September 8, 2014
Author: Hannah Nam, Resident Physician
We finally arrived in Guaymate last night! We are staying at a large facility that is part of a local church. Our mosquito nets worked quite well and we woke up relatively unscathed to the musical sound of crowing roosters.
Water and electricity run sporadically throughout the day, which does make for interesting planning. It makes one wonder how much poverty traps one into consuming their thoughts just on completing the basic activities of daily living – and this is even with running electricity and water. I do feel we have all adjusted quite quickly, especially given that three of us are veterans by now.
We started the day with a hearty meal consisting of scrambled eggs, fluffy bread, and an assortment of mangos and papayas. It was hands down the best papaya I have ever had, possibly the papaya to ruin all other future papayas. And of course, cafe as dark as sin to awaken all your senses.
|One of the beautiful murals in Guaymate|
Today we visited the Guayamate Municipal hospital, which is located mere steps away from the church we are staying at. We sat down with Dr. Oscar Estevez, the Medical Director, to hear more about the progress and setbacks regarding the COPE quality improvement process over the past 6 months.
The most notable progress was regarding advocacy. The hospital was unable to secure a constant running generator for the past 2 years, which in turn had affected all aspects of hospital operation. Dr. Estevez had finally been able to meet with the municipal officials to discuss the state of the hospital (as he wryly noted, “it’s election season,”) and had returned optimistic that they would soon be able to make many of the necessary changes. The hospital had even been able to oversee three emergent surgeries in the OR that lacked electricity.
|Hospital epidemiologists provide TB education to patients in the waiting room|
In addition, the ambulances that had been donated by the Japanese government a year ago were finally serving the community in creative ways. Previously, the ambulances had not been utilized to their fullest potential (if at all) because the hospital was unable to afford the gasoline and driver that would be required to operate them. The hospital was now able to use the ambulance up to 50 times per month and bring patients the emergency room as needed. The maintenance fees were being supplied by collecting nominal fees from the patients that were able to afford it, while it was free for those who could not. It was also being utilized in innovative ways, to also bring Dr. Mateo out to the bateyes and provide care and education as needed.
Otherwise many of the other problems that still loomed large throughout the hospital were related to issues of funding and lack of personnel. I really do struggle with the fact that the salient theme that threads through almost all of the problems relate to absolute and abject poverty. I am not entirely sure how my role as an academic can provide help to this community when the overlying problem seems so paralyzingly unsurmountable. However, through COPE, I do hope we initiate some discussions on accessible and specific solutions.
After our meeting with Dr. Estevez, we set out to La Romana for access to wi-fi. The visit can be summarized into a few observations:
1. I am a smelly person when I get sweaty and I think I’m mostly okay with it
2. El Presidente is a delicious beer when served ice cold after a walk in the sweltering heat (and by sweltering heat, I mean the kind of heat that you feel penetrating and melting your pores).
3. The guaguas make you feel like you gained instant membership to a large family – it has everything from the embarrassing uncle to the amiable grandfather to the boisterous aunt (the kind who wants to know why you’re not married yet)
4. Being a kid is awesome: there was a boy about 6 years old that sat next to me on the guagua. He inhaled a cup of chocolate and caramel ice cream and promptly fell asleep leaning into my lap.
P.S. Also started a fantastic book that seems quite fitting in many ways – “Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty” by Abhijit Banerjee and Esther Duflo.