Monday, July 2, 2012

Dominican Republic

I'm sitting in a little cafe in our Casa de Campo resort, taking advantage of wifi and air conditioning, an entire world apart from where I've been working all morning. Along with a handful of other med students and a pediatric resident, I've been spending a good portion of the day walking through Bateye 16, home to a few hundred or so migrant Haitian workers. The setting is similar to the communities in Guatemala where I worked previously, populated by coffee plantation workers. This time however, the men work on a sugar cane plantation owned by an absurdly large and overarching company called Central Romana.

I'm a week in to this trip and continue to feel as though I learn so much about the people around me and their countries--both home and adopted. My project endeavors to sketch a portrait of their lives, specifically within the context of healthcare. I'm interested in their relationship with various healthcare providers--hospitals, clinics, health promoters--and what barriers keep them from accessing such care, be they monetary, personal, or work-related. In my interviews, I ask each person about their lives, when and why they moved to the DR from Haiti, feelings about their job and their health, thoughts about their families and moving back to Haiti.

I've found myself in some rather interesting conversations, some disheartening, some entirely outside the realm of logic (these data points might have to be thrown out for unreliability). I think I'll try to take some photos of the more intriguing stories and type up little blurbs when I'm stateside next.

During these daily community survey visits, we've encountered some interesting clinical cases. Annie, another med student and good friend of mine, is working on a hypertension study. As part of her interview, she measures blood pressures of each of our subjects. The number of HTN cases we've found is almost unbelievable. I've heard our translator run through the Creole version of HTN management so many times now, and every time am disappointed by our inability to provide medication or any sort of support other than dietary and lifestyle modification tips.

Toward the end of last week, we interviewed a middle-aged woman, at the end of her 10th pregnancy. Her BP was 230/110 which is absurdly high, pointing toward preeclampsia. We took her to the hospital that afternoon and spoke with the big boss man about her case. The treatment for preeclampsia is to deliver the baby, if he/she is viable. Turns out our patient was full term, though she had reported being 8mo pregnant. There was talk of preemptive and non-consented tubal ligation to prevent future cases of pre-eclampsia...the medical ethics part of me is throwing a fit just thinking about it. At the same time however, I can understand his perspective--families living in the bateyes can't generally afford quality healthcare, nor do they have enough time away from work to seek it out. Hospital visits tend to occur in the most emergent of cases, and issues that don't impact their ability to work rarely gets the clinical management it should. Still, a secret tubal is probably not the best policy.

When we went to visit her the next morning, she asked about her baby whom she hadn't seen since the delivery. We checked in on her newborn and found her to be doing well, tucked away in one of the two incubators in the tiny one-room NICU. She was one of the most beautiful little babies I've seen. I wonder what would have happened had we not interviewed this woman that day. Having worked in the public health field for some time, I am not as affected by the situations I see as I once was. Even in my early, though mild, case of cynicism, I found our encounters with this woman to be heartwarming. Getting her to the hospital, seeing her through the process and safely home again, gave me such a sense of fulfillment as I haven't felt in awhile. I only wish solutions were so easy to come by in all of the other cases. I'm curious to learn more about how this whole event fits into this woman's life, from a social standpoint. We essentially kidnapped her and within 24 hours, she had a baby girl and her family had yet to find out. And what about the tubal? What implications will that have on her life?

It's been an interesting experience working with this community. I've learned a lot from their stories and am always left wishing I had the power and the means to do more than just nod sympathetically. I am learning a bit of Creole though. It's been fun. The guys we're working with are great--helpful, fun, and committed to their community. It's really nice to see.

Impoverished and vulnerable communities like Bateye 16 are far from lacking in the world. Having worked in similar settings does not make it any less upsetting to hear about and see the difficult lives they lead. But my interactions with such communities fuels my motivation to learn about the body, medicine, healthcare, in the hopes of changing the world one life at a time. I read something once that comes to mind now:

"Certain things catch your eye but pursue only those that capture your heart."

I think I've found that thing, and I fully intend to do just that. Sometimes school just gets in the way of learning.

Haven't uploaded pictures yet, but will do so when I'm stateside!

Pura Vida

Despite the last post, it turns out I've had plenty of opportunity to travel since April. I made it to Costa Rica twice in April and May, and am currently in the Dominican Republic working on research project.

