CHOP's Global Health workers give firsthand reports on their experiences caring for children in Consuelo and the bateyes of the Dominican Republic.
Global Health Fellow Marc Callender, M.D., shares his thoughts on life and work in Consuelo. This story originally appeared in the January 2012 issue of At A Glance.
It’s fantastic to be back in the Dominican Republic. During my medical school days at Johns Hopkins, my girlfriend and now wife, Greer, worked for two years here as a community developer in a rural community, and I volunteered with her organization as often as I could. We always wanted to return to work here together, but figured we’d have to wait until we were empty nesters for the opportunity. When I first learned of the Pincus Global Health Fellowship, I knew it would be a dream come true.
In late August 2011, we and our 3-year-old son, Elias, arrived in Consuelo. The next week — along with Hurricane Irene — came a group of CHOP clinicians through the Allies Program. Together, we slogged through the muddy roads of Cachipero, a poor neighborhood of Consuelo, where we enrolled children under age 5 in “Niños Primeros en Salud,” a primary care and preventive health program run by Centro de Salud Divina Providencia and Robert Reid Cabral Hospital (the “CHOP” of the Dominican Republic).
While weighing and measuring each child, we asked the families about their access to healthcare, water and healthy foods. I was struck by the sincere hospitality everyone offered us, under the most modest conditions, and was honored that they opened up their lives to us. Cachipero is the fifth barrio, or neighborhood, to participate in the program, and I look forward to growing with these families over the next two years.
My first week was a great introduction to the integrated, community-centered approach to medicine that is the core of CHOP’s work in the Dominican Republic. While house calls have fallen out of practice in the States, here I have the privilege to see a child in the clinic in the morning and to visit the family at home in the afternoon. Engaging patients and families in their particular contexts helps me a great deal to give counsel that is applicable and practical.
Lara Antkowiak, the first D.R. Pincus fellow, paid a visit to facilitate my transition to life and work here. It was a symbolic passing of the torch — as we visited families in the neighborhoods together, a transfer of trust occurred among community members from Lara to me, for which I am grateful. Successfully sustaining these already existing relationships will be the key to effecting sustainable change in Consuelo.
Lara worked to educate and empower mothers in Consuelo regarding breastfeeding. I’m certain that her work will have a positive impact for generations. During my time here, I plan to reach out to fathers with the hope of increasing their engagement in the health of their children. Father involvement has been shown to lead to better health outcomes for children. I desire to mobilize these men of Consuelo, through education in preventive health, nutrition and child development, to help build a healthier community.
Apart from my work in Consuelo, I also see patients at the Columbia Family AIDS Clinic in La Romana, an hour west of Consuelo. Working with children infected with HIV has long been a passion of mine, and my work in this specialized clinic has been a rewarding experience. Greer supervises the maternal-to-child HIV transmission prevention program at the clinic, and it has been exciting to work together in the same place with a shared mission. Elias is loving preschool, making new friends and speaking a lot of Spanish!
It’s been an eye-opening first few months, to be sure. I’ve been pleasantly surprised by the depth and breadth of experiences to which I’ve been exposed. In the last week alone, I visited patients in the neighborhoods and in the clinic, participated in educational conferences with local providers, encountered patients with complex diseases, and collaborated with the nation’s vaccine director. It’s an incredibly humbling, yet thrilling, job, and I feel blessed to be part of the CHOP Global Health team.
CHOP Social Worker, Layla Ware de Luria, shares her experience enrolling new patients into the NPS program. A Global Health Allies team went door to door, weighing, measuring and surveying new 0-5 year olds in the midst of a hurricane!
Animo! Animo is a Spanish word for a positive outlook when circumstances are tough. This is the perfect word to sum up our little working group here in the DR. We flew from Phila to Miami to have the flight cancelled because of Tropical Storm come Hurricane 3 Irene. We stayed overnight in Miami with no luggage trying to collect information from the DR and peers to decide whether or not to attempt the trip the next day. The next morning there was no new information but the decision was- if the plane leaves-so do we.
