Wake up to the sounds of “ GuiNNneoOoo madUUuuro GuiNneo Madurro,” the sing-song voice of the Haitian woman who walks down my street every morning selling “RIiiiIPPpeeee Banaannnasss RIIPpppe Bananannas” from a basket on her head.  I find her voice incredibly soothing.  I have a sore throat. Everybody here always has “gripe” (a word used to describe an assortment of cold symptoms).  I never fully believed that gripe could be so pervasive until I started to live here.  The environmental burdens and lack of public health infrastructure in the Dominican Republic really do lead to poorer health – experienced and vouched for first-hand by yours truly.

Laura heads out the door to meet with Sergia from the Ministry of Public Health.  Part of our partnership-building includes finding mutually beneficial ways to collaborate with the government sector.  Right now we’re looking to incorporate some of the Ministry of Health’s educational materials into our Community Health Workers Training course, and to demonstrate the potential impact our program will have on the region.  She tells me she will stop by our partner clinics to see about our referred patients on her way back.

Crawl out of my mosquito net, flip the light switch.  No hay luz – no electricity.  That means 3 hours until my laptop battery runs out.  Turn on the propane tank, light a match for the stove, boil some drinking water for oatmeal and papaya, plug the modem into the stand-alone battery, and check my e-mail.

Respond to Caitlin, a young American directing a not-for-profit based in Puerto Plata called Project Esperanza.  Plan to meet her tomorrow afternoon to discuss her programs: grassroots schools, a Boy’s Home for street kids, and a summer medical service trip.  We write back and forth about possible collaboration.

Write to Dr. Batch, HHI’s Principal Medical Lecturer for our Community Health Workers Training course.  Touch base about class this Saturday.  He will teach the first half about chronic illnesses, symptoms, and treatment.  I will teach the second half about nutrition, exercise, and the role of the cooperadores in prevention and management of hypertension and diabetes.

Contact Dr. Craig, HHI’s Board Chair.  Joke that I have spent the past seven months drinking coco-locos on the beaches of the Dominican Republic, then confirm date and time for International Programs Directors applicant interviews.  (Our replacements.)

Start creating the resource guide for the ‘Maternal Health’ Community Health Workers Training class.

Get a mosquito bite.  Take a bucket shower.  Immediately start sweating.

Left over rice and beans for lunch before heading out the door.   Dump the bowl of fruit and vegetable peels over the fence for the ducks and chickens that live next door.

“!Hola! Oye, vecino, !tanto tiempo!”  Waves, hand-shakes, acknowledgments, cat calls, hissing, marriage proposals, and hollers as I walk through Monte Llano.

Pass by HHI’s office and pay Janel this month’s rent.  “?Qué lo que Angi?” “What’s up girl?”  Dominoes, boiled yucca, and bachata.

Walk to Pancho Mateo to meet Cedric, our cooperador, to follow up on patients from HHI’s March medical service trip.  I wait for him at his house, chatting with his daughters.  He is one full hour late.  Dominican time.

Equipped with blood pressure cuffs and clipboards we first find Victor, a 5-month old with pneumonia, and his mother.  I have his patient consult form in front of me.  We clarify how long he is to take his antibiotic.  “I thought the doctor said the entire bottle, but then I wasn’t sure.  Okay, now I’m clear.  Gracias.”  No problem, Señora.

3 hours, 15 patients, 6 long conversations, 8 impromptu blood pressure screenings, and 1 very disgruntled Chela later (who is still not convinced the ulcer on her leg will heal although it did look better) I give Cedric a hug and head back to Monte Llano.

Four motorcycle taxi drivers offer me a ride, but I tell them I’m walking.  “You’re going to WALK all the way to Monte Llano?!?”  It is literally 3/4 mile.  Mental note: stress importance of exercise during class on Saturday.

Stop by Meme’s produce stand for some tomatoes and cheese.  He gives me two mangoes with a wink, “One for you and one for Laura.”  He’s the best.

Get stopped by Omar, a friend from when I used to live in Villa Ascensión.  Listen to his story for why he needs $10.  Tell him my story about sustainability, organizational goals and priorities, and empathize about the lack of welfare in the Dominican Republic.  Again listen to his story about why needs $10.  Give up, and tell him I’m sorry but that he’s out of luck.  He asks me to be his girlfriend.  No.

Back at home. Continue to sweat.  Laura got back while I was gone, and is now sitting with her laptop open on our fantastically ugly “futon” – a sofa with a wooden slab that detaches, hand-made by Papo, the carpenter around the corner.  I eat a mango.

Laura and I converse about the past eight hours.  Bounce ideas off of each other.  Adjust the schedule for tomorrow based on today.  Re-design the game plan for the next month.  Imagine an expanded vision for HHI that includes social services.  Argue about our limited capacity.  Discuss a new system of making appointments for follow-up cases.  Organize the stack of resources Laura picked up from Sergia.  Laugh about Omar’s proposal.  Cry about 89-year-old Malhilde in Pancho Mateo lying naked on her bed as Cedric and I checked her blood pressure.  Agree to give our brains a break for the day.

Tomato-eggplant-carrot salad with cheese and a zapote for dinner.

