More CHAOS

Chaos Glass Studio, Sutter Creek, Calif.

Fiddletown, Calif.

Down Highway 49 for the day!

Hakone

Hakone

More Hakone

Hakone, Saratoga, Calif.

Saturday - Coming Home!

While I'm sad to say goodbye to the DR, I am SO looking foward to
sleeping in a bed, showering with hot non-canal fed water, not needing
constant mosquito spray, and being able to flush toilet paper, or
flush at all for that matter. We are so blessed here in the US.

We headed to Cibao International Airport, had lunch, and headed to
Panama. As the group was boarding, except me (I was near the front,
they were in the back), I wandered over to the window that overlooked
the airfield. I spotted a gecko, clinging to the window above the
enterance. See picture! Aside from the tarantula, he was the only
other critter I saw in the DR that we don't have at home.

The flights home were long and exhausting, compounded by nausea and
the smell of food in a compact space. I watched "The Blind Side,"
which was awesome.

We got into LAX a half hour late, and pressed on through Customs and
Immigration. The agent who processed me was friendly and smiling, but
he was definitely in the minority as smiling goes. All the others had
crabby and rude agents; one of them was really mean to Kelly. Really,
dude, she's 13. Be the adult.

We grabbed our bags, caught a reimbursable (yay!) 1.5 mile $17.50 cab
ride to our super beautiful Hilton Garden Inn, and zonked out. It's
Sunday now, and I'm blogging from bed. I'm flying home this afternoon,
with laundry and plenty of good memories!

Friday - Last Clinic Day

After getting roughed up by the heat and humidity on Thursday, we were
super relieved to come upon our clinic site on Friday. Shaded by
trees, and a second story, our four room clinic had only the humidity
and human demand with which to contend. It rained right after we
opened, but did little to slow the numbers of locals flocking to our
clinic.

Nestled in amongst homes of varying wealth, the school was across the
road from a clinical lab. When we passed it in the morning, it had had
a cinder-block fire in the front yard, complete with chicken-stew size
pot. The image was surreal. It reminded me of the home of the local
healer (read: witch doctor) I'd visited in a township in South Africa.
Chickens out front, a fire going, etc. All of the doctors had wanted a
picture of this place, but were too busy to get away. Kelly and I
snuck out the gate of the school in the late afternoon to run down the
street and snap the pic. Which will be posted after we get back to a
computer.

This clinic served a different population than those earlier in the
week. Many of the patients were Haitian, and spoke only Creole.
Luckily, there were ample young people in the surrounding community
who showed up as patients and offered to work as Spanish-Creole
translators. As many of our providers, including Lynne, are fluent in
Spanish, it didn't seem to cause much disruption.

In the morning, I helped set up our suitcase pharmacia. Which was
established in the school's kitchen. Which contained a tarantula up in
the corner of the ceiling/wall that could have at any moment jumped
down and caused grave cardiac events in those working the pharmacy. At
one point later in the day I'd gone back in, only to fond our eight-
legged friend missing. He was quickly located a short distance (on the
ceiling) from his morning position, but all working in the general
area were astutely aware of his movements. Again, picture to follow. I
couldn't resist. He was probably the width of my hand (plus fingers),
when moving. Apparently his friends also visited various sleeping
quarters around the orphanage, but we luckily dodged that bullet.

After lunch, we began registering the afternoon's patients. News of
our free clinic spread fast, and at one point the giant white metal
rolling gate at the entrance to the school was forced open by the
crowd outside, and they
surged toward registration, yelling. This lack of control caused us to
reconsider our methods of entry, and in a short time, control was
restored.

As with all clinic days, patients had to wait between screening and
seeing a provider, and then again for their prescriptions at the
pharmacy. This down time, and abundant shade allowed for some brief
education. In the morning a group of our volunteers recited the
English and Spanish versions of our anatomy flip charts, while acting
it out. It was like an anatomy version of Simon Says. The parents and
grandparents enthusiastically joined in, and the monotony of the wait
was eliminated. The same volunteers offered one-on-one instruction on
teethbrushing, as all patients received a toothbrush and tube of
toothbrush. As our other group offered a dental clinic to the
community back in Jaibon at the orphanage, and did a crazy number of
extractions, we thought it was a worthy topic. Grandmas and kids alike
motioned along with the instructors, which was super cute. As this was
going on, I was filming the anatomy lesson.

