First Days on the Job

Thursday (6/27) was our first day at the clinic, sort of. The clinic primarily a maternal and childhood clinic. This clinic offers many services including: vaccinations, HIV testing/counseling, OB-GYN, pediatrics, family medicine, dental care and sonograms. The clinic promotes the 5 Star program and IMCI (Integrated Management of Childhood Illness). 

The 5 Star program is for pregnant mothers and infants up to 60 months (5 years old). Each stage of the program awards up to 5 stars to the mother or child. For instance, the mother first enters the program while she is pregnant. She can earn her 5 stars for getting all necessary vaccines, HIV testing/counseling, doing lab work, visiting the doctor six times, and bringing the newborn within 7 days of birth. After birth, the stars are now awarded to the baby during the different stages. The stages are 0-6 months, 7-12 months, 13-23 months, and 2-5 years old. Within each stage the baby is awarded stars for doctors visits, vaccinations, growth and weight progression, breast-feeding, and other age-specific factors. The program is structured in a way that ensures the mother and child are receiving adequate healthcare management from pregnancy to early childhood.  Health literacy remains an area of improvement in the DR.  One of this program’s goal is empowerment of women by progressing health literacy in all mothers.

The 5 Star program

IMCI is a program that was designed by the WHO and UNICEF in 1995 to provide a comprehensive algorithm for the diagnosis and treatment of 5 of most common diseases that cause illness and death in children under 5 years old. These diseases include: pneumonia, diarrhea, malaria, measles and malnutrition. The IMCI aims to improve childhood illness by integrating aspects of nutrition education, vaccinations, and other influential factors including maternal health. The ultimate goal of the program is to reduce mortality, frequency and severity of the illness, by integrating treatment and prevention strategies, to ultimately contribute to the improved health and development of children.

Okay, now that we all understand a little more about the clinic, I can now tell you a little more about what Derek and I have been doing! We live in a 3-bedroom, 2 bathroom house on the grounds of the clinic. The clinic and the guesthouse are surrounded by a 5-foot fence and have a guard on duty 24/7 (that one is for you, Mom!). The house has running water, electricity, WIRELESS internet (thank you to the volunteers who were here a few weeks before us) and ceiling fans. You many have noticed I did not mention air conditioning, but surprisingly the fans keep it fairly cool inside.

Home Sweet Home! The top right picture shows how close our house is to the clinic! We have a full kitchen, cozy living room and quaint dining room! Bottom right is Derek's room complete with a futon and a bright yellow mosquito net! Mosquito net = must have in DR!

We have a roommate! Her name is Liz, she is a recent graduate from Macaulay Honors College at the City College of New York and is participating in a program called the Jeannette K. Watson Fellowship. She arrived June 8^th and is staying for 10 weeks! She is fluent in Spanish and Derek and I are VERY appreciative of it! She has been a great help orienting us to both the clinic and the city of Monte Plata in general. Liz, Abdias (the medical student from Haiti), Derek and I spend a lot of time together, four best friends!

Derek, Liz and I have housekeeper who cooks for us. Her name is Aude and she is a fantastic chef! She has made us a variety of foods and always makes fresh squeezed juices for us! So far, our favorite is her homemade limeade! We are very grateful for her generosity.

Aude prepared two wonderful lunches for us! Top left was chicken with peppers and onions, vegetable salad, brown rice and beans, and a ceviche peppers and onions. Our next lunch was pork chops with peppers and onions, rice, beens,   and fried cauliflower...this was AMAZING! Fruit is abundant here! We always have bananas, mangos, passion fruit, papaya, apples and plantains!

So now for the clinic! As I mentioned before, Thursday was our first day at the clinic, sort of. Derek, Liz and I were up and ready to head over to the clinic at 8am. We were met by Abdias shortly before we left and he informed us that we were to wait at the house for Teresa, the Project Hope coordinator from Santo Domingo. My impression was that she was going to be there shortly, but in reality she came at about lunchtime. So needless to day, our first day at the clinic was not so much in the clinic. When Teresa arrived, she had an American doctor with her. He was interested in volunteering at the Project Hope clinics in the DR.  Teresa gave all of us an introduction to Project Hope and the clinic.

