Archive for March 30, 2018

Alternative Spring Break – Dominican Republic, Day 4

By Danielle Dimacali
Photo by Manmit Singh

The most important thing when traveling to a foreign country is having an open mind and open heart to new experiences and ways of life.

These alternative breaks are extremely valuable for students to see how health infrastructure operates in a country with less resources. However, we must ponder: is it worse? is it better? The short answer is neither. We realize everything is relative.

It’s been a true privilege to be able to see and compare hospitals, clinics, and home visits in the Dominican Republic. It’s been incredibly meaningful to see how c-sections, pediatric emergency visits, canguru care for premature babies, and wound care happens here.

From people pouring sugar on pressure ulcers, hospitals autoclaving their own materials, to carrying a baby in arms from the OR to the NICU, we saw that things operated here differently yet worked for them. Furthermore, we realized that simply being there and continuously showing up and being present for a family is integral in the art of nursing.

After presenting with some basic essentials, we were returned with a beautiful prayer and song. On the other hand, nursing is also research driven. Through partnering with local nursing students here in the Dominican Republic, we equip and empower them with tools to help transform their community through a resilience model. However, it is crystal clear to us that there is already so much resilience embedded into the hearts and communities of the Dominican Republic.

Alternative Spring Break – Dominican Republic, Day 3

By Danielle Dimacali
Photo by Manmit Singh

Rather than a typical health clinic with a 15 minute time slot, we went into the community of Manhattan with a doctor and did home visits to contextualize the patient’s health and way of life.

We walked through the dirt roads and knocked on doors only to be graciously welcomed into these patients’ cement homes, and more intimately into these patients’ lives. As we did our interview and nursing assessment and interventions, we were overwhelmed with a sense of community and acceptance as foreigners, even so far as a woman taking a painting she made off her wall and giving it to us.

We continued our day volunteering at the hospital, and noticed the stark differences in resources and supplies. However, the patients and staff were overwhelmingly eager to have us to listen to their story and help in anyway we can whether it be doing a newborn assessment, watching chest tubes be put in after a gun shot wound, or going across the street to fetch an empanada and jugo de naranja and an empanada for a patient.

Although their health infrastructure may be different, we appreciated the beauty in the differences and the resilience of the people.

Alternative Spring Break – Dominican Republic, Day 2

By Danielle Dimacali
Photo by Manmit Singh

Symbiosis. The strength of this trip lies within community partnerships and continuity of care. As we toured San Vicente hospital, we were all welcomed by the nurses, staff, and doctors who were enthusiastic to see Dr. Foster yet again for her 15th and final trip. We saw the canguru program for premature babies in action, with moms carefully holding their baby on their chest waiting to be seen by the doctor for an infant follow up. We also saw the tremendous amount of research and global community parternship it took to implement the program in the first place.

We then did a community home visit as per the referral of PT students who visited this home a week prior. After a tragic accident that left the head of the household paralyzed with a trach and some of his skull removed, we found ourselves admiring the resourcefulness of the family and the support they gave each other. Ending with a prayer, we realized how crucial it is for nurses to simply be present and work symbiotically with the family.

Alternative Spring Break – Dominican Republic, Day 1

By Danielle Dimacali
Photo by Manmit Singh

After flying across international borders and traversing through TSA guidelines, we are warmly welcomed by Dr. Foster and our gracious host, Rosa, at the airport. The Spanish chattering, the bachata playing in the streets, and the warm embrace of the islands remind us we are indeed in the Dominican Republic.

Rosa’s casa is warm and inviting— adorned with plants, scattered with fruits, and a Dominican Republic feast of plantains, rice, beans, chickens, and fresh squeezed passion fruit juice waiting for us on the table. We realized how lucky we are to be in such a unique position to learn about not only the Dominican Republic health care infrastructure, but have an intimate glimpse of the people, the culture, and the way of life through an immersive experience. As we recognize our own biases and our role as Emory Nursing students and American outsiders on this trip, Rachel succinctly summarized our expectations for this trip with this Ralph Waldo Emerson quote: “Though we travel the world over to find the beautiful, we must carry it with us or we find it not.”

Alternative Spring Break – Puerto Rico, Day 7

By Lindsey Zwecker
Photographer: Trisha Cabantac

On Friday, March 16th, we went to a nursing home in Ponce, Centro Geriatrico de la Ave. We were thrown right into work and helped the staff with the morning showers of the residents. Once all the residents were showered and dressed we took them into the dining room for breakfast.

We took blood sugars and helped feed some of the residents. After breakfast, we took most of the residents into the day room. We ambulated some patients through the facility and helped the charge nurse give out medications. Soon after we all gathered in the day room and one of the nurses played music.

We had a great time dancing and playing dominoes with the residents for a couple of hours. Gladys whipped out her guitar and some of the girls in the group sang some songs for the residents alongside her. The residents loved it and it was such a joyful time.

We then walked around the facility and turned and changed some bed ridden patients. Afterwards, we took the residents back to the dining room for lunch, again helped serve and feed them.