In the afternoon, a similar downtime arose. Shortly before departing
for our trip to the DR, I had received the gracious donation of two
CPR manikins from Jack and Anita Grogan of the Sudden Cardiac Arrest
Association. I had purchased Laerdal face shields from Life Assist to
allow for hands-on (actually, mouth-on) training before I left, and
Friday was the day that I got to bring them out! Other teams had
considered using them, but when school was cancelled (either a holiday
or teacher strike, it was never clear), they had to scratch their
original lesson plans. Which was to my benefit, as I was no longer
depriving them of the manikins!

Kelly and I first inflated the infant manikin, as it most resembled a
full human, and there were many babies in the crowd. We were hanging
out with our Creole translator, who was also learning English. As our
little group read from the English and Spanish booklets enclosed with
the manikin, children began gathering around, looking on in
curiousity. They too wanted to see the muñeca (dolly), so we found
some desks, and began an impromptu "baby choking" training. The kids
were really fast learners, and our little group caught the attention
of the grandparents of our participants. As I explained (as best I
could) that the doll was "un muñeca por RCP" (CPR manikin), and that
we were modeling how to dislodge a foreign object from a choking baby,
they got really excited. They encouraged the kids, and explained to
others who walked up to check out our scene. When their prescriptions
came up, and they needed to head home, the grandparents hugged me.

After our group partially disbanded, we went in search of others
waiting in line. We found the provider waiting area, two rows of chair-
attached desk units in the outside breezeway adjacent to the
courtyard. Again, baby muñeca was a big hit. This partiular group of
patients waiting were predominantly Creole speakers, but those who
could speak Spanish and Creole repeated and translated from the back
row of desks. The group was mostly mothers and elementary-aged
children, who were all very excited to learn about choking babies
(many of the moms in the general area were holding squirming
toddlers). We repeated our interactive lesson, and used a bunch of the
Laerdal face shields to let the kids attempt rescue breaths. One
little boy, whose desk top I'd borrowed to place the manikin, was very
stoic, but kept watching. As we demonstrated, and the other kids
successfully got their rescue breaths in, causing the little plastic
lungs to inflate and the tiny chest to rise, he became more
interested. I gave him a mask, and motioned that he could give it a
try. He hesitated at first, but got the chest to rise on the first try!

After a while, the line began to move, and our area became congested.
Kelly and I went down toward the group waiting to be registered and
screened. We set up shop on a blue table under a tree, and I was
walking her through the scenarios (with Weisser in my head the whole
time, "Baby's looking at you..."). A woman walked up and tried
speaking to me in crazy fast Spanish. I had her pause, and called over
Amy, one of our fluent group leaders. She explained that the woman was
a nursing student, who was drawn towards medicine when her sister's
husband and four year old child were in an auto accident a few years
prior. They didn't survive, and the woman indicated that the child may
have survived if someone at the scene had known CPR, but no one had.
She continually repeated, "it's very important, very important." I had
Amy ask her if she was familiar with "RCP," and she said she was. I
asked her about CPR training in the communities, she indicated that
the local doctors provide classroom instruction on the subject in the
primary schools, but that the training is mostly blackboard-based. She
indicated that students are instructed to find the proper landmarks on
themselves, but no further hands-on training is provided. They do not
have manikins upon which to learn and practice. The new Heimlich
training devices they advertise in JEMS would make a world of
difference in this community.

We wrapped up our training as the clinic saw its last patients, and
headed back to the orphanage to pack up for our next morning
departure. After dinner we had a round-table recognition group talk.
After the power killed, we broke out the flaslights, which were
finally replaced by generator-powered lights. However, this didn't
help the water issue in the showers, and while I was hand washing an
outfit for the plane using a bar of Ivory soap and a wonderful
headlamp (thank you!!!), two girls tried to hop in the showers. I paid
them little attention until they ran out of water. They'd soaped up
using the risidual water pressure left in the lines, but after that
was gone, and the pump had no power, the two soapy girls were SOL
without water. Two of the sinks had water, somehow, so they shuttled
cups of water back and forth to rinse off. All while holding their
respective flashlights, as we were in a cinderblock building with no
moonlight.

After laundry, I started packing, and fell asleep.

Sent from my iPhone

Wednesday - Fun Day

Sorry for the break in the blogging; we've been so tired, I've fallen
asleep instead of blogging!

Wednesday we had our fun day, a day without clinics. We started the
morning relatively late (@ 0730, not 0630) and left for Monte Cristi
around 0830. We took 10 shuttle buses to Monte Cristi, where the other
Orphanage Outreach orphanage is located.

