A Physicians Assistant Student’s Experience at HHI — by Jeffrey Bonnaud

January 25, 2013


Volunteering with Health Horizons International in the Dominican Republic was an    unbelievably incredible experience, one that I will surely not forget. I can’t wait to return either as a student in part of my primary care rotation, or following as a graduate. You hear about different organizations working in medical service but HHI is unlike any other. First of all, it is staffed and run with such incredible people who all truly have a passion for global healthcare, while having a very efficient and well managed chronic care program that they focus on. Uniquely enough, HHI works with community health workers who are highly respected individuals in the communities who act as the middleman between patients and the medical staff. They check in on patients in between the quarterly clinics assessing their blood pressure, medications, etc. My experience would not have been the same if it weren’t with an organization like HHI.

As a PA student, we loaded in the trucks each morning being taken out through nothing but sugar cane fields and valleys to remote villages where the people truly depend on us. Being able to care for others who would otherwise not have an equal opportunity to be seen or managed for their chronic issues is an amazing feeling and experience. In a group of 6 PA students, we were split into shifts working between triage, the lab, or seeing patients with the doctors. When working with the doctors, they allowed me to take charge of the interview with the patient and interpreter while adding additional questions to ask if I left something out. After seeing multiple patients of similar complaints and through the education while working alongside the doctors, I soon began asking all the appropriate questions to come to the assessment and plan. Working with the medications that I had only studied hours over, everything began coming together in sync. This experience not only opened my eyes to primary care, but also continually showed my passion for global health. I would recommend working with HHI to anyone who has the opportunity!


A Warm Welcome…

February 28, 2012

Written by Leniza Tineo, Patient Care Management Volunteer for HHI

Having had the opportunity to volunteer with HHI for two weeks, I cannot be more grateful for the opportunity. I spent an unforgettable time alongside hardworking, dedicated, persevering people, who have one goal in mind—to make a significant impact on the lives of people in the Dominican Republic. Coming from the Dominican Republic myself, I’d never visited the communities that HHI serves. When I first arrived, I was warmly welcomed by the Clinical Programs Director, Janelle, who took me under her wing and guided me through the chaotic and often confusing healthcare system in the Dominican Republic. I got to visit the public hospital in Puerto Plata, and the private clinics in the area as well. As you may imagine, the differences were stark. I was in awe after witnessing the unfortunate conditions of the public hospital—surgeries are conducted in operating rooms with open windows and too often the poor patients who desperately waited to be seen by a doctor, had to return home disappointed. The hallways are divided by iron bars resembling a prison facility. I was amazed by the poor sanitary conditions. I was even more amazed when I learned that because of the overwhelming number of patients and the lack of resources, doctors do not always provide the best quality of care.


Leniza, CHW Willy, Maria, an HHI long-term volunteer from Peace Corp, and Willy's Mom, eating rice and beans at Willy's house in Pancho Mateo

Along with visiting the public and private hospital in Puerto Plata, and in nearby Sosua, Janelle brought me to the community of Poncho Mateo. I am truly thankful for having met the wonderful people of Poncho Mateo. I was welcomed with open arms and this increased my enthusiasm and made me want to do everything possible within two weeks to help these people. It is one thing to read about a patient, but meeting them in person makes you realize that your effort could make a world of difference for them. One client’s family in particular, whom I worked closely with during my stay, had me over for coffee while we discussed the patient’s case. Another family offered me “moro,” one of my favorite dishes. The community is filled with people who have few material things, but who are very rich in spirit and have unwavering happiness. They continue to uphold their beliefs in the midst of poverty—they hope things will improve for them, but either way, they are simply happy to be alive. They do not miss the things they do not have and are often eager to share what little they possess.

I am proud to have been a part of such a wonderful organization. HHI’s effort to improve healthcare in the DR is truly remarkable. I hope someday to return to the community of Poncho Mateo and perhaps also visit the communities of Severet, Negro Melo, and Arroyo de Leche. I definitely look forward to the warm welcomes and to drinking more cups of coffee on people’s porches.

HHI Research: Cervical Cancer Screenings

February 20, 2012

Written by Nicole Pfeiffer, former International Programs Director and Public Health Researcher.

