We had another interesting reflection last night. Fr. Bill led us in a discussion using Ignatian way of thinking. One girl was telling us that one of her patients was basically living his last days and that the therapy they did was to sit and pray with the family. I know this would never be re-imbursed for in the States, but the family really appreciated it and was hugging them and sharing with them. Also, I went to Conani yesterday, which is a orphange. We took a group of kids who all pretty much have some sort of disability to a nearby park to play with them and love them up since they aren't typically given a lot of attention. The kids were shrieking with joy on the playground and they all wanted to hold our hands or hug us. We reflected on those situations and how much simple things can mean to people. We think that we are coming down here to share our education and help people with our therapy skills, but the things that mean so much to people are often things that don't take special knowledge....just some time, attention, a smile, or physical touch (Dominicans put my hugs to shame!)

Hahahaha!

So as of last night, I did not yet have the chance to get Yogun Fruz at Bon....which for those that don't know is frozen yogurt with various combinations of fresh fruit blended in. It is the most amazing thing and I don't think there is anything that compares in the US. So a group of 4 of us went last night despite the pouring rain. We got soaked on the way, but this is how much we love Bon ice cream! When we left there, the streets were flooded and there was basically a river flowing where we had to cross the street. I was wearing flip flops and I lost one while trying to wade through! The water was moving fairly fast and was too deep for me to find it again. So I had to make my way on the guagua van half barefoot...good thing I got a tetanus shot before coming here! Luckily the guy in our group gave me a piggy back ride from the guagua to ILAC (still in the pouring rain) because it is a gravel road with debris in it. It was quite the trip (it was actually very fun!) and I'm pretty sure that was some of the best ice cream ever!

the view outside our family's house at the campo

Home visit in the campo

El grupo at the campo

We just got done serving over 75 patients

Free clinic in the campo -patient with knee pain

At the campo river

Deanna, Me

Jumping off the rocks into the river

Mercado Modelo

Live band at the restaurant in Santo Domingo

Dinner in Santo Domingo

Carrie, Me, Shawn, Deanna, and Maggie

On the Plaza in Santo Domingo

Me, Deanna, and Amanda

Last weekend, I didn't have time to write about it, but we went to a campo (rural community). It was called Vaca Gorda (which means fat cow!), and it actually was fairly large with 2,200 people who live there. It is 2.5-3 hours to drive from the ILAC center and closer to the Haitian border. They grow a lot of crops including beans and peanuts, and they have a ton of animals rooming around! We stayed with host families who each took about 2-3 of us into their homes for the weekend. Suzi (another CI here) and I stayed in a house with a family of 8 people. We met our families when we got there and it was semi-awkward sitting on their porch trying to make conversation when my Spanish speaking abilities are very limited. Luckily Suzi can speak quite a bit so she was able to translate for me a lot, but I wish I could have been more involved in talking with them. At night we played cards which helped break the ice a little bit and I learned a couple games they play here in the DR.



The living conditions were definitely different from what I am used to. I think most of the homes are made of cement with tin roofs and doors/windows that are somewhat open to the outside. Our house had 1 main room, a kitchen, and bedrooms that were partitioned off by curtains. I had to share a double bed with Suzi and I know that someone was giving up their room and sharing with other family members for us. We slept under mosquito netting, though I still left with some more bites. Their bathroom consisted of a hut in the backyard with a hole in the ground. I took one shower all weekend and it was a bucket shower in the backyard with wood plank and tin walls. There was a large barrel that you filled up with water from a faucet and used a bucket to dip water out of it. It would sure wake you up in the morning as it was ice cold! It was very difficult to sleep at night because you hear animal sounds all night. Apparently roosters start crowing around midnight and continue till dawn. Not to mention the cows, pigs, dogs, horses, and chickens. What was amazing to me though was the hospitality and generosity of our family. Our 16 year old sister, Manuella, was our special friend who was always wanting to hang out with us. It is definitely incredible what disparity there is between these parts of town and the resort areas of this country.

On Saturday morning, the students all gave inservices presentations to the cooperadores in the campo, who are basically on-the-job trained health care workers. Then we had a free clinic to provide PT consultations to people in the campo. We saw a lot of back pain, shoulder, and knee injuries because most of the people there are farmers and manual laborers.

On Sunday, I took 2 of our students on a home visit in the campo to see a patient who because of her level of disability, had no way to get to the clinic. She had a stroke and has a lot of weakness and contractures of her joints. We did a lot of education and taught the family exercises and how to help her transfer. What was interesting is that is was very difficult to tell if the patient had aphasia or my Spanish language skills are just that bad! When we were done seeing her, they asked if we could also see the father of their house. He had apparently been struck by lightning and has episodes of dizziness. So I'm wondering if that is just a result of nerve damage that I can't fix, but I really have no idea since I can't say I've ever had a patient who was struck by lightning! And maybe he could use some type of anti-nausea medication, but I obviously have no access and limited knowledge about that. We did make him a quasi-eye patch out of bandana since he had double vision. He also had a leg length discrepency causing scoliosis and back pain, so I made a shoe lift out of a random sandal I found in their backyard....just cut off the sandal straps and tied it to the bottom of his shoe. Not likely to stay on the best, but here you have to get creative and work with what you have.

