4/18/2008 Friday - 4/19/2008 Saturday

Weekend in Santo Domingo

This weekend we spent in the Dominican Republic’s capital, Santo Domingo (SD). The city of SD holds lots of history secondary to it was Bartholomew Columbus, brother of Christopher Columbus, who founded the settlement which is today the oldest European city in the New World.

We stayed in a hostel called “Bettey’s.” It is a hotel/hostel owned by a Louisianna woman and she has a small art store in the lobby (See Picture Above).

We spent most of our time in the Colonial Zone, which includes many historic landmarks. The Dominican Republic has a very interesting history. Before the Spanish settled in the DR, the land was inhabited by natives. The Spanish invaded and began colonizing the land. The Spainards worked the native people so hard building fortresses, churches and estates that they killed off all native people within 12 years. From then until now the DR has been invaded by pirates, ruled by the french, Liberated from Haitian rule, and controlled by a Dictatorship. From 1930-1961 the country was ruled by dictator Rafeal Leonidas Trujillo. During his dictatorship he believed that people were either for him or against him. He saw All Haitian people to be against him, and during his time as leader executed over 12,000 Haitians. His leadership ended in his execution, leading to the DR finally becoming a democratic country. Above is a picture of the Dominican Flag. The blue is said to stand for Liberty, red for the fire and blood of the independence struggle and the white cross is a symbol of sacrifice. The emblem shows a bible symbolizing a country established in the Catholic faith.

We also visited the Catedral Santa Maria La Meno (Above), which is the first Catholic cathedral in America. The tour guide said “That 85% of the Dominican Republic is Catholic and the other 15% are alcoholics!” (That tour guide had me figured out didn't she!)

We also visited an amber and larimar museum. We saw insects that were preserved in amber that were over 50 million years old. Larimar is that rare blue stone found only in the DR and is often set in silver. They say that amber is a color of Luck while larimar (blue) is a color of love. So if you want a piece of luck you buy amber jewelry and if you want to find love you buy larimar jewelry. AND………..if you want to get “lucky with love” you buy a ring that is interchangeable! hehhe

4/9/2008 - Wednesday

The Batay

Today we headed back to the Batay to administer parasite medications to the children and adults. The volunteers at the ILAC center are constantly working on filters for the water, but the Batay’s water source still contains lead and parasites. The above is a picture of an ILAC volunteer educating the Batay people on water filters. The water filters are placed in large 5 galloon buckets. Chemical engineers continue to develop filters that are cheap and effective in purifying the water.

The medication is administered 2 weeks apart. We administered the first dose and the second group of PT students will return the last week for the final dose. The above picture of one of the schools we went to in order to give the children the medication. The school is a simple building consisting of cement floors and desks. The tin roof makes the inside of the school approximately 85 degrees. The children are excited to receive the medication although it’s a disgusting white paste. Isn’t it funny, no matter where children are in the world they want more of everything!! We had to mark the children because children will come back for more medication!!

The ILAC center has also organized fundraising projects for the woman of the Batay. For example this particular Batay makes candles (picture above) to sell and other’s make coconut jewelry. The money raised from these projects goes to the woman and children of the Batay for milk and other pre/post natal care.

The kids of the Batay are so cute and you just want to take them all home –soooooooooooooooooooo– Look mom, I put one in a box and shipped him home, he should arrive soon!!

Other activities while we were at the Batay included treating patients. Here is a picture of a man who 7 years ago “fell” in the rice fields and every since has had difficulty with functional activities. The man presents text book s/p stroke, so we are guessing that the stroked caused the fall. The man can walk with MinA but mostly lays in bed or sits in a chair all day b/c his family members are busy cleaning, cooking, and working in the fields. We had given him a walker and some Neosporin for some open skin lesions he had. We also gave his wife a gait belt so she can protect herself when transferring him.

Above: Some more kids!

4/8/2008 – Tuesday

4/8/2008 – Tuesday
Today after clinic we had the opportunity to go to a cultural museum and cigar factory. (The cigar factory was smaller then the actually one) However there were individuals making hand-made cigars. The Cigar brand is called La Aurora and was established in 1903. Each individual at the factory makes only 150 cigars a day. The total process from seedbed (planting) to harvest is 75 to 80 days.

