Our Last Day in the DR

Friday morning both the Cabral and Moca groups had their last day in the clinic where we had small despedidas or going away parties with the clinics. The Moca group went out to lunch in Moca. The Cabral group met at a patient’s house to teach the family and the therapists how to do pool therapy. The family made lunch for us and then we headed back to the ILAC center. Both groups of students had an opportunity to do some shopping in downtown Santiago. Finally, that evening we enjoyed a night out at Mariscos Central near the Monument. We walked over to Montezuma for some dancing but we returned home at 11:00 pm to the ILAC center to pack. Early the next morning we were on our way back to the United States. It is hard to believe that our time in the DR is over. We will miss everyone but look forward to new experiences in the future.

A Trip to Juncalito

On Wednesday, May 11th we left for the small mountain top community of Juncalito. The ride up the mountain was breathtaking. After arriving, we got settled in our rooms, enjoyed a short hike, had lunch, and began the hike down into town for our clinic. At the clinic we treated 26 people and even did one home visit. We treated a number of people with musculoskeletal problems as many people here work as laborers. We really enjoyed the people of Juncalito and the beautiful sights. Then we hiked back up the mountain in the rain and enjoyed dinner. We had a relaxing evening and retired early. The next morning we did a sunrise hike down the mountain to the waterfalls where we enjoyed an icy swim. After breakfast, we had to head back to Santiago. It was a beautiful trip and we enjoyed the people and our work in Juncalito.

A Post from Erin

Charla- Neuro Rehab Collaboration with students/therapists

May 9th the SCU PT students, the PUCMM PT students, and several local PTs got together to collaborate on neuro rehabilitation. After some interesting introductions, including stating whether or not we were married, single, or in a relationship, we presented four case studies and then splint into smaller groups to work on them. The topics included Parkinson’s, spinal cord injury, traumatic brain injury, and stroke. Together the students and PTs discussed relevant examination findings, interventions, and goals. It was a unique experience learning from one another and seeing how closely we think alike being educated in two different countries.

Tour of Moca!

Today the Moca group was given a very special tour of a few of Moca's highlights by the rehab director, Rosa! First we went to a very beautiful church by cab from the rehab center - due to Rosa not liking to walk very far (and it was also much quicker). This church had beautiful stained glass windows and everything else in the church was lovely and ornate. The church had a wonderful plaza equipped with fountains, benches, trees and skeletons! Wait what? Yes skeletons. During construction of the plaza, they found that it was a burial site for individuals from the 1400's. They preserved the resting places of these three individuals, but decided to cover them with a glass casing for viewing by the public. What an interesting shock it was for us, as we toured the pretty plaza and gazed down into the glass casings to find buried skeletons!

After the first church, we took a quick delicious break at Bon - a icecream chain. YUM! Rosa bought us all cones with 2 scoops of varied flavors, which all were delicious! Next, we walked to a much larger church than the first. On the way to the church we passed different buildings, statues, and parks; all of which had a story and Rosa was great at knowing them all!

The second church we toured was amazing! It was a large church and was decorated with beautiful ornate statues, pictures, stained glass windows, and flowers. The organ at this church is one of a kind and was constructed in Italy. It was huge! I wish we would have had a chance to hear it, for I bet it sounded amazing in the large hall of the church! Outside of the church there were lights all pointing towards it, and according to Rosa, at night the church is illuminated and is an amazing sight to see!!!

We only were able to take a short quick tour of Moca, but we had a great guide and learned a bit of history about the town, its people, and the Dominican Republic! What a great morning!

Cabral Kids

We must have worked cute little Albert too hard as he fell asleep in my arms after our session (Jasey, Erin, Karen and I). It has been such a joy and great opportunity to work with the Dominican kids! Their smiles are all so contagious :) We have also been able to work together with the Dominican therapists at Cabral hospital to further enhance patient care.

Weekend in Santo Domingo

Friday we boarded the ILAC bus for a weekend getaway in Santo Domingo, the country's capital. After a two and half hour scenic bus ride we arrived at Bettye's hostel, a cultural experience in itself. We went on a tour of Zona Colonial highlighting important landmarks of Christopher Columbus' time. Following the unexpected two hour tour, we were treated with Dominican-American food- pasta and burgers.