Sunday afternoon, we hiked to the campo's river and jumped off the rocks into the deep area. It was thrilling, but I assure you it was also very safe :) I also jumped in with all my clothes since I did not pack my swimsuit. I'm pretty sure that when we got back to ILAC, I had the best shower of my life!

The fun ring I bought at the market

Street in Santo Domingo

Street in Santo Domingo

The beach

This past weekend we went to Santo Domingo, the capital of the Dominican Republic. We went out for a nice dinner Friday night as Creighton's thank you to us. It was SO good! We had a sample of different cheeses and breads for an appetizer. I had seabass with risotto, and we shared mango sherbert and tirimisu for dessert. We went out dancing that night and I learned how to salsa (the basic anyway). On Saturday, the students go on a tour of the city (I did it 2 years ago), and it is a tradition with the professionals to skip out and take a day trip to the beach. I was sure to cover with SPF 50, but it didn't matter too much because it was really cloudy anyway. But there was a very nice ocean breeze. Sunday morning we went to a bakery for breakfast and then to the market (mercado modelo). I found some things to bring back including a fun ring that looks like a shell.

A room on the orthopedic floor

We saw the kid on the right who has an infection of his leg which he fractured, and the kid on the left who fractured his leg when he was 3 years old after he got in a fight with another kid. His growth was disrupted so that that leg is now significantly shorter than the other one, and has an external fixator to lengthen the bone.

In the ICU at Los Ninos Hospital

my hot legs :)

the monastery

We had a great group discussion last night, reflecting on our time here. It started with the thought that on our climb to the waterfall yesterday, the way back down looked different (we were going down rocks/water instead of climbing up them). When we go through life, sometimes events/situations can change our perspective on things. So we talked about our time here and how our perspectives have changed. The lifestyle here is relatively simple and sometimes I think I could be very happy just living in a little casita...sure would be less to have to clean! But it can also be frustrating the little resources that are available here. We go into the hospital every morning and think that we are helping them with our education on what we do and why it is important because we believe that our way is better. We are trying to help change the attitude there (the culture of staying in bed and being taken care of), but our service is actually a learning experiece for us in return. We think our healthcare is superior and that they need help, but there are also things they do better than we do. For instance, family involvement is central to the care of the children (they require a family member with them at all times). I see a lot of patients in the US that have no family that is available or supporting them, and that would probably seem terrible to a Dominican at our hospital. We talked about how the Dominicans are so trusting of us (can you imagine being treated by someone who can barely speak English?) and I'm pretty sure they would let me do surgery on them if I offered it. I am very grateful for the education and opportunities that have been available to me so that I can have the knowledge to make a difference. I wonder how it would be different here if there was more education. The people here though are wonderful. They are so hospitable and generous with their time and with what they have, even though it is very little. I hope to try to slow down once in awhile, spend more time with people and "be a human being, not a human doing" as someone last night said.

I spent time talking with the physiatrist at the hospital today and we had a great discussion on our healthcare cultures and how rehab and PT is...very interesting. We also be-friended a couple medical students today who knew some English and got to talk with them about a lot of different things.

It was kinda neat that yesterday, the head nurse said to us that one our patients has been to this hospital multiple times and wasn't walking, but now she is! She thanked us and said that we were doing a great job.

I went to the mercado (the market) today with my students and oriented them to the art of bargaining :) I did not get anything yet...I am holding out for our trip to Santo Domingo this weekend where there is a huge mercado. And then on the guagua back to ILAC, I had to teach my students that if a Dominican man asks you if you are married (which is a very common question posed to Americanos), you always tell them that you are :)

I am loving my time down here...it is so peaceful (most of the time...except for the fact that there is music playing loudly pretty much everywhere/all the time!), the ILAC center is a beautiful environment, and I am meeting some very interesting PTs and making great connections. Not so great though are the zillions of misquito bites I have obtained...they really like me.

And PS: the Spanish has been getting better :) The people here just appreciate when we try, and while I am certainly far from fluent, I have actually been communicating fairly well. It's gotten to the point that when I am talking in English to fellow ILACers, Spanish comes out reflexively at times!

Monastery and waterfall hike

This afternoon we took a trip to a Monastery where there are 8 monks. We sat in on one of their prayer services, then one of them talked to us about their place and what they do. They follow the Benedictan rule and a life of contemplative prayer. They have Mass every day, meet 7 times to pray together daily, and work in their kitchen and garden. Afterwards, we went on a hike outside the monastery, which is in the mountains. We hiked up through the river to end up at a huge waterfall. It is a very physically demanding hike to say the least! It is one of the most beautiful places I have ever seen. It refreshes your soul, and I think that there has to be a Creator! Pictures will follow, as I did not risk the life of my sister's camera on this hike and will get the pictures from the designated waterproof camera-taker :)

The cutest 4 year old ever

Walking in the hallway and playing with bubbles, with a patient who has a subdural drain and an IV (I am holding the drain and saline up since there is no moveable IV pole).