In CR, I had ambitious plans for my last-minute trip, to make it to both the Caribbean and Pacific coasts. I walked up to the beach in Puerto Viejo de Talamanca on the Caribbean coast, and never left. When it came time to leave, I almost didn't leave, being so enraptured by this place. It was absolutely gorgeous. It gave me an opportunity to step out of the crazy responsibility-laden life I normally lead, and to simply live in the moment, on a beach with some great people. I could go on forever about how much I love CR, but it might turn into rambling. I went the second time with the man friend, which was equally enjoyable in a very different way. It doesn't quite exude the romance of Kenya, but the beaches stretch for miles, the beer's served up cold, and the people are lovely. The water is incredibly warm at all times, perfect for those of us who like a little night-time swim every now and again.

The coconut rice on this coast is tannnn rico. If you ever find yourself in Puerto Viejo, might I suggest staying at either Cabinas Larry or El Dorado...they're both great little hostels, the first at $12/person/night in a private room, the second $10/person in a more hostel type setting. Both have free wifi, though it's relatively easy to come across wifi in this awesome little beach town.

Ben and I also rented bikes for less than $10/day and biked down the coast, stopping at different beaches along the way. It's a great way to get around and check out the nearby playas. The next time I get down there, I'm hoping to get down to the Panama border, as well as the other coast. I'd love to talk more about it if you're interested mes amis, but don't want to bore y'all with details. So as always, email me if you want to hear more!











Monday, April 2, 2012

I'm back!

I realize it's been almost a year since I last updated this blog, as some of you so kindly pointed out. Normally, I would be embarrassed about my slackage, but since I was never the blogger type, I don't feel so bad. My last post was after the amazing Masai Mara safari in Kenya. I still have very fond memories of that trip, and I look forward to the next time I'll be traveling in Kenya...hopefully next time, I'll have a travel buddy. Any takers??


As an update on the rest of the trip, I traveled up the coast of Kenya, stopping in Mombasa and the little island of Lamu. Mombasa was this sultry, coastal city full of history, exuding a mysterious and fun-loving vibe against a traditional, religious background. I met friends of friends here, enjoyed a massive seafood dinner on a boat, and stayed in what seemed like a miniature palace. Then there was Lamu. If only I could've spent more time here. The entire island was pedestrian and donkey-only (unless you count the sole tractor I've seen around). The streets were uneven and narrow, lined by tiny storefronts hiding what might have been secret treasures long forgotten. The beaches were empty and the water a clear blue. I befriended a guy named Moses who showed me around and made sure I wasn't bothered excessively by the sleazier types. The food was great, and the views beautiful. If you're headed there soon, I highly recommend the hostel I stayed at. The rooms were clean and huge, the staff super friendly. They even had a mini library which was convenient for my lazy beach days.




 My trip back to Nairobi was a little more eventful than it should have been. The short story? I hitchhiked my way back down the coast, felt the fight-or-flight response engage when we pulled off onto an unfamiliar dark side road (to explore some shared mansion, it turns out), and crashed at a complete stranger's house. But, I survived.

Uganda was next up on the itinerary, where I met up with a friend/ex-lover-type of mine. We whitewater rafted up the Nile--yes, so touristy--but oh so much fun. It was a neat feeling to float up the river, imagining the centuries of history that had happened around that spot. 
Our next stop, Lake Bunyonyi, "the place of many little birds," was easily one of my favorite places during the trip. We had a bit of a transportation disconnect, so ended up on a dock at 4:30 in the morning. What could have been a terrible situation turned out to be really peaceful and serene. Here's a shot I took as the night started to lighten. We spent a couple days here, rowing aimlessly around the lake, and just lounging and catching up. This is another place I would add to any Ugandan itinerary.


Rwanda was my final stop before a return trip home from Nairobi. I saw parts of Kigali and Rwinkwavu, Partners in Health HQ. We had an interesting tour through the hospital, where I was acutely reminded of the motivation behind these med school dreams of mine. It was a nice end to a good trip that I wish could have gone on longer. I'd love to make it back some time. But now that I'm on med school lockdown, it may be some time before I get either the time or the dinero to make it happen. One day...

In the meantime, it looks like las aventuras de crystal are going to be much more domestic. There's a potential Dominican Republic trip planned a few months from now, but before that happens, I'll keep you posted on the life of a struggling med student who's rediscovered an obsession with working out.

Three main motivations:
  1. Diabetes sucks. and it's a risk factor for everything else. (for all my friends with diabetes, I feel your pain and promise to be a compassionate MD to all my DM patients)
  2. Anatomy. Have you seen what fat looks like inside the body? Not a good look. Also, muscles. Sexy.
  3. Gotta stay on that grind if there's even a slight chance my residency will resemble Grey's Anatomy. Helloooo, McSteamy.