday to follow up on our patients with community health workers Mercedes Sanchez García and Santa Corina Sanchez. Mercedes’s husband Franklin drives me from Montellano to Arroyo de Leche on his motorcycle.
The road to Arroyo de Leche takes about an hour to navigate by motorcycle on a good day. When it rains you have to walk through muddy sections and over flooded bridges.
When I arrive in Arroyo de Leche I meet with Mercedes and Corina to chat while they prepare lunch on their fogones (outdoor stoves). How are their families? How are their patients doing? Do they need any medical supplies from our office in Montellano? Lunch is the biggest meal of the day, and everything they feed me is delicious. My Thursday lunches are-by far-the best meals I eat here. After lunch we go from house to house checking on their patients.
There are tradeoffs to living in the campo (countryside). Campesinos lament the lack of cell phone reception, internet access, libraries, schools and medical facilities. But they don’t have to worry about paying rent. And food is abundant in the campo; they have plenty of land to raise animals for food, fruit trees are everywhere, and the river that gives Arroyo de Leche its name is a source of fish, shrimp and crabs (see photo below). The city-dwellers in Montellano, on the other hand, live in a high-tech world but unemployment is high and many of them struggle to pay for rent and food.
On Saturday we went to the air force base for HHI’s third annual community health workers celebration. They were awarded certificates in recognition of their hard work, and they renewed their vows of service. We also had a super fun pool party!
I’ve been in the Dominican Republic for about a month now. On Monday evening I played 4 v. 4 soccer with some little kids at the local park. I love soccer. Tuesday was my 26th birthday, and my coworker Rachel hosted a cozy birthday celebration, complete with cupcakes and cocktails, on the balcony of her second-story apartment. I spent all day on Friday helping one of our patients undergo testing to be cleared for a Saturday-morning surgery at an excellent private hospital in Puerto Plata. The most difficult challenge was finding two units of blood for our anemic patient; unlike in the United States, hospitals here don’t have blood banks, so patients have to solicit blood donations from their family and friends, or from paid donors. On Saturday I moved into a new apartment. My roommate is Laura McNulty, HHI’s executive director and one of its founders, and I am enjoying her stories about how HHI began and how it has grown and improved over the years.
Whether you are a surgeon, a medical assistant or a receptionist, sometimes you need a battle helmet to work in medicine. Because sometimes the medical system seems to take extreme measures to prevent patients from getting the treatment they need, and fighting to defend your patients can be perilous. Your Goliath may be a health insurance company, a pharmaceutical company or a phone tree. Regardless of the adversary, you have to come ready to do battle, and there is no better way to prepare yourself mentally than by donning a battle helmet.
When I left Denver to move to the Dominican Republic, I knighted my former coworker Jessie Kainrath and passed on my battle helmet to her. This turns out to have been a mistake. Not because Jesse has proven unworthy of my battle helmet. I am confident she is using it to do great things. No, the problem is that I really need my battle helmet here in the Dominican Republic. When it comes to medicine, everything is a little bit harder to get done here, and some things are much harder.
Transportation, for example. In Denver the most difficult transportation issue commonly facing our patients was RTD, the public bus system. When our patients missed the bus, or when the bus was running late, they showed up late for their appointments. Here in the rural towns near Montellano, transportation is a whole different ballgame. We have one patient who lives in Severete and needs to have a 3-day inpatient surgery at a private hospital in the city of Puerto Plata. This is a two-hour journey on a good day. The first half of the trip is through jungle-like terrain on an unpaved road made of gravel, rocks and dirt (or mud). Parts of the road are very steep and rains have made it uneven, to say the least. The preferred method of travel is on a rugged motorcycle. Sedans certainly can not make it. Our patient is elderly and immobile, so she will need to ride down in a large SUV. But it is expensive to hire a taxi driver who owns an SUV, and even SUVs are stymied when it has rained for several days in a row, flooding the small bridges along the road.
There are other challenges. The small paths in the communities we serve are made from a mixture of pebbles and sharp rocks that seem to have been specifically chosen for their remarkable ability to eat away at those rubber things on the bottom of crutches that keep patients from slipping. There is no Creole-Spanish interpreter in admissions at the large public hospital, even though it is one of the few places where Creole-speaking Haitian immigrants can go for treatment. And trust me, the admissions process is not an intuitive one. I have spent the last week coordinating medical care for many of our patients. I enjoy problem-solving to overcome the challenges that arise, but I wish I had brought my battle helmet.