Once harvested, the tobacco is kept in barns built on the fields. These curing barns allow the tobacco to naturally lose their chlorophyll, turning from green leaves into the earth colors known in black tobacco.
When the time in the curing barns is through, the leaves are stacked in large piles or pilones to begin the process of fermentation. This is where the leaves release their ammonia as they decay. The heat in the fermentation is carefully monitored because if the leaves get too hot, it can ruin the tobacco. The pilones are constantly tended moving center leaves out and outer leaves in to create an even fermentation. This process can last from 1 to 8 months before the tobacco is ready for baling.
From this point the tobacco leaves are aged. Tobacco that is not aged sufficiently will have a bite that many confuse with strength. Properly aged tobacco will round out, even ligero. Some of the tobacco also spends additional time in old rum barrels that help the leaves marry their flavors for increased complexity.
The tobacco leaves which are selected for the wrapper of our cigars are aged for 1-4 years, which produces the fine consistent color, texture and flavor characteristic of the cigars of La Aurora.
Once the tobacco is ready to be used, workers slowly re-humidify it. As the tobacco ages, it does dry out and can be brittle. The leaves need moisture returned to keep them supple and The leaves need moisture returned to keep them supple and flexible.
When making to the cigars, the employees work in pairs. One forms the basic cigar by bunching the correct amount of filler and then encasing it in the binder. This basic cigar is then inserted into a mold which holds the tobacco under pressure to help keep its shape. These blanks of filler and binder are kept in the molds for 2 hours or more.
After spending time in the molds, the second roller finishes the work. The rollers must be ambidextrous since the wrapper leaves can be either right or left handed. The roller first examines the leaf to determine its orientation (left or right) which depends upon the direction of the veins. The leaf is cut to the proper shape for the vitola being produced. Then with extreme care, the roller applies the wrapper in such a way that the result is visually pleasing.
Just like a fine wine improves with rest and aging, fine cigars do as well. Who would have thought that Papa Plumb and I have so much in common. He enjoys his stogs and I enjoy my wine – both smooth and aged!.Once the cigars are made and pass the quality control, they are sent to our aging room. The cigars from La Aurora are aged up to 7 years.

Okay dad, stop drooling – it was a great experience and the smell was fantastic.

4/4/2008 – Friday & 4/5/2008 Saturday

4/4/2008 – Friday
Leaving for the “Campo” today. The word “Campo” refers to the country side of the Dominican republic. Imagine the worst gravel road in Iowa, add approximately 200 right/left turns, add large pot holes, and add a large bus without air-condition and you can paint of picture of what the ride to the “Campo” was like. The ride into the mountain took 3 hours there.
We arrived at the campo at 7:00 to a cooked meal of spaghetti and fried salami. Ahhh what a nice change from beans and rice. They also had a mass for us and the women’s choir was so pretty singing all the songs in Spanish.
The campo that we are staying at is called Las Lagunas. It is a small community that contains only a small store, church, and school. Before we left there were many pictures painted of what “campo” can be like including:
No electricity
No running water
Chickens in the house
Bucket showers
Well the lord must have blessed us this weekend because I guess we were in one of the richer campos. 2 other CU girls and I stayed with a woman named Mercedes. She is married and has 2 children. Both children live in Santiago, and her husband was away for the weekend. We each had our own bed in a simple home with running water and a toilet!! When we arrived to her house she offered us Café’ (coffee). Mercedes and her family make their income harvesting coffee. As we sit and sip on the best cup of coffee I have had in my life we are surrounded by bags of coffee beans. It doesn’t get much fresher than that. We say up and talked to her for about an hour. We struggled through with our Spanish but we were able to carry on a half way decent conversation. We went to bed and crawled under or mosquito nets for a good nights rest. In the mountains it’s much colder and it felt so goooooood to be cold when we slept.