We had a surprise visit from one of the Puerto Rican senators, Senator Cruz, that helps out a lot with the nursing home.

After the nursing home we went back to Blankito’s for lunch. We then went to Castillo Serrallés in Ponce that was built in the 1930s for Juan Eugenio Serrallés who owned the large sugar cane factory in Ponce. We were able to tour the beautiful house and get some souvenirs.

The group ended the trip with a beautiful dinner at a local Italian fusion restaurant in Ponce Plaza and celebrated all the great experiences we had in Puerto Rico.

On Saturday morning we traveled back to San Juan from Ponce to go to the airport and landed safely back in Atlanta. I think I speak for the group in saying that the trip was really inspirational and humbling, especially to see places like the hospital that still did not have power and the nursing home. This trip not only taught us to be more culturally sensitive when providing care in our practice but also to appreciate the resources we have as nurses in the United States and how important it is to give back to the community around us and in places like Puerto Rico.

Alternative Spring Break – Puerto Rico, Day 6

By Lindsey Zwecker
Photographer: Trisha Cabantac

On Thursday, March 15th, we headed to Hospital Castañer where we were welcomed and given a tour by Dr. Jose Rodriguez. The group was given a brief history of the hospital and we were able to meet with the nursing director.

This hospital is located in the mountains and serves the surrounding towns. The hospital still did not have power since Hurricane Maria hit so it was being run completely on generators.

The group had the opportunity to go through different rotations in the hospital. Pairs went to the emergency department, the inpatient facility, the clinic, the laboratory, and went on home visits with a doctor.

Most of the facilities ran very similarly to how hospitals run in the states but the home visits were very different and an interesting experience. Two of us went out with a doctor, an LPN, and a med student in a small van to different patient houses that were either too far into the mountains or the patients were bed ridden and unable to travel.

Although Spanish was a barrier for most of us to communicate with patients, we overcame it and had an amazing experience learning how hospitals are run in Puerto Rico. Tomoyo even had the opportunity to place an IV for the first time ever.

We finished the trip watching a movie about how the hospital was founded and created and toured the new emergency department that is being built currently.

After the hospital, we traveled back to Ponce and everyone took a nap in the van. The day was really amazing for the group. It was eye opening to see how a hospital is run in Puerto Rico and see the similarities and differences between care and nursing roles. It was especially interesting after learning so much from the nursing association president on Monday and then seeing what he taught is physically in the hospitals.

Alternative Spring Break – Puerto Rico, Day 5

By Lindsey Zwecker
Photographer: Trisha Cabantac

Today, March 14th, the group had an amazing day at the Salvation Army. The corps organized for us to present a variety of health topics to a regular group of older adults. The director introduced all of us and a couple of the group members led the room in different songs to start the morning.

We then proceeded to teach the group in pairs about nutrition and diabetes, how to do self-breast exams, Alzheimer’s disease, and hypertension and smoking cessation. A few of us were able to speak to the crowd in Spanish but for the most part Gladys translated what we presented in English to the group and helped us answer the audience’s questions.

The adults were very engaged and interested in our topics. After the presentations, we led different stations for each topic. At one station we took blood pressures, at another we took blood sugars, we did breast exams, and we continued the conversation about Alzheimer’s.

They were very grateful for us and it was so rewarding to teach them about health and wellness. Once everyone had been assessed the corps fed us another amazing lunch of churrasco con arroz and grandules, and guineitos en escabeche. The group then headed back to the hotel for an afternoon off. We, the students, decided to go souvenir shopping and secretly go to a local bakery where we picked up some pastries to celebrate Dr. Zhang’s birthday at dinner! We ate at a local pizza place for dinner and of course got ice cream again.

Alternative Spring Break – Puerto Rico, Day 4

By Lindsey Zwecker
Photographer: Trisha Cabantac

For our fourth day in Puerto Rico, the group had quite the adventure. We started off going to a local Salvation Army store in Ponce where we fed and took blood pressures of some homeless people. We got the chance to practice some Spanish medical terms and worked on communication with the local people. We served 96 people that morning. Afterwards we went to National University College and met with nursing students. We had the opportunity to mingle with them and hear about their program and Dr. Zhang gave a lecture on NCLEX questions and how to prepare for it.

Next, we ventured to the main Salvation Army building in Ponce where they cooked us lunch, our favorite meal so far this trip, chicken with gandules and arroz. We then went back to the hotel to rest for a couple hours before heading out on the major adventure of the day, street medicine. The group piled in the van and we traveled to Cayey, Puerto Rico to meet people from the organization Initiative Comunidad (IC). On the way, we stopped for dinner at beautiful restaurant, Pastelillos, on the ocean where we ate some interesting paradillas. These were 12-inch-long empanada-type foods that were stuffed with chicken, beef, conch, shrimp, cheese, and the best of all… shark. The views were beautiful and the group had a wonderful time looking at the water and sitting on the beach. Of course, we took lots of pictures.

