“That is my dream,” Cedric concludes, leaving us to ponder his words in a powerful silence.  For the past 20 minutes, we’ve been sitting in a small, sweltering church, listening to Cedric, one of HHI’s community health workers, talk about his hopes for his community and for himself.  “I want to help the people here in Pancho Mateo and also serve as an example for my community in Haiti.  I want to show them that while we cannot achieve much as individuals, as a group we can.  Si se puede, si se puede.” Cedric’s words, softly spoken in lilting Haitian accent, come as a font of inspiration for us.

Cedric, our community health worker from Pancho Mateo

We have been here just over two weeks, and yet it feels like years since we have come to live on this little Caribbean island. It is an island of extremes: cool and refreshing mountain villages just minutes away from hot and dusty city streets, lavish five-star resorts dotting a landscape of extreme poverty, and the coexistence of distinctly unique Dominican and Haitian cultures.

Similarly, the past two weeks of our training has been filled with extremes. There have been lows, to be sure: walking through the barracks constructed by sugar companies for their Haitian migrant workers to see stagnant water, garbage aplenty, and chimney-less homes filled with smoke from cooking fires.  At times, the problems here have seemed overwhelming in their magnitude and scope: one of our first nights, we happened upon a serious motorcycle accident on the highway.  With no helmet laws, no streetlights, and no ambulances, the situation was dire and we felt completely helpless.  It was an immediate and horrifying introduction to one of the many public health issues that abound in this country.

Meg and Nicole with Estela, our community health worker from Negro Melo.

However, there has also been hope.  We spoke with Peralta, a community leader from Saman, about the many initiatives his neighborhood committee has spearheaded, from a public park to a basketball court for children.  We met with Donna, an inspirational and dedicated Canadian who built a clinic up in the mountains in remembrance of a young girl that died of a urinary tract infection — a death entirely preventable by adequate primary care.  We have also partnered with SESPAS, the national Public Health Department, to arrange a class for our community health workers regarding dengue fever prevention.  And, of course, we are continuously grateful for and amazed by Angi and Laura, the outgoing International Program Directors, who have done an incredible job of laying the groundwork for Health Horizons International.

In the end, we’ve realized that Cedric isn’t alone in his dream of promoting community health and neither are we.  Thinking back on the people who have bridged this country’s extremes – rich and poor, Haitians and Dominicans, international NGOs and local leaders – we come to the conclusion of our training with a resounding sense of gratitude and hope.  And with a renewed sense of confidence that “si, se puede.”

Saludos,

Nicole and Meg

Packing my handful of t-shirts and Caribbean souvenirs into two suitcases – 15 minutes.

Changing over names and information for Internet and lease accounts, saying goodbye to friends, neighbors, cooperadores, community partners, and Laura, Jon, Dana, Meg, and Nicole – 1 week.

Fulfilling my term as co-founder and one of the first International Programs Directors for Health Horizons International – Eternity.  And by eternity, I mean 10 months.  But it feels endless.  The work is never-ending, and my dedication enduring, after all.

I write as I sit on the plane flying me back to New Jersey, and my mind simultaneously resists the urge to parachute myself out of here back to Montellano (where neighbors and friends said goodbye by sharing fried cheese and offering gifts of plastic angel figurines) and the urge to propel myself faster than this plane is capable of taking me into the United States (where seatbelts and efficiency, comfort and family will be at my fingertips).

With Mercedes - from whom I drew incredible strength

I don’t have the words that sum up what this past year has been like for me or for Horizontes de Salud.  Something akin to parachuting out of an airplane and propelling forward toward a destination, I think.  What I do have is an extreme amount of gratitude for everybody and everything that allowed for it to happen.  What began as a year-long adventure on a tropical island, a single feeling of compulsion to commit to action, and a glimmer of hope in the musings of a handful of dreamers, has developed into a fully functioning international not-for-profit organization fighting to effect sustained positive change – the first of its kind in the region of Puerto Plata.

As I go on to medical school, “going home to be able to come back,” in the words of new IPD Meg, I leave behind an organization continuing to build a new vision for improving community health in the barrios and bateyes of the northern Dominican coast.  I trust HHI’s leaders will improve the current system that links the passion and experience of international personnel and resources with the realness and necessity of local capacity building and health improvements, while learning from challenges and successes along the way, openly and constructively, never too proud to change for the better.  I enthusiastically remain on HHI’s Board of Directors, playing whatever advisory and supportive role I can this upcoming year.

Laura, Nicole, and Meg - the leadership of HHI.

I know Laura, Nicole, and Megan will continue to effectively expand upon this idea of serving the underserved and marginalized based on a model of solidarity, even though the geographic, cultural, historical, and social distances between the reality of the situation on the ground and that which those of us that work there have the capacity to understand, seem impossibly large.

