Archive for March 22, 2014

BSN Dominican Republic 2014: Our Last Hurrah

Sorry for the late update on our final day in the DR. We’ve all been scrambling to get back into the swing of “real life,” and are now putting together a presentation for grand rounds at the med school and for the nursing school.

Friday was our last full day in the Dominican Republic. We conducted our last home visit with a man who had a spinal cord injury after his motorcycle collided with a truck carrying cattle several months prior. He had large wounds on his left foot from the accident, and a large stage four pressure ulcer almost a foot wide. It was clear that our visit would take some time, so some of the group left after the initial physical assessment to go conduct more surveys in Manhattan. Sarah and I stayed to finish with cleaning up the wounds and dressing them with whatever supplies we had available (which happened to be clean water, ointments, peri pads from our maternity supplies, Tylenol, and tape). We were able to suggest adjustments to the way the wounds were cleaned and treated, and were happy to leave him to be cared by loving, attentive family members.

In the afternoon, we went to the nearby nursing school to celebrate the opening of their new building, which was marked by many impassioned speeches by school officials and a round of brightly-dyed fruit sodas. We then took the bus out to the local college’s agricultural department land. Emory nursing students had planted orange trees there several years ago, and we got to see their progress.

In the evening, we spent the night out on the town learning to dance the bachata! We were happy to spend our last day working hard and playing hard.

BSN Dominican Republic Day Six: Kangaroo Kids and Mapping out Manhattan

This morning, Rita, Sarah, and I went to Manhattan to conduct a census and health surveys. We paired with members of the community, and went door to door to ask questions about their access to food, electricity, plumbing, trash disposal, and disease prevalence.

The community has roughly 225 families, and we surveyed about 50 of them. We noticed that many of them only had one full meal a day, which was usually rice and beans. Few had indoor plumbing, but most had electricity. Many children had asthma. Unfortunately, most of them said that it took them over half an hour to get to the nearby hospital.

Meanwhile, Bryonna, Miriam, and Krystena spent some time at San Vicente De Paul Hospital in the newborn Kangaroo care section. They were able to see the progression the children in this unit made through the use of Kangaroo care. Due to the environment, the doctors saw fit to provide nutritional supplements for many of the children such as vitamin A &C, iron and electrolyte powder to combat an amoeba infection.

In the afternoon, we all visited the museum house of Las Mariposas. Las Mariposas, or “The Butterflies” were three sisters from a wealthy family. They fought against Rafael Trujillo, the former dictator of the Dominican Republic. Trujillo was in power from the 1930s until his assassination in 1961. Although he brought the economy unprecedented growth, it came at a price—human rights violations were common, and he was responsible for the deaths of 50,000 people. Trujillo had them assassinated when they visited their husbands, who were in jail for treason. When they died, they became martyrs. We loved seeing powerful women play such a central role in Dominican history.

BSN Dominican Republic Day Five: Taking on Maribal

Today, we went with Rosanna to Maribal, another small, low-income community in San Francisco. The community had a small clinic with three beds to treat a variety of complaints, and to provide vaccinations and other preventative care. It was there that we met two community leaders who were able to point us towards people who needed medical attention. Most of the patients had been seen by Emory’s PT team the week before, so most of them had musculoskeletal complaints and mobility issues.

Three of the patients were incredibly well cared for. They and their families/neighbors knew how to apply each intervention, and why the interventions were being done. They had a great working knowledge of their medication indications and usages. One nine-year-old girl with cerebral palsy wasn’t as lucky. Her parents were young and unemployed. She had two younger brothers and another brother on the way. The parents were totally overwhelmed and had somewhat checked out. We found her dirty, half naked, covered with bug bites, and her limbs were bent in tight contractions.

In the afternoon, we met with healthcare providers and volunteers who were to serve as leaders of la casita de salud to find out what they identified as the most critical services needed for the clinic to provide. They indicated that they wanted to conduct surveys to identify the biggest health needs in the community. Additionally, a group of community members that serve as volunteer first responders wanted to be certified at CPR. Tomorrow, we will go to Manhattan to conduct these surveys to find out what the baseline is for disease prevalence in order to help focus their efforts and track progress.

BSN Dominican Republic Day Four: la casita

We spent this morning at the hospital. Half of us went to the maternity unit, and half of us went to the emergency room. The students who went to the maternity unit were so impressed by how mother and infant care has managed.

The hospital has launched a Kangaroo care campaign, with help from Dr. Foster. The mothers are encouraged to hold the infants to their chests for most of the day. This helps the infants regulate their body temperatures, breathing, facilitates lactation, and helps the mothers bond with their infants, among other things. In a low tech hospital, this intervention is indispensable in promoting infant growth and well-being.

Patient education is very thorough in these units. Bryonna and Krystena reported that the mothers had fairly high levels of knowledge about post-partum and infant care. Mothers also get the opportunity to learn from each other. There are six to eight beds in each patient room. New mothers get to spend a lot of time together, and often share their experiences, feelings, and perspectives with each other.