We arrived in Monte Cristi a couple hours later, and made our first
stop at a minimart. It was like the Bi-Rite crossed with a 7-11. We
hadn't exchanged any money, so were unable to shop, as they only took
pesos. Our stop was brief, and we continued to OO's English Institute,
located right across the street from the town center, which held a
park with monuments, grass, and benches. The E.I. is a three story
(and sleeping dorms on roof) building, where children from the
community come to learn English during the day. Kids in the DR go to
school for only half of the day; kids who participate in classes at
the English Institute do so opposite of their school schedule. If a
child goes to elementary school in the morning, they have the
opportunity to be in English class in the afternoon, and visa versa.
The EI accepts 5th to 8th graders, and children move through the
program each year. The EI classrooms look like elementary classrooms
in the states; the cardinal directions are labeled on the walls, the
alphabet and nursery rhymes are featured prominently, and most solid
objects are labeled in English ("couch, door, desk, ceiling").

After leaving the EI, we travelled to the Monte Cristi orphanage. That
orphanage is much more developed than ours in Jaibon, as OO has been
at the MC for a longer time. From the roof of one of the buildings,
you can look out and see the ocean. On clear days, to the South, you
might see Haiti. 45 children live at the MC orphanage, and some young
adult residents receive intensive English training to prepare for
college-entry testing. OO sponsors orphanage kids if they'd like to go
to college. Right now, four young women from the orphanage are
studying in the capital.

Once we left the orphanage, we stopped at a curio shop on our way to
lunch. The owner and his wife worked the register (cardboard box with
USD and Dom pesos). They met in Texas, at a Bible college. He's
Domincan with great English skills, and she's from Texas. As a group,
we spent a small fortune. My Dad will be happy to know that I'm not
bringing him home non-functional crap. Only vanilla!

After shopping, we headed to lunch at a wonderful outdoor restaurant,
where they served nearly one dozen different dishes, buffet style. The
seating was cafeteria style, and the roof was thickly thatched. Birds
were flying on and out of the edge of fronds, bringing food/supplies
back to their nests. Very cool!

After lunch, we went to El Morro beach! We ran into the Carribean, and
were the last group out of the water. It was a lovely 75+. We all
received saline sinus flushes, courtesy of the ocean, repeatedly. If I
lived here, I would never leave the beach.

We wrapped up at the beach, and headed back to Jaibon. We stopped
again the Monte Cristi, at an ice cream shop. Much excitement ensued,
as 20+ ice creams (hand-scooped) were dispensed. The flavors were very
similar to ours, but under the circumstances, tasted better than any
in the States. I bought an ice cream for our hot bus driver, Victor,
who acquired multiple ice creams by the time we left.

We got back to Jaibon at dinnertime, and was followed by movie night
for the orphanage boys. They came up to our pavilion and watched
Spanish audio, English subtitle Shrek. Lynne, Kelly and I were too
pooped to watch it, so we spent the evening trying to wash the sand
from our ears, hair, etc.

This is a wonderful country, but regular access to a shower is a total
life enhancer. :-)

Sent from my iPhone

Thursday - Clinic Day 3

The picture below isn't from Thursday, but rather Friday, but I was
too busy to pose. Thursday was another school-based clinic, so we
wound up treating many kids with so-so chief complaints, because they
all wanted a basic checkup from the American doctors. The complaints
caused a day full of wild goose chases, but did result in some really
good necessary care for a solid population.

One of those patients was seen in the women's health room of the
clinic. She was screened with a 230/110 BP, and was brought in to see
the provider. A series of confirming BPs later, the seriousness of her
complaint (headache) was confirmed. Joy, an NP, gave the lady some
hypertension meds and sat her down to be monitored. While others
unknowingly tried to shoo her out, Joy wouldn't let her ICU patient
leave the room (only to stroke out while walking home). After an hour
or so, her BP had reduced adequately for the situation, and she was
sent to the pharmacy for meds, after receiving education on her
condition and ways to treat it. To the people who question the
importance of education in a trip like this, sometimes it is all you
can provide. When we treat a grandma or a baby in the clinic, we treat
the evident, as we can with the supplies on hand. If we take the time
to provide a name and explanation of their condition, and tactics for
management, our patients will have the tools to take personal
responsibility for their own healthcare. If they know that a
particular symptom requires a certain action (meds, hospitalization,
etc.) they will be more inclined to seek appropriate care. Grandmas
all over this region now know that their grandbaby's virus may lead to
life-threatening dehydration, and that they need to treat it by mixing
a concoction of salt and sugar. They also understand why antibiotics
are not applicable, and how to prevent its spread to other kids. Our
own citizens miss these points frequently.