My last blog post was on the same day as the Dominican presidential election. The ruling Dominican Liberation Party won. On August 16th Danilo Medina will be sworn in as president with Margarita Fernandez as his vice-president.
I am fighting a war of attrition against the colony of ants that inhabits my kitchen. They are wearing me down emotionally and nutritionally. Last weekend I washed my laundry by hand for the first time ever. While my white socks turned out fine, the black ones are now oddly stiff. During my first two weeks here I lived almost exclusively off of Corn Flakes and PB&Js, but on Monday I made the 30-minute trip by taxi to the nearest grocery store. I cherish my new culinary options. After many humiliating nights at the local pool hall, I finally won my first game of pool. Here they play a style of 8-ball called negrita which is distinguished from the American game in two important ways: 1) if you make a ball in it counts, whether you intended for ball A to go in pocket B or not, and 2) if you mistakenly hit the 8 ball into a pocket you do not lose; you put the 8 ball back on the table and continue the game. My old pool buddies Audra and Jessie would fare well here.
It has been two weeks since my last post, and I know I said I would be posting on my blog weekly, but I decided not to post last weekend because I wanted to wait until I had photos. I got the photos a few days ago, so here we go!
The HHI team is a mix of American staff who live in the Dominican Republic year-round (like me!), local Dominicans who work with HHI, and American health professionals who travel to the Dominican Republic three times per year to treat patients at week-long operativos (primary care field clinics).
May 7-11 was one of HHI’s tri-annual operativos, and I intentionally arrived in the Dominican Republic a few days before the start of the operativo so I could participate. By Sunday, May 6th everyone on our medical team had arrived from the States, and we met at their hotel in the morning for orientation and to discuss logistics for the upcoming week. On Monday we would set up a field clinic in the town of Negro Melo, on Tuesday in Severete, and on Wednesday and Thursday in the town of Pancho Mateo. On Friday we would do house calls for patients too sick to travel to our field clinics. Planning these tri-annual operativos is a logistical nightmare, but everything went very smoothly all week long. The HHI staff who planned our May operativo did an incredible job.
During the operativo we woke up early each morning to set up our field clinic. Our medical team traveled on large rugged trucks from HHI headquarters in Montellano out into the countryside to the towns we serve. We brought many large boxes filled with medications and supplies, plus enough food and water to get us through the long hot days. When we arrived at our destination we worked as a team to unload the trucks.
Once the trucks were unloaded we set up a pharmacy and hung sheets from the ceiling to divide the interior space into separate consultation rooms. Churches are good venues for field clinics because the interior is spacious and well-ventilated (ideally).
Our patients started lining up outside the field clinics early in the morning, waiting to be seen. During the weeks leading up to the operativo HHI’s community health workers had given out appointment cards to patients who needed to be seen.
My role in the May operativo was to help run the pharmacy and interpret for HHI’s medical providers. In the pharmacy I counted pills, filled prescriptions written by our doctors, and explained to patients how to take their medications. As an interpreter I worked with physicians, physician assistants, a diabetes expert and a mental health nurse practitioner. The first day I interpreted was only my fourth day in the country, and my ears were still adjusting to the unique Dominican accent. I found that I could understand most of our patients very well, but older and less-educated patients spoke with an accent that was too thick for me to understand. I ended up recruiting one of the community health workers to assist me. She would repeat what they said in an accent that was easier for me to understand, and I would interpret that into English for the doctor. Whew!
We saw about 100 patients per day during each of the first four days of the operativo. HHI’s focus is on primary care, so most of our patients were seen for conditions such as diabetes, hypertension and asthma. However, we also treated many patients for intestinal parasites, malnutrition, skin infections and urinary tract infections. On Friday morning we did house calls for patients who were too sick to come to our field clinics. We saw three patients who needed transportation to a hospital to receive immediate medical care, one of whom was very close to death. All three patients are now doing well.
On Friday afternoon I spent some quality time with the HHI medical team on the beach in Cabarete and at their beachfront hotel in Playa Dorada. After a week in the DR I was still feeling pretty homesick, but being among such nice people helped a lot. While at the hotel in Playa Dorada I took advantage of the luxuries not available at my apartment in Montellano: really good food, time on the beach, and a long hot shower.