One hundred and ninety rows by 46 columns – it’s one way to sum up the last month I spent in the Dominican Republic.  In December, I was grateful to return to HHI in order to help research access to cervical cancer screenings. The aforementioned rows and columns contain the answers to surveys conducted with nearly 200 women, offering insights into everything from their beliefs about the causes of the disease to their experiences surviving it. As these responses are analyzed, the spreadsheet will hopefully help HHI design programs to help reduce the burden of cervical cancer and other women’s health issues in HHI’s partner communities.

However, for all the information the spreadsheet contains, I am also acutely aware of what such numbers fail to capture. For one, such black and white figures cannot possibly convey the broad spectrum of injustices suffered by women who lack access to preventive services. Despite the fact that cervical cancer can be prevented, detected, and treated in its early stages, it remains the most deadly of all cancers affecting women in the Dominican Republic. In fact, a woman in the DR is over 8 times as likely to die from the illness than a woman in the US. But the magnitude of this reality isn’t conveyed so much in statistics as it is in conversations with women who are facing it. No numbers will ever add up to the suffering of one woman in Pancho Mateo who lacks the money for the treatment she needs to address advanced stages of the disease. Nor will figures ever account for the anxieties of her daughter, who refuses to be screened herself in fear that she will share her mother’s fate.


Nicole with Willy, his mom and their neighbor who were all very helpful in conducting the survey with Creole speakers.

But the numbers also leave out a very broad margin for hope. Neat columns and rows don’t leave space for the messy mud HHI’s team of dedicated community health workers volunteered to trek through in order to interview and educate their neighbors about the disease. They also don’t leave room for the enthusiasm in one Haitian woman’s voice when expressing her desire to work with HHI in order to spread the word to other women in the community.  Nor will they capture the time that busy hospital administrators and public health officials took to discuss how we can collaborate to make deaths from cervical cancer an issue of the past.

While the numbers will provide valuable information into the specific ways in which HHI can assist in reducing the burden of cervical cancer, in the end the real story will be told not in concrete figures, but in the achievements of its dynamic protagonists – community health workers, patients, local healthcare providers, and community members, working together for a common cause. It may be a winding tale, but in the end, I’m confident that the story will have a healthier, happier ending. I look forward to seeing how HHI can be a part of it.

HHI Medical Service Trip Experiences

February 2, 2012

Sandra Marzella, MD

Sandra plays "Muscles" with a boy in Pancho Mateo

Once again I am shocked and amazed at what I see here.  The conditions people live in are deplorable.  Babies crawling around in the dirt, trash everywhere, no running water, etc.  Tonight on the phone my son asked about Skylanders.  How do you explained to him that not only do they not have this, but they don’t have a Wii, only few have a TV, and for some, their problem can involve where to get their next meal.  It truly is living in another world.  I can only imagine that they would laugh if I mentioned things such as car seats (here infants travel on laps on the back of motorcycles,) baby gates and safety locks.  I am certain no one in the low income communities owns a crib with matching sheets.  They all co-sleep with their infants as with many of the older children.  Their homes don’t have room for much.  Many have large families.

The unemployment rate is 90% in the towns we have been working in. They have no options for work.  However, they are very happy people. Seems kind of strange but most seem content.  Most people here don’t complain of depression or anxiety.  Much different from home.  Also there is livestock all along the  now muddy, ditch filled roads. No shock absorbers around here!   Our truck has to beep to get the cows to move.  There are sugar cane fields everywhere that are no longer used but people are not allowed to farm them.   When I work with these people I feel very thankful for all I have.  When I get back to my room, I most appreciate the running water, a/c, and electricity which we are not seeing in their communities.  Can you imagine living in place with so little?  This is personally rewarding and yet emotionally difficult at the same time.  They need so much and yet we can only offer a small amount.


Kim take a break from clinic to play with kids in Pancho Mateo

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Kimbely Tschetter, Physicians Assistant Student, QU

After a day of training, we headed out into the communities and set up clinics in churches and an empty home.  Most were one-room buildings with a tin roof, no air and lots of little kids crawling through the windows. Beds sheets were strung up for makeshift exam rooms.  We had a crude check-in area and triage space. I ran the lab which consisted of a small table, a window ledge or the pulpit in the church…whatever space I could find. I ran blood glucose tests, urine analysis and pregnancy tests. During the last two days, I also worked with the doctors in the exam rooms, asking patients questions through the interpreters, doing the physical exam and making a healthcare plan.