I spent Thursday morning wrangling patients, shuffling them between
providers, depending on their needs. In the afternoon, Kelly and I
swapped jobs, and I worked in the pharmacy. What a freaking zoo. Any
sane pharmacist to stumble in would have had a coronary in the middle
of it all. Meds are sorted and stored in suitcases, which are lifted
and opened on perimeter tables around the room. There are hundreds of
meds, and the pharmacy was commonly staffed with people inexperienced
with pharmaceuticals. One person asked me how I knew so much about
pharmacy; i couldn't imagine not considering it common sense.

Contemplating this later, I chalk it up to years of mom and dad
talking shop at home, post-it's and pen samples from drug companies
all over our house, my EMT certification, my internships and
volunteering at UCDMC and Mercy, and my Anatomy/Phys classes, where
these were expected to be known. To get into a field requires legwork,
knowing the difference between Tylenol and Atenolol is just the
beginning.

After a record number of patients (370!), I came home Thursday covered
in a rash. Aside from the ridiculous number of bug bites I've received
(will be counting them after I get home), I'd been so far lucky to not
have my skin freak out. A very mild sunburn (really, it's already tan)
is really the only other issue I've caused myself. The rash however
was more or less unavoidable. I popped to Benedryl and passed out at
the end of the night. By Friday at lunch it was gone. I should also
note that Thursday's location was meagerly shaded, and was by far the
most hot (miserably hot) location we've been in. Concrete everywhere
makes for some upward heat deflection. Ugh, it reminded me of the
basketball courts in the summer.

Thankful for temporary relief from (self-inflicted) itching, I'd gone
into our tent, only to have it rain beautiful clear cool rain into the
evening. And all I wanted to do was be in it!

After dinner we had a panel discussion Q&A with the providers. Lynne
was one of those participating, and she gained many new admiring
students after the talk.

Below is a pic of one of those wild goose chases mentioned above. I
was dipping a patient's urine in response to a chief complaint of
painful urination and blood in the urine. We never found it, but it
was a good learning opportunity for all the students in the room, as
well as the patient.

Kelly at Ice Cream Shop

On our way back from the beach, our bus leader Bryson, bless his
heart, had the bus detour to an ice cream shop. 20 people = 20 ice
creams and ~ 10 waters; at ~ 100 pesos per ice cream, that was brisk
business for 20 minutes! ($1 = 36 pesos)

El Morro Beach

This afternoon we visited El Morro National Beach. The water was a
pleasant 75 degrees plus, and we spent a couple hours swimming around.
The beach was similar to Nor Cal beaches; rocky on the approach, but
sandy at the waves. Muy bonita!

The picture shows one of our ten rented buses, and a moto and pickup
of a family who passed us as we climbed the trail to leave. Note that
the pickup might fit three; we were passed by three generations of
family members, of which there were probably 7 or so. Road safety is
exciting here!

Clinics- Day 2

Today was our second day of clinics. Today's clinic was also held in a
neighboring community of Jaibon. We depart at 0730 on rented shuttle
buses (size of Airporter), arrive shortly after 0800, and are usually
seeing patients reach providers (as opposed to registration and health
screening) by 0900. Today we saw around 325 patients in our clinic of
6 provider stations. We have two peds, two family practice, and two
women's health/general med provider tables.

We were set up in a single room church today, and similar to
yesterday, were treated to a great experience thanks in no small part
to our host. Yesterday's school principal, and today's church pastor
were so gracious and helping. We cleared the room of pews, which we
set up outside as our waiting benches at screening, pharmacy, and
waiting room (under a tree).

We're seeing many children with viral illness and nutritional
concerns, either insufficient nutrition, or improper consumption (many
rotted teeth amongst a handful of clients). The physicians are seeing
their patients one after another, until the break for lunch or the
wrap-up before dinner. But they are providing all the aspects of care
they'd provide in the States.

Parents are receiving information on recognizing dehydration, the
importance of oral health, and the benefits of breastfeeding. Patients
are being screened for high blood pressure and high blood sugar, and
are receiving education and counseling as such. Diabetes and
hypertension are major players in Dominican health, and are important
to address in order to minimize further health complications in the
future.

