DR Update 6: Strike 3, Doctor Out?

Dominican love for the baseball is pervasive, and this adoration appears to have spread to the workplace. The national fasciantion with strike outs is only matched by a country-wide tendency to engage in labor strikes.

Strikes, or huelgas, are dime a dozen (doce por peso?) here. Last week, there was some type of strike (so non-newsworthy that I couldn't find an article on it) that blocked transportation between the capital and Baní. The result was that the Baní hospital's HIV doctor literally could not get to work. And since he's the only physician with expertise on antiretrovirals, no patients received HIV-related services that day.

The latest newsoworthy strike involves health care professionals. Doctors and nurses are striking for 72 hours across the country, apparently. The government is assuring Dominicans that health care will not change as a result of this labor action. However, I cannot imagine how a significant decrease in hospital staff will not harm patient care. This is an area in which a doctor's elevation of the patient's interests above his/her own may limit what types of protest are ethical. It will be interesting to see what comes of this latest huelga.

DR Update 5: Ruh Roh!

UPDATE: Crying wolf. Todo está bien.

From the headlines, Red Alert!...

Los organismos de socorros se reunieron esta tarde de urgencia para informarle a la población que a partir de las ocho de la noche de hoy y hasta el próximo jueves una activa onda tropical provocará intensas lluvias, por lo que declararon alerta roja para ocho provincias y alerta amarilla para seis. La información el presidente de la Comisión Nacional de Emergencia, general retirado Luis Luna Paulino, el director del Centro de Operaciones de Emergencia (COE) general Manuel Méndez García, la directora de Meteorología Gloria Ceballos y representantes de otros organismos.

Basically, there's a tropical wave (apparently a pre-storm) in the Caribbean. We'll be enjoying intense rain and wind gusts until next Thursday. (#)*$#%

Something tells me that living on a dirt road will not be a benefit in the upcoming week.

DR Update 4: Project

So why exactly am I here in the Dominican Republic?

This is actually a surprisingly difficult question to answer since there are many reasons, some of which have changed.

Originally, I was going to come to Baní to help the organization Infante Sano evaluate its new HIV prevention program, a type of PMTCT (prevention of mother-to-child, or "vertical," transmission) project. Infante Sano is a non-profit NGO that does work both in public Dominican hospitals and in two organizational clinics in underserved communities near Baní. Recently, the organization received a grant to improve access to HIV services in catchment areas of its clinics. One of the goals was to provide rapid HIV tests at the community clinics to increase uptake of the test, receipt of results, and the proportion of HIV-positive, pregnant women receiving preventive services. Well, it turns out that the program hadn't figuratively hit the ground by the time I literally hit the tarmac at the Santo Domingo airport. Thus, my goals necessarily had to change.

As I mentioned earlier, I realized soon after arriving in Baní that my language skills (or lack thereof) would severely constrain my work. Thus, the project created by my supervisor here seemed daunting: in 6 weeks, I was to learn about counseling and testing in a local hospital and translate lessons learned to a feasible community-based rapid HIV testing program. In other words, I was told to create the program that I came here to evaluate. There was also talk of my improving my Spanish so much that I would be able to provide community-based HIV counseling. [Insert joke about pigs flying and H1N1...] Fat chance.

Despite speaking Spanish as well as Sarah Palin stays the course, I did manage to learn a lot about hospital-based counseling and testing in recent weeks. The program is impressively robust and has integrated counseling, testing, and clinical services. The doctor on the service is also extremely dedicated to his patients, and I've learned a lot about HIV care in resource-constrained settings. (These constraints are relative, of course, and our neighbors in Haiti definitely have it much, much worse.)

Despite this limited success, I've started my fourth week here in Baní, and it's time to start promoting rapid HIV testing in the communities served by Infante Sano's clinics if we want an iota of a chance to cultivate any community interest in HIV testing. But herein lie several problems... First, half of the staff (including my supervisor) is gone for a full week, having traveled to Boston for a strategic planning process. Second, we don't actually have any rapid tests yet--and it's not even certain that we'll be able to get our hands on any rapid tests before I jet off. Third, we don't know what type of sample is required for the rapid test; if serum is required, we would have to draw blood and spin it down. Since we don't have any lab equipment, this situation would be a kiss of death for community-based testing. Fourth, my fact sheet on the rapid test is still unedited and unprinted.