The main chronic care conditions were high blood pressure, diabetes, asthma and epilepsy. HHI serves four communities in the northern part of the DR.  A few years ago, the sugar refinery shut down suddenly, which has led to very high unemployment in the area.

I could not have been more impressed with HHI, the non-profit I’ve been fund raising for for  the past few months.  They squeeze every penny out of ever dollar that is donated.  The American staff, all of whom are accomplished professionals with master’s degrees in different areas of healthcare, live without hot water or reliable electricity.  Theirs is truly a labor of love.

One of the highlights of the trip was getting to know my classmates better, away from the pressures of school. There was zero complaining the entire week, everyone worked extremely hard and I was so proud to be a part of this team. In four days, we saw 423 patients.  I look forward to working with HHI during future volunteer clinics in the DR once I am a licensed physician assistant.


Brad Wilkinson, MD,  Vice Chair, HHI Board of Directors

Brad and Sandra evaluate a sick infant Pancho Mateo

This January’s Operativo was the best of the eight times I have been to the DR. It is enormously rewarding to see the Chronic Care program finding its legs and actually having a positive effect on many many patients. To share in the teamwork of the Cooperadores and the International Program Team members, the enthusiasm and dedication of the QU and Tufts students, the compassion and skill of the physicians is truly a moving experience. And that doesn’t even touch the most wonderful feature of all– the privilege of helping to take care of hundreds of lovely people suffering under the burden of an inadequate, expensive, distant, and episodic health system. I would go back tomorrow if I could.

Contemplations on my 8th Medical Service Trip with HHI

January 20, 2012

Written by Dr. Craig Czarsty, President and Chairman of the Board of Directors of HHI

I just got back from my eighth medical service trip to the Dominican Republic and this was the most satisfying of all. HHI has been building a chronic care program and increasing the number of patients in it. We have reached the point that on this trip most of the patients seen were by appointment only. The trip in May will be entirely by appointment. While this may not seem like much of an accomplishment to those who are used to electronic medical records and requesting appointments by email, it is a really big deal for us in the D.R. It means that each patient we see has a chart that contains not only previous clinic visits but interim reports of visits to the patients by the cooperadores and the International Program Team. We know of no other NGO on the north coast doing likewise. Special thanks to Janelle, Rachel and Tracy of the IPT who make everything run so smoothly.

Speaking of the cooperadores, it is particularly gratifying to see how far they have come. For the first time, they worked in intake and triage during the clinics. More importantly, they accompanied the patients they follow to their appointments with the docs. This allowed them to hear firsthand what the docs told the patients so they could help reinforce the message over the next four months until the next medical service trip. The cooperadores are an amazing group of motivated individuals who are anxious to make a difference in their own communities.
We had a veteran group of physicians with us, Brad Wilkinson (Vice President of HHI), Stacy Taylor, Sandra Hughes and Anne Brewer. The QU Physician Assistant students rolled up their sleeves and jumped right in. They are a great asset to HHI. The Tufts undergraduates stayed very busy with their public health project.
On a personal note, I was very proud to have two special people accompany us on the trip. Marc Bouffard is a fourth year medical student at Tufts and he is the one who got me involved in the Dominican Republic in the first place. He called me way back in 2004 and asked if I would like to accompany a medical trip with him. The rest, as they say, is history. Also joining us was my daughter, Mary Frances, who went to high school with Marc so I suppose without her Marc wouldn’t have known me! Mary is HHI’s web master and came on her first trip to observe the operations and take pictures for the website.
It has been an amazing journey for HHI so far and I am really excited about the work we are doing and the direction we are headed.

A holiday wish

December 24, 2011

Written by Laura, HHI Executive Director.

With the end of the year upon us, HHI is proud to present our first Annual Progress Report. We are so grateful to everyone who has made this year possible, and invite you to share your thoughts and questions after reading this reflection on 2011. Thank you so much for reading our blog and following our journey this year. It is an honor to know that people near and far have become invested in our work to improve community health in the Dominican Republic.

I hope you will keep our patients and partner communities in your thoughts this holiday season – the challenges they face each day remind us that our work has only just begun.

When Angi and I moved to the Dominican Republic in October 2009, we arrived with a vision for establishing the foundation of HHI, and little else to recommend us. In those first few months, I learned that HHI would succeed only if we could build trust — and the only way to do so would be to demonstrate results. As we listened to community members, based our goals on their insights, and proved our commitment to following through on our word, people began to believe in us. We have been truly fortunate to welcome amazing staff, community health workers, and volunteers whose actions continue to build and fulfill the trust of the people whom we serve — and of people like you whose support make it possible.