Still, before moving to the island last October, I had been back and forth several times throughout the past five years, learning, acting, and becoming better, proving to the universe that distances are not so stagnant, or so impossibly long.  I believe the space between here and there is dynamic and relational depending on where you are coming from, where you are, and where you want to go.  For me, it has never been so clear yet so hazy.  I have never felt so full of strength but also ridden with anxiety.  I continue to parachute and propel myself onward, respecting the journey, designing the path, and remaining optimistic of what remains beyond the horizon, regardless of the length of the distance or number of hurdles along the way.

With hope and gratitude posting from New Jersey,

Angi

After months of recruitment, preparation, and anticipation, we finally welcomed HHI’s new International Programs Directors, Megan Schultz and Nicole Pfeiffer, to the Dominican Republic last week.  Over the course of the year ahead, Meg and Nicole will be taking to new heights what Angi and I began here in the DR.  Our first few days of training have been filled with ideas, questions, community introductions, and meetings, and they will soon be taking the reins as Angi and I transition out.  Loyal blog audience, meet the newest additions to HHI:

Nicole comes to HHI from Chile, where she spent the last two years working for the English Opens Doors Program, a joint initiative of the Chilean Ministry of Education and United Nations Development Programme.  She taught English in the desert mining town of Copiapo, and was later hired to manage international promotion for the EOD program in Santiago.  Originally from New Jersey, she graduated from The College of New Jersey in 2008 with a Bachelors Degree in International Studies and English, and also completed study abroad programs in Argentina and Thailand.  She brings experience working on behalf of marginalized communities around the world, including elderly and disabled residents of inner-city Trenton, low-income high school students in Union NJ, women and children affected by AIDS in Thailand, refugee children from Myanmar, and abandoned and runaway teenage girls in Chile.  She also interned for the International Organization for Adolescents, where she assisted in researching strategies to prevent child trafficking, and was awarded the International Studies Research Award from TCNJ for outstanding independent research.  Nicole is passionate about improving global health and promoting cross-cultural exchange.

Meg comes to the Dominican Republic after completing her third year at the University of Wisconsin School of Medicine & Public Health, and will be dedicating the next year to HHI before returning to earn her MD.  While an undergraduate, she studied abroad in the Dominican Republic with a focus on community and public health.  After graduating from college with majors in English Literature and Spanish, she joined Teach for America and worked as a high school Spanish teacher in Baltimore.  She obtained a Masters in Education from Johns Hopkins University in 2005 before moving to Boston to complete the post-baccalaureate pre-medicine program at Harvard University.  She also worked at Partners In Health, assisting with multi-drug resistant tuberculosis research in Peru and later developing a curriculum for community health workers in Rwanda, Lesotho, Malawi and Haiti.  As a medical student, Meg was named a Future Leader in Preventive Medicine by the American College of Preventive Medicine and a Global Health Scholar by the American Medical Student Association.  She served as President of the MEDiC Council, a network of student-run free clinics in Madison, and Student Leader of the UW Chapter of Physicians for Human Rights.  Meg is passionate about the roles of education and healthcare as agents of social change and justice.

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With one week until Angi’s departure and the beginning of her first year of medical school, and two weeks until I move into my new role as HHI’s Executive Director, we are on the brink of a major transition.  It’s encouraging and motivating to know that our international presence will be in strong hands with Meg and Nicole.  The blog will not be the Angi-and-Laura Show anymore, but will be expanding to include articles by the new IPDs, trip members, Board members, and other guest bloggers — anyone who is involved with HHI.  Many welcomes and much growth ahead!

Adios for now,

Laura

Jon screening for cardiovascular risk factors in Severet

As many of you avid HHIBlog readers know, Angi and Laura have done an excellent job conveying both the fascinating and important work they do here as well as providing for us, the loyal readers, a snapshot into the day-to-day lives of these awesome individuals. But now, as Dana and I (or Jon and I, as we are writing this together) transition from HHI fans to HHI staff, I think there is one necessary aspect that we need to convey-

Everything here is so small! One thing I will say about Laura and Angi, despite the fantastically huge achievements of theirs, physically they are not quite as imposing. So we were in for a little bit of a surprise when we stuffed ourselves onto gua-guas with legroom for our 14 year old selves, or packed onto motoconchos with butts hanging off the back and knees jutting out into the sugarcane. Not a lot of comfortable travel options for the giant gringos that we are! In fact, after over 250 heights collected in various communities around Monte Llano (as well as blood pressures, blood sugars, weights and circumferences!) not a SINGLE man has been taller than Jon nor a SINGLE female taller than Dana!

Dana - HHI's Summer Investigadora

That’s ok though – because there is a serious benefit to being the giant gringos wandering door to door in these communities. We are very recognizable! Being both extremely recognizable and working in the communities day after day has really ingratiated us to the people that we are collecting data from. We have been offered coffee, limoncillos, and coconuts freshly retrieved from the 30 foot tall tree (we have accepted). We have been hunted down and asked to go screen a person’s aunt or friend across town. We have had throngs of children excited to wander with the giant gringos, or perhaps more morbidly, excited to watch us poke people with (a very tiny) needle and create 1 drop of blood for a glucose reading.