Saturday morning we left early for a tour guided by the Medical Director of a public hospital. All the services provided at the hospital are free to those who are unable to pay. The hospital is supported by government funding and charities. We had a thorough tour including the emergency department, pediatric area, maternity ward, dialysis treatment rooms, the ICU, and lots more. After touring the public hospital we are reminded how grateful we are in the U.S. to have air-conditioning and modern technology in our hospitals. Also that day we visited a nursing home, a parish house, and a batey. In contrast to Batey Libertad, this batey was more developed and modern. The Vicini company is working to consolidate multiple bateys into larger working communities. This batey is a trial to attempt to accomplish this task. During our travels to and from the various sites we encountered extreme poverty, many sugar cane fields, and gigantic craters in the road. We were very fortunate to have had Eduardo on our bus to narrate our tours and provide a unique cultural perspective. We had a very busy week filled with meaningful experiences; however, we were exhausted and needed some time to relax. So..... we headed to the BEACH!!! We had our fill of sunshine and Caribbean Sea. We enjoyed massages on the beach, riding the Banana Boat, tropical drinks, and bargaining/avoiding vendors. Despite all the fun and relaxation, we were diligent about applying sunscreen regularly! To complete a great day we indulged in more Dominican-American food and drinks. That evening we watched a performance of authentic Dominican music and dancing in the plaza. Our very own Sue had a Merengue dancing debut on stage among professional dancers. After that, some group members went to a little hole-in-the-wall to dance with the locals. They were amazing! Dancing is an important aspect of the Dominican culture and it was great to experience it first-hand.

Sunday morning we spent time perusing souvenir shops and exploring the streets of Santo Domingo. Along the way we befriended a stray dog. She loyally followed us around the city, patiently waited for us outside the stores, and was sad to see us ago. After a fun-filled weekend in Santo Domingo we enjoyed the rest of the day back at ILAC relaxing and preparing for a busy week ahead.

Friday at Moca

Today we had an incredible experience (both sad and exciting). We had a patient that was in a motorcycle accident (very common here: 250 a day in Santo Domingo alone) and she ended up with a traumatic brain injury, right sided paralysis, a trach, and we assumed several internal injuries based on the nasty scars on her stomach.  This was her first visit to PT, her accident was 9 months ago. She has not been doing much of anything since then, and in order to get out of the house, someone would lift her from her bed and into a wheel chair.  We did not get her exact age, but we would guess she was in her late teens or early twenties.  She was in a lot of pain, but eager to learn whatever we had to teach. After assessing her mobility and sitting balance, we realized that she would be capable of doing a lot more than she has been.  We asked her if she would like more independence and she said yes.  We taught her how to do a stand pivot transfer from the bed to/from the chair to allow her to be more active in the transfers and have more independence.  At first this was a challenge since the mat was about waist height and could not be raised or lowered. We ended up problem solving and taking her to the pediatric room where they had a mat that was closer to the height of her bed.  The first couple transfers were a challenge due to the language barrier and the brain injury, however she learned quickly and we were able to teach her sister how to help her so that she can practice at home.  She was so excited about being able to have more functional ability than she has for the last nine months that she gave me one of her bracelets as a token of gratitude. 

 

  This was an incredible experience to be able to assist her in this way, however it was definitely bittersweet.  The downside is knowing that she has so much potential that she will most likely not attain due to the lack of knowledge of neuro conditions and the lack of resources.  We will hopefully get to work with her again next week and do as much education as possible for her family and the other PTs so that she will get the best treatment possible.

