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Recently, a graduate student at Virginia Commonwealth University wrote up a profile about our international service projects in the Dominican Republic. Although she was curious about my involvement, she also discusses SOMOS and Fundación Sol Naciente. I think she did a nice job as an overview, and I’m posting it in case you’re interested.
So far, the team is coming together. As of right now, we have 2 doctors, a nurse practioner (Margo!), an RN, a 4th year medical student and (hopefully) 2 pharmacists. We keep expanding what services we can provide, so I’m hoping to add some additional providers. If you are interested or know someone who you think would be interested, please let us know about them or them know about us.
As a brief final report from June’s trip, I’m excerpting from the report we submitted to HOMBRE’s leadership:
“Our project was limited somewhat by the fact that I was unable to secure any U.S. providers other than myself to participate on this trip. We had budgeted medications and supplies for 3 physicians working for 8 days. As it turned out, we worked with a Dominican physician on June 4, 5, 6, 10 and 12; and a second Dominican physician on June 7. This limited our total # of patients seen, as we had to spend some time on June 4 and June 7 orienting the Dominican doctors to our system. Also, on June 8 we did not have a Dominican physician and so could see fewer patients that planned.
Overall, our estimate is that we saw approximately 425 patients from June 4-8 and another 100 patients June 10-12 for a total of around 525 patients during the project. I think that, had we been able to secure 1 or 2 more physicians (as I had hoped) we could have easily increased this number to 800 or 900 patients.”
Personally, I am tremendously proud of the HOMBRE students I worked with and am thankful to them for their hard work, their perseverance and resiliance, and impressed by their determination during this project. Kate Zedler, Mai Grant, Zeenia Gilani, Mona Singh, Trevàn Rankin, David Hsu, Max Sirkin, Nhi Nguyen and Katie Sprinkel: all did an amazing job, and I am glad that I was able to work with such an outstanding team. Mohammad Torabinejad (one of the SOMOS students) was invaluable, and many of the community’s residents worked very hard to make this trip a success.
Today, we completed our work in Paraiso. We did not have any other doctors today, so the team spent the morning providing housecalls to chronically ill residents in the community who are not able to get to the school clinic and then in the afternoon moved the medications to the Fudacion Sol Naciente health center. We start there tomorrow morning at 8 am.
To date, we have provided care to more than 400 patients in Paraiso. This will be the first time working in this new site, and we are not sure what to expect. Hopefully, though, this might provide another way to work with an underserved community in Santo Domingo.
Internet access has been very limited, but here wa are. We are just finishing our 3rd day of work in Paraiso, and have seen approximately 300 patients in the school clinic and another dozen on housecalls.
Things have been challenging because our medications have already started to run low, requiring a re-supply today courtesy of a local wholesale pharmacy. Still, we were able to obtain the necessary meds and can continue with a full-speed clinic tomorrow and for the next few days at least.
We´ve been seeing typical illnesses–upper respiratory, GI, high blood pressure and asthma being fairly typical. Among the less common problems are Parkinson´s disease and tuberous sclerosis (a childhood seizure disorder syndrome) as well as a patient just released from the hospital after an apparent episode of unstable angina.
The isolation and marginalization of this community, so near to the capital city and the tourist areas and yet with so few services and such limited access to medical care, is in stark relief as we see patients with treatable illnesses left untreated for the want of access to the healthcare system or to affordable medications.
We have been very welcomed into the community, and the HOMBRE students have been working together as an incredibly generous, flexible and efficient team. They are all talented and focused, skilled at the work we are asking them to do, but fun to be around at the end of the day.
I will try to post again in the next few days now that things seem to be settling in a little bit.
In exciting news, DASV is going to be taking part in a service trip June 2-June 13, 2009. This trip will be as part of Virginia Commonwealth University’s School of Medicine HOMBRE project. This is the first year that DASV will be service site for HOMBRE, and our organization will help with finding the needed medical providers and faciliating their travel.
This will also allow for the first time as an organization, to have a large-scale medical service team in the Dominican Republic during the summer. This is a big step towards sustainablity: if we intend to provide appropriate and adequate medical care to the community, we need to have a greater presence than what has been available to date.
This is a big opportunity for DASV to provide additional care in Paraiso as well as to enhance its effectiveness as an organization. The site will be updated as the dates get closer and plans get clearer.
In April 2006, a thoughtful 2nd year medical student from Yale named Maya Roberts wrote an opinion article published in the Journal of the American Medical Association (JAMA) titled “Duffle Bag Medicine”. This article criticized many short-term medical relief trips that worked in communities with little regard to those communities’ residents. Many of these trips included non-medical volunteers acting in medical roles and the individual groups often had no long-term commitment to the community and lacked even the basic language skills to communicate with the residents.
Ms. Roberts (presumably now Dr. Roberts) pointed out that this approach to medical care would be unacceptable in the United States: poorly trained or untrained volunteers, inability to communicate effectively with a community’s residents, and lack of long-term connection with the community in question lead to unhappy and potentially dangerous results. At best, the medical relief trips may make little difference in the community members’ health and well being. At worst, the trips drain resources that could have been better used elsewhere and run the risk of causing harm or disruption in the community they intend to serve.
This is a great concern of ours. We do not want to fall into the “Duffle Bag Medicine” trap. We have sought a deep and ongoing engagement with the community of Paraiso. We have sought the community’s input throughout the project, and have developed a strong relationship with the community’s leaders: both official and unofficial. We have used a community-oriented focus throughout the medical efforts in the community. Untrained volunteers are not responsible for medical care, but rather work in support roles in the clinic and in community organzation and community development projects.
We recognize that the danger of causing inadvertent harm to the community is very high, and we realize that valuable resources are being used in our efforts in the Dominican Republic. We have sought to be responsible to all of our stakeholders–the community, the providers and other participants, and our supporters–to do right by all of them.
Our eventual goal is to help the community identify the issues that underlie the health of the community (water access, nutrition, etc) and to work with the community members as they develop their own responses to these issues. At the same time, we hope to enhance the medical care we can provide in Paraiso.
We are not providing duffel bag care. We are working with a community-oriented focus and have as a goal a stronger community which is able to address its own concerns and issues in the future–both at the community and medical levels.
(If interested, the JAMA citation is: JAMA 2006; 295(13): 1491-1492)
From January 3 to January 10 2009, we had a team of 13 professionals and 12 undergraduates from the College of William and Mary providing free medical care to the community of Paraiso, near Santo Domingo.
During this time, we provided medical evaluations to nearly 650 patients, both in the school-based clinic and through roving medical outreach teams. Of these patients, 118 (nearly 20%) of them had medical problems severe enough that we will attempt to provide follow up care during our next trip. These medical problems included diabetes, asthma and high blood pressure as well as more urgent short-term problems such as infections.
Our volunteers paid for their own travel, lodging and food costs. The organization was responsible for medicines and necessary medical and office supplies. Considering this, these patients were seen at a cost to the Dominican Aid Society of $3.84 per person.
In future posts, we will describe the current project in more detail in order to give you a better idea of the organization’s current efforts.
January 2009 service team
Dominican Aid Society of Virginia 