New faces in the Dominican Republic

Disclosure: Certain things will not be explained in complete detail because Jillian and Derek did an amazing job explaining it already (look below).

 Monday, July 29, 2013- We have arrived!!!

We flew in this morning/afternoon. Orlando, Liz and Abdias picked us up and it took close to 2 hours to get from the airport in Santo Domingo to Monte Plata. After arriving we dropped off all our stuff and met the staff at the clinic [which is literally 10 steps away]. We also met Aude who made us amazing food!!! 

Super excited to be here!!!

Tuesday, July 30, 2013- Official 1^st day at the clinic

As part of the 5 stars program, mothers have to exclusively breastfeed their child for 6 months… this literally means EXCLUSIVELY that includes NO water, juices, baby formula etc. So of course I had to know how they could tell if it's exclusive or not because I know from experience that when something is looked down upon it’s easier to fib a little than to admit the truth. That being said, Reyna (the supervising nurse at the clinic) taught us that they are able to tell whether or not a mother has been breastfeeding their child exclusively because the texture of the baby’s skin feels different. A baby who has been breastfeed exclusively has skin that feels soft like a “sponge cake” and if the mother is giving the baby formula it feels thicker due to the increased fat content of the milk.

We spent 2 hours walking around Monte Plata looking for a router (the router that was here before we arrived broke… super sad face). We seriously thought it wouldn’t be that complicated but apparently no one in Monte Plata sells any, not even the “computer stores” in the town. I never realized how dependent we are on the Internet. There’s a landline phone here but the phone number is unknown and I guess it will remain unknown because we have yet to ask anyone for the number

Wednesday, July 31, 2013

Today we shadowed Dr. Rodriguez, a pediatrician. We saw 3 children with typical presentations of dengue. Dengue is a tropical virus transmitted by mosquitoes, which usually breed in standing water. Subjectively, the majority of patients present with headaches, fevers, joint and muscle pains and objectively they have decreased WBC & platelets and an increase in lymphocytes. After the fifth day the WBC and platelets slowly start increasing, with the WBC going up first. When someone has dengue you can only provide symptomatic treatment- acetaminophen for headaches or fevers, keeping them hydrated, etc. Since dengue is viral, antibiotics are not effective and the only thing you can do is monitor the patients' WBCs and platelets and make sure the dengue doesn’t become complicated (will elaborate in a second). Dr. Rodriguez believes [translated] “it's not the illness that kills a patient but the poison that is given to cure it.” For many patients, Dr. Rodriguez didn't prescribe any medications.

Thursday, August 1, 2013- Dengue

       We followed Dr. Monzueta, another pediatrician, today. Six of 16 peds patients had dengue. So we learned a lot more about dengue. According to Dr. Monzueta, there are 3 types of dengue- Classic with no alarm symptoms, with alarm symptoms, and severe (hemorrhagic). Alarm symptoms consist of mild bleeding such as in the nose, gums or bruising, and vomiting. With the hemorrhagic the patient gets internal bleeding which can cause shock and lead to death. Since there is no specific therapy, at this point all that can be done is pray for the patient. Thus “what doesn’t kill us makes us stronger” is a belief that many have, including Dr. Monzueta. Interestingly, although dengue is viral it doesn’t transmit immunity so if someone has had dengue they can get it again, again and again.

       Two of the peds patients also had amebiasis, which is an infection caused by an amoeba (a parasite). This is really really rare in the US and more commonly is seen in underdeveloped parts of the world where there is a lack of adequate sanitation. It is highly contagious and someone who has it can transmit the infection through his or her stool. The doctor prescribed the children metronidazole and told both the child and parent to make sure they wash their hands after using the restroom.

After lunch we shadowed in the “laboratorio.” They do ALMOST everything in this lab. We were able to watch 3 rapid HIV “one step ” tests, which is an immunochromatographic assay that detects the antibodies of HIV in human whole blood serum or plasma. It looks similar to a pregnancy test- 1 line is the control line and a second line if a patient is HIV positive. The test even differentiates whether the patient has HIV type 1 or type 2. If the results are positive, the sample is sent to the capital, where they confirm it using another method. All the HIV results are kept in a HANDWRITTEN book with the patients’ name, cedula (similar to our social security #), DOB, test results (if positive, method used for confirmation and its’ results), technician’s signature and doctor who ordered the test. No one has access to this book except those who are imperative to the patient’s care. 

Friday, August 2, 2013- Santo Domingo

We took the guagua today to Santo Domingo where we will stay for until Monday because we will be participating in a “lactancia materna” walk, which is dedicated to the importance of breastfeeding. 

We were able to see the other clinic (looks almost identical to the one in Monte Plata) and we also met our preceptor (Teresa), Mr. Richard Farland who is the president of Farland Capital Inc and his daughter today. Mr. Farland is very passionate about giving back to the people of the DR. As a child he was raised here for a few years because his father was the last ambassador that served during the dictatorship of Trujillo. Interestingly, he was also once a Project Hope board member. 

At the end of the day, we went to our hotel and took a walk that ended at the best frozen yogurt shop EVER- yogen fruz- a Canadian frozen yogurt company that blends fresh fruits with plain froyo… apparently there’s 2 in VA and we never knew!