Anthropology and Modern Art

Today we toured Centro Leon, a museum filled with anthropology and modern art. We learned a lot about the Dominican Republic's history and its first inhabitants. We learned that the people from Africa brought many things, including: music, bright colors, spices for food and the opera! Whoa, what...the opera! No, my bad, the tour guide said, "okra." Okra, is an edible green not belting voices! However, Sue and I were uncontrollably fighting back a strong urge to burst out in our extremely contagious laughs as we did not want to disrupt the tour. Our tour guide spoke English beautifully with an obvious Spanish accent. As we entered the modern art exhibit, I stared at a large photograph with six prints of people covered in nylon stockings with circular band-aids stuck all over their bodies. Our tour guide asked, what these 6 people had in common and my classmate replied, "They are all covered in dots..." and I chimed in with the word, "band-aids." We obviously do not use the right side of our brain often as the photograph depicted racism and these people were hurt, so they were covered with band-aids. Needless to say, we still had a wonderful day, which was filled with learning more about art and how to make cigars, as we toured the cigar factory as well!!

Wonderful and grateful patients!

Today was our third day at our clinical site in Moca! Our first patient of the day was this very excited older women who recently had an ischemic stroke. She was so excited to see us and thus was speedy in everything she did, whether it was speaking or doing the exercises we were giving her. We kept saying "slow down" in Spanish, but she did not seem to understand my poor pronunciation because most of the time she just kept going faster and faster! She was so excited to have us working with her, meeting everything we did and asked with a gigantic smile and continual max effort! Saying that we were angels sent to by god to help her and she was so grateful! She also continually told us that we looked so beautiful, just like Dolls! It was so rewarding working with her, because I could tell every second we were with her how appreciative she was! Many moment on this trip thus far have been comical, but it is moments and people like these that touch our hearts!

Centro Leon

After working at our clinics in the morning we toured Centro Leon and the cigar factory. Later we played a volleyball game of Team Moca V Team Cabral!

Visiting Batey Libertad

Yesterday we visited Batey Libertad and learned about the community from Papito and several of the youth in the community. After our tour, we played with the kids and even had a game of Batey Basketball 4 v 4 (men v women) while our fans looked on!

Despite having much fun, we also learned about some serious grassroots efforts of the community as they work to improve the lives of the community members. Education is extremely inportant here in the Batey. The new school now goes up to 8th grade. Last year it only went to 5th grade. Progress is being made each year! There has also been a project to pick up trash in the community. There are health cooperadoras who help coordinate health projects, aquaducts and water filter projects, and homework rooms for the children to continue their studies when not in class. Children may attend school here in the Batey even if they do not have papers. There is also a boy's and girl's soccer team. They occassionally play as far away as Santo Domingo. The men's team has been undefeated since 2010!

We learned about the Famn Valiant which is a women's group that makes candles. WIth the proceeds from the business, the community obtains papers for people to get the work visas and residency cards. A new law has made it easier to get papers. The first step is to pay $200 USD for a work visa. Then after a year the community members have the opportunity to apply for residency status which costs even more money. Becoming a legal citizen is often cost prohibitive, yet this community is determined working to make dreams a possibility.

1st Day at Cabral

Tuesday, May 3^rd: First day at clinical sites

Half of us rode the guagua to our site, Cabral. This site included pediatric, neurologic, and orthopaedic therapy. The six of us split into smaller groups: Jasey and Danielle worked in the pediatric unit; Erin and Ellen worked in the neurologic unit; Naomi worked with los hombres and Karen worked with las mujeres in the orthopaedic unit. We arrived not knowing what to expect and slightly out of our element. However, the Dominican therapists welcomed us with open arms. It was difficult at times to talk with therapists and patients en espanol, but we soon found that a smile is universal. We were able to laugh at our silly mistakes, like confusing the word hombre, man, with the word hombro, shoulder. Coming from cold Minnesota, they could tell that we were unaccustomed to the heat, asking, “Estas calor?” After several hours, we were called into the office for some tasty jugo, demonstrating the fact that in the Dominican culture, people come before tasks. Before we knew it, the morning was over and we were heading back to the ILAC center in another full guagua!

Muestra tu Bondad- Show your goodness

If there is any one thing to be learned so far on this trip, it is that at the root of everything in life people just want to feel loved. In a country where people have little money, sharing your time can be worth a mountain of gold. On our third day of the trip, we were fortunate enough to spend time with getting to know Dominicans across the lifespan, from the elderly at Hospicio to the children at Angeles de Conani.






