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Bienvenidos! Welcome to the Program in Community Public Health, Santiago, Dominican Republic

Welcome to Santiago de los Caballeros, Dominican Republic, home to CIEE’s Summer Community Public Health program, a two-month focus on health and well being in this vibrant developing nation. CIEE’s Community Public Health Program offers its students a special opportunity to mix learning about Caribbean and Dominican culture and customs with working alongside community members in various settings, experiencing and confronting the everyday challenges that Dominicans face, and contributing towards the ultimate goal of affording everyone the opportunity to live healthy and happy lives. In this manner, students both learn from their host culture and leave their positive imprint upon that culture.

07/30/2014

El Coco: Tierra verde y cielo azul (Part 1, Wednesday Week 5)

CPH Student Mary Turocy had the following to say about her experience in rural clinics.  Follow her experience on her blog here: http://mysummertimetravels.blogspot.com/2014/07/tierra-verde-y-cielo-azul-part-1.html
 
"Green earth and blue sky"
Last week marked the halfway point of my trip. It was completely different from any other week so far, because we spent it living in different rural clinics throughout the province of Las Hermanas Mirabal, which is about an hour and a half west of Santiago.
CIEE students (Asia, top row far left, Jessica, bottom row far left, Denise, bottom row middle and me) and El Coco clinic staff
We were divided into small groups of two to four people. The three other girls in my group and I were assigned to the clinic in El Coco. The town has about 900 families and is very close knit. There were yuca, corn and plantain fields, but the fields are small so at most it's a 2 or 3 minute walk to a neighbor's house.
Scarlet and I!
Many of the other groups lived in their clinics, but our clinic didn't have space for that. We slept at the house of the mother of a woman who works at the clinic, but we ate, showered and kept our stuff in the clinic and just bought a backpack to the house every night. This arrangement was a little strange, but I'm very glad that we got to stay with a local family. Sylvia, our host mom for the week, was incredibly kind and generous. She treated us like her children and got teared up when we had to leave. Sylvia is taking care of her four year old granddaughter, Scarlet, and we also got to know her very well during the week. She loves to draw and play school. She "taught" us the Spanish vowels and numbers, and we taught her to write "perro" "gato" and "ratón."
We arrived at the clinic on Friday afternoon, but because the clinic isn't open on weekends, we didn't get to start working until Monday. We spent most of Saturday getting our bearings, trying out the kitchen in the clinic and playing with some of the local kids. On Sunday we went to a talent show in a nearby town, and then we went to Mass in the evening. The service was simple but very joyful. The towns are so small that one priest travels between many different churches--the service in El Coco was his fifth of the day, and the congregation spent about five minutes simply thanking him for coming to celebrate Mass for them.
On Monday morning, we started our clinic experience by organizing the medicine shipment that had arrived on Friday. Because it's a public health system, the medicines are all generic and arrive together--very different than the US! We recorded the arrival of each medication by hand (the clinic has one computer, but nearly all of the record-keeping is done the old fashioned way). It was worrying to see that the clinic had run out of many medications before the shipment's arrival, and even more concerning to realize that some medications hadn't been in stock for over a year. We also helped the doctor calculate her needs for the next month's shipment, even though she doesn't always get the quantities she orders. Trying to do basic arithmetic in Spanish was more challenging than I expected!
Making home visits to fill out fichas
On Tuesday, we conducted home visits with the doctors and other clinic staff to fill out fichas familiares. The fichas contain basic demographic information and health histories of everyone in the household, and also summarizes the living conditions of the family (type of walls, roof, floor, bathroom, water storage etc.) Most of this was already complete, but they are trying to computerize the records, so we had to go back to fill in missing information before they send the records off to be computerized. Most people were surprisingly fine with a large group of people showing up and asking to see their IDs and insurance cards and to know how many bedrooms they have and how they dispose of their trash. Every house, no matter how humble, has a stack of plastic lawn chairs for visitors, and at every house the wife/mother wouldn't be content until we were all seated. It was really nice getting to explore the community and talk to people in their home environments. There was a large variety of living situations but Dominicans in general seem to be content with and grateful for what they have.
We also got to observe the consultas or office visits or hang out in the waiting room whenever we weren't busy. The office visits were generally short, and most of them were for Chikungunya. Chikungunya is a viral illness transmitted by mosquitos that arrived in the DR in March or so. It spreads really quickly and is all over the news and pop culture (See the music video!) It's not fun to have, but the good news is it's not life threatening. The main symptoms are fever, headache, pain in joints, particularly wrists, knees and feet, and a rash. The main treatment is Tylenol, which is by far the most commonly prescribed medicine at the clinic. Unfortunately, a lot of people, (including some doctors!) believe that it's an airborne virus because they don't think it's possible that mosquitos are spreading it this quickly. This is particularly bad because the only prevention strategies involve avoiding mosquito bites (using repellent and mosquito nets, and eliminating standing water where mosquitos can breed), so if people don't believe the mosquitos are responsible the disease will continue to spread.
 