Jon screening community members in Pancho Mateo

The most gratifying thing for us, though, has been watching people in the community get on board with our project. As we first approach a group of houses people are generally wary of us. What do these tall people who appear to be siblings want from us? To test my blood pressure? A BLOOD TEST?! Why would I do such a thing!? But after we conduct all 6 minutes of the survey and measurements and they realize how quickly they can learn substantial things about their health, they are quickly gathering their grown children, their neighbors, their parents, everyone nearby so that these people too can learn about their health and contribute to the picture of cardiovascular health in their community. Nobody helps us more to convince those unwilling to submit to a blood test than the person that we have just tested immediately prior. It’s amazing to watch again and again. After awhile, even the ever-present children are running to us begging to have us take their blood sugars so that they can contribute too (we don’t oblige them, although sometimes a joking reach for the needle will make them think twice).

Dana taking blood

Last weekend, we celebrated a great milestone in our work to establish HHI’s international programs: the end of our community health workers training course.  The last eight months since we started the course have been an incredible learning process, and while this is really only the end of the first step, it was worth the celebration.  About sixty friends, family members, and community partners were there to honor our sixteen first-ever cooperadores de salud, and the beginning of their roles as promoters, providers, and leaders in health in their communities.

After a delicious lunch of rice, beans, chicken, and salad – cooked by the two wonderful women of the Rancho Típico Montellano, a local restaurant/bar/club/carwash (a common combo in the DR) that we rented out for the afternoon – Angi, Jon, Dana and I welcomed the guests. I was glad that so many community members were there to hear more about HHI and the cooperadores program.  The more individuals that understand and are engaged in our work, the better and more effectively our programs will be able to serve their communities.  Angi then said a few words to remind everyone of the value of service and the power to create change – themes that we continually highlighted throughout training.

The cooperadores then stood an recited the Community Health Workers Oath:

“With my family and my community as witnesses, I promise to be an honorable, fair, and kind community health worker.  I will use my knowledge and resources for the benefit of my entire community.  I will treat others with compassion and patience.  I will work together with my community and with HHI. I will fulfill the responsibilities of a community health worker and dedicate myself to improving community health. I will do this work out of my own will, from my heart, for the love of God and the world.”

Mercedes taking her oath.

Thanks to generous donations of first-aid supplies, stethoscopes, and blood pressure cuffs from Covidien, McKesson, Deb & Cris Freitas, and this year’s medical service trip participants, we were able to provide each cooperador with a certificate and first-aid kit.  As a side note, Angi bought out the entire supply of lunchboxes at La Sirena to turn into first-aid kits, and it was probably quite a sight to see Jon, Dana, Angi, her friend Kristin, and me walking down the highway carrying sixteen brightly colored lunchboxes on our arms.

Blanco receives his certificate and first-aid kit.

Isabel steps up to a round of applause.

With their new knowledge, support, and resources, the cooperadores will be responsible for following up with patients, including those being treated for chronic illnesses like hypertension.  They will design and present health education workshops three times per year, as well as hold weekly “office hours” for people in their communities to come talk or consult their course materials, which cover topics like first-aid and emergencies, community education and public health, preventing and treating chronic and infectious disease, and caring for vulnerable populations.

The cooperadores from communities where we hold medical service trips will also play a crucial role in ensuring our clinics provide the best quality care possible.  As the program gets going, they will be able to identify community health problems, design interventions, and implement solutions with HHI’s support – creating lasting change in the health of underserved communities.

As we wrapped up, our cooperadora from Severet, Dorka, asked if she could say a few words.  It’s always an experience to hear Dorka speak – as a pastor, her passionate eloquence and ability to deliver a message is rivaled by few.  Her words, full of appreciation and hope, inspired her fellow cooperadores to take what they have learned and put it into practice.  She also generously offered a beautiful prayer for HHI and the people who work to fulfill its vision.

After that, photo-ops!

Antonia & Chichi

Estela and her proud family.

Now the work of management, evaluation, adaptation, and growth begins in full force.  The new IPDs (stay tuned for an introduction!) will be spearheading these efforts over the course of the next year.  We have such an opportunity to create change in the way health is understood, promoted, valued, and defended.  I know it will continue to be a long and challenging road, but at the end of it, I cannot be anything but optimistic.

Felicitaciones a todos!

With a sigh of relief at the amazing fact that an event in the DR went off without a hitch, and a high-five for all the day represented, we set off back down the highway.  Saturday afternoon was spent at the beach, for sure.

Always,

Laura

PS: Thank you Kristin for all her beautiful photography during the celebration!