At Hospicio, we made many new friends, attempted to brush up on our limited Spanish phrases and vocabulary, and some of us even managed to spice things up with a little dancing action. They were extra happy to have us come and visit for they had feared the rain would deter our plans. Apparently in the DR it is very common for people not to go to work or travel places when it is raining. Another interesting fun fact is that the Dominicans hold a strong belief that the water from the first rain in May is very special, it has youthful powers so they will save it to rub on their faces. The residents at Hospicio were very mad at the nuns because they would not let them go out into the rain, many of them kept muttering "those nuns, ohh those nuns".



At Angeles de Conani, we made even more new friends! It was difficult to see so many children challenged with various struggles from physical impairments to developmental delays to lack of a true "home". On the other hand it was beyond easy to fall in love with them all.

The phrase "Muestra tu Bondad" translates in English to "show your goodness". Hopefully this was evident on that day, for the rest of our trip, and throughout our professional and personal lives as well.

No entiendo... I don't understand

Today was our first day at our clinical site: Moca! The first challenge was, well, getting there. We barely made it, and the price changed with each trip on the guagua (poor Lisa got charged an extra 10 pesos... maybe because she's taller? anyway)... We made it. We put on our white coats, name tags, and met our rehabilitation director, Rosa. With nothing clear but our communication barrier, we sat in silence and sipped on coffee stronger than Schwarzennager (sp?) Rosa's first question for us was 'What is your objective here?' Ummmmmm. 'We are here to serve'... 'have more coffee'

So then our day began. We paired up to follow various PTs at the clinic, and were a BIT unsure of the work-flow of the clinic (again, clear communication barrier). The morning consisted of observing, jumping in to treat patients (communication barrier) according to their treatment plan (communication barrier) and to the discretion of the primary therapist (communication barrier)....

One specific moment was a particular highlight and summation of our service for the day. Amy and I were tagging along with a PT who was seeing a patient for neck and low back pain (we think)... as we followed the PT like ducklings into the small treatment room, there was a quick exchange between PT/patient... and our PT quickly left the room with a lightning speed closure of the curtain behind her (we took this as a sign that we were not to go with her...) so we stayed. Little did we know, the PT was actually leaving the patient alone to CHANGE OUT OF HER CLOTHES. It was when she began this process, that we realized it was time for us to leave also... (communication barrier)

We calmly left the room and stepped into the next room, to laugh hysterically.


We later found helpful phrases and pictures on the wall... for the communication barrier....

But overall we felt a little under-qualified to be wearing our white coats with such a hefty language barrier. All in all it was good day. We learned about the depth and breadth of our communication barrier, and most importantly realized the importance of keeping an open mind and good humor at the forefront of any treatment we offer. What we learned from today's whirlwind feel, was that amidst the difficulties that come with not speaking the same language, we are given the challenge and privilege to rely on human interaction. We are very much looking forward to more laughter and relationships with the gifted therapists and welcoming patients at the facility. We can't wait to see what tomorrow brings... stay tuned. BUENOS NOCHES!!!!!!

People versus task

As we are now in a new country, the Dominican Republic, we needed to begin our first full day with cultural competence training. We had a lot of preparation prior to our trip, but a refresher course was a helper. One thing that was immediately helpful was the notion of “people versus task.” In the United States, we are very focused on tasks as our main objective throughout the day, whereas latino cultures are more focused on the people. This was immediately evident on our scavenger hunt that we were sent out on to get a feel for the lay of the land and throw us into the culture and language. I volunteered for the first task, which was to ask how much a shoe shine costs. I had one other student coach me on how to say this in Spanish, which I practiced over and over prior to encountering a person. I then repeated my practiced saying. He first gave me a blank stare, and then went into his life story without answering my question at all. After over 5 minutes of him informing me that he is 80 something, has been shining shoes for over 70 years, has 4 grown children, many grand kids, enjoys music, and many other personal facts, all while my other classmates who understand Spanish stood laughing and watching me look very confused and clearly not understanding where I went wrong in asking my question. Not learning our lesson, my other classmate attempted another item on our scavenger list, she asked a street vendor what flavors of skimice (like mr. freezies) were available. The vendor looked confused and replied “bien” (good). He did not understand why we were not asking how he or his family was doing. Finally we all realized, we were already making cultural mistakes of concentrating on the task and not the people. We then finished our scavenger hunt always first saying hello and asking the vendors how they were doing, shared fun facts, and then finally got to the task question. This strategy delivered better results, but we continue to need prompts from each other to put people over task.

