Global Outreach: Dominican Republic

Amid commands of “Simón dice tocar la naríz!” and“Simón dice que salten!” a group of more than 40 Dominican children and young adults are doing more than touching their noses and jumping in their small, open-air classroom.  Through a Spanish version of Simon Says, they are learning about parts of the body from a group of Texas A&M Health Science Center (TAMHSC) College of Medicine students as part of a five-week mission trip to Palenque on the southern coast of the Dominican Republic.

For five weeks in May and June 2010, four second-year medical students traveled more than 2,000 miles to Palenque, a town of about 15,000 residents on the Dominican Republic’s Caribbean coast. Since 2002, small groups of medical students and a faculty advisor from the TAMHSC-College of Medicine’s Bryan-College Station and Temple campuses have partnered with the L.T. Jordan Institute for International Awareness to travel to the Dominican Republic for medical and educational mission trips.  This year, Associate Professor of Family & Community Medicine Dr. Lani Ackerman joined the group for a few days in June.

The students—Giulia Ippolito, Stacey Mathew, Nikhil Seval and Sherry Spacek—first applied for the trip in October 2009.  Once accepted, they interviewed with Texas A&M University’s L.T. Jordan Institute and the TAMHSC-College of Medicine’s Department of Humanities in Medicine.  Requisite safety training completed the process, and by January 2010, they were planning and gathering supplies.

Once they arrived, the students spent the first week planning lessons and activities for patients and children of Palenque.  The next four weeks were devoted to seeing patients in a clinic, teaching young people at what the students called the “Healthy Kids Camp” and sharing similar lessons with the community.

“In the morning, we would go to the clinic in Sabana Grande, one of the town centers of Palenque,” said Ippolito.  “There we would assist in minor procedures like removing stitches, taking blood pressure, administering shots, things like that.”

The hospital-clinic housed approximately 30 rooms in a large U-shape, and there was no air conditioning.  Most days, in a waiting room packed with women needing obstetrical care, the heat was nearly palpable.

While patients waited, the students conducted charlas, mini educational lessons, on family planning, diabetes and hand-washing among others.  In Spanish, charla loosely translates as “chat.”

“We all worked together to determine a pertinent topic,” said Mathew.  “Then we would figure out how to say it in Spanish.  In fact, we used the same techniques with the adults that we did with the kids—interactive skits, games—and folks were really receptive.”

While in the clinic, the students also shadowed doctors in different specialties like dermatology, emergency medicine and neurology. These young medical students also participated in something they hadn’t yet done in school, their first birth and Cesarean section, and all agreed that it was an amazing experience.

Two students even “scrubbed in” on some surgeries using the aseptic technique they learned about in class.  Ippolito and Seval applied sutures to close a hernia repair and an orchidectomy (testicle removal), respectively.

“I actually got a lot more hands-on surgical experience than I thought I would,” said Seval. “One patient had prostate cancer, so the doctor’s solution was to perform an orchidectomy, and the doctor let me finish up on sutures after the surgery.”

“The clinic performed many hysterectomies and obstetrical surgeries,” Mathew said.  “Women’s health and pre-natal care are their most highly utilized services, especially since teen pregnancies are so common there.”

Because the Dominican Republic lacks a consistent, clean water supply and organized trash disposal, many children have recurrent infections and bouts of illness.  As a result, pneumonia and respiratory ailments are common.

“I heard my first wheezes and rhonchi [rattling] lung sounds while examining a little girl that was suffering from pneumonia,” said Sherry Spacek who used stickers she brought with her to comfort the children.

“I’m happy to say that I didn’t bring a single sticker back home with me,” she said.  “And I learned that stickers have an uncanny ability to draw a smile to a child’s face.”

In the afternoon, the students would host the Healthy Kids Camp for 40-60 children at a school in Playa Palenque, the poorest town center. Since two-thirds of Palenque’s 15,000 inhabitants live in rural areas outside the town, the school served as the most convenient meeting place for the children, some as young as four and as old as 18.

The group would begin with an icebreaker to get their attention, followed by a lesson.  Then they would integrate the information into games or activities suited to the age groups.  That’s when the fun began.

“Everyone, even the older kids, was so appreciative for even the smallest things,” said Ippolito.  “The teenagers enjoyed coloring as much as the younger children because they had never had things like crayons before.”

“The children didn’t have much control over what they ate, and they knew little or nothing about portion control and healthy food choices,” said Mathew.  “So we used interactive games to teach them healthy options.”

In one lesson, the students used the song “Head, Shoulders, Knees and Toes” to identify parts of the body.  The next day, the children learned about different emotions and how to deal with feelings in healthy ways by drawing facial expressions on masks made of paper plates.

Since the school had no air conditioning, most of the lessons were held outside, and even the nation’s most popular outdoor pastime was utilized for teaching.

“Sometimes we would throw a baseball to the students and ask them questions,” said Ippolito.  “We engaged them as much as possible in learning, and they really got more out of the games than just the lectures.”

The students included everyone, even those children with learning disabilities, and discovered that some, despite their impoverished circumstances, were quite talented, and they all were avid to learn.

“I loved working at the camp because most of the kids were from low-income families and some had learning disabilities,” said Mathew.  “When it came down to it, they were the children most eager to learn.”

After camp each day, the students would wait until 6:00 p.m. when the heat abated and walk home from the beach.  After dinner and some brief downtime, they would gather at 9:00 p.m. to plan the next day’s lesson, translate it into Spanish and gather materials—even if that meant hand-drawing all the coloring pages for dozens of children.  Most days, they were in bed by midnight.

“We got our NBME [National Board of Medical Examiners test] scores while on the trip,” said Ippolito. “We all passed, and to celebrate, we went to dinner.  The next day, we were back in clinic and were reminded why we want to be doctors.”