With an incredible sense of humor and a desire to get to work we got on the plane to Santo Domingo in our clothes we had been wearing for 24 hours and flew to the DR. Upon arrival, the bags had been lost and the storm was beginning full force in the DR very shortly after arrival. With promises of our luggage later that night and Martina’s famous cooking we travelled the 45 minutes to Consuelo with our invaluable friend and colleague Abel.
The following day we got up, had some coffee, still with no luggage or running water headed to the Centro de Salud. Work in the Barrios was impossible with the still raging storm locals were scared and stressed, many not home because they were forced to head for friend’s homes or sturdier buildings. In Consuelo, schools were closed, the Centro de Salud closed at noon and we were sent home, wondering if we going to be able to work at all this trip.
That night we collected ourselves, our luggage arrived in pouring rain (It had been three days since we last saw it leave on the belt in the Philadelphia airport) from a brave driver from Santo Domingo who was the only one willing to drive around in the flooding streets. We counted our blessings, ate more of Martina’s famous cooking and enjoyed each other’s company and Maura’s version of 20 questions.
Finally Wednesday came, the weather cooperated and we headed to the Barrio Chachipero where our work was to enroll children under age five in the preventative health program set up here. The neighborhood of Chachipero gets its name from the ashes that used to rain down on it when the now defunct sugar cane plant was still operational. The small neighborhood of about 150 homes stands in the shadow of the skeletal buildings that processed sugar cane some 10 years ago. When the factory closed, so did the economy of Consuelo.
There are now precious few jobs, the main economy now is pulling the metal and copper out of the plant and selling it on the black market. Abel told us stories of folks being shot with regularity by the plant guards, while stealing the metal. We met one man who had been shot in the foot while stealing metal who told us that even though he had been shot, the price of the metal was well worth it because there is no other way to make any money for food.
Working from morning until dusk, we enrolled the entire Barrio in one day. Parents over and over again were amazed that two doctors, Deb Voulalas and Marc Callender, would travel out into their homes with unpaved streets to talk to them about their children’s care. Abel and Larissa Slavic (herself from the DR, not far from Consuelo) chatted with families, weighed children and interviewed families with such ease it did not seem at all the fledgling effort it really was.
Ramona, the Nurse at the Centro and NPS shared her knowledge and experience with the team and it was clear to us all that this effort would have been almost impossible without her. Finally, two medical residents from Robert Recabral Children’s Hospital were with us and though they were there to learn they showed grace and skill beyond what was expected of them.
Tired, sunburnt and with much animo, our little team returned home to La Casa Roja Wednesday night. We had come this far not knowing exactly what to expect, not expecting at all what actually had occurred and like the little engine that could, succeeding with the sheer will and positive attitude.
It is now Thursday morning and our energetic little group is headed out to Barrio 41 to work in the torrential rain and mud. While conditions are difficult we are all aware and appreciative, of each other and that families allow us to share their experiences and our knowledge. Viva La Republica Dominicana!
Global Health Program Manager, Maura Murphy, shares her impressions on healthcare in the developing world following a trip to the bateyes of Consuelo, DR.
Two days ago I went out to the bateyes with a Dominican doctor, two nurses and a health promoter. We set up shop in an unused classroom in a school in the middle of the sugar cane fields and waited for people in the bateyes to line up to see a doctor. From 10am to 2pm, the mobile clinic team saw close to 50 patients of all ages, with varying degrees of sickness and aches and pains. This was the first time the team worked in this particular bateye, called Altagracia, named after the patron saint of the Dominican Republic, and they will return in one month’s time to follow up on the community.
When we were driving through the sugar cane fields to reach Altagracia, I reflected on how, for many people living in the bateyes and in many places in the developing world, accessing healthcare is an extraordinary task. To see a doctor, one must not only have the funds to pay for the consult, the tests and the medicines necessary to treat them, they must also find a way to get there.