 
Chikungunya music video

There's so much more to write and I've already written a short novel, so I'll save the rest for another post!

07/19/2013

Fiesta de Despedida

Our 19 students dressed to impress at their going away party The program officially ended July 20th, and the going away party despedida was held on the 17th. This was a chance for students to have a final night together with everyone who accompanied them during their time here, including host families, professors, health promoters, PUCMM support students, and PUCMM and CIEE administrative staff.

CIEE's Melba and David showing off their merengue skillsThe party, organized by José and the students, was a huge success, and included plenty of dancing, reminiscing, slideshows, good food, and many heartfelt thank-yous by a group of CIEE students.   This group will be missed, but we all know that they are on to some big things in life, and we have a feeling a good number of them will be back for a visit sometime soon. 

 

A Week in a Rural Dominican Clinic- Monte Llano

        After an exciting weekend getting to know the small town of Monte Llano and its inhabitants, I couldn't imagine that our experience could get any more exciting. But every day met us with a new twist. Monday was our first day in the clinic, shadowing Jahaira, a young doctor 6 months into her mandatory year of work at the rural clinic. Our experience in the clinic was really interesting. Most of the patients who came in were coming for medicine to cure la gripe (the flu), but what I learned at the clinic was much more complex than the type of medication prescribed to lessen flu-like symptoms. I got a first-hand view of the Dominican healthcare system, which has some good elements and some setbacks. With a social security card, which most people seem to have, all the medicine and services at the clinic are free. When the doctors don't have the resources to treat a patient, the patient is referred to a specialist in the nearest hospital. The service in the public hospital in Salcedo is also free, but transportation down there from the village is pricey and time-consuming. In addition, I heard stories about poor care in Salcedo due to overcrowding of the public hospital. We saw cases of Tuberculosis, infections, asthma, body pain, and injuries from motorcycle accidents. Many villagers came in with hypertension due to the diet and lifestyle in the town. Though medication for high blood pressure is also free at the clinic, many people don't take their pills because they don't understand why it's important due to a lack of education. Kritheeka and I did a charla (lesson) for patients at the clinic on Thursday focusing on Hypertension because it was the most prevalent chronic disease in Monte Llano and the surrounding villages.

        We also saw a lot of very young mothers and pregnant women. In Monte Llano, it is common for women to get pregnant at age 15 or 16, with girls as young as 12 or 13 having babies and getting married (there is no legal age minimum for marriage here). This is very much part of the culture, and one of the things that have been hardest for me to understand, much less accept. Kritheeka and I (age 21 and 20) thought it was funny that people were surprised that we are unmarried and don't have kids. Then our young friends in the village explained that it is common for young teens to get married here and have babies. Surprisingly, this is not due to a lack of access to birth control; the clinic gives out birth control for free, funded by the government. This was even more surprising to me in such a catholic country! Again, there is a lack of education about birth control, and condoms are readily available but rarely used. The role of women in this country has been one of the hardest things for me to deal with in the D.R., both from my own experiences here and hearing stories of Dominican women's lives. When I asked Jahaira if she thought people believe that men and women are equal, she said yes, but that people here believe a woman's role is taking care of kids, cooking, and doing housework while the man is supposed to provide for the family. I guess it comes down to having a different definition of equality, and a different idea of gender roles based on the culture you grew up in. The problem of education in these towns is also significant; there is no high school near the town at all, and many of the inhabitants have very little education. When women get pregnant at a young age, they take care of their kids instead of continuing their education. Only the few villagers who have family members in cities are able to move to continue their studies.

        A lot of what I learned in Monte Llano was not specifically about medicine, but about cultural norms, socioeconomic inequity, racism, sexism, and poverty. I think we got a clearer image of Dominican culture in the small town because there are less outside influences than in Santiago. Although some of these experiences were troubling, I was surprised by how much I loved the small town atmosphere, detachment from technology, surprise visits from friends, and the emphasis on spending time with people instead of always trying to get the next thing done.

07/15/2013

HEALTH MATTERS: Summer 2013 Newsletter

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This summer's 19 students in the Zona Colonial
19 CIEE students called Santiago home for seven weeks this summer.  Arriving on June 1st  students were met at the airport by CIEE staff and taken directly to a host family reception, where they met their new families, who were all eager to ease students into life in the DR and make them feel like a true part of the family.  Orientation_charla

After settling in with their host families in Santiago, students spent their first full day in the country in La Vega, doing an intensive orientation session at Casa Club.  During this time, CIEE staff  covered the most important information that students would need to know during the following weeks. After their orientation in Casa Club, students spent the next several days participating in various orientation week activities.

