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We were happy to have our second day off today. It was a nice Sunday, and the students and residents decided to take another trip to the beach. This time we opted to stay closer to Santo Domingo, so we asked our usual taxi driver to take us to Boca Chica. This was a popular beach and tourist destination. Many vendors walked the shores selling everything from necklaces and flotation tubes, to hair braiding and sunglasses. We spent many hours floating in the calm, not so clean, water. It was a relaxing morning and afternoon, with good weather. Accompanying us on our excursion was our driver and his son who even got in the water and shared in our makeshift lunch.

Meanwhile, Dr. Dan Lawrence and Dr. Ball went on their own adventure around the capitol district of Santo Domingo. Their stops included several historic museums, Columbus’ son’ house, and finally witnessing a healing prayer session. We met back together at our hostel around 4:30pm where we were met with some maintenance problems. Air conditioners in our rooms were mysteriously not working, and water service would come and go. Despite these problems, all of us came out clean from the beach and ready for an excursion down to the Zona Colonial. With stormy, dark clouds as our companion, we went on a walk to the very touristy, downtown Santo Domingo. Dr. Ball did not come with us, but decided to stay behind at the hostel for some much needed rest and to plan our next clinic day at Ramon Lopez’s location. It was crowded downtown, but in general most stores were closed for Sunday. We made one stop at a much needed souvenir shop. Molly managed to find a Dominican Republic patch for her travel bag, already having patches for all the countries she had visited. Steve found a purse made of pieces of coconut for his mother, as well as postcards for friends and family.

The restaurant we ended up at for the evening was called Anacoanes, a popular establishment with outdoor seating. We got a variety of food, including wraps, pizza, and chicken curry. We managed to finish most of our meal before the rain forced us inside for dessert. After 2 well-made flans and a round of shots covered by the restaurant, we took a taxi back to our hostel, ready for a new clinic tomorrow.

Candace Roman – Medical College of VA MS4

A team photo, for the record:

Today was our 6th day of clinic at the school. After picking up 2 Fulbright students and their 2 friends who help us translate, we arrived around 9 am and were greeted by many cheerful school children. The principal helps coordinate the check-in process by giving each patient a number from 1-100 and the one page form that includes demographic info, progress note, and prescriptions.

Katie and I completed the triage process on the first 70 patients by lunch time. We would get the chief complaint and try to discern who was coming for a “check up” or well visit and those with acute or chronic medical conditions. We’d also take vital signs. Taking a temperature proved to be one of the most challenging aspects of triage–on the next trip I’d like to trade in the DORA THE EXPLORER thermometers for the disposable paper ones that are not so finicky.

We’re happy to have a new team member, Dan. He arrived today directly from the airport and jumped right into the “consultorio” role and was seeing patients by lunch time.

For a cultural experience, after clinic we walked into the village to watch cock fighting. Some of the bravest in the group paid 50 pesos for a seat inside the wooden and barbed wire theater while the meek stayed outside. I think watching one cock fight was enough for most of us. I also wonder if spraying the cocks with chlorox beforehand would really help stop the spread of disease?

We enjoyed a great final dinner for Ranit, who flies home tomorrow, at a restaurant on the ocean. Besides seeing the patients, one of the best aspects of the trip has been the congenial and fun group of physicians, residents and students. More to come tomorrow……

Today our team headed back to Paraiso for another day of clinic and home visits. As usual, we had a harrowing drive, absent of turn signals, obedience to traffic laws and heeding to pedestrians. We really don’t need our morning coffee with the adrenaline rush we get on the way in and I wonder if teaching traffic school might not be more beneficial to the community health than antibiotics and toothbrushes. It’s an interesting transition too, from our hotel to the barrio. We start in the quieter suburbs of our hotel and are soon in the city, surrounded by cars and mopeds on all sides. The sidewalks are full of people headed to work, manning their vending carts or begging at the corners. Then the buildings spread out and the potholes deepen so much I wonder if they will swallow our bus completely. Needless to say, the vehicle has not a spring of suspension left. Shacks appear at the roadside, the streets narrow and we are in Paraiso. I watch this trip every day as if it were a movie, feeling disconnected from it all, but for the people of this city it is their reality.

