Week 4

3 04 2010

On Friday, all 27 of us shipped off to different rural clinics in Salcedo. We split into groups of 2 or 3 and in total covered 12 clinics. I was assigned to “Los Cacaos” with a friend who also goes to Yale, Lauren. Los Cacaos was about 45 minutes from the heart of the city of Salcedo. When first arrived in the city, we went to the central office where we met all of our doctors and nurses who we would be working and living with for the week. Our doctors were two young women who just finished up with medical school, they were 22 and 23. Our nurse was an older woman who had been working at the clinic for about 3 years. The city was not nearly as developed as Santiago and looked to have less resources in general. After the brief introduction we went to have some lunch and took a quick trip to the grocery store to buy some last minute food items to last us through the week. Then we crammed (and I mean crammed, think 8 people) into a pick up truck and drove to our clinic.

The ride was bumpy and curvy but beautiful. The mountains here are so different from anything that I’ve seen in the states. The mountainsides are lined with different fruit trees and tropical vegetation and the views from the tallest parts are incredible. When we pulled up to the clinic, it hit me that I would be experiencing a life that was quite different from that in the city. The clinic was equipt with 3 rooms, 3 bathrooms (one complete with a shower), a kitchen, a waiting area, a nurses office and a doctors office. The clinic had been recently renovated so everything was functional but cleanliness was not it’s strong suite. Lauren and I walked into our room, which was originally for patients who needed monitoring, complete with two hospital beds , and IV hanger, and a bathroom. We looked at each other, smiled, and said “well, this is going to be an interesting experience”. We put our sheets onto the mattresses that we first disinfected with Clorox wipes (Mom, you taught me well) and went out to meet some people in the community.

We first met Virgilio who didn’t work at the clinic but basically spent all day there. He has lived in the town for quite some time and know almost everyone and everything about the area. As the week progressed, he was a valuable resource. We walked through the streets with one of the doctors and Virgilio to introduce ourselves. Most of the people sit outside on their “porch” or in their “yards” on plastic chairs and pass the day talking with family, friends, and playing Dominoe. As we passed through, at almost every house they would say “entren entren, sientense” meaning come in and sit down. Almost everyone greeted us with “hola americanas” and asked why we were there in Los Cacaos. The community is made up of both Haitians and Dominicans and the wealthy live among the poor. There is one primary school which goes through grade 8 and for high school the kids have to travel to the next town. The center of the community is the “Colmado” which is like el campo’s version of a convenience store. After a few introductions, we headed back to the clinic to attempt to make something for dinner.

For the week we lived off of crackers with peanut butter and jelly, cornflakes with yogurt (there was no refrigerator but we were allowed to keep the yogurt in the colmado), rice, and pasta.  After an ice cold shower (at least there was running water), we settled into our hospital beds and got some rest. The remainder of the weekend we spent getting to know the community and preparing our “charla” or chat about diabetes that we would give during the week when the clinic was open.

The clinic is open from 8am-3pm Monday-Friday. We would come to discover that these times were just suggestions. The doctors would usually arrive around 8:30 or 9 and leave whenever they though there would be no more patients. The clinic was full with patients from about 8 to 11 or 12 and then a few would trickle in until about 1. Lauren and I got to observe all of the consultorios (appointments) each day for the week. The structure of the appointment was ver eye-opening. A patient would enter the doctors office, the doctor would ask the patient to explain his/her symptoms and without much more conversation and usually without any physical examination the doctor would get up, go over to the cabinet and select the appropriate medicine. No vital signs were taken unless someone complained of a fever or asked to have their blood pressure taken. Physical examinations were only conducted if there was pain in a specific place (and that only happened some of the time and depended on the doctor). It seemed as though there was an antibiotic or pharmaceutical treatment for everything. Many people came in an complained of “la gripe” which I was taught meant “the flu” but seemed to be used as a universal complaint much like a cold. I also went to the clinic knowing that the flue was a virus and left the clinic doubting my sources because some sort of medicine, and often antibiotics, was given when a patient complained of la gripe. The first day, I was shocked. Nothing like this would happen in the states, I thought. I have never gone to the doctor without being grilled about medical history, current health practices, and a full physical examination even if I was just going to complain of a sore throat.

The clinic was well equip but the availability of medicines varied. The community knows that medicines are delivered on Tuesday, so we saw about twice as many patients that day. There are technically two different medicine cabinets, one for donated medicines that can be used for patients without insurance and one cabinet with medicines from the government to be used for people with insurance. And by insurance I mean public insurance. But despite the division of medications, the doctors used medicines from both cabinets without regard for whether or not the patient had insurance.  Giving out medicine was like giving out candy. The patients were only content if they walked away with some sort of pill, syrup, or injection. It was also common for the patients to ask for medicine for family members or friends. For example, one woman came in and walked out with three different medications: a syrup for her child with the flu, a cream for her skin rash, and birth control for her daughter who just got married (at age 13). Her daugters were not present at the clinic to be seen but the doctors were not hesitant to provide whatever medication the women thought was necessary. The notes taking and record keeping was minimal. There was no computer and one main book where all of the appointment notes were kept. And by appointment notes I mean one line where the doctors usually just wrote the medications that were given out.

At around 3pm everyday Lauren and I would go for a walk through the community to chat with the people and work to understand the culture of el campo. The lifestyle is incredibly slow and relaxed. There is not much to do other than talk, play dominoes, eat and sleep. There is a lot of poverty but the people seem to have everything they need and the environment in which they live is beautiful. One evening some of the people who we became close to came to the clinic and played us some merengue and bachata. We also learned how to play dominoes which gets very serious and competitive in el campo. By the end of the week, I was ready to get back to city life but wanted to take with me the appreciation that the people in el campo have to relationships and just a general joy of living.

We arrived back to Santiago on Friday and then headed to the beach for the weekend. It was a much needed little vacation to gear up to start classes again for the next week.

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3 responses

25 06 2010
mimi

Hi Sweetheart: Today is Thursday and only one more day to go before we all hear from you again! You have really been missed! Fox Hollow is almost completed and will open July lst with a full l8 holes to play. You are going to love it- it is really looking good. Mr. Mike has been asking for you and I’ve been keeping him posted on your adventures. Looking forward to our golf together—-Love you more! MIMI

6 07 2010
mimi

Hi Sweetheart:So happy you are back – that week sounded exhusting! Really enjoyed your update and the great pictures.These people have a wonderful attitude and seem so thankful for the minimal basics they receive. I really hope you get some healthy meals now that you are back – like veggies and meat. It’s great you can get to the beach and relax and have some fun! Good luck with all your classes this week.

Te echo mucho de menos!
Un beso,MIMI

8 07 2010
Allison

Hi Cutie!
Loving the blog and reading about your life in the DR. Can’t wait for our Skype date on Sunday. I miss you! I’m so glad that you’re having a great time and soaking it all in. I am already planning for lots of fun upon your return! 🙂
Sooo much love,
Allison

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