Enjoying pizza at program director David's house after the race and identity workshop
They became accustomed to Dominican academic life, met the estudiantes de apoyo (support students), a group of Dominican and Haitian students who are present to guide CIEE students through life at PUCMM, navigated through the city on a scavenger hunt, learned to dance to the Dominican Republic’s popular merengue and bachata rhythms, met their friends’ host families during a progressive dinner, and participated in workshops designed to address contemporary social issues in the country, such as race, identity, and gender from a Dominican perspective.  After their first week of activities, students were well-prepared to take on many of the challenges that awaited them throughout the program, as well as enjoy leisure time activities such as going on CIEE’s excursions, independent travel, and experiencing Santiago’s nightlife.  

 a quick photo by the Monumento during the city tour 

HOST INSTITUTION

Campus tour of the PUCMM library by an estudiante de apoyo

 As a host institution for the Summer Community Public Health program, the Pontificia Universidad Católica Madre y Maestra (PUCMM), provides the setting where students meet for their classroom sessions, have access to student facilities such as computer labs, libraries, and cafeterias, and experience university life from a Dominican perspective. PUCMM also sees many of its own students graduate with medical degrees, thus providing CIEE students interested in the fields of medicine and public health valuable perspectives on medical education and practice in the Caribbean and the Dominican Republic. Academically, students enrolled in 9 semester hours of courses, including Spanish Language (which also incorporated medical terminology and cinema components), Medical Sociology, and a Community Medicine practicum. Class time was complemented with special guest lecturers, and visits to many different types of medical facilities, including hospitals and clinics; the nation’s most modern museum and cultural center; a local botánica at los hospedajes, a lively market showcasing herbs and alternative medicines and products for wellbeing; and Santiago’s main water treatment facility were also part of the extended classroom experience. 

CIEE students Roxy, Breanna and Ashley at the PUCMM's annual international fair.

CIEE-PUCMM Intern José along with Japri, Ashley, Liz, and Rachel at the International Fair

THE GROUP:

an adventurous group descending the 27 waterfalls in Damajagua

This summer, 19 motivated women from various universities spanning the entire USA, and fields of study participated in the program. The summer program has the fame and good fortune of always attracting very friendly, hard-working, and intellectually curious students, and this summer was no exception. If there’s one thing that life in the DR always teaches CIEE students, it’s the necessity of flexibility—by placing their experiences within the context of their goal to better understand life in a developing nation and the everyday challenges that Dominicans must face, students really seemed to come to realize that it is usually the most challenging experiences from which they gain the
most.  

students at Cayo Arena, an isolated sandbar in the middle of the ocean, surrounded by a gorgeous coral reef

Rural clinics:

Liz and Nathalie with Dra. Maridalia Cuevas of Clinica Blanco Arriba showing how to prevent Tuberculosis

 One of the benchmarks of the CIEE Community Public Health program is our longstanding relationship with top medical personnel in the mostly-rural Hermanas Mirabal province (named after the heroic sisters made martyrs by Dictator Trujillo’s henchmen in 1960). For one week during the middle of the program, students formed small groups of 2-4 and teamed up with staff at small rural clinics to participate in a clinic stay. During this time, they experienced differences between the public health system in the urban setting of Santiago and the rural setting of their clinic in Hermanas Mirabal province, and also assisted in general treatment of patients (taking blood pressure, recording medical histories,  weighing babies, etc). In addition to their time spent in the clinic, students also spent lots of time getting to know the locals of the area through house visits, playing sports with the local children, or sitting in on a game of late-evening dominoes at the corner store or neighbor’s house. Students took advantage of their time at the clinics to present on various health-related topics that they had developed during their first several weeks in the program, such as acute respiratory infections, diabetes, etc. At the end of such an endurance-challenging week, there was a celebratory going-away party followed by a visit to the Mirabal Sisters Museum, giving students the chance to see the house where the sisters and their husbands
worked so hard to end Trujillo’s tyranny.

 Zona Sur:

Students visited the community organization  Hogar Crea during a Community Medicine class.

 As part of the Community Health Practicum course, socially-based experiential learning was a key component to this summer’s program. Each student participated in the program’s campaign to promote and assist in the healthy lifestyles of people living in Santiago’s marginalized Zona Sur, during which time they teamed up with local health promoters and spent time interacting with residents of the area, organizing and presenting informational forums on the treatment and prevention of prevalent illnesses and helping to collect medical histories to enable more accurate and effective medical attention in the future. Students really enjoyed the opportunity to travel throughout their assigned neighborhood, chatting with the people they met and learning their methods of staying healthy while also sharing advice on how to further develop a healthy lifestyle. The amount of presentations that groups facilitated this summer and the number of targeted observers that participated in these presentations was astounding, all due to the motivation of the students and their eagerness to work with local health promoters. Some students even gauged the number of people they believe were positively affected by their presentations and promotional work, and the results surely left them feeling satisfied. 

 

More highlights from this summer... enjoy!

under the sea, students snorkel in a tropical reef surrounding Cayo Arena

View from el Monumento.

Playa Ensenada

Brittni and Arelys descending the staircase at Meson de la Cava, a gourmet restaurant located inside a cave in Santo Domingo.

all aboard at Playa Ensenada