Every day is hard work, including today, but it is satisfying at the end of the day. I think it is because the people here are so thankful, and because our team is made up of hard working, fun people who I am glad to work with. Dr. Ball is our commander-in-chief who will battle the crush of rush-hour traffic to secure more albendazole, Ranit who is quiet and observant, Sarah who says the swarming school kids drive her nuts but then has them laughing and scrambling after her and Debbie who is continually interested in everyone around her. Then we have Katie with her spark and liveliness, Steve who keeps us laughing but in all seriousness is the glue of our team, Jen who seems delicate but is tough as nails and Candace who works hard but manages to continually be a peaceful influence. They are a blast.

My job today was to travel into Esfuerzo and visit people in their homes. Our guide, as usual, was Luiz. He is tall and gangly, talks a mile and minute and knows everyone. He really cares about his neighborhood. His stride is long with a slight limp as he maneuvers us through the narrow dirt roads with haphazardly built shacks on either side. Motorcycles continually pass us, along with pick-up trucks piled with everything from mattresses to water to sell. Everything looks like it will fall apart if jostled too hard. We visit a few homes to measure height and weight of the children and ask questions about the water supply. The women laugh at us as we ask if their water is safe, and I don’t need to know Spanish to understand the answer is “no way.” As the day goes by I realize that we are really out there to meet with people where they are, more than to bring any great medical help. They are warm, friendly and interested in us. They are thankful for what they have, cliché though it may be, and for that I am glad to know them. I returned home today very happy, again, to be here.

-Mollie Vorster, 2nd year resident at VCU-Shenandoah Valley Family Practice Residency

We returned to the clinic on Wednesday to find the courtyard filled with children shrieking, running, and playing. School was back in session following Monday’s national holiday, Constitution Day. The day proceeded smoothly, albeit accompanied by the new background rumble of a school full of children. Yet again, each team member comfortably filled his/her designated role in triage, consultation, pharmacy, and home visits to Esfuerzo. We continued to treat many of the same complaints: “gripe”, hypertension, tinea infections, body aches, as well as perform well-child exams. The pharmacy began to see a shortage in children’s vitamins, toothbrushes, and the more heavily-prescribed amoxicillin, Tylenol, Motrin, and hydrocortisone cream. We began to redistribute the medications into smaller packages and performed substitutions as necessary. We treated approximately 105 patients today. At the end of the day, the bright-eyed and energetic children swarmed upon us. Enthralled with the foreigners and their cameras, they pleaded to have their photos taken and posed in turn. Even as we piled back into our mini-van, they stuck their heads in through the windows and continued to chatter with us. We returned to a homemade Dominican dinner at the Hostal Yu and discussed our day. The highlight of the day was a large sugarcane given to us by a patient, which turned out to be a good accompaniment for post-dinner mojitos.

-Jennifer Montgomery, 4th year medical student at VCU

Tuesday was our well-deserved day of rest! We arranged for our daily bus driver to take us to Guayacanes, a beach about 1.5 hours drive from the city and it was less touristy than others like Boca Chica. The beach was essentially ours save for a few locals renting umbrellas and the water was clear, warm, and inviting. A nearby restaurant gave us a place to relax from the sun a moment and served delicious mango ice cream in a real frozen mango. We were able to remain on the beach through one rain storm, but our day ended with everyone getting drenched by an afternoon downpour as we ran towards the van. So the ride home was wet but it was the first time we truly appreciated our warm showers since most other days we come home hot needing a cool rinse. Dinner was an exciting experience at a restaurant that catered to entertaining and introducing to local culture. As we waited for our food, two people danced including a dance where one person stood on a rum bottle and was spun around. Afterwards the woman dancer grabbed Dr. Tommy Ball to join her in a dance and he got to show off his latin dancing skills for the entire table. Despite objections, the male dancer grabbed Katie Mitchell to dance as well while the rest of the table brainstormed excuses for why they could not dance, such as gripe, epilepsy, and diarrhea. The night ended as it usually does, laughing together on the 5th floor patio enjoying the breeze and city view.