My students and a patient walking in the ICU

Day 2 of clinical sites and Monastery visit

Today is Tuesday, April 13th...what a fabulous day! Much better than yesterday! I think it just took me the whole first day to feel somewhat oriented to the hospital to know where we were going, what our role is, and how we are going to go about it. We had a great time with our patients. We started out in the ICU. I helped one of my students first with a 6 year old girl who had basically a traumatic brain injury. She just started opening her eyes and attending to stimuli, but only localized. Then we saw another girl who was 6 years old and in for ketoacidosis/dehydration with blood sugar =351. We decided it would be good to get her out of bed and walk her around the ICU since she was fairly mobile, and the nurses seemed somewhat confused by this. I don't think that the kids in the ICU there ever get out of bed. We had to wait awhile though because they wanted her to eat first because I guess they were concerned about her diabetes even though her last blood sugar taken was fine. And they were saying that she had an IV, which we said (of course!) we would take that with her! Mobility is just not something they really do there, so it was neat to be able to talk with the staff and for them to see that walking a patient in the ICU not only is OK, but that it is really good for her and can be done!

We spent some time in the neurological unit (which of course I love). The highlight patients we saw included a teenage boy who according to the staff, has a brain tumor (but we aren't sure?) He did awesome today! He is starting to get some return strength in his weak leg and we did a lot of cool facilitating movement. He works with us really well and the family is actually very receptive. The struggle for me is that I wish I had the resources/equipment here that we have in the US. I guess I am learning to be more creative, but a set of parallel bars sure would be nice! The other highlight patient was one of the cutest 4 year old boys ever. I noticed he had a subdural drain in, and thought he would be a good patient to check out. As we presented out plan his aunt who was there, she kept saying, "no puede, no puede....(he can't, he can't)" because of the drain. We spent some time talking with her, telling her that it was ok, and why helping him with mobility right now was important. We walked in the hallway with him and played with bubbles which he loved.

There are a lot of challenges where we are working since PT is almost nonexistent there and we have to work through some barriers with the language and culture. We are trying to help some patients and also educate family/staff about mobility, but we also don't want them to think that we are the Americanos trying to change their place and stepping on their toes. We try to be very respectful while pushing forward at the same time, and so far it's going great!

Los Ninos Hospital

Monday was the first day with my students, Sara and Kelsey, at out clinical sites. We are at Los Ninos Hospital which is pediatrics. We take a guagua (an old van) to our sites every day. Traffic here is 20 times crazier than anywhere in the US. In a guagua, you pretty much cram as many people in it as possible and a cobrador (the person who collects your money) hangs out the side of the van through the open sliding door. I think we counted 24 people on our guagua yesterday!

It was really overwhelming the first day at the Hospital! My students have already been here for 2 weeks with their first instructor, so they were able to show me where we see patients and explain how their workflow typically goes. It is very different than where I am used to working!!! There are probably about 8 kids in each big room and I get the idea that a family member is required to be with them all the time (which I guess is good because the staff don't seem to be checking in on them regularly). There are a couple doctors I met, one is a physiatrist who is great and really helpful; the other is on the burn unit. There are also a lot of medical students and nurses that work there. Only one PT works at the hospital and is solely in the burn unit very part time (I have never met her). So PT just doesn't exist on the other main floors of the hospital.

On Monday, we first saw a couple kids on the burn unit (1 successful treatment and 1 kid who was in a lot of pain and crying so we couldn't do much with him). Then we saw a few kids on the orthopedic floor and neurological unit. There is no way that we can decipher much in the patient's chart because not only is it in Spanish, but their abbreviations are also very different. We pretty much just walk around the hospital looking at the kids lying in bed that look like they could use PT and then try to work with them. Monday was very difficult for me because I am used to having students in my familiar work environment, so trying to lead them around in a foreign country, with a language barrier (my Spanish is not so great), and different health care culture was hard! After Monday, it was so overwhelming, that I thought at times, "what am I doing here?"

In the afternoon on Monday, we had a free PT clinic at the ILAC center. An orthopedic team from Creighton comes here in January to perform a bunch of surgeries, and the PT follows up with them in April. Sounds great, but for a lot of them, it is really a late start (especially for patients with total joint replacements!) The students are supposed to lead the evaluations/treatments and I supervise and help them as they need it. It went alright, I just really wish I knew more Spanish!!

Walking/running path out back

For Mom and Josh -what are these?

For Mom and Josh :)

The fountain in the middle of ILAC

The ILAC central

Inside the church

La Iglesia -the church at ILAC

Outside the casitas

My casita

Creighton's ILAC (Institute for Latin American Concern) center where we are staying is beautiful! (Minus the misquitos). All of the instructors stay in casitas (little huts) with 2 people in each. There is a very pretty church and I believe that everything in it was handmade in the Dominican. The center has a little courtyard with a fountain in the middle and out back is a big grassy area with gazebos, a running track, a little weightroom, and a garden.

I love the coffee here...they make it very strong! And the weather is great! We have good food usually....a lot of rice and beans, eggs, salad, bread, yucca, pineapple, plantains, and mystery meat :)