Week 3 in the DR

Published: June 2nd 2012
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Heading back from Jarabocoa to ILAC for the third week in the DR brought a sense of home and comfort. We had all settled in quite nicely to our own double bunk beds, a workout routine of running around the sand track in the evenings, and our consistent 730AM, noon, and 6PM meals followed by reading and dominos. The weather was a tropical breeze with warm sunny days, cool evenings, and even chilly nights. Everyone found a routine at their clinic sites and shared their patient stories daily at meal times.

Conveniences that are more often than not a necesity in the United States don't exist in developing countries. Most people have cell phones and some sort of motor vehicle usually a motorcycle. Never do people have machines to wash dishes and clothes. The social system is built on the amount of wealth your family has and the class your are born into doesn't often change. People don't marry out of their class and people don't move up or down in class. Unlike in the US where we value individualism and "picking ourselves up by the bootstraps" and making a better life for ourselves. Their culture is community and family oriented. They make decisions for the best interest of their entire family. Such an interesting sense of love and devotion these people showed toward each other. Something almost non-existent in the US. It is difficult to explain fully because it was such a different perspective. Obviously my path in life is at the other end of the spectrum since I have traveled and lived all over the US in the past year to better my life and my career seldomly seeing my family. This would be unheard of in the culture of the DR. There is a tremendous presence of faith in their culture which is infectious to be around. People have no expectations no sense of entitlement no demands about what they deserve to have. They are gracious everyday for what the receive no matter what the circumstance or what it has cost them. Their saying is, "Si Dios quieres!" meaning if God wills it then it will happen. For example, a dirt road a family lives on, that is miles and miles away from town and medical help, is wash away by a rainstorm preventing them from getting medical treatment that a family member needs. They believe that there was a reason that happened and that maybe it was saving them from an even worse event. There is always a positive light in every situation. When you are used to the unheard of things happening to you, nothing seems bad enough that you can't handle. It's all relative.

There was one patient in particular that made a lasting impact on my time at the Moca clinic. I will refer to her as A since I am trained to keep patients' information confidential. She was an 18 year old female that had been in a serious motorcycle accident resulting in a traumatic brain injury. I don't know any further background on the incident since there was very little medical information available when I first saw her. She had been going to therapy for at least a month before we arrived and was six months out of the injury. She had an entourage of family members that accompanied her to PT and took care of her as best they could for what they were educated to do.

The Dominican therapists were untrained in working with a patient who functioned at such a low level. A was unable to roll or sit up independently and was extremely distracted and lethargic. The therapists had been performing passive range of motion (moving her limbs for her) and not much else because A had developed a wound on her low back from laying in bed. Her family had never been educated on how to transfer her from bed to wheelchair (which was unheard of to have a wheelchair) and vice versa, how to position her in bed so that she wouldn't develop pressure ulcers and so on. The glady allowed us to work with her and we were excited for a challenge.

We immediately began working on stimulating her to maintain eye contact and head position...I will spare you the details of her treatment progression...essentially we started with the basics and training the family on how to properly care for her. The wound did not bother her during treatment and by the end of the 2nd week she was sitting up independently something she hadn't done in 6 months. It was promising the return she was getting after such a long period of time. She was a smart girl and was starting to get her sassy personality back. I didn't often know what she was saying to me but the expression on her face showed that the light of hope was starting to flicker again.

At this point, the beginning of week 3, she had been progressing exceptionally well but still wasn't getting and muscle contraction in her right leg despite our methods. She was now able to roll and sit up independently and had improved eye contact, head position, and posture. On her last visit of the third week she came to us elated pointing to her leg that she was lifting in the air as she sat in her wheelchair. Our immediate thought was it's time to stand! More to come on this story next week...

Our midweek cultural visit included visiting a Monastary in the mountains outside Santiago. A monk that has lived at the monastary for 25 years (never leaving) gave us a tour and sold us the jewerly and bread that he makes which is what he devotes his time to when he is not in prayer. We hiked a short trail to a waterfall close to the monastary and enjoyed some fun in the river.

After a full week we set off to the colonial city of Santo Domingo. They call Santiago the city in the countryside and after staying in Santo Domingo this made complete sense. Santo Domingo was one of the first cities that Christopher Columbus had lived in. The Spanish settled there and there is still a strong Spanish influence which is half of the culture in the DR the other half being African. There is much tourism in Santo Domingo and the architecture and layout of the city feels very European which is fitting but very different compared to Santiago.

We toured the city visiting many of the historic colonial buildings, walked through the large central market, and visited a cigar shop where handmade cigars were being made. We enjoyed dining in the city and checking out the nightlife. It was a very relaxed atmosphere on the coast next to the Caribbean Sea. There were many shops with art and handmade jewerly being sold. It was pleasant weekend and we were already getting nostalgic as we anticipated our last week in the DR just around the corner.

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