Having experienced both the May Medical Service Trip and a two-week Patient Care Management term, Rachel and I were fortunate enough to gain a broad perspective of the HHI model, vision, and success stories. There were several elements of the organization that impressed me, including the sense of community, the team approach to important matters, and the many ways in which HHI has grown during its brief history. It was not until I returned to New York and was reflecting on my experience in the Dominican Republic that I realized the scope of organizational development that I witnessed in less than one month in Montellano. The recent advancements in the community health worker program, the main office structure, and the staff house will undoubtedly assist in better serving the communities of Arroyo de Leche, Negro Melo, Severet, and Pancho Mateo.

The outstanding group of community health workers (cooperadores) is a collection of extremely dedicated individuals who strive to educate themselves on essential health issues in order to educate their communities and improve the quality of life of those around them. In the weeks and months before I arrived in the DR, a new group of cooperadores began their training and started reaching out to members of their communities to provide basic health services and support. These nine newcomers joined the six veteran cooperadores to form a small army of community health workers. I was absolutely blown away by their commitment and enthusiasm. Many of the cooperadores spent the clinic days greeting the patients to whom they had given appointment cards, taking blood pressures, and sometimes accompanying their respective patients to consults with the HHI medical service trip physicians. After the conclusion of the service trip, this team of dedicated community health workers performed home visits to follow-up on patients’ progress. With the newly-expanded team of cooperadores, I know that the communities will continue to receive the support and education that they need.

Another great stride in the development of HHI that Rachel and I witnessed was the relocation of the HHI headquarters to a convenient location. Due to the growing number of patient records that had been accumulating in the staff house and the increased supply of medications being stored in the apartment, personal and professional spaces had become intertwined. Fortunately, HHI was able to rent a great space with plenty of storage closets, and Rachel took the lead in carrying the records and medicines (in 95º heat) to the brand new office! Located across the street from Maternidad Hospital and in the same building as a diagnostic testing center, this new professional space reflects the growth of the organization and HHI’s commitment to utilizing services offered by local hospitals and clinics.

Lastly, with the staff house now freed from filing cabinets of patient records and suitcases full of medications, our apartment seemed a bit more like ‘home.’ Employees and volunteers now have a great place to congregate, discuss the day’s activities, plan for the future, and then relax at the end of the day. Even more exciting was the purchase and installation of an inverter that will keep power running at the staff house 24 hours a day! This addition also means that the internet modem and router will keep the world-wide web flowing through staff house all day, every day—connecting HHI’s staff with those who care about the organization’s progress. I cannot express how important this advancement was and how it will continue to impact HHI’s ability to outreach to the Board, stakeholders, former volunteers, potential volunteers, family, friends, and more.

I feel so privileged to have spent nearly a month working with HHI—an organization that truly lives its mission and strives to perfect its model. I look forward to following HHI’s progress and seeing how it continues to grow and develop in the future with the help of amazing staff members, volunteers, and cooperadores. Que les vaya muy bien!

It has only been 16 months since I last volunteered on a medical service trip with HHI, but I have been astounded by the changes that have occurred in that short period of time. To my delight, I found that most patients are seen by appointment, thus concentrating on those with pressing medical needs and/or previously identified chronic diseases. While there are still walk-in hours, we can now focus on those most in need of the help of an experienced physician. Unlike last year, each patient who is seen now also has a medical chart which contains a problem list, a medication and allergy list, previous clinic visit notes, labs and x-ray reports. Given the cultural and language barriers that are present, having a chart very quickly gets a doctor up to speed on what the patients’ basic issues are and what their past experiences with HHI have been.

In the past, we relied heavily on surplus drugs from the U.S. donated by pharmaceutical companies. This was problematic in that many of the medications were expensive and inappropriate for the impoverished residents of our communities – once the samples we gave were gone, there was no way to continue with therapy. Now, however, HHI has a rational, appropriate formulary using locally purchased drugs at very low cost. Not only are we supporting the local economy, but we are able to provide low-cost therapies to patients on an ongoing basis.

There is now also the ability to make referrals for services such as labs, ultrasounds, x-rays and specialty consultations. By carefully selecting our referrals, we are able to subsidize this care, negotiating prices on behalf of our communities and then helping to foot the bill for both medical care and transportation. This is an entirely new level of integration with medical services that just last year were out of reach for our patients, either due to cost or distance. Most remarkable of all was the new corps of cooperadores, or community health workers, in each community. The cooperadores help organize the clinics, case-find sick patients and follow-up on chronic disease patients by making sure they are taking their medications properly and assuring that they come to their follow-up visit every four months.

On our first clinic day in Negro Melo, it was raining cats and dogs; Megan and Nicole were worried that follow-up patients would not keep their appointments. However, in spite of the pounding rain and rivers of water and mud, just about every scheduled patient showed up for their appointment! One wonders how many of our patients back home would walk through ankle-deep mud during a downpour to go to a blood pressure check! You just have to love it! I’ll be coming back next year and can hardly wait to see what new wonders of primary care HHI has created on the ground in the communities of Negro Melo, Severet and Pancho Mateo!

– Dr. Good
For more information about Health Horizons International, please visit: www.hhidr.org

After three too-short weeks in Montellano, following four months of adjusting to life and work in the States, I pressed my face against the airplane window for take-off.  I was surprised to feel the plane arc back, instead of heading straight out over the ocean.  A new flight path, tracing the shore of the north coast from above.

