Getting things moving!

Sorry for the length of the blog in advance but much has transpired since the last one!

On Sunday morning (6/30), I was awakened by the sound of roosters and the locals on motor bikes and horses as they passed by a path near my bedroom window. For breakfast, I decided to try the cereal that is available here for us. It’s called ‘Fitness’. The cereal in the states that comes closest to it would have to be Oatmeal crisp.  It tasted great but I am not quite sure I if its consumption made me lose many pounds.  My laundry was then hung out to dry from the machine wash the day before. The Dominican heat was able to dry them in under an hour! The initial plan of the day was to visit Los Haitises National Park, which is about 20 minutes from Monte Plata. However, we were uncertain as to what routes the local buses or “Gua Guas” would be taking and how many stops would have to be made before we reached Los Haitises.  We decided to save it for a rainy day. On second thought, that idiom doesn't actually work considering the tropical weather. It will be saved for when mother nature cooperates.  

Instead of staying in for the whole day, I decided to venture into the stadium across the street from our house. Within the roofed gymnasium there is a basketball court, a volleyball court and an area for taekwondo classes. The entire grounds also consists of a baseball field.  Jillian and I have yet to see a game played there. When I entered the gymnasium, I was lucky enough to find someone who spoke some English. I was then able to play some soccer and basketball with the local children who were mostly of high school age. School is out here in the Dominican for the typical eight week long summer break which began June. As a result, the gymnasium is always full throughout the way and it makes for a popular hangout spot for the children.

Gynamasium. It's equipped with basketball court, volleyball court and an area for taekwondo classes

Estadio de Baseball - Isidro Santana (PAPO)

When Monday (7/1/13) arrived, we had come upon the start of new work week here in Monte Plata with the added prospect of staying in Santo Domingo for few days at the end of the week! We also learned that Dana Fitzsimmons and Teresa Narvaez were going to be joining us on Tuesday.  Teresa is the Project Hope country coordinator for the Dominican Republic. Dana Fitzsimmons, as mentioned in the other blogs, is pharmacist based in Washington D.C who will be guiding our activities here in Monte Plata.  For the day, Jillian was able to observe the nurse’s station. She’s making a synopsis of her experiences for this blog.  I went into more detail about the 5 Star program with Abdias.  The main health initiative that is being emphasized in Monte Plata clinic is exclusive breastfeeding for the first 6 months. Breastfeeding is not only free but breast milk provides the best food for optimal growth. The concern here in Monte Plata and other places around the world is that some women stop after a few months. When that happens, there is an increased risk of babies drinking contaminated water and using unsanitary feeding bottles and therefore increasing the risk of infant illness and mortality. If anyone would like more information, feel free to let me know.

From left to right: Abdias, Teresa, Don Ceasar, Liz, Jillian, Dana

Later in the day, I also had the opportunity to shadow a general doctor or family doc. Considering that there are far fewer patients in the afternoon, I was only able to observe one patient.

On Tuesday (7/2/13), Dana and Teresa arrived to greet us in the morning. “Mr. Monte Plata”, Don Ceasar, was also kind enough to greet us and welcome us to Monte Plata. He does a lot of philanthropic work in the community and has been responsible for much of the construction work and development in Monte Plata. Many of his sons are medical doctors. Despite the reverence and respect he has in the community, he does not ask for any special favors. He mentioned that he prefers to give back while he’s alive so he can appreciate the gratitude of giving. The one quote he gave to us, albeit translated, that will stick with me is “Everything is done with feeling.” I think that phrase describes much of what the Dominican people are like.  They are very friendly, sensual, easy going and have an open way of life. Despite the poor conditions that some live in, they still express “le joie de vivre.”. He even offered us coffee and the opportunity to meet his grandchildren. We all thanked him for taking the time to pay us a visit and we told him we would take the time to stop by for some coffee.

This is Orlando showing us the list of medications that were used within the last month. The plan is to have a running list of all the medications including directions for use, side effects and monitoring parameters.  Much of how medications are ordered was also discussed here.  Orlando is the program coordinator for the Monte Plata clinic.