Guaga Adventure!!

After 17 hours of traveling, we arrived safely in Santiago, Dominican Republic! After a good nights rest, we embarked on a scavenger hunt around Santiago. It began with a ride in the guaga! A guaga is the DR’s version of public transportation. It is a large van that appears to seat 12 but in reality can seat up to 32 with many passengers sitting on others and hanging out the door; on this particular adventure we accommodated 24 including the driver and cobradora!! A cobradora is a gentleman who assists passengers and collects the 25 pesos to ride the guaga. His job requirement consists of good balance as he needs to hang out the door of the guaga without holding on, as well as having a strong knock, to signal to the driver that passengers need to exit. Another necessity is the horn in each vehicle needs to be heard; for example they could honk to say “hello”, honk to say “crossing the intersection”, honk to say “switching lanes or honk “to aboard the guaga” to people on the street. The horns are very much needed as there are no traffic laws only traffic “suggestions.” So we have all learned to not only double, but triple check in all directions before attempting to cross the street.

One of the scavenger hunt requirements was to ask one of the many shoeshine boys, “How much will it cost to get your shoes shined?” I did indeed ask two young boys in spanish, however they gave me a blank stare because they spoke Creole and not Spanish. Thankfully, Sue recognized this and jumped in and began speaking Creole to the young boys. Sue and I then got our shoes (keens and merrells) shined for 15 pesos (50 cents) by Willy and Charlie, 12 and 14 years of age, from Haiti. Our shoes have never looked so clean!! We plan to return to Parque Duarte (park) to have our shoes shined again by Willy and Charlie.

It's a Small World After All!

It’s a Small World After All . . .
Sue Klappa

We have all arrived to the ILAC center in Santiago in one piece. It has been a wonderful adventure so far! As we were boarding our flight to Santiago in Miami, one of the airline workers was asking us where we would be going in the DR and what we would be doing. He also offered suggestions for places to see. He was so proud of his country and wanted to be sure we all knew some interesting things to see. It didn’t matter that entire Group 5 was behind us waiting to board!


Once on the plane, Lisa and I found ourselves sitting next to a woman from the DR in row 19. . It turned out that her daughter was studying physical therapy at the Catholic university here in Santiago and knew Professor Candida Aybar, a long time friend of mine! We had a lovely chat and now have a standing invitation to visit this lady’s home!


Our day on Sunday started with an early morning run on the figure 8 track out back of the center. We had breakfast, an orientation to ILAC, changed money, had lunch, and then were off on our scavenger hunt in downtown Santiago. We all tried to be somewhat culturally respectful but nevertheless we could not hide the fact that we were gringas! The students had an opportunity to practice speaking Spanish as they took the public transportation called guaguas downtown. The guaguas are minivans crammed full of people – sometimes up to 32 at a time! We had our shoes shined by a couple of boys aged 12 & 14 from Haiti. I was thrilled to practice my Creole as Charlie & Willie two young men from Haiti ages 12 & 14 shined our shoes! Then it was back to the ILAC campus for dinner and a mass by Fr. Bill.


On the way to the guaguas stop we ran into a former patient from last year who is doing much better. He called out to us and told us how much help we had offered him last year. One of the cooks was also so excited to fill us in on how her son was doing. We had treated him last year. Now her son is fully recovered and is playing in the minor leagues for the Cubs.


All in all it has been a great first day or so. There are always many fun connections that are made here in the DR. It is also wonderful to get caught up with old friends and make new connections. It is definitely a small, small world!

Team DR 2011 Adventure Begins!

Twelve 3rd year DPT students, Dr. Lisa Dutton, and Dr. Sue Klappa are ready for their service learning adventure in the Dominican Republic. On Wednesday, April 27th we attended the Sending Ceremony, had our trip meeting, and finished up last minute details. Tomorrow we meet at the American Airlines check-in counter at 4:00 am! Yawn! We are all so excited!