We had all learned so much about how healthcare was carried out in a resource-poor setting and had had plenty of opportunities to better our Spanish. But some of us were feeling a bit disheartened by the end of the day. We weren’t personally treating huge volumes of people, and our efforts to serve the patients we did see were somewhat hampered by resource limitations and a language barrier. We were a bit confused about our purpose for being on the trip.

That afternoon, we went to the opening ceremony for the new casita de salud. This small clinic will serve as an educational and preventative health promotion center for mothers and infants in Manhattan, a small, low-income community on the outskirts of the city. Emory provided organizational support for getting the center established. But this casita is ultimately going to be led and staffed by local healthcare practitioners, with Emory students and faculty supporting them on their terms.

We realized that this trip is not about treating as many people as possible in a one week time span, although we will have some direct patient contact to fill in some gaps in care. We are here to help Dominican residents work on Dominican problems, thereby creating sustainable solutions that empower people in the area to take charge of their own communities.

BSN Dominican Republic Day Three: ¡Empezamos!

Today, we got acquainted with the hospital we will be working with this week. The Hospital San Vicente De Paul provides a wide range of services to the 185,000 people who live in San Francisco de Macoris and the surrounding communities. We all met many passionate, inspirational people who were involved in trying to drive Dominican healthcare foreword.

Emory has particularly strong ties to the maternity unit—Dr. Foster and her past teams have conducted research, implemented various health care initiatives, and donated equipment in this area. We toured the NICU, the perinatal rooms, and the labor and delivery rooms. It was humbling to realize what few resources this hospital works with. We had the benefit of fetal monitors, programmable IV pumps, sterile, disposable equipment, and single-patient rooms during our maternity rotations. The nurses and doctors had none of these things at their disposal. It was incredible to see them do so much with so little.

In the afternoon, we followed up on three community visits conducted last week by Emory’s physical therapy students. The PT students left us very helpful notes on the patients’ chief complaints, interventions they had done, and issues that needed follow up from us. The nursing and PT interventions complemented each other very well. One patient, an elderly man in his 70s, had a history of stroke and was having rigidity and pain in his right knee, which caused him to rely heavily on his left leg to ambulate. The PT students were able to teach him exercises to strengthen his weak leg and to balance his weight in healthy ways. We were able to reinforce the teaching, treat his pain to make the exercises easier, and address other medical issues. Most of us had a tenuous grasp of spoken Spanish, but we were able to get through the visits with one fluent student, one fluent instructor, and some creative hand gesturing.

We concluded the day by going out to celebrate Krystena’s 24th birthday!

BSN Dominican Republic Day Two: If you like piña coladas…

In many areas of the Dominican Republic, Sunday is for resting. We took a bus to the coast with our hosts to la Playa Grande, and spent the day frolicking around on the beach. We had platters of whole fish, heads included, delivered to us with a generous side of plantains from the restaurant shacks clustered around the beach access point. Piña coladas were served inside hollowed out pineapples. At the end of the day, we returned to the house, relaxed, recharged, and ready to take on our mission on Monday.

BSN Dominican Republic, Day One

Day One:

Greetings from the Dominican Republic!


Over the next seven days, we will be working at a a public hospital and conducting home visits to help support healthcare in this country.After a three hour flight, we were warmly greeted at the baggage claim by our hostess, Rosa, and her friends and family. Rosa is a nursing professor at the local university. They grabbed us for hugs as if we were long lost family. We took a two hour bus ride from the airport in Santo Domingo, to San Francisco de Macoris, our home for the next week.


San Francisco de Macoris is a city in the north central area of the country, and is the capital of the Duarte province. With a population of roughly 250,000, it is a mid-sized city surrounded by agricultural land and tree-covered mountains.

During our bus ride, we began to get acquainted with the area. The Dominican Republic is a very physically intimate culture, and unfortunately this same closeness extends to driving—vehicles tailgate each other in ways that would cause white knuckles in even the most daring of Atlantan drivers. Traffic light signals are taken as suggestions, and pedestrians stroll around moving traffic to get around. Since motorcycles are more affordable than cars,they are ubiquitous throughout the area. Very few people wear helmets when riding them, and two, three, or even four people pile onto the bikes at once. Because of this, motor vehicle collision injuries are incredibly common.

Unvaccinated, unsterilized dogs roam the streets in packs. Although people in this country produce just as much or even less garbage than we do, sanitation infrastructure is somewhat underdeveloped. Bags of garbage are piled up on sides of the street. The streets are framed by a hodgepodge of apartments, shacks, and single-family homes stacked on top each other. Brown-outs and black outs are common, and much of the rural area does not have access to running water.

But this country has an incredible sense of community. People sit on porches and in the streets to speak with each other. Multiple generations often live in one home. People hold conversations in close proximity to each other, and touch each others’ hands and hair while they speak. They are also delightfully, vividly LOUD. As I am writing this from the balcony, people on the streets below are blaring music on boom boxes, holding entire conversations by shouting and singing, mopeds are revving, drivers are honking their horns at each other, and half a dozen dogs are yapping at everyone who passes them. Even though people living in this country face tremendous social issues and profound poverty, they have a beautiful country and an infectious sense of conviviality and excitement. We can’t wait to learn more about this culture and try to help out where we can.