Read “Rules for Radicals” by Saul Alinsky lying in bed before going to sleep.  Shout questions at Laura through my door while scribbling notes under my mosquito net – “What about trying to talk the local insurance companies into cutting deal for our patients?”  “I still don’t think that would allow them the access they need, and who would manage their cases?”  Beat.  “What about having a community supported agriculture program so people can access cheap fresh fruits and vegetables?”  “Good idea. How?”  Beat.

Think.  Read.  Scribble.  Think.  Shout to Laura.

“Laura, Saul Alinsky says his personal philosophy is anchored in optimism, an optimism that brings with it hope, and a will to fight for a better world.  What do you think about that?”  Beat.  “Laura?”  She is asleep.

—–

Were I to write about another day, another week, and a personal experience not related to HHI, I would talk about how my first two plans to go help Haiti fell through.  I would write about how I was introduced to Gerry, a United Nations World Food Program Retiree, business owner, and philanthropist, who is providing 65,000 liters of clean water every day to 12,000 refugees living in a tent community outside Port-au-Prince, Haiti.  I would write about how we shared ideas, how he asked me to go assess the health situation at this camp, how I told him I had no experience, no money, and no power before wholeheartedly agreeing to go.  I would write how I realized that “helping Haiti” was not a short-term decision, but a longer-term commitment, a commitment that I have decided I will make.

I would describe what I witnessed and experienced the four days I was in post-disaster Haiti two weeks ago, and how I have since been working on a project to build compost latrines as a medium term solution for a portion of the 12,000 refugees currently without basic solutions to major sanitation problems.  I would talk about the underlying level of desperation and chaos clinging to the superficial goings-on of normalcy and regular life in Haiti.  I would invite and encourage blog readers to help support this latrine project while reminding them that my work with HHI continues, and how we also seek funds to support our dream of building a new vision of primary care and integrated improvements to community health in the Dominican Republic.  But I am not writing about this day.  This entry will have to wait.

In the words of Mr. Alinsky, I am anchored in optimism and fighting for a better world.

Here’s to tomorrow,

Angi

In Severet recently, I found myself sitting with Dorka and Pedro on their porch, talking and drinking freshly-made chinola juice.  It still amazes me that whenever I show up at someone’s home, regardless of what they are doing or how many people are squeezed into the room, a chair materializes immediately and I’m told to siéntese, siéntese! Sometimes the chair is no more than a few pieces of plywood holding up a piece of threadbare canvas that I gingerly balance myself on top of; sometimes it’s a metal frame with homemade rubber straps criss-crossed into a seat; sometimes a real plastic chair, sometimes even a nice wooden one.  If it’s a family with even a bit of money, a glass of juice is almost always offered as well.  For all the times that I long for a sense of privacy in this culture of open doors, I still can´t help but value it for this feeling of welcome.

Dorka is one of our cooperadores, and Pedro, her husband, is a pastor.  I was there to talk with Dorka about making up the most recent exam in our community health workers training course, which she had to miss because of an event at church.  After I explained the take-home test to her, she went out back to take down the laundry and put the next load up to dry, leaving Pedro and me on the porch.

“Quiero decirte algo.” I want to tell you something.  I hate to admit that my immediate reaction was one of apprehension, anticipating a request for funding for some personal need and having to patiently explain the limitations of my role.  Considering this happens nearly every day, I can’t help but have developed this reflex.  Expressing empathy, while at the same time being clear about what the goals and work of my organization are, is the best way I’ve found to handle these situations. But, it still tears at me.

Instead, in his soft-spoken and eloquent Spanish, Pedro began to talk about work that is never recognized or rewarded.  About feeling that something is the right thing to do, even though it’s difficult and you cannot see the end.  About tackling issues that are bigger than yourself, your family, your needs.  It took me a few minutes to realize what he was talking about.  I’ve watched you come here and into other communities, he said, seen you spend time with the people and get to know their hearts and minds, listened to you talk with them about their health, heard my wife talk enthusiastically about the class she is taking with you.  I know you work very, very hard.  You are far from your family and friends, but you are always smiling. The work you are doing,“es un trabajo de amor.” It’s a labor of love.  What you are doing is a beautiful thing.

I have always considered myself to be self-motivated.  I do what I do because I believe in it.  But sometimes, I get to a point of feeling overwhelmed by everything I know I need and want to do. When others’ advice, for all its good intentions and definite worth, starts feeling like personal judgment.  When even positive feedback feels empty, because sometimes you really need to be here to understand the complexity of the issues.  When I wonder if people in the communities see me as just a young gringa who takes their blood pressure every once in a while, or if they even care about the idea of community health at all.

It’s at times like that when people like Pedro appear and, by some sort of grace, fill me up with a sense of genuine appreciation and affirmation that I can truly believe in.

When I came home and met up with Angi, I told her what Pedro had said.  A look of slight amazement came over her face, as she told me that Johnny, the pastor in Villa Ascensión, had pulled her aside today and given her strikingly similar words of appreciation and support.  We traced our days back, and realized we were each listening to these humbling and rejuvenating words at almost exactly the same time.

It’s kind of nice when the stars align every once in a while.