After dinner, we ventured further to Cayey. On the way, we stopped and purchased sandwich making supplies to feed the homeless with IC. We made our way to the group leader’s house where we then made sandwiches and hygiene kits to hand out. Once all the supplies were ready we headed back out on our van following behind the group leader’s car to different places where IC meets different homeless people. The goal of the experience was to feed and talk to these people in order to establish a relationship and help them out. We went to five or six different areas in Cayey and Cidra and fed them the sandwiches, coffee, juice, and a delicious soup. It was a wonderful experience to see these people and how they live and most significantly hear their stories. We finally headed back to Ponce around 1 a.m. and went straight to bed for our early morning on Wednesday at the Salvation Army Health Fair.

Alternative Spring Break – Puerto Rico, Day 3

By Lindsey Zwecker
Photographer: Trisha Cabantac

Today, March 12th, we learned all about the healthcare system and the role of nurses in Puerto Rico. We began the day at the Salvation Army in Ponce. We gathered in the dining hall where we were welcomed by lovely table settings, cold water, and freshly made coffee that the director provided for us. Our first presentation of the morning was from Sr. David Espinet, president capitulo de Ponce, the president of the Ponce chapter of the Puerto Rican nurse’s association. He talked to us all about the different types and roles of nurses here as well as the different degrees a nurse can receive from universities. It was very interesting for the group to learn about the differences and similarities of the healthcare system here versus in the mainland United States when it comes to the profession of nursing. The most shocking thing that we learned was that a single nurse on a unit may have up to 20-25 patients at one time that they are responsible for. Crazy to compare to the 4-5 patients that a nurse cares for in the mainland United States.

After Sr. Espinet’s presentation we got to hear from the director of the Salvation Army in Ponce who told us about the history of the Salvation Army in Ponce and more about the programs and activities that the Salvation Army runs. She then guided us on a tour of the beautiful facility.

Afterwards, the group went to a fun lunch at a restaurant called Bankitos, where we ate burritos, quesadillas, and taco salads. Once our stomachs had settled and we debriefed the morning we were off to our next location, the Pontificia Universidad Católica de Puerto Rico (PUCPR), the Catholic University of Puerto Rico. There we met some lively nursing students and had the privilege of swapping information about our programs and learn about the life of a Puerto Rican nursing student. It was amazing to hear how passionate and enthusiastic the group was about the nursing profession. The greatest part of the day however, was when one of our students, Lauren Duncan, asked them to salsa dance for her. Two students jumped up began to dance and proceeded to teach Lauren as well. Soon the whole group, PUCPR students and Emory students broke out into dance, teaching each other and became submersed in laughter and amusement.

Once the dancing settled down and the group finished trading stories we were given a tour of their nursing school. We soon learned that their education is not very different from ours. Their simulation labs have similar, if not the same, manikins as we have at Emory, and we saw a student participating in a “check-off” exam for a skill just like we do. We quickly learned that the Puerto Rican students actually have many English textbooks and that all of their equipment and medicine is in English. But, they have to additionally know everything in Spanish so that they can explain things to their patients. We were amazed at their intelligence and how simple they thought it was even though they are learning nursing and medicine in two languages.

We ended the day with a wonderful dinner at Fusión, an authentic Puerto Rican restaurant, and then again with some delicious local ice cream. Tomorrow we are starting off the day feeding the homeless of Ponce and meeting another group of nursing students at an additional university.

Alternative Spring Break – Puerto Rico, Days 1 & 2

By Lindsey Zwecker
Photographer: Trisha Cabantac

We arrived in San Juan, Puerto Rico around 3 o’clock yesterday the 10th and immediately headed off in our van to Ponce where we are staying and spending most of our time. All 11 of us squished into this large van with our luggage and the group lit up with excitement. Everyone ooo’d and aww’d at the beautiful mountains and sighed at the evident damage from hurricane Maria. Our first stop was Raítes a delicious restaurant where Gladys, our trusty Puerto Rico native, pre-ordered us monfongo with shrimp and flan, Tres Leches, and guava with white cheese for dessert.

After dinner, we headed to Ponce. Even in the dark we were amazed at how beautiful the city was. We were all exhausted from traveling and went straight to bed.

In the morning of the 11th, we had a great breakfast in the hotel and then explored the city center of Ponce.

We then headed off to the boardwalk in Ponce where we got to do some souvenir shopping and eat some delicious authentic Puerto Rican food. And possibly the highlight of the day, feeding fish and pelicans sardines by the dock.

Afterwards we headed to a fair in Salinas where the national guard is stationed. There we got to meet Gladys’s son, Ricadro, and listen to some live salsa music and again do some shopping. We ended the day with a great dinner at the hotel and some ice cream from a local shop. And to cap it all off, we happened upon the municipal orchestra playing a set in the street in front of the capital building.

We are grateful to enjoy some site seeing for our first two days but are eager and excited to get to work and learn about the healthcare system in Puerto Rico tomorrow.