Wednesday, November 17, 2010

Monkey Jungle & Lessons on Volunteer Medical Efforts

A few weekends ago I had the opportunity to visit and help out with a free medical clinic run by an organization called Haitian and Dominican Assistance Cooperation (HADAC). This past weekend I was able to go again and bring 12 beneficiaries of our programs to receive wonderful and free dental services. I am incredibly grateful for the teeth that were pulled and capped as well as the cavities that were filled! I also had a fun time interpreting and helping out.

The clinic is located at a tourist attraction the organization recently opened called Monkey Jungle. The whole deal is essentially a profitable business set up to generate funds to run the clinic which serves Dominicans and Haitians in need. It simultaneously gives tourists a way to have fun while giving back to the comunity they are visiting. This type of thing is exactly what this country needs. Honestly, I have seen more examples of money coming from the tourist industry supporting negative (or neutral at best) practices toward or among those in need than supporting positive practices. Therefore, harvesting such resources to serve people medically is a wonderful example!

Monkey Jungle and the on site clinic are located just outside of Sosua, nine kilometers down a road called Los Chocos. The tourist attraction includes zip lining, a wall climb, a caged in jungle with monkeys roaming, a restaurant, and a gift shop. The price for zip lining is 2000 pesos per person (about $60 USD) and there are special deals for parents coming with children. For those not wanting to zip line but just to visit and look around, the cost is 500 pesos (about $16 USD) per person. It appears as though relationships have been or are being established with tour companies that take tourists from their hotels to such excursions. However, we come in contact with volunteers and travelers often who don’t stay at hotels and may still like to find their way out by moto.

The medical clinic, which is completely free, includes a shelter with benches at the bottom of the hill for patients to wait. When their turn comes, patients walk up the hill to very nice facilities. Services include general medical care as well as full dental care. The dental care is especially unique here because even fillings are done for free, unlike anywhere else. Volunteer doctors, nurses, dentists and other assistants are coordinated to receive between 35 and 50 patients every Saturday. HIV tests and maralia test are available but x-rays, ultra sounds, and other blood, urine, or fecal tests are not available. Patients in need of surgery and more serious cases are referred to other facilities such as Centro Medico Cabarete, which is a hospital set up with a similar for-profit/non-profit concept and is very close to Monkey Jungle on the main road that passes through Sosua. I have not beeen able to visit this hospital yet and am unsure of how patients are determined as someone able to pay for services or not, but I know that income generated from those who pay funds services for those who cannot pay. I worked for a short period of time with the wife of the doctor who founded this hospital at OyM Hostos School, a wonderful bilingual school in Puerto Plata which I wrote about in a previous post.

From my visits to Monkey Jungle and the on site clinic, I conclude that this project is completely full of positive potential and will serve to truly improve the quality of life of many in need. It is also a young project and will likely have kinks to work out in the beginning years. While I’m sure that those in charge have considered all angles, for the purpose of creating a think tank and to post what I have learned on my blog, here are some thoughts I have from my five years of experience doing fundraising and service work in this country.

  1. Treating People in the Most Need

It appears as though a challenge may come up that those coming to the clinic are not those in the most need. I plan on getting the word out among the beneficiaries of our programs and perhaps continuing to take people out from time to time. There is such great need and it’s true that it is futile to distinguish between treating someone who would be considered very poor and someone else who is extremely poor, but as Project Esperanza had Tulane medical students run two weeks of intensive day clinics over the past three summers, I have seen that some people do come to free medical services to get a second opinion or get their perscriptions filled, while others come with no other option. We have found that treating those who can find treatment elsewhere creates dependency and can actually interfere with the growth of society whereas treating those with no other treatment option is empowering and stimulates the growth of society.

  1. Getting Patients in Need to the Clinic

In the past we have charged patients 10 pesos each to cover their consultations, any necessary medicines, and necessary eye glasses. This 10 pesos just causes patients to recognize that the services they are receiving are valuable and should be appreciated. The distance that most patients will have to travel from their home to Monkey Jungle will likely more than do what our 10 peso fee is intended to do. However, it will also likely be a barrier for those in most need to get to the clinic. Therefore, I think the solution is teamwork with organizations who have consistent presences in the field, such as our organization as well as Health Horizons International who I wrote about in a previous post, along with individuals serving in the most impoverished communities. I believe that HADAC, the organization that has created Monkey Jungle, runs a feeding program in a batey so I’m sure that will draw in the most urgent needs as well.

As a side note, the woman who has led the Tulane medical group these past three years is now leading efforts to begin a clinic in Jacksonville, Haiti. She is a great friend, partner, and I’m proud to announce the foundation of Sante Total (Total Health in Haitian Creole).

