Audience, you will have to excuse our delay in posting.  Please believe that these past couple of weeks have been “full, full, full,” as they say in Latin America, of learning experiences, growth, and adventures.  And now, for one of each:

November’s Short-Term Medical Service Trip

Beginning with a very significant learning experience – the happening of HHI’s first short-term medical service trip!  (Aplauso.)  Ayaz, one of the doctors on the HHI board of directors, led a team of 5 fantastic doctors from the Stamford and UConn Family Residency Programs in providing primary care to several village communities in our area – La Cienega, Severet, Arroyo de Leche, Mosovi, Negro Melo, Baraguana, and Agua Negra.

We worked in villages that had limited access to health care, always trying to fill a gap in need rather than duplicating or disrupting what is already available.  In the villages where we had community health workers, we leveraged their leadership and clout by having them organize the flow of patients, and make note of those that needed follow up care.

The clinics ran smoothly, and the doctors were amazing.  Their dedication to the cause showed, not only in their thorough consultations and flexibility in the pharmacy, but also in their sweaty brows/backs and meaningful debriefing conversations during lunches, drives into the villages, and free time at the beach.  I feel confident that the communities sensed (and smelled) how hard they were working.  We as HHI, hope to continue collaborating with each of the communities in which we worked.  I am grateful to the doctors that were here, and am proud to be called a member of their team.

In retrospect, it’s almost unbelievable that all of my personal experience in the Dominican Republic up until now has been based off of my own participation in these week-long trips.  The past three times I was here, I went home to the United States after several days of clinic, rinsed away any remnants of scabies shampoo and deworming fluid, and washed my clothes two times in a fully functioning washer/dryer before starting classes the following Monday – back to reality.  Now, as International Programs Director for HHI, part of my role is to connect patients to resources after our doctors leave, to develop a better referral system, and to follow-up with patients.  In this reality, not only is showering and laundry all the more difficult to do in the campo where we live, but so is actually addressing the longer term health care needs of our patients, and being true to our mission of being an organization that works toward continuous health care.

So we try.  Since the trip, we have:

1. Established a dental referral agreement with Hospital Gregorio Luperon in Montellano.  All patients referred to Gregorio Luperon by HHI’s operatives will pay for half of the services rendered.  HHI will pay the other half.
2. Developed a plan of action on how to make improvements for the January & March trips.  HHI trips will have a standardized pharmacy, referral system, and training manual.
3. Incorporated the community health worker role into HHI medical service trips.  Community health workers will be the point people within the communities for organization and facilitation of follow up care.

Men in Suits Enter the Village

And now, growth.  Two weeks ago, we had a meeting with ProBateyes – a multi-service organization affiliated with several NGOs as well as the Dominican State Department of Economy, Planning and Development.  The director, Dr. Joaquín Ramirez, his secretary Madelyn, and driver Amaury arrived, along with Dr. Batch, and Dr. Lesley, in a caravan of white SUVs and sat at our kitchen table here at Villa Ascensión as we discussed how HHI and ProBateyes could collaborate.

The meeting was a bit surreal – we don’t see directors of major organizations, never mind business casual dress, in the village all too often – but it was also productive.  Dr. Ramirez has offered to speak to the Department of Public Health about HHI and our Community Health Worker course, we shared ideas on how to improve our own short-term medical trips, and set a date for a follow up meeting in the beginning of December.

Giving Danke

Finally, the adventure.  What was supposed to be a day-long meet and greet with one of ILAC’s rural communities, its community health workers, and the short-term medical service team that was running a clinic outside Santiago, became a week long stint of translation and on-the-ground learning with a team of 15 German doctors.  In one of the more interesting experiences during my time here so far, I suctioned for a dentist, shadowed and translated for a gynecologist, and learned how follow-up and continuity works for ILAC’s short-term medical service trips.

Their team was comprised of specialists and general practitioners, and the clinic was set up in one village for the entire week.  Patients traveled there to be treated, and the community health workers of each village managed transportation and registration.  We stayed in the homes of members of the community, and ate three home cooked meals together as a team.  It was informative to learn from this very gracious team of doctors, community health workers, and ILAC’s staff.  Laura and I now have a concrete visual of how ILAC’s short-term medical service trips work in practice.  During Thanksgiving dinner, we had a conversation with Jose Miguel, Director of Administration of ILAC, where he advised us on how to move forward from here, and stressed ILAC’s interest in collaborating with Health Horizons International.  We were filled with gratitude (and fried plantains – we didn’t celebrate Thanksgiving very traditionally, considering we were the only Americans among a bunch of Dominicans and Germans.)  I look forward to presenting at ILAC’s Board meeting in February and am excited by our partnership that continues to mature.

Working in the developing world in the context of health care, on a day of thanksgiving, I cannot help but feel overwhelmingly grateful for my own personal education, health, and mere existence.  Furthermore, I am thankful for the communities and organizations we have met and continue to work with here in the Dominican Republic.  I am thankful that HHI has the opportunity to have a stable presence here, and to grow.  I am thankful to work alongside community as we fight together for the goal of education, health, and equal existence for all.