4/5/2008 –Saturday
Good morning, nothing like waking up to turkeys outside your window!! We got to sleep in today til about 7:30 – we are all starting to feel fatigue being this our 8th day going in a row.
Breakfast consisted of fresh brewed coffee, fresh fruit, and oatmeal. The oatmeal tasted so good because it is made with pure cream.
From 9-noon we presented “Charlas” or inservice to the Cuapradoras. Cuapradoras are individuals that serve as the ILAC representatives in 125 campos throughout the Dominican Republic. We presented all in Spanish on various topics including:
Low back pain
Sprains/strains
Body Mechanics
Developmental stages
You can imagine the need for the community to have an educated individuals to provide medical advise being it that the nearest medical help is a 3 hour drive away.
Also, these individuals (including men and woman) perform hard physical labor all day – with many complaints of back/neck pain from long days in the fields.
In front of our house later that afternoon was coffee beans spread out on a large metal slab to dry before they are roasted.
From 2-5 PM we conducted a PT clinic in the elementary school treating over 30 patients. Needless to say, it was a long day.
The community had a small get together for us Saturday night. This included a dancing the Marenga and Muchacha. All ages from the 4 year old boy to the 80 year old man was dancing. The American girls could barely get off the floor before getting asked to dance by another Dominican boy. It was quite funny because they didn’t talk at anytime during the dance – but we all had a good time.

4/3/2008 – Thursday

4/3/2008 – Thursday
I forgot to mention that we have wireless around the entire ILAC campus. I have called home and to Phil several times. I’m currently sitting in a rocking chair outside on my laptop.
The weather has been raining and cool. The cloud coverage has allowed the days to be cooler and nice for sleeping
Today we treated several interesting patients. There diagnosis’s include:
A 3 year old boy was walking in his house when he stepped in a hole at his house. Inside the hole was a rat and he obtained a large rat bite on his foot. He was being hospitalized for infection.
A 12 year old boy was walking on the street and was bite in the face by a dog. The patients scar had 4 huge gouges. Most children who are bite by dogs are bite by rabid dogs - Due to the fact that the none rabid dogs are usually too weak and thin are not aggressive.

4/2/2008 – Wednesday

4/2/2008 – Wednesday
To the clinic again, however this time there was a transportation strike. We were delayed secondary to a strike taking place on the main road into town. We catch public transportation approximately 100 yards from the ILAC center. When we finally went to the stop that morning, there was burnt trash all over the road, and the locals said that they were using tear gas.
Oh how could I forget, we had cream of wheat for breakfast. It contained cinnamon and real cream. It tasted so good b/c Dominicans use naturally flavors and very little sugar. It’s funny because after every meal everyone is still hungry for sweets! J The little corner store down the road sells cookies for 6 pesos a pack (6 cookies in a pack) They are those good cookies that are vanilla or chocolate filled with frosting in the middle.
Today at the clinic was much better than the first. We spent a lot of time On the orthopedic floor. Here children are casted due to fractures or wounds. Do to the aggressive nature or Dominican boys, the children are often kept at the hospital to ensure that the child is running around, climbing trees, riding motos etc. So basically these children stay in bed all day.
I felt a lot like patch Adams today. We went to one room that housed approximately 8 kids. We blew up ballons and asked the children if they wanted to play. All the kids got out of bed and we begin hitting balloons around the room. The children were so excited to be out of bed and playing.
An interesting food we ate today was Quipe and bananas dulce. Quipe is a type of meet that is mixed with wheat and fried. It was brought to the DR by the Lebanese, and is enjoyed with ketchup. (A lil better then the Hagis that I hate while in scottland J) Bananas dulce is bananas cooked and caramelized with sugar. Much like bananas foster’s minus the ice cream.
This afternoon we headed to the Batay. Batay are Haitian refuges made by the Dominican republic to house Haitians during harvest and planting season. By Dominican law Haitians are allowed to come to the DR to work and must return after harvest season. This particular community housed approximately 1000 people. Understand that they may come and are not all guaranteed work. For example, 600 may show up to the fields for the season, and the Dominican Land owner may only need 300. That leaves 300 people to return to the Batay without pay for that year. Often times theses individuals will survive on a calories intake of a banana a day. In the Dominican Law also Haittians are to be transported in the day only so all can see them coming going. Several times government buses have showed up to the Batay at 5:30 in the Morning to load up the Haitian and buss them back to Haiti without pay. Needless to say this an area of extreme poverty. The are currently working with the ILAC center to better the community and its drinking water. The water is getting better, but is still contaminated with Lead and parasites.
Next we spit into groups and went out to treat family members of the Batay citizens that were in need. There we are sitting in a house containing 3 rooms and cement floors speaking with the Batay people. We evaluated a older man who fell 7 years ago while working in the rice fields (per the family members). The patient presents with the diagnosis of a stroke, but they are unaware of that term. He requires many family members for his care secondary to his decondition. He also has open skin lesions, something that looks like a dermatitis or scabes. How is he to heal, the water they drink and bath with is contaminated and he’s putting in on open wounds. After or PT intervention we return back to the center of the community where there is a dirt baseball field. There children are playing with nothing more then a pole, trash for bases, and a ball. It’s so hard to explain what it was like to be immersed in such a community. This is poverty at its worst, however children still can laugh and play. We will return next week here to administer parasite drugs to the children.
This evening was unscheduled, which was much needed. We have a small figure 8 track out back that is about 300 yards a lap. It isn’t anything more than running on a gravel road back in Omaha. But it was so nice just to put on my head phones and have some “ME” time.
Tonight at 9:30 we had mass again. I read the responsorial psalm that was “The lord hears the Cry of the Poor.” Pretty fitting due to the fact that we spent the afternoon in the Batay. Father Pat related his sermon to reason’s why we serve the poor and the differences and similarities of these different communities.