As I watched through a window not much larger than a notebook page, the entirety of my life’s current work was suddenly laid out before me.  I could make out the smokestack of the old sugarcane refinery, and walk my eyes a few blocks to the right, where I knew our office stood in the shade of some coconut trees.  The ocean is much closer than I realized; the tall sugarcane and warnings of danger have prevented me from ever walking that way.  I could trace the main road in Montellano from where it intersects the highway, turning right then left at the old train, memorializing the time when cane was hauled from the fields by rail, and over the rickety bridge to the sugarcane road.  From there, miles of cane and mountains, where I had just said goodbye again to people, communities, hidden from sight in so many ways, the least of which is from up here in the sky.  With the bay of Sosua peeking out from the left, and the unmistakable bend in the highway at Gran Parada on the right, everything and everyone we work so hard to serve and empower were captured in a 10-inch picture frame.

It’s humbling to remember how small we are.  It’s even more humbling to realize how many people — living, dying, suffering, celebrating, healing, hurting, working, fighting people — can exist in a single windowpane.  It’s a dual perspective afforded only by taking a step back — by getting a bird’s-eye view.

The few months after I returned to the States in September were, in retrospect, more challenging than I even realized at the time.  Progress was made and plans were implemented, but every day brought a greater list of things we should do than things we were doing.  We were connecting dozens of patients to needed referral sources, but desperately needed to reassess our capacity and priorities for patient care versus public health and education.  We more than doubled our bank account, but we still needed more strategic and on-going development initiatives.  We were engaging students in project development and fundraising, but were continuing to question how to fit medical service trips into a long-term organizational vision.  It was daunting to manage these conversations and decisions while also establishing HHI’s stateside presence from scratch.

Being back in the DR afforded me the perspective to recognize and articulate these very real challenges, and fostered significant conversations about HHI’s future.  After a year and a half of trial and error, successes and failures, and most importantly, taking the time to learn about and form relationships with people and communities, we are in a position to make tangible moves toward a long-term vision.  Thanks to the more than doubling of our (wo)manpower in the weeks post-medical service trip, we are now focusing on growing our community health workers program, developing public health initiatives, and creating new partnerships to strengthen the existing local health system.  I returned to my office on the Tufts campus in Medford almost three weeks ago, inspired and energized to go.

I still picture that windowpane when I think about the details, the action items, the goals.  I’ll always remember that perspective…

~Laura

It is a bit difficult to get into the holiday spirit in the Caribbean.  This time of year, I am used to snowy climes, cloying Christmas music, and massive amounts of sugar cookies.  However, in the Dominican Republic, December temperatures hover in the mid-70s, the only background music is ever-present merengue, and typical Christmas fare consists of apples and grapes (neither of which is ever frosted to look like a snowman, much to my dismay).  But perhaps the most difficult thing about being in the Caribbean at this time of year is being far away from family – surely the most essential ingredient for a happy holiday.

On a recent warm and sunny morning, I swallowed all that Christmas sulk and climbed onto a moto to go check up on some patients.  Estela, our community health worker from Negro Melo, had told me of an infant with a white scaly rash, and one of our hypertension patients was running low on her medications.  After a 45-minute moto ride filled with mud and mosquitoes, I arrived at Estela’s door to see a warm bowl of beans and rice waiting for me on her table.  I laughingly admonished her; she always has a warm bowl of beans and rice waiting for me, and feeding me is definitely not part of her job description.  She batted away my protestations, telling me I was far too flaca (skinny) when I first arrived in this country, but now I’m looking a bit more fuerte (strong) and she feels personally responsible for that change.

After my second lunch of the day, Estela and I headed over to Blanca’s house to check on her baby.  As I spoke to Blanca, neighbors and community members slowly started filtering in, as is the norm.  First came Maria, who has called Estela her doctora and me her cardióloga ever since the blood pressure meds we give her started working; after myriad attempts to inform Maria of our correct titles, I’ve finally given up and now just accept her nicknames.  She plopped down at the kitchen table and brought out her medication bottles for a refill.

Then Rosario stopped by.  A lifelong epileptic, Rosario used to suffer two seizures daily, and she wears the resulting scars externally: one of her eyes is permanently diverted to the right, and the last time I saw her, one side of her body was completely covered in bruises and scrapes from a recent seizure.  Anticonvulsants are hard to come by in this country, as well as expensive, so Rosario’s seizure control had been sporadic at best.  But last month, HHI started supplying Rosario with daily antiseizure meds, and Rosario was here today to declare their efficacy.  She hugged me immediately upon entering Blanca’s kitchen.

“¡Esos medicamentos me dio son buenos!  Ahora puedo fregar los platos, y tomar café con mi esposo – ¡soy fuerte!“  Those medicines you gave me are good!  Now I can wash the dishes, and drink coffee with my husband — I’m strong!”  I smiled, but the room immediately erupted in laughter.  I sat, thoroughly confused by everyone’s delight in Rosario’s increase in coffee consumption, until Estela bashfully explained that “drinking coffee” has two meanings in the Dominican Republic.  A light bulb went off above my head, and once I finally got the joke, everyone burst into hysterics all over again.

Eventually I took my leave from Blanca’s warm and joyful kitchen, and on the way home I thought about my afternoon.  I thought of Estela, always trying to feed me yet another bowl of beans and rice; I thought of Maria and all her nicknames; I thought of Rosario and her indomitable spirit; and I thought of  the multitude of laughing children, always eager to hug my waist and braid my strange straight hair.  Somehow along the way, despite my skin color and my continuous mangling of the Spanish language, I managed to form a little family here.  They may have never seen snow, and they may prefer apples and grapes to sugar cookies, but we can still share stories, and meals, and jokes.  We can still learn from each other and laugh with each other.  And right there on the moto, amid all the mud and mosquitoes, a wave of holiday spirit washed over me.

-Meg

For more information about Health Horizons International, please visit www.hhidr.org