This year, you watched us grow from five community health workers to fifteen. You read about our first attempts to respond to patients with uncontrolled blood pressure and diabetes, and offered your support as we developed a comprehensive Chronic Care Program. You heard about our efforts to help patients in need of surgery and specialty care. You responded, and watched us build a network of local referral partnerships while also providing one-on-one, community-based follow-up to our patients. You asked what our plans were for addressing public health issues, and encouraged us as we undertook research studies and illness prevention initiatives that enable us to make a long-term impact. None of this has been easy, nor will the path forward be perfect — but, together with the people we serve and partner with, we are fulfilling the trust we earn.

There is such a need to make a difference in this world, and I hope that you are all able to give to a cause that you are truly passionate about this holiday season. If you have followed our work this year, and believe in our dedication to improving community health alongside people affected by poverty, please consider making a tax-deductible donation to HHI. Your solidarity has made our impact possible. Thank you for continuing to walk with us on our journey in the Dominican Republic.

With gratitude and sincere wishes for a wonderful holiday season,



Your donation helps to build a new vision of health in the Dominican Republic ~ this holiday season and beyond.

Checks may be mailed to:
Health Horizons International
c/o Community Health Program, Tufts University
112 Packard Ave.
Medford, MA 02155

Donations may also be made online by clicking the button below. Please note that PayPal retains a 3% transaction fee.

Thank you for believing in our cause.

To learn more about the impact your gift makes, please click here to download our 2011 Annual Progress Report, or click here to view it online.

HHI is a 501(c)(3) non-profit organization. All donations are tax-deductible to the extent permitted by law.

A thesis in the time of cholera

November 16, 2011

Written by HHI’s current research intern, Heidi Berthoud.

Water is accessed in many ways in the Dominican Republic, usually through a combination of waiting for the local city water to be turned on (most likely not potable), buying water from large trucks that come house to house (not potable), buying large 5-gallon bottles (supposed to be potable), or gathering water from a natural source like a spring, well, or river. I came to the Dominican Republic to work with Health Horizons International (HHI) to investigate local attitudes and practices surrounding water use and access in several small communities around Montellano. The plan was to use the information I gathered to both aid HHI in their public health planning around water in the local communities and to form the basis of my MPH thesis.

About three days after I arrived rumors of cholera began spreading through Pancho Mateo and the other small communities along the river near Montellano. A baby died of suspected cholera in Pancho Mateo and more suspected cases were arriving in both the small, local hospital and the larger community hospital in Puerto Plata. The local Ministry of Public Health took action and decided to host a community forum comprised of a panel of local water and public health officials as well as members of the military. Through the networking of the HHI team here, we were introduced to the director of Public Health for the Puerto Plata region (Dr. de Pena) who then came to give a charla (group information session) to the HHI community health workers and invited us all to attend the larger community forum.  The first announcement from the Ministry of Public Health was that they were planning to “militarize” the river and block the communities from continuing to bathe, drink, defecate, and throw garbage in the river. They explained the etiology of cholera and how it was a feces borne illness that proliferated in conditions where people came in ready contact with contaminated human waste. They urged everyone to wash their hands after going to the bathroom, before preparing food, and after changing a baby’s diapers, and they urged everyone to buy chlorine and chlorinate all drinking water in order to avoid the spread of the disease.

Many leaders of the local community groups and neighborhood associations arrived at the forum well prepared with statistics and data regarding the chronic lack of access to potable water and proper human waste disposal. They voiced their frustration that the concerns they had been raising for the past few years to the government about the lack of water access and a sanitary means of disposing waste had now created living conditions where cholera could thrive. Times are tough here and many people in these communities are unemployed or underemployed. The community leaders were beyond frustrated that the ministry and the government was insisting their community institute a plan that requires them to have access to something (clean, regular water and latrines) that many don’t have and can’t afford to have. I was very impressed at how organized and knowledgeable the community leaders were and how prepared they were to fight for improved conditions in their communities. After a lengthy debate that lasted well after dark, the ministry of public health announced they would be sending trucks filled with clean water which would be distributed for free in order to provide the community with a consistent alternative to the river.