On Saturday, May 12th the visiting medical team returned to the U.S., and now my job is to help our patients with follow-up care and referrals to specialists. On Tuesday I went on my first motorcycle ride into the countryside, to deliver medications and to network with our community health workers. On Wednesday I accompanied a 96-year-old lady to a consultation with an orthopedic surgeon to discuss the possibility of an amputation for two toes that are necrotic and tremendously painful. On Thursday I spent all day in the public hospital with a 52-year-old man who suffered an ankle fracture when he was hit by a motorcycle. In my next post I will talk more about this aspect of my work here.
None of the stores are open today, and you cannot buy alcohol today. For today Dominicans are voting in their presidential elections. They say tomorrow the streets will be alive with celebrations and protests, regardless of whether the victor is Danilo Medina or Hipólito Mejía.
In my free time I am playing pool with new friends, reading a good medical fiction called Cutting for Stone, and writing essays for my medical school applications.
HHI is doing great things in the Dominican Republic, and it is an honor for me to be here volunteering with them.
After months of anticipation, it’s hard to believe I am finally here in the Dominican Republic. I left Denver on Thursday at 11:50pm and twelve hours later, after a layover in Miami, I arrived in the Dominican Republic on Friday at 2pm local time. I was met at the Puerto Plata airport by Janelle, the Clinical Programs Director for HHI and a very gracious hostess and guide. After an 8-minute taxi ride we arrived in the small town of Montellano where I will be living while I’m here. Janelle gave me a walking tour of the town: the supermarket, pharmacy, produce store (I am admittedly not a big fan of veggies), bakery (I have been known to eat a doughnut or two), bank, baseball field, HHI headquarters, water bottle refill place, cell phone store, etc. I unpacked and picked up groceries and water, and then Janelle and her roommate Emily invited me over for a really nice dinner. By 8pm the long day of travel had caught up with me and I returned to my apartment and fell fast asleep.
Unfortunately, my next-door neighbor is a rooster. Unless I am forced to take desperate measures, I probably won’t be sleeping in past sunrise (6:10am) any time soon.
Orientation and training is on Sunday, and our week-long primary care field clinic starts on Monday. So today (Saturday) was my last free day before things get busy. I went for a run in the morning, ate a breakfast of corn flakes and powdered milk, went to the airport to greet some of our medical team that was arriving from the U.S., and then spent the day with them at their really nice beachside hotel at Playa Dorada. Today I met eight of the medical professionals on our team (physicians, nurses, social workers, etc). Several others will join us tomorrow. They are all wonderful people, and I’m really looking forward to working with them.
This evening I went exploring and found a cool open-air venue with two pool tables. There were about twenty guys there in their early 20’s. They gave me a warm welcome, and I played with them for a couple hours. I didn’t win a single game. I’m not bad at pool, but they were all really good. I get the feeling they play a lot.
Next week during the primary care field clinic we will all be very busy. I think I will primarily be helping with medications and patient charts. It should be quite the experience. I’m still figuring out my new camera. Next weekend’s post will have pictures.
I am very happy to be here, but it was heartbreaking saying goodbye to my family and friends in Denver. I miss you. Thank you for your support.
To my family, friends, mentors and supporters:
On May 3rd, 2012 I am going to move to the town of Montellano in the Dominican Republic to begin serving as a medical volunteer for the organization Health Horizons International (HHI). You can learn more about what I will be doing by clicking on the tabs above. While I’m in the Dominican Republic I will use this blog to share my experiences with plenty of photos.
Please subscribe to my blog, by clicking on the “Follow” button on your screen, so you can receive an email each time I make a new post. I would love to hear your thoughts. Feel free to comment on my posts, and let me know if there is something you would like me to write about.
As a medical volunteer, I am responsible for raising enough funds to pay for my service trip. You can support me by making a tax-deductible donation in my name to the nonprofit Health Horizons International Foundation through PayPal at http://hhidr.org/donate/financial-donations. After you give PayPal your credit card information, make sure to click on “Add special instructions to the seller” and type “for volunteer Brian Daily.” After you make a donation, you will receive an email from PayPal with a receipt.
I am incredibly excited about this unique opportunity to learn and serve others, and I am eager for the adventure to begin. Woohoo!
P.S. The title of my blog should read “Brian Daily abroad,” not “Brian Daily, a broad.” From now on, anyone who make a sly comment about my blog’s title has to make a donation to support my service trip 🙂