  1. Coordinating Volunteers

Another challenge that Monkey Jungle and its on site clinic will likely face, and likely have already, is the coordination of volunteers in order to consistently and smoothly run the clinics. As anyone who has coordinated volunteeers over a long period of time knows, this sometimes gets complicated. Where companies and businesses are run with defined authority, clear roles and responsibilities, rules of conduct, contracts guaranteeing committment on both sides, etc., lots of this can get lost with volunteer efforts. Roles and responsibilities get confounded, authority is undermined, people come and go more freely, and the result is frustration among those taking responsibility over the efforts, along with inefficiency. We have found that the way to deal with these issues is to attempt to use those same aforementioned practices that one would use to run a company. The only difference is that the work is done voluntarily, not for pay. However, the volunteer is aware of this ahead of time and accepts the position on his or her own free will. The work being done is no less important than the work of any company or business. In fact, in many cases, it’s more important!

  1. Interpreting

The last challenge that we have faced is one of communication and education. This may seem obvious, but I have witnessed too many poorly interpreted medical consultations and (not just with volunteer groups but often with Dominican doctors and Haitian patients in public hospitals) to keep quiet. I also have lost friends due largely to their lack of understanding of their condition and their treatment. On the contrary, I have seen and participated in clinics that were beautifully interpreted and the result is satisfaction on both ends. If patient-doctor communication is a serious issue where doctors and patients speak the same language, the issue needs an extra amount of care when there is a language barrier. The truth is that patients often nod and act as though they understand something when they really don’t. Additionally, doctors and volunteers often assume they understand more of the conversation than they do. Therefore, skilled and thorough interpretors make a world of difference. Accurate and thorough interpretation is a matter of life and death in some cases as much as the presence of the doctor and the treatment. See Project Esperanza co-founder Kristin Preve’s article on How to Avoid Mistakes in Medical Interpreting.

  1. Simple Education

Many patients who are in true need lack basic education and have grown up with and been raised by others who lack basic education. While leading educational discussions with Haitian patients waiting to be seen at one of the day clinics we ran this past summer, we found that most patients did not know why women have menstrual cycles or where the blood comes from. Many people say that they are anemic but when asked what anemia is, they reply that it is a lack of blood. Many people also use the term “pressure” which is also used for high blood pressure, to explain diziness, fatigue, and shortness of breath. Many mothers give baby food to babies as young as one month and give cow’s milk to babies way too young too. They claim that the baby wants to eat and milk isn’t enough for him or her. Education on these topics as well as many other topics gives patients understanding of the problems their bodies face. After they better understand the problem, they can better understand the treatment and the lifestyle changes they are often asked to make. We have found that educational discussions using simple explanations can entertain and inform patients waiting or provide clarity to someone during a consultation. An example of such an explanation is as follows:

Anemia does not mean that you lack blood. If you were to look at blood under a microscope – Does anyone know what a microscope is? No? A miscroscope is a piece of equipment that you can place an object under, then look into, and it makes the object appear much bigger than it really is so you can see it better. When you look at blood, how would you describe it? A red liquid? Well, when you look at it under a miscroscope, it appears as lots of red circles in a clear liquid. Each of these circles should have iron attached to it. I’m not talking about iron like an iron bar (used on most windows and doors in this country) but the nutrient iron. (I also use the word vitamin here even though iron is not a vitamin because I’ve found that the word vitamin is more commonly understood among uneducated Haitians here.) If your blood doesn’t have iron then it can’t nourish your body and it doesn’t appear as red. That’s why your fingernails and gums are whiter when you’re anemic. That’s also why you feel tired when you’re anemic. Your blood is not nourishing your body as it should because each little ball does not have its iron. So to avoid anemia, you should eat foods that are high in iron.

The educator would then ask listeners to explain back to him or her what was said. He or she would also go over foods that are rich in iron and continue to review the foods to be sure that patients remember. Reproduction and baby care education are interesting and highly important topics for everyone! While all health topics are important, understanding these topics of reproduction and infant care can have such drastic effects on the lives of families which makes it extremely valuable in my opinion. See Pregnancy, Birth, and Neonatal Care Practices in the Dominican Republic & Haiti.

These are, again, solutions to many problems we have faced and practices we have developed and executed with success. I hope that sharing these solutions with readers will help others doing medical missions and working in clinics and hospitals in the Dominican Republic and all over the developing world. What an amazing field to be working in! While technology continues to advance in the developed world, we should never forget the value of the dedication to applying simple solutions in areas of need. The solutions are often so simple. It’s the humble and dedicated workers who are lacking. And yes, I do claim to be a humble and dedicated worker – although not by my own strength. God is the one responsible for keeping me that way.

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