The stickers have been hugely popular with the kids, and are only
overshadowed by toothbrushes. I thought that stickers would be king,
but travel packs of brush and paste can bring the house down! Today
Kelly witnessed a child in utter distress when all of her siblings
received toothbrushes, and she somehow failed to receive one. Kelly
dug through the bag of toothbrushes, and unearthed a princess
toothbrush, chasing after the family down through the churchyard to
deliver the brush. Needless to say, baby stopped crying, and now has a
princess friend to brush with!

We returned from the clinic, tired and very dusty. We cleaned up a
bit, had a great dinner (rice, beans, chicken, pineapple), and then
listened to Bryson's highly entertaining "History of the DR."
Ironically, as he began to talk about evil (Columbus, dictators,
slavery), the power (lights and mic) would kill. Initially highly
entertaining, eventually kind of distracting. But he did a great job,
and wrapped it up so we could watch a movie (In the Time of
Butterflies) about the end of the Trujillo regime. Excruciatingly sad
movie, especially to watch in a group.

When the movie ended, we were treated to birthday cake on behalf of
three volunteer birthdays this week, as well as to celebrate being the
largest (# of volunteers) health clinic ever!

I rounded off the night by washing my scrubs (and Kelly's) in the
bathroom sink with my trusty bar of Ivory soap. They are now clipped
to the interior ceiling of our tent, and are dripping all over me (and
this phone!). I am covered in mosquito bites, despite my obsession
with Sawyer's bug cream (this stuff must be sugar water, I swear).
Four per kneecap, four and three on the arms, respectively, and more
than I can count on my hips, calves, ankles, and bare feet. Some are
merging, like the skeeter sat there, ate, rotated, ate again, and
continued this pattern for a full 360. Dengue fever, here I come!

I now know what banana fields look like, and the damage caused to the
human body while harvesting the bananas. These men of the community
are all strong, built, and well kept, with backs that are failing them
40 years too soon. The cute elderly men have the faces of a 50 year
old with bodies that age them.

Tomorrow we'll be headed out to Monte Cristi, where the other health
clinic group of 200+ people is staying. We'll tour the town, stimulate
the economy a bit, visit the orphanage in Monte Cristi, and have lunch
at a local restaurant. After lunch we'll head to El Morro, the beach
near Monte Cristi, for an hour or two there. It's ~ 2 hours from
Jaibon, but we'll be back at dinnertime.

As I type thus, there are sounds outside that remind me of home, and
South Africa. There is the chain of dogs barking messages across the
valley, like in Indian Valley. There's a cow (maybe a few) nearby, as
it occasionally moos and snorgles. I think I hear owls, but there are
many nocturnal birds around, as they trill from trees just beyond the
bathroom. Some of them sound like an amplified screech owl crossed
with barn owl chicks, while another is indescribably non-song like.
Hope to find a lovely bird soon! Saw piggies today; I miss piggies!

There are bumble bees here that would fit nicely in a teaspoon, but
don't appear overly aggressive, just commanding of the air space
around ear-height. Big, furry, and black, they've been freaking out
pansies all week long. Awesome.

Off to bed!

Sent from my iPhone

Chateau Scannell/Chambers

Clinics - Day 1

This morning we woke up early (0630) to shower and make a 0700
breakfast appointment. It included cinnamony oatmeal, hard boiled
eggs, toast, and pineapple. We loaded our supplies, and headed out at
0730 to our first clinic. It was held at a local school about 10
minutes (by drive) from our orphanage. We arrived and set up in four
elementary classrooms down a corridor with an interior courtyard. The
registration was in the breezeway to the interior of the courtyard,
while the vitals/triage station was just inside under some trees. The
pediatric room, staffed by Lynne as well as another peds doctor from
USC, was right near triage. The room had a ceiling fan (life saver!)
and big windows on the interior and exterior walls facing the
courtyard and the entrance to the school.

The room next to peds was dedicated to wound care and women's health.
Beyond that room was the family medicine room, where families could be
seen one member after another.

The last room was our pharmacy, which was wall-to-wall sorted
suitcases of drugs. Kelly worked in the pharmacy, and was proficient
enough in catching errors and troubleshooting that others at lunch
asked her if she was a med or nursing student. When Lynne explained to
one nurse that Kelly is 13, she apparently stared back in disbelief.
Go Kelly! The pharmacy seemed full, but by the end of the day we'd run
out of albuterol for children. There is so much asthma here.