After lunch, Liz and Abdias gave us the official tour of the clinic. It is small, but always bustling with people! After our tour, we met with Dr. Mansueto, a pediatrician.  She began going over the IMCI algorithm with us in great detail. Luckily we had Liz and Abdias to help translate. The algorithm consists of defining the illness, duration, signs and symptoms, classification, treatment, medication, and a follow-up visit. We all ‘roll played’ being the doctor/interviewer and mother/father of the child.  It was surprisingly easy to do. This algorithm was actually designed to be used by anyone, not just a health professional. For instance, a mother can maneuver through it at home to determine the next step in helping her baby, whether it be bring him/her in to see the doctor or to give some acetaminophen to help reduce a fever.

Derek, Liz and I practicing using the IMCI program, Derek was the baby's father. Dr. Mansueto kindly instructed us!

The next day (6/28), we were shown where the clinic stores all of their medications and medical supplies; they call it “the pantry”. It is a large room detached from the clinic filled with medication and boxes of random healthcare products such as tooth paste, mouth wash, facial cleanser, and much more. Each week, a few of the non-medicinal products are selected to go into their “grab bags” which are sold at the pharmacy for a discounted price.

The majority of the medications in the pantry are antibiotics and written in Spanish. But there is a small section of donated medications that are all written in English. Our task for the day was to translate the basic directions and side effects for each of these medications. We made a chart which included the brand and generic names, direction in English and Spanish, common side effects, and any miscellaneous information that we thought was necessary to someone to know about the medication.  We also took it upon ourselves to create a visual aid for ear and eye drop administration similar to other visuals aids that are hung on the walls of the clinic.  Liz was kind enough to help us translate the directions into Spanish.

Creating the English/Spanish medication translation document and some of the medications inside the pantry.

That evening, Liz, Derek and I explored the town. The clinic is about a quarter of a mile outside the main streets of town. The main part of town is filled with people! People were everywhere, walking down the street, shopping, socializing, playing in the park; it was a very happening place on a Friday evening! The main mode of transportation is via motorcycle. They do not wear helmets and they fit as many people as they can on one, including children and infants. It is a bit nerve-racking to see little babies being held on speedy, rickety motorcycle. We saw clothing shops, grocery stores, banks, bancas (equivalent to a lottery shop and are on every street corner), barbershops, ice cream shops, pizzerias, City Hall, churches, murals and lots of stray dogs.

As we explored further and further outside the main streets of the city, you could see the progression of declining wealth. The houses nearest the city proper were concrete, two stories, gated and often had driveways. As we ventured further out, the houses were made out of wood and sheet metal and much smaller. Also many of these homes were off dirt roads that were in bad condition. But the people there seemed happy. They were very friendly, greeted us with a smile and an “hola”, one little girl even said “hi” to us!

Liz, Derek and I adventuring into town!  

On Saturday (6/29), we went for another walk around town, this time exploring the other side. We saw several baseball fields, shops, schools and bancas. We were in search of a real bank, but they appeared to be closed on Saturday, though no hours were posted. While walking, we passed a group of four boys, ages 9-13, and asked them if they like to play baseball and basketball. They told us that they like to play both sports and do karate at the local gymnasium. They were very excited to talk with us…Liz translated, of course! Our walk was cut short as a looming storm that chased us back to the house. It rains here almost every day, but luckily not for too long, showers last anywhere from 10-45 minutes. It is constantly humid and about 85 degrees. My hair really thrives in humidity! (That is a joke for anyone who doesn’t know I have curly, and now really frizzy, hair!)

Exploring more of the city! Pictured are the boys we met outside of the gymnasium. The bottom left is a map of the provinces of the DR painted on the side of a local high school. Bottom right is me standing outside of a local farmacia!

This coming week we will meet with Dana Fitzsimmons, a pharmacist and medical outcomes specialist for Pfizer. Dana spent 4 months between the two Project Hope clinics in 2008. We are excited to meet him! We will let you know what next week has in store for us in our next blog. Until then, adios!