Archive for December 20, 2011

Sun, Sand and SEEP

The view from our house

The view from our house

Our journey in Eleuthera, the Bahamas began on Saturday with our arrival onto the island. It is a beautiful island with stunning beaches and gorgeous crystal clear water. In our first few days, we were immersed in Bahamian culture – going to church, visiting the beach, taking part in a Bahamian Homecoming and enjoying local food. We also have seen some of the health disparities that exist on Eleuthera: lack of consistent power and potable water in some communities, dumping trash on the sides of the road and the beaches, and the expense of food that is mostly imported, to name a few.

One of our main goals while here is to evaluate what the Bahamian communities we are partnering with hold as priorities for their health and then assessing what the strengths and areas of growth exist. The community leaders gathered together today to discuss the ideas for One Eleuthera – an overarching program to join together and unite all the health programs on the island. Many of the themes that arose during the meeting centered around emergency care for Eleuthera. The South Eleuthera Emergency Partners (SEEP) is a group of citizens that is committed to emergency care in the southern part of the island. There is an emergency program for the central part of the island called HACE. And in the northern part of the island, emergency care is dependent upon the separate settlements. These agencies along with several other health organizations make up the health initiatives on the island. Our plan right now is to evaluate several of these programs in the next week and then to explore how well these programs are promoted and utilized in the communities.

Today our group went out in pairs and trios to four of the island’s clinics. Everyone had a little bit of a different experience, but each one of us enjoyed a rich day of learning  about the Bahamian health system and growing as student nurses. I had quite the adrenaline rush when I was doing intake with one patient, and the patient began to have a seizure. As he fell toward me, I was able to lower him to the ground, make sure he had an open airway, and hold his head as he continued to seize. Since the doctor was at our clinic, we were able to transfer the patient to the “Emergency Room” (a small room off of the waiting area) where he was well cared for over the next few hours. It was a very heart-pumping experience! I’ll leave you with a picture of the beautiful landscape.

 

Winding down

The final few days of our trip were a whirlwind of activity, as we stormed ahead to finish our pending projects.  But, of course, we certainly found time to enjoy ourselves, too.  The Dominicans wouldn’t have had it any other way.  On Wednesday afternoon, the DR’s former Minister of Health invited us over to his house.  I’m not sure exactly how Jenny came to know him, but in her words, “he’s just a really nice man and a great person to know.”  Expecting him to live in the city, we were surprised that the ride lasted a good 45 minutes.  By the time we arrived in his town, I said to myself, “I’m definitely not in San Francisco anymore…”  The upscale area was peppered with construction of new, gated developments.  Billboards advertising the ritzy homes and amenities appeared all along the main road.  Eventually we turned between the gates of this man’s upscale neighborhood.

We pulled through the gates of his house onto a large plot of land filled with fruit trees and beautiful flowers.  His wife greeted us at the door explaining that her husband had not yet arrived (we should have known better than to arrive nearly on time).  She showed us to the back yard, which was filled with not only fresh vegetation but also all types of birds roaming around freely and a few other livestock.  There were ducks and swans and doves and peacocks, and—of particular interest—turkeys.  Unprompted, Cassie began to make turkey calls, which was a hidden talent she had never previously revealed.  Immediately the turkeys returned the call in a wildly entertaining conversation.  We passed the time egging Cassie on to continue turkey calling.

We were then escorted inside and “the help” was ordered to fetch fresh coconuts.  A skinny, deft Dominican man promptly left bearing his machete and returned with a green coconut for each of us ready to drink the water inside.  Never before had I drank directly out of a coconut, which I learned is an acquired skill (I ended up leaving with more water on my shirt than in my belly).  Regardless, the kindness, generosity and hospitality of this man reaffirmed the warmth of the Dominican culture.

Similarly, on Thursday we were invited to Ortencia’s home, who is essentially the COO of the Hospital San Vicente de Paul.  She, likewise, lived a good 45 minutes outside the hospital in a beautiful upscale home.  The occasion served as a reminder that our presence down here provides a cause and an inspiration for many special interactions that don’t seem to occur otherwise.  For instance, even though the hospital members work closely together within a network of extremely close relationships, none of them had ever been to Ortencia’s house before—even the other executives.  Yet this night hospital members and their families, as well as the community leaders, joined us at Ortencias in a gathering of close to 50 people.

Like the homes we had seen thus far, the large piece of property contained innumerable fresh fruit trees and gorgeous flowers.  Ortencia’s friendly assistant and the hospital director took us through on a walk across the street through a farm to an area where they kept horses.  Apparently there was a beautiful river a bit further, but an approaching thunderstorm prevented us from proceeding further.  Of course, on the way, the assistant insisted we stop at a neighborhood bar for a quick spin on the dance floor.  She pulled a man from the crowd and directed him to show Christie a few moves while the rest of us watched.

