More work and visits before our final goodbyes - Last week in DR!

We spoke to our preceptor, Teresa, to inquire about the possibility to returning to Santo Domingo to see a hospital in the capital.  Luckily, she said we could spend our last couple of days in D.R. in the capital city!  This meant that our last day in Monte Plata would be Monday (7/22). As a partying project, we made a video about the transformation of the storage room and various items that are available therein.  The final video will consist of Abdias, Liz, Jillian and I introducing ourselves as different members of a healthcare team and how we utilized our skills to make the storage room more efficient. After that short segment, the video will be edited and there will be a voice over describing the different sections of the storage room. Before leaving Monte Plata, we thanked the staff for being so welcoming and receptive to our ideas.

The staff at the Monte Plata Project Hope clinic are truly fantastic. They are passionate about their work and are very receptive to new ideas for the benefit of the people of Monte Plata. I'm surprised we actually ended up taking this group photo. Everyone seemed busy at the time but it turned out very well.

We checked in the same Hostel as before, Dominico Mundial, in Santo Domingo that is located in Zona Colonial. It is an ideal location because the it is a major tourist attraction.  It is home to the first cathedral built in the Americas and the first pharmaceutical company in the Americas.  There are also many parks, museums and a walking mall that encompasses many restaurants and shops.      

The next day (7/23), we went to the big Project Hope almacén in Santo Domingo.  In this instance, this almacén translates to actually being a big warehouse. Inside there’s a section of the warehouse reserved specifically for Project Hope items.  Even though the section of the warehouse is for Project Hope, the Order of Malta actually owns the space.  Much of the items are donations from AmeriCares, Gifts in Kind (GIK) and Food for the poor.  This almacén functions as a distribution center for many Project Hope affiliated institutions in the country.  We spent some time making sections for syringes by volume, syringes with needles by gauge and also insulin syringes.  Organization in this almacén isn’t as important because its main purpose is to serve as a distribution center as opposed to a storage unit. 

The middle picture shows some of the signs we created for syringes, syringes with needles and insulin syringes so they could be easily identified

Wednesday was exciting since we would be getting the chance to see the Ministry of Public Health. The Ministry of Public Health is the national health authority in the Dominican Republic.  In short, their mission is to ensure access to quality healthcare, promote health programs and to enhance user satisfaction and generate public awareness in matters of health. We also given a tour of the many areas including their almacén, pharmacy and various people in charge of making sure the proper paperwork is and used and used correctly as well as making sure the medications are handled correctly until they reach their final destination.

Jillian, Liz and I in front of the Ministry of Public Health sign in Santo Domingo

On Thursday, we had the opportunity to visit a medical sub-center. This was as close as we could get to a hospital. The director of the sub-center was kind enough to give us a tour of the building. We saw the operating rooms, inpatient rooms, nursery, emergency room, pharmacy, and more. The most shocking room was the nursery. It was empty, literally empty. There were several beds for mothers and several metal cribs for the babies. The cribs for the babies did not have mattresses in them because previous babies had soiled them and the sub-center could not afford to get new ones. We were all very shocked by this room. Maybe Project HOPE can help them find more waterproof mattresses or more preferably waterproof mattresses.  It would ideal if the sub-center itself could afford to purchase some on its own as well as occasionally receive donations from Project Hope.

The main part of our tour was the pharmacy. It was a rather small room filled from floor to ceiling with medicines. This was the main pharmacy for the sub-center. If a medication is needed in another department they have to come to this pharmacy to obtain the medication. This pharmacy also had a small “pick-up” window where patients could bring prescriptions. While we were touring a patient came with a prescription for simvastatin. The pharmacy technician grabbed the bottle of simvastatin and just poured some into small cup, this is what we would call “eye-balling” it. Jillian and I took the time to look at a few of the medications on the pharmacy shelves. This was the first pharmacy where we saw contraception outside of the emergency contraception with we saw at the Padre Martin pharmacy in Monte Plata. They had two different brands including a copper Intra Uterine Device (IUD). They told us that they dispense it often. This was also the first place where we saw narcotic medications. These were kept in a locked cabinet.

 

Some pictures from our visit at the sub-center hospital in Santo Domingo. The top left picture shows the empty cribs that we saw in the nursery. Hopefully that room can become usable with waterproof mattresses. The rectangular picture on the left shows one of narcotic medications available in pharmacy's locked cabinet. This was morphine sulfate. The two middle pictures are of the contraception available at the pharmacy.

For our last two work days in the D.R. (7/23 and 7/24), we were able to teach the ‘teach back method’ to the staff of the Herrera clinic in Santo Domingo.  Thanks to Liz and a medical student at the clinic, Jillian and I were able express the importance of the method. This time, we actually went through a mock patient interaction scenario where the method would be utilized.  I believe the ‘teach back method’ can have a greater impact in Herrera clinic relative to Monte Plata because patients are not given the first dose of the their medication in the community health room. Furthermore, it was important for doctors to be cognizant of the methods since they play a vital in making sure patients know critical information about their medications.  They may be the only one to give patients health information throughout their stay at the clinic. Despite the Herrera clinic being in the bustling city of Santo Domingo with many patients, the method has the chance for increased patient compliance and health literacy.

Teach back presentation and discussion at the Herrera clinic in a meeting room in Santo Domingo

Friday was rather short since we had an afternoon flight. Jillian and I went into town to purchase some last minute souvenirs. Teresa was very thoughtful in taking time out of her busy schedule to pay us a visit before we left. I consider her my mother in the Dominican. We said our finals goodbyes. It was truly amazing to come in contact so many great people who do great things for the betterment of others and society as a whole. It has truly been an unforgettable experience.

And that wraps up our journey in the D.R! Hope you enjoyed reading. Look out for 2 more final recap blogs of our experiences in the D.R from Jillian and I.