-Katie Mitchell, 4th year medical student at Georgetown University

Today we left our Hostal at 8:00am and headed in our minivan to Paraiso. We were greeted by about 50-60 locals, all eager to see the Doctor. They were lined up holding their ticket that Magalys (school principal) had handed out before we arrived. We split up to the 3 different rooms, triage, consult, and pharmacy. Dr. Thomas Ball (attending) and Candice Roman, MS IV headed to Esfuerzo with our local guide Luis. They visited 4 different houses, tending to their medical needs and also completing a survey. Dr. Molly Vorster (PGY-3) checked in the patients, collecting demographics and appropriate vitals. Molly noticed that there were more male patients checking in today. And once again a common chief complaint was “gripe”, which can translate into multiple physical symptoms. The patients then headed to a consult room for their visit with the doctor. Dr. Sarah Fellers (PGY-2) and Steve Sosnicki, MS IV were in one consult room. They mostly saw patients with “gripe”, headaches, body aches, rashes and high blood pressure. The other room was staffed by Dr. Debbie Brunner (attending) and Jen Montgomery, MS IV. They also saw some interesting dermatological cases. The patients then headed to the pharmacy to be greeted by Dr. Ranit Mishori (attending) and Katie Mitchell MS IV. Most patients received parasite treatment, vitamins and a tooth brush. Other common medications included antibiotics, anti-hypertensive medications and topical steroids/antifungals. At the end of the day, a total of 100 patients were seen. Highlights of the day included performing minor surgery on the local dog, Heidi by Dr. Molly Vorster. Using sterile technique, Dr. Vorster beautifully removed a tick from its neck. Dr. Fellers says one of the highlights was having a translator who didn’t sneak English. Jen Montgomery was especially excited about the local cuisine served at lunch, and she is known for going for seconds. Katie Mitchell says one of the highlights of the day was also the food (these medical students like to eat!) and was pleased to have a traditional American dinner of pizza with corn topping that night.

-Sarah Fellers, 2nd year Family Medicine Resident at Georgetown University

I received 3 updates, representing the last 3 days in the DR. Not sure who wrote which one, but I will post them individually so as to edit later if needed.

DASV-Hombres Fall 2009 trip to Paraiso, Santo Domingo, Dominican Republic is underway! Day one in our clinic was busy and fruitful.

Our team of 2 attendings, 2 residents, and 4 medical students assembled yesterday. After a morning of counting and packaging meds we visited the site. A brief tour, guided by Wallace, of the neighborhood opened many eyes. This morning we returned full force and set up clinic in the local elementary school. Patients were there waiting for us.

The system of registration had a few kinks, but Katie Mitchell’s organizational skills ironed them out. Ranit Mishori and Candace Roman provide consultation in one room, Molly Vorster and Jennifer Montgomery staffed room 2. Translation in the consultorios was helpfully available thanks to our Fullbright friends Irene and Reina. Patients moved through in family groups and emerged at the Farmacia with prescriptions, which Steve Sosnicki and Sarah Fellers filled and dispensed. The crowd was orderly enough, and seemed to enjoy the festive atmosphere.

In the evening Deb Brunner arrived, supplementing our attending staff. Tomorrow we start home visits and a survey of diarrhea illness in the Esfuerzo barrio. We are hoping for more translators.

–Tommy Ball, MD (trip leader, family medicine residency faculty in Front Royal, VA)

I’m very happy to write that the participants on the current Dominican Republic service trip–all of whom are new to the project–have agreed to write about their experiences. I’ll be posting them to the site as they arrive. The hope is to have a new author daily, and this will allow you to experience the trip through new eyes.

The next medical service team to Paraiso is leaving for the DR in 4 days. The team is made up of physicians from the VCU-Shenandoah Valley Family Practice Residency, Georgetown University’s Family Medicine Residency program, and medical students from VCU School of Medicine and Georgetown University.

This team is planning on being in-country for 13 days, and will be providing direct clinical care for 10 of those days. We’ve tentatively planned on providing care for over 1,000 patients.

This is the third trip to the community this year, and is a major step forward in trying to provide better ongoing care to the community.

This trip was a relocated trip that originally was traveling to Honduras until the political situation there became too unstable to allow the trip to proceed. We might or might not have these participants working in the DR next year, but one never knows how these contacts might develop moving forward.

Hopefully, I’ll be able to provide some updates while the team is in the DR. Keep an eye on this site just in case.

Dominican Aid Society of Virginia

Contact us: DominicanAid@yahoo.com
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