4/1/2008 – Tuesday

4/1/2008 – Tuesday
First day in the clinic
For breakfast had fresh fruit and Coffee, feeling pretty tired today, the day had to start at about 6:20 AM
To get to the clinic we must catch the Guagua (a mini van type vehicle) that is suppose to comfortably fit approximately 15 people, but they will squeeze in anywhere to 20-25 people. You make friends with your Dominican friends really quick. A Guagua ride cost 15 peso and takes about 25 minutes.
From the Guagua we dodge more traffic and catch a “F” car. Again this is like a buick size vehicle, suppose to fit comfortably 5, but we squeeze in seven. The “F” car cost 12 pesos and that ride is approximately 15 minutes.
Finally we arrive at La Hospital Los Ninos. This is our first day at the clinic we meet with the head nurse. At this clinic there are not other physical therapist, so half our mission there is to educate doctors, nurses, and other family members on the importance of PT related topics.
The first child we see is a who had been hit by a moto (mo-ped). In the DR they will ride 3 to a mo-ped without helmets. So I would say that 75% of all pediatric brain injuries come from MVA or moto/pedestrian accidents. Dominicans with ride 2 parents and squeeze there young child in the middle on the moto – all without helments and proceed to drive on 4 lane highways! (Brittanie spears would fit right in)
Regardless this small child lays in the bed incoherent. His mother is uneducated on his condition. The patient has a traumatic brain injury but yet is not hooked up to any machines to read vitas (HR, BP, Intercranial pressure, blood pressure, etc).
Here in the Dominican republic the mother is the “Health chart.” In other words the mother reports to the doctor regarding ALL health related information to the doctors. Hospitals do not keep thorough records of children’s immunizations or health conditions.
We then go to the “Casting Room” where the orthopedic doctor is and where the patients bones get set and or recasted. Here we observe tools being cleaned with bleach and children going under general anesthesia when their bones are getting reset. But again, the children are put under without vitals taken or being monitored.
To return to the ILAC center we reverse the above modes of transportation. We return to the ILAC center to eat lunch. Normal is Rice and Beans with fresh pineapple.
This afternoon is spent preparing “Charlas” or in-services for the campos this weekend (more on this to come)
This evening we have mass at the church which is located in the middle of the ILAC center. It is build completely from Dominican materials –from the tweed for the seats to the clay for the Stations of the cross. Father Pat’s sermon focuses on that faith comes in many shapes and forms, and we don’t need to see it to believe it. He mentions that when he was younger, it was not that he didn’t believe in the lord, it was simply he didn’t need him for fulfillment.
Father Pat was on his way to a Mission trip when he was younger when the doctor told him he couldn’t go because he had the flu. The “red flag” lab results that made the doctor think was the flu, was actually Leukemia. In his time in the hospital, Father Pat Memorized all the gospels. So when he speaks on the alter, he has a sense about him that just makes you believe – believe in anything, yourself, the lord, faith, and/or hope. He is approximately 40 years old and lives in the Dominican republic full time, serving the adults and children of the Dominican republic.