I worked as a Floor Manager, and pretty much stuck around peds all
day, as there was controlled chaos constantly. Children were in class
across the tiny courtyard, and "in class" is better defined as "class
is being offered, if the kids would come back inside." They were super
curious, and wanted to watch their friends and neighbors meet with the
American doctors. We found that these kids have an uncanny worship of
all things dental; if you're looking to stage a Latin American coup
using the population, you'd best pack toothbrushes, and lots of them.
Same with stickers, although this is also a common fascination in the
States.

All told, we saw approximately 300 patients today, and still made it
home in time for a wonderful dinner. What little excitement sack
lunches stirred up was made up for at dinner. We were served mashed
potatoes, seasoned and fried chicken, pineapple, and corn. Kelly and I
returned to the tent a while later to retrieve our gummy worms which,
in the heat, merged into a giant gummy blob. Not appitizing at all,
but we thought we'd cool it off and whip it out on the plane home for
some sugary comic relief. So much for thinking that chocolate
avoidance was sufficient!

After dinner Amy provided a brief talk on the orphanage system in the
DR. It was illuminating, and partially explained some of the rage
issues we witnessed amongst a couple of the orphanage boys over the
weekend.

Although exhausting, today was an awesome start to our week's clinics.
Tomorrow is a new community and new kids. They are all just as playful
and impish as our kids at home, these ones just mock us in two
languages instead of one. Below is a picture of Kelly in the school's
breezeway, saying goodbye to the kids as we were packing up for the
day. The little girls in front of Kelly had just moments earlier been
posing for the group of us, hands on hips, primadonna style. Watch for
more from these two cut-ups in Lynne's pictures.

It's 2300, and time for bed! Goodnight!

P.S. A shout out to my Pops - I'd forgotten what waking up to
dysfunctional roosters was like... The roosters here can't crow (like
they do in the movies), and it reminded me of our past roosters and
sexually confused hens. Cockle-doodle-(cough, gag, cackle). ;-)

Clinic Prep

So after lunch we had orientations for health education classes, which will be held in two schools, one in Jaibon (the town in which we're staying), and the other in a town a short drive down the highway. Groups have since met and constructed lesson plans and gathered/created instructional tools (posters, flashcards, and models).

The health clinic orientation followed soon after. Lynne, Kelly, and I are assigned to the clinics all week long, as Lynne is one of less than five physicians in the whole group of 200+ volunteers. Kelly has been assigned as the Pharmacy Manager, while I will act as the Floor Manager, keeping the flow of traffic, supplies, runners, and patients running smoothly as they rotate among registration, triage, provider care, and the pharmacy. This organizational style is modeled directly from ICS (Incident Command System),  whether they know it or not. This is wonderful, as I am familiar with ICS from my recent stints working H1N1 clinics in Sacramento. I have found this type of organizational model is imperative, as chaos is always lurking right behind your next patient.

After the clinics orientation, we debated whether or not to start sorting medications, as we have many hundreds of pounds is supplies with which to stock the clinic and pharmacy.  We decided to postpone until after dinner, which was served shortly thereafter. Dinner tonight was spaghetti, with local artisan bread (davis bakeries have NOTHING on the ones here) and watermelon. There are large water coolers (think orange and white things from athletic teams) available with water and juices all the time, which is nice, since it's hotter than... pretty much anywhere not currently engaged in active warfare.

It is super humid here (think DC in August), and mosquitos to boot. Same size as from home though. The bathroom situations are notable, if not a little off-putting for many. The sewage system fails to tolerate toilet tissue, so while there are flush toilets, TP must be discarded in a wastebin in each stall. When people fail to remember this, and disregard the request to retrieve TP with a stick prior to flushing, the toilets flood. So now my feet are Haz-Maty, and right after showering!  :-(

People will hopefully catch on quick!

After dinner, we labeled the tables with various pharmaceutical groupings, and proceeded to unload a Kaiser pharmacy-worthy amount of meds. Those in need with common ailments will be able to receive both top-notch care and prescription medications. Those with itch have nearly 4 gallons of topical hydrocortisone available, as Kelly and I unearthed gallon baggy after gallon baggy of tubes from our "Derm" table of meds. CVS' throught the country must be experiencing an unexplainable run on anti-itch creams. Ah scabies, how you alter our economy. 

We packed up our supplies, and have them ready to load tomorrow, when we depart at 0730 for our first clinic. This week's clinics will be held in communities not before served by OO Health Clinics. We hear the townspeople are excited for our arrival, and we're excited to see them too!