While we had expected to stay for some snacks and perhaps a beverage, we returned to a feast of a traditional Dominican stew containing various root vegetables and several kinds of meat.  When we asked what kinds of meat, Ortencia responded, “Oh, you know, a bit of everything—chicken, pork, beef, and whatever else.”  I’m glad she stopped there because the stew was delicious and I’m sure there were protein sources that we Americans are not accustomed to consuming.  I’d rather not know.

After dinner, the music was turned up and dancing ensued.  Before we left, Ortencia gave each of us a souvenir hand-painted dish depicting scenes from typical Dominican life—a gift which was absolutely unnecessary, but which I will certainly keep as a reminder of our experiences over these two weeks.

Adios o hasta luego…?

The three-hour bus ride to the airport provided ample opportunity to begin to digest everything that we’ve seen, heard, smelled, touched, experienced and felt over the past two weeks.  As things seem to always go, the time has flown by.  Reflecting over it though, it is truly amazing the amount of work we managed to accomplish despite the major forces slowing us down.  The depth of the relationships we were able to forge despite language and cultural barriers is truly amazing.  I have made friends here in the DR that I will certainly never forget.

As the bus waited for us to finish tying up loose ends, Carmen came to the house to bid us adieu and wish us well on our journey home and in our careers as nurses.  She asked me when I was going to come back, and I explained (careful not to make promises I couldn’t keep) that Emory’s program is designed to circulate students so that as many as possible have the opportunity to have the same transformative experience as we have been privileged to have.  I could tell she tried to keep a smile on her face, but her expression was indescribably bittersweet and made my heart melt.  Later, Dhaysi, our new Dominican best friend who I consider a sister figure, asked the same question—when were we going to return.  Dodging the question, we said, “When are YOU coming to the states to visit us??”  With a touch of lament, she responded that it’s much easier for us to come down here than for her to come to the states.

It’s true.  Obtaining an American visa, especially if you’re not among the elite in the DR, is terribly difficult.  As we all know, many foreigners arriving with a temporary visa decide to take the opportunity to stay undocumented for a hope of a “better life”.  Well, from those few Dominicans that have visited the US that I’ve spoken to, and from my experiences down here, most would not consider American life better at all.  Regardless, it serves as an important reminder of the privilege I have for simply being born in my country and the world of opportunity that that provides—literally.

Looking Back

Now that we are back in Atlanta and South Georgia once again seems very far away, I have had some time to reflect on this experience and what it has meant to me. The experience was so incredible in so many ways that is hard for me to pinpoint exactly how it has changed me… and yet I know that I look at the world differently than I did six weeks ago.

Before the Moultrie experience, the migrant farm worker population was not one that I had ever really considered before. Like most people, I hadn’t ever really stopped to think about who picked the fruits and vegetables that I ate. I had never considered what their life might be like or the challenges they face. Now I can’t stop thinking about it. When I was at the grocery store the other day looking through the produce I found myself wondering who had picked it…. Did they have a family? When was the last time they saw a doctor? Did they have macerated feet and a tiny flap skin encroaching on their eyesight? It makes me feel both proud to have served these people, however briefly, as well as helpless. Although I know that the work we did in South Georgia benefited the farm workers that we saw, the whole operation sort of feels like putting a bandaid on an artery. I sometimes wonder if the people we saw with hypertension will ever get medication for it or if they even have the means to make the lifestyle changes that we suggested. It’s so heartbreaking to think about the children that we saw in the schools, so full of energy and potential, may end up dropping out of high school to work in the fields just like their parents. This population faces so many challenges, which are only increasing in the current political environment and sometimes the scale of the problems just seems way too big to even conceive of a solution. I know that as nurses it is our job to care for individuals, but in a setting like this, the inadequacy of the whole system can be very frustrating. I guess that is the constant struggle of the public health nurse… which brings me to the other great impact that this experience has left on me.

Ever since I started nursing school I have been doing hospital clinical rotations and I know that as a nurse you are supposed to be excited about working in a hospital but I was not. Ever. Hospitals are not where I fit; they are not where I feel that I make a difference or where my skills are best used. Although I knew that there were other options out there, I didn’t really know what being a community health nurse would look like.  Being able to work in a community setting with a vulnerable population has really renewed my faith in nursing and has confirmed for me that I am definitely in the right place. This is the kind of nursing that I want to do, I just felt like it fit! I am so encouraged about having such a great first experience with public health nursing and I know that it is where I am meant to be.