With Humility and Thankfulness,

Angi

¨So in this situation, which role are you playing: the health promoter, the medical provider, or the community leader?”

I caught Angi’s eye from across the room as Dr. Frandi posed this question to our first community health worker class, and neither of us could help but smile.  Our last two weeks here have been devoted entirely to the planning and development of our curso de capacitación: “Primeros Auxilios y Formación de Cooperadores de Salud” (First Aid and Development of the Community Health Worker).  The course is a realization of one of our objectives for being here: to train and support a team of individuals from area villages as community health workers.  The cooperadores will play a crucial role in building their community’s interest and investment in health, along with improving access to and continuity of health care.  Although we did not originally think we would be tackling this objective so soon, the timing of our arrival serrendipitously coincided with Dr. Batch’s readiness to get this program off its feet.

When we were in Santiago a few weekends ago, we took a day to visit ILAC, a well-established health and social service organization whose rural community health worker program is truly something to aspire to.  We spent the entire day touring the main campus and meeting with the Director of Administration and several other staff members.  We learned so much about how to successfully start a program of our own.  Drawing on ILAC and on our research into other community health worker programs, we continued working closely with Dr. Batch to build out a curriculum.  We are also partnering with Crossroads and the Dominican Red Cross, from which Dr. Bob and Juan Carlos have given us indispensible advice and support.  From the logistics around creating and printing course packs (all in Spanish, of course!), securing classroom space, and writing budgets, to long and passionate discussions about our ideas and goals for the program, our long-term vision, and our roles as members of a leadership team, the process of getting to Day One was an intensive and exciting one.

The course now has 18 students from 12 village communities around the Puerto Plata region. The group ranges in age, the youngest being 15, and the oldest well into his 40s, and is also diverse in terms of past experience in health, education and literacy level, gender, and race.   The recruitment process carried us across the rural countryside to some of the most remote villages in the area, where access to medical care is most challenging for geographic, economic, and socio-cultural reasons.  We went through local leaders and government to describe the program, and the type of person we were looking for – someone who is respected within the community, who has the desire to help others, and is responsible and motivated.  Not only were the pastors, town council presidents, and other community leaders we spoke with incredibly eager to refer us to potential students, but now that they are familiar with the program, they will be crucial advocates as we look to become more and more involved in their villages.

The instructors for the course are all local Haitian doctors, and are some of the most inspiring people I’ve ever known.  They are all members of AMHEUD (Association of Haitian Doctors Graduated from Dominican Universities), and/or FONLOMBAY (Extend a Hand Foundation), two organizatons dedicated to supporting and improving the well-being of Haitian communities.  Getting to know them has been amazing, and it’s especially exciting that we’ve really grown to work in a collaborative partnership.  That’s why Dr. Frandi’s presenting his clinical case, while also tying in the broader community health worker roles that Angi and I had laid out, was so meaningful.  We worked very hard to come to a consensus about what this course was going to be all about, and it seems to have paid off so far!

The course itself is designed to train competent and multidisciplinary cooperadores de salud who will function as health promoters, medical care providers, and community leaders.  Specifically, the students will:

• receive first-aid training,
• learn about disease prevention and how to treat basic illnesses, and
• learn different methods of educating their communities and working with them to address individual and public health concerns

The format of the classes includes lecture and classroom activities and discussions, hands-on training at two local hospitals, and community-based research projects with in-class presentations.  We will also be giving exams and doing periodic individual feedback sessions to evaluate progress and the effectiveness of the course itself.  The class will meet all together once a week on Saturday mornings for the next year.

 

As cooperadores, we envision the students as having important responsibilities within their communities:

• They will be giving monthly charlas (educational talks) and developing programs and activities to meet the health needs of the people, in collaboration with already existing health care organizations and local Health Committees.
• They will be on-call for providing first-aid in case of emergencies, and will also help to coordinate care for people who are ill.  This coordination and continuity of care role also applies to HHI’s medical service trips — our goal is basically for the short-term trips to function in partnership with local systems and to thereby supplement their capacity.
• They will be advocates and leaders for their communities, and work in partnership with individuals and organizations to address health issues on a community level.

The first class went over all of these details, and included small and large group discussions about health and illness, a clinical case study, personal goals for the course and for their future positions, and expectations and responsibilities as students.  We created a contract together so that everyone had a say in setting ground rules.  Finally, we administered a pre-test to establish a baseline and get an idea of everyone’s previous knowledge about first aid, since this is the first module we will be teaching.

Hopefully this gives a clearer idea of what exactly the curso de capacitación is, and please feel free to leave us questions and comments!  I am so happy with how the first class went, and it was wonderful to see how enthusiastic the students were to be involved.  Even though we’re definitely still being cautiously optimistic, Dr. Batch, Angi, and I may have high-fived afterwards.

Our first HHI medical service trip is arriving on Saturday, so we imagine it will be another busy week ahead!

Until next time,
Laura