I need sleep, but more tomorrow. The picture below is of our tent ("Chateau Scannell") third from left, and our bathroom/shower facilities in the back right. The trees in the foreground are mango trees, and currently have fruit on them. As do the nearby coconut trees nearer the orphanage playground. 

Sent from my iPhone

Clinic Prep

So after lunch we had orientations for health education classes, which will be held in two schools, one in Jaibon (the town in which we're staying), and the other in a town a short drive down the highway. Groups have since met and constructed lesson plans and gathered/created instructional tools (posters, flashcards, and models).

The health clinic orientation followed soon after. Lynne, Kelly, and I are assigned to the clinics all week long, as Lynne is one of less than five physicians in the whole group of 200+ volunteers. Kelly has been assigned as the Pharmacy Manager, while I will act as the Floor Manager, keeping the flow of traffic, supplies, runners, and patients running smoothly as they rotate among registration, triage, provider care, and the pharmacy. This organizational style is modeled directly from ICS (Incident Command System),  whether they know it or not. This is wonderful, as I am familiar with ICS from my recent stints working H1N1 clinics in Sacramento. I have found this type of organizational model is imperative, as chaos is always lurking right behind your next patient.

After the clinics orientation, we debated whether or not to start sorting medications, as we have many hundreds of pounds is supplies with which to stock the clinic and pharmacy.  We decided to postpone until after dinner, which was served shortly thereafter. Dinner tonight was spaghetti, with local artisan bread (davis bakeries have NOTHING on the ones here) and watermelon. There are large water coolers (think orange and white things from athletic teams) available with water and juices all the time, which is nice, since it's hotter than... pretty much anywhere not currently engaged in active warfare.

It is super humid here (think DC in August), and mosquitos to boot. Same size as from home though. The bathroom situations are notable, if not a little off-putting for many. The sewage system fails to tolerate toilet tissue, so while there are flush toilets, TP must be discarded in a wastebin in each stall. When people fail to remember this, and disregard the request to retrieve TP with a stick prior to flushing, the toilets flood. So now my feet are Haz-Maty, and right after showering!  :-(

People will hopefully catch on quick!

After dinner, we labeled the tables with various pharmaceutical groupings, and proceeded to unload a Kaiser pharmacy-worthy amount of meds. Those in need with common ailments will be able to receive both top-notch care and prescription medications. Those with itch have nearly 4 gallons of topical hydrocortisone available, as Kelly and I unearthed gallon baggy after gallon baggy of tubes from our "Derm" table of meds. CVS' throught the country must be experiencing an unexplainable run on anti-itch creams. Ah scabies, how you alter our economy. 

We packed up our supplies, and have them ready to load tomorrow, when we depart at 0730 for our first clinic. This week's clinics will be held in communities not before served by OO Health Clinics. We hear the townspeople are excited for our arrival, and we're excited to see them too!

I need sleep, but more tomorrow. The picture below is of our tent ("Chateau Scannell") third from left, and our bathroom/shower facilities in the back right. The trees in the foreground are mango trees, and currently have fruit on them. As do the nearby coconut trees nearer the orphanage playground. 

Sent from my iPhone

Orientation

So after a restful night's sleep, and a glorious shower (lack of hot
water is not an issue, but a blessing; it's sun-warm, so perfect for
sweat removal!), we met for a breakfast of pancakes, eggs, watermelon
and pineapple, which is super sweet. We then had an orientation of the
week, and learned some ground rules.

After orientation, we took a brief tour of the property and the
orphanage grounds. We visited the church on the grounds, and saw the
lagoon, which is similar in size to our Mendocino propert pond, but
acts in reality as a glorified garbage dump. The highlight was hanging
out with the kids in the orphanage common area, and seeing 3 week old
puppies, also residents of the orphanage grounds. I've taken a great
deal of pictures on the camera, but will have to upload at home.

After lunch, the scent of which is currently wafting from the kitchen
behind me (yum!), we will sort all of our medicines and supplies, in
preparation for clinics, which start tomorrow. We will also meet with
the other clinic participants to lay out a ground plan for a
successful clinic.

Also, a note to my mom, I think I heard owls last night, but I don't
know which kinds are found here. Research and email my travel account
when you get home from Mendo? xoxo

More to come!

We've Arrived!

After the longest day of travel ever, we've arrived in Jaibon! We rode
an air conditioned rented bus (Airporter-looking thing) about 1.75
hours, while the driver blared bad radio. We arrived to find our bags
already unloaded, thankfully! We were assigned our very own family-
sized tent, which we rapidly converted into chateau Scannell, complete
with laundry line (inside the tent!), OFF bug fan to oust mosquitoes,
and copious battery-powered light sources.