For people living literally in the midst of the sugar cane fields, transportation is one of the most difficult hurdles to overcome. So, people live for months and in many cases years without treating medical illnesses. These illnesses seriously affect quality of life for children as well as adults. For children in developing countries, however, it is not only a lack of access to care that makes them vulnerable, but also an underlying presence of poor nutrition that makes them especially at risk for dying from a preventable illness.
In Altagracia, as in many other bateyes, malnutrition is a product of poor sanitation, an insufficient water supply and poverty. Children that grow up with chronic malnourishment will be affected by an increased burden of disease and the effects of stunted growth when they are older, which will in turn make them less able to work and provide a different life for their own children, a vicious cycle.
Luckily, only a few of the children that the team treated in Altagracia were below weight, and none of them were suffering from acute malnutrition. When the team returns, they will follow the children and ensure that they are still above weight, and if not, they will provide nutrition packets designed to improve nutrition for those individual children.
Nevertheless, as we were driving out of the bateye, into the picturesque sugar cane fields once again, I couldn’t help but think about what it would be like not to be able to afford the bus ride to my doctor, or be unable to find the funds to buy a prescription medicine I might need.
The truth is, I will probably never know. All I can do is try not to forget the people who do.
Dr. Pamela Mazzeo shares her impressions and experiences while working with a group of Global Health Allies in Consuelo, DR, in October 2010.
I got caught in a wind tunnel crossing University Avenue yesterday, running back to Epic training in Colket after a mid-morning caffeine fix in Abramson. My hair and scarf whipping in a gust, leaves and construction grit swirling above the pavement, coffee cooling too quickly in my to-go cup...it seemed almost unimaginable that in 36 brisk little hours I'd be shrugging off my cardigan in balmy Santo Domingo.
But here I sit under a circling ceiling fan, mosquitoes buzzing outside the window screen! Along with my teammates, a group of eight other CHOP doctors and nurses, I'm settling into Casa Roja. This is our home for the next two weeks, in the town of Consuelo, midway along the eastern half of the Caribbean coast of the Dominican Republic. It's my second trip here with a CHOP Global Health team, and I've come back because I couldn't pass up the chance to be part of the evolving relationship between CHOP and our partners here.
When I was here in June of 2009, as a second-year resident in pediatrics, we spent just about every day riding into Consuelo's bateyes (communities clustered around the Dominican sugar cane fields, populated by migrant workers and their families) and staffing mobile pediatric clinics. The days were long and the work was intense, and I inevitably came home with my skirt smeared in a sticky mixture of albendazole and Gatorade...but the experience of working in the bateyes was unforgettable.
Certainly, some of the poverty we saw was striking and the disadvantage hard to take in. In the end, though, I think I was more impressed by the fierceness with which the doctors and community leaders of Consuelo approached the task of caring for their fellow townspeople. Since then, a number of CHOP and other groups have come through Casa Roja to help support the Consuelo team in their mission. CHOP has established a Global Health Fellowship, with one fellow based full-time in Consuelo and working with our colleagues here in the Centro de Salud Divina Providencia. The batey outreach program is thriving.
Now, our focus will be different. Instead of hauling huge Tupperwares full of amoxicillin and permethrin to and from the bateyes every day, on this trip, we'll be spending more time in the barrios here in town. We've prepared talks on basic but critically important topics like handwashing, vaccine-preventable illnesses, and breastfeeding, and we'll be doing educational outreach as much as medical. I love this new emphasis, because it reflects what I think of as a central mission in pediatrics: empowering families to help their children achieve their highest potential.
For now, I'm loving the breeze from the fan and the sounds of salsa horns drifting in from the bar down the block. It's Saturday night in Consuelo. We're too travel-worn to do much more than blog and surf Weather.com right now (Hurricane Tomas, feel free to take a sharp right anytime!), but it's nice to know that, a few streets over, music is pouring out of a storefront bar, and a mama is standing on her porch holding her baby, dancing in place with a huge smile on her face.
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