Ripple Effect

Let’s say you are the parent of a child with asthma, which happens to be the most common chronic childhood illness in the United States. During an asthma attack, the airways to the lungs contract, and the body must work harder and harder to exhale. Without prompt treatment, the situation can overwhelm the respiratory system and a child can stop breathing altogether.

Aptly-named “rescue medicines” usually relieve the crisis, and you probably keep those on hand. Also, chances are an Emergency Room is within fairly easy reach. But still you worry. Even in Philadelphia, home to a wealth of outstanding healthcare facilities, children die every year from asthma.

Now imagine that you and your asthmatic child live in a Dominican batey. In addition to figuring out how to put food on the table (assuming you have a table) and get potable water, you live in the shadow of your child’s chronic illness. Your access to medications is sporadic at best. The nearest healthcare facility is an hour away by motorcycle (a mode of transportation that kicks up enough dust to do awful things to the lungs of someone already struggling to breathe).

Very real situations like this one form the discussion agenda for the Health Promoter Workshop, run by the Global Health team during each visit to the Dominican Republic.

Health Promoter is the title given to a group of about 60 Dominican women who live in or near the various bateys. Although they are laypeople, the Health Promoters receive training that allows them to keep an informed watch on the batey children and help educate families about health concerns. They are a constant presence in these communities that extends the periodic care provided by medical teams. For their work, Health Promoters receive a small stipend from the government.

The workshop is a day-long session at which the Promoters learn the skills they need. It takes place at the Catholic Hospital in San Pedro, a larger town about a half hour’s drive from our house in Consuelo.

The trainees arrive looking sharp in new white polo shirts that designate their Health Promoter status. Everyone gathers for a welcome and a prayer to give thanks for this day of learning, then we head into classrooms.

For the next several hours, the doctors, nurses and therapists – aided by the team’s unflagging interpreters – engage the Health Promoters on topics ranging from child development to nutrition to taking vital signs. The team uses all sorts of teaching techniques. There is role-playing and lively Q&A sessions. Each Promoter receives her own stethoscope and practices listening to her classmates’ heartbeat and breath sounds. Pediatrician Debra Voulalas acts out what respiratory distress looks like. Therapists Natalie Danner and Soby Philip use real foods to show what children should be eating at various ages.

What is striking is the obvious interest the Health Promoters bring to this day. Presenters at many CME events would be thrilled to have such rapt attention from their audiences. These women want to learn. They know how important they are to the children they serve.

When the workshop concludes, there is a lovely closing ceremony, with thanks and recognition all around. The Health Promoters receive certificates commending their participation. One of my tasks has been to write each Promoter’s name on her certificate. I do this painstakingly, partly because the names are hard for me to read, but also because I want every certificate to be perfect. They deserve that.

The team stays in San Pedro for the evening, doing a bit of sightseeing and ending up at a pretty seafood restaurant. Our interpreters join us for dinner. There’s an interesting menu, a good wine list and lots of high spirits. The team has worked hard and everyone is savoring their first meal out in a week.

Then one of the interpreters, a Dominican man who is 21 years old, casually mentions that this is the first time he has EVER eaten in a restaurant. He says, simply, that he is very happy. For a moment, everybody gets quiet, then we proceed with dinner. There is never a shortage of opportunities here to remember how fortunate we are.

Posted at 02:22PM Nov 07, 2009 by Linda Lightner in Health  |  Comments[6]