We had a quick but tasty dinner, with out of this world pineapple, and
checked out the showering facilities. It was so hot Kelly said the
cold shower was refreshing, rather than shocking.

We then regrouped and joined our new pre-med friends from Arizona
State for some seriously competitive card games. Molly and Mom, good
call on the playing cards! Will donate them at the end of the week!

We'll be gathering tomorrow to prepare for the clinics that start
Monday, to sort meds and organize supplies. A night of sleep is soon
approaching; tomorrow is another day!

Arrived at LAX

After a crazy day of washing, sorting, packing, and trying to boss my
mom around, I made it to the airport. I've since arrived in one piece
(6 pieces, if you count the luggage) at LAX. Just waiting on my lovely
travel companions Lynne and Kelly, and at 1:00am we'll be off to our
next stop, Panama. We change planes there, and arrive at 3:30 pm in
Santiago, Dominican Republic.

Thank you to all who've given donations and support! Without you, I
wouldn't be dragging two 50 lb. rolling duffle bags full of medicine
and medical supplies. Without you, none of this would have been
possible.

Sent from my iPhone

Panama

So after a delayed departure from LAX (apparently the crew was
delayed, and typically one needs a pilot to depart), we spent about 5
or 6 hours in the air, finally landing in Panama. Immediately I was
reminded of South Africa. The soil is brick red, and the dense
greenery looks like it's slowly overtaking the airport. I suppose
that's what you get for cutting out an airfield from the forest.

The airport in Panama was very humid, and had more chocolate shops
than I'd ever seen. Not candy shops, but chocolate shops. Sometimes
you have to leave the US to realize the stranglehold Nestle has on the
world's chocolate market.

We set out for the last leg of our trip, to the DR, at noon. I fell
asleep, finally, and awoke to a hotty flight attendant (Luis) passing
out sandwiches. Which could only be described as non-poultry mystery
meat with cheddar and grilled onions. I had to mentally repeat to
myself, "Beef or pork. It's not capybara." I realize I should be
grateful for any food, but my mind just keeps wondering! Remember that
nutria infestation in Florida a few years back, when they finally
decided to embrace the pesty rodent as edible fare? No? Well I do.
Which made me move on quickly to my lemon cookies.

Once we land in the DR, we'll need to drag our drugs through Customs,
and then meet our group leaders outside the airport. Somehow, 200+
people and their 400+ bags of meds will get loaded up, and sent onward
(on bus, maybe pickup truck, we don't know). We should arrive at the
orphanage around 5 pm, if we aren't waiting for others at the airport.
So far we've spotted a handful of other young women in Orphanage
Outreach shirts like ours; it'll be a full house at the orphanage this
week!

Will update once I get a nap in! My eyes are bloodshot, and we're all
a little worked over right now. Nap time!

Sent from my iPhone

I've Arrived at LAX!

After a crazy day of washing, sorting, packing, and trying to boss my
mom around, I made it to the airport. I've since arrived in one piece
(6 pieces, if you count the luggage) at LAX. Just waiting on my lovely
travel companions Lynne and Kelly, and at 1:00am we'll be off to our
next stop, Panama. We change planes there, and arrive at 3:30 pm in
Santiago, Dominican Republic.

Thank you to all who've given donations and support! Without you, I
wouldn't be dragging two 50 lb. rolling duffle bags full of medicine
and medical supplies. Without you, none of this would have been
possible.

:-)

New Pages In Blog!

There are now other pages to my blog! Rather than clutter the home page of my blog with extra stuff, I've added some extra pages, accessible from the shortcuts on the top right section of my blog. One of the pages now has information about Jaibon, the town in which I'll be staying. There you can check the local time (although at $1.69/minute, it's unlikely I'll be answering calls at ANY hour!), see what the weather's like, and check out the map of the Dominican Republic. Enjoy!

Monte Cristi

Intro to the DR

Family Week - Dec. 2009

January 2010 Health Team

Hello!

I thought it would be a good idea to create an online space where all media related to my travels can be collected. This blog was created to do that, for free!

I will be leaving for the Dominican Republic on March 12, 2010, for a week of medical clinics in the town of Jaibon. I'm hoping to take lots of pictures and video, and plan to keep all family and friends up to speed on the trip via this blog.

=)