So I proceed, fingers crossed. We'll see how it goes...

DR Picture Update 1

Location 1: Baní

Baní is my "home base," where I live and where I work. As mentioned earlier, I live in an apartment above the office of Infante Sano with other volunteers form the United States. One day, we had a coworker over for dinner and decided to make dumplings. I had to dig really deep (read: to my genes) and pretend that I knew how to cook Chinese food. I think the DMPLG gene is by the PNGPNG gene on the q arm of chromosome 4.

Making dumplings at the apartment, putting all of the comida china/pico pollo places to shame. Other person pictured is Lindsay, a pediatrics resident from Children's Boston.

Pot stickers (pegaollas?) in the DR. w00t.

Climbing a tree in a public park in Baní...

One fun cultural difference between the US and DR is that people here really like to pose for photographs. This is an attempt to emulate that proclivity--in other words, my being a huge poser in multiple ways. (So meta...)

Location 2: Barahona

Before Lindsay left, we traveled by guagua (bus) to Barahona, closer to the Western border of the DR with Haiti. The beach in this region is truly spectacular. We ran into a Peace Corps volunteer on the guagua, and he was on his way to act as a translator for a medical mission. This is a really convenient location for a medical mission, don't you think?

Los gringos at Casa Bonita in Barahona. This is what work is like every day. Or not :(. All of the doctors from the medical mission jumped into this pool soon after. Once I heard someone mention CME (continuing medical education), I ran for the hills. You've already met Lindsay. The other person pictured is Erik, a volunteer from Virginia who's going to start medical school soon--the poor soul.

We met a Peace Corps volunteer who literally lives on this beach. Where can I sign up for Beach Corps service?

Location 3: Cambita Garambito (near San Cristóbal)

Cambita is a campo (small town in the countryside) where the family of a coworker lives. Cambita comes from the work for bartering, which was a major form of trade here prior to the development of dollar dollar bills (peso peso bills?). I've made several trips over to hang out with my coworker's family and friends.

The baseball field in Cambita. People are sure serious about their baseball here in the DR.

Los gringos, otra vez. The volunteer on the left is Amy, a nurse-cum-future midwife-cum-international development superstar.

On the way up a mountain, Erik's car overheats and pulls an Old Faithful.

Crashing at some person's vacation home. (Seriously. We went there to hang out in someone else's back yard--which was a great call. You'll see why in the next picture.)

The scenery was ridiculous. The person in pink is Yosely, my coworker. Other people pictured are her family and friends.

DR Update 3: Activities of Daily Living

Sorry about the lack of updates recently. I'm going to try to write more regularly for the rest of my time here in the DR. This entry is dedicated to documenting some of what my day-to-day life is like here in Baní.

Luckily, I'm living in a very modern apartment. The kitchen is well-stocked, complete with gas stove and refrigerator-freezer. I also had the good fortune of moving into the last available room in the house, which has its own bathroom. In other words, I have way more personal space than I lived with last year when I lived in Vanderbilt Hall. All of this said, there are still a few aspects of life that are different:

• I live in an apartment above my office: My daily commute is literally 15 seconds as I walk down the stairs--shorter than my mini-trek to TMEC from Vandy. But I can't 2xAV (experience at supernatural speeds) office work. My bedroom is the room behind the brick on the second floor.

• I take bucket showers: There's often not enough pressure from the water pump (la bomba), and I take bucket showers with water that I set aside in a pail. I've been amazed at how little water is necessary for a thorough scrubbing.
• I wash clothing by hand: And thus, I'm pretty sure that my clothing isn't very clean... After I finish scrubbing, I use a nifty centrifuge to expedite the drying process before hanging the wash out on the line.

• I ride around on the backs of motorcycles: The most accessible form of transportation is catching a ride on the back of a motorbike, or motoconcho. For about 30 pesos (<$1), I can catch a ride from my house to the center of town.
• I don't have AC: I didn't have AC when I lived in New Haven or Washington, D.C., either. But in those places, I wasn't super paranoid about insect bites (thanks, micriobiology class!)--and I had screens on my windows. Nowadays, I either sleep with the windows closed (and fan at maximum speed) or with the windows open (wearing a gallon of OFF!).

More on my life and project in the next update!