During Dana's reintroduction to the Monte Plata clinic, he hugged many familiar faces that he’d known from his time in the D.R. starting in 2008.  When he can, he tries to make yearly visits to see the progress that is being made in the clinics in the D.R. Dana actually started a program in the D.R. Project Hope clinics called ‘Preguntame 3’ or ‘Ask me 3 questions’.  The questions serve as a verification  system to make sure the patients are getting the necessary information in order to receive adequate care. They questions are: what is my major problem?, what do I need to do? and why is it important for me to do this?” I’m sure Dana feels great pleasure and pride to be able to return to the D.R. and see that the program he created years ago remains sustainable. Afterwards, Dana, Jillian and I talked about the potential projects we could pursue in the remaining 3 weeks we have left in Monte Plata. They are: the teach back method, continuity of care, developing key communication strategies, translations, identifying cultural differences in the area, developing a marketing plan for 5 star program……and many more!

The top 4 pictures are of us in the "community" office.  The bottom two are of us in the storage room which houses a combination of donated meds and those on the inventory. The goal here was discussing how to arrange all the medications stored here more efficiently.  That's the project for us!

My focus will be on assessing and implementing a training program for the nurses about the teach back method.  The teach back method is used not as a way of checking for a patient’s knowledge, but rather their understanding or comprehension.  For example, if a doctor writes a prescription for an Amoxicillin Suspension for a 3 month old baby, the doctor or nurse should ask the baby’s caretaker to repeat back the instructions that he or she said so the baby gets the best treatment.  In the Monte Plata clinic, the nurses give the first dose of a medication on site.  This is a fantastic practice because this allows the clinic to mix the antibiotic suspension, which can be a complicated process for a caretaker at home.  Moreover, it can be an added challenge for a baby’s caretaker to find purified water to reconstitute the medication.  The implementation of the teach back method can help save lives and improve healthcare. The extent of my project will be towards the nursing staff in the “community” office. The “community” office is an area in the clinic where dosing labels are made, dosing instructions are explained and the first dose is administered if need be.  The goal is the idea of ‘training the trainers’. In order words, the trained nurses can train other clinical staff and make the educational process sustainable. If anyone wants to know more about my potential project, let me know.

Assessing the workflow and identifying potential ‘holdups’ in care are important in evaluating how well the clinic is running. When entering the clinic, the patient registers at the front desk. The receptionist gathers their insurance information and they are given a number for when they will be called. Before the patients are seen there is a morning prayer given the fact that the D.R is primarily Roman Catholic.  As the patients are waiting to be seen, there are morning “charlas” or chats. There is a different health topic on different days, so depending on when patients come into the clinic they might not get information on a particular topic that may apply to him or her. The daily chats include health information on AIDS/HIV, breastfeeding, and the 5-Star program to name a few. The challenge is making sure the patients are engaged in the discussion and trying to establish one-on-one time with patients so individual educational needs are met. 

After leaving the clinic, Jillian and I walked around town with Dana. We all had the chance to visit a nearby pharmacy.  Pharmacies in the D.R. function more as drug dispensaries than the multifunction pharmacies seen in the United States. “Farmacia” as they are called are solely drug vendors without an pharmacist, pharmacy intern or technician who has some drug training.  Many prescription only medications found in the United States like Lisinopril are available in the D.R. without a prescription. We haven't yet had the chance to see the popular pharmacies available in hospitals. It would be interesting to note the differences. They, for example, would have the ability to purchase and dispense controlled medications such as Morphine Sulfate.

"Farmacia" in D.R.

In the evening, Teresa played some Dominican music in the guest house.  Dominican music consists of the merengue, salsa and bachata.  The music requires a lot quick leg shifting and hip movement. Having grown up dancing to Cameroonian music such as Makossa, I could see that Dominican Music has some African roots.  Dana, Jillian, Teresa and I all danced to the music.  It was great to dance to latin music for the first time.  I knew I would get to show off my average dance moves!

Jillian and I dancing to some Merengue with Teresa! It's pretty obvious I have no idea what I'm going but I got it going!

Our Dinner for the evening was Pasta, mixed veges and of course the ever delicious "plantanos fritos" or fried plantains.

>Adios until the next one!