With this as a backdrop, I began my research here and decided to focus primarily on two communities; the small but densely populated community of Pancho Mateo where the suspected cholera outbreak was and where both Haitians and Dominicans live side-by-side, and the rural and remote community of Arroyo de Leche which is comprised primarily of Dominican agricultural workers. My first order of business was to check out the river in Pancho Mateo and the various water access points in both Pancho Mateo and Arroyo de Leche. I immediately saw that despite the seemingly absolute declaration that the river would be “militarized” I saw no military presence and many people continuing to use the river for water access. I also discovered that no free water was being delivered as planned and even now, nearly four weeks later, only one free water truck per week arrives and this is apparently via an evangelical church in Arizona. I spoke with several water truck drivers and they all assured me that they charge for the water in their tank. Many people in Pancho Mateo continue to complain of diarrhea related illness and many expressed the thought that whether it’s cholera or not, being sick is just a normal part of life here.

Last week Tracy (Public Health director at HHI) and I had a productive meeting with the Ministry of Public Health. When I expressed interest in seeing the local water filtration plant they said that we could come with them on a visit there this week. One of the scientists working on water analysis (Dr. Marmolejos) was surprised and upset to learn that no free water had been arriving in Pancho Mateo as promised.  He was equally surprised and upset when I showed him pictures of the rudimentary water access points in Pancho Mateo. I hope we can address some of these concerns when we meet with the water filtration officials.

What I’ve found, to my surprise, is that the remote community of Arroyo de Leche has fairly regular water access. They tap into the local acueducto and for a fee, they pay to have piping installed in or near their homes. There are also many natural springs that flow regularly and provide seemingly clean drinking water. So far, no one in Arroyo de Leche has expressed that they are without water or that they suffer regularly from diarrheal illnesses.

In the meantime I plan to continue interviewing households in both communities to see what the common water themes are. I have two fantastic local research partners, one of whom is able to help translate Haitian Kreyole during the interviews with the Haitian community and can also explain the intricacies of Dominican slang. Already it’s clear that the Haitian section of Pancho Mateo has the least consistent access to water and latrines, which also adds to their sense of feeling stigmatized since cholera arrived on the island in Haiti first. As I’m quickly learning, water access is a complex political issue. One woman I spoke to in Pancho Mateo insisted that the water pipe being fixed in front of her home was the work of the PLD, which is the major political party here. In an ironic twist, it may just be the cholera outbreak on the eve of a presidential election here in the DR that helps bring water to Pancho Mateo.

Information sheets about cholera in both Kreyole and Spanish








Dr. de Pena presenting at the community forum








One of many community leaders explaining (yet again) why they need access to clean water and latrines







This woman said she was a chemistry teacher and had performed her own test of the local water. She challenged the local water district director on his assertion that the water that did occasionally arrive from the city was free of bacteria









A community leader in Pancho Mateo (and HHI Community Health Worker) being interviewed by the local news the day after the cholera community forum.






Water collected from the river in Pancho Mateo








Some members of the community continue to use the river in Pancho Mateo










Willy (research partner and HHI Community Health Worker) investigating a water access point in Pancho Mateo. Residents said they aren’t really sure when the water will arrive, but since the cholera outbreak some parts of Pancho Mateo are now receiving city water every three days.








Elena in her house in the Haitian section of Pancho Mateo with the buckets she uses to collect rainwater from her roof. She said she also shares this water with her neighbors.






One of several water access points in the Haitian section of Pancho Mateo that was being used for corn preparation. I was told jokingly that the water arrives here every year on January 1st.






Investigating one of many cisterns, found primarily in the Dominican section of Pancho Mateo. When the city does send water, people can fill their cisterns but otherwise they have to pay to fill them.






Consistent running water access in Arroyo de Leche








Washing dishes in Arroyo de Leche










Corina (HHI Community Health Worker) and Nuorcia standing across the stream from one of several natural springs in Arroyo de Leche







Water being delivered, for a fee, to a nice neighborhood in Montellano










Bottle of “purified” drinking water in the HHI staff house which we purchase for about 1 USD each. There isn’t any regulation on the water purification companies that sell these bottles so everyone relies on local word of mouth regarding which is the best. A public health official just told us that “Agua Honey” is the best.








Dr. Marmolejos preparing to show us how they test the mineral balance of the water.


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