How I Spent My Summer

Do I really only have 6 more days left? How is that even possible? Where has my summer gone? What have I accomplished?

Yes, I only have 6 more days left, whether I like it or not and it's possible because the seasons are changing. Today was my last teen health class and Saturday is the last community health leader (CHL) class which will be followed by a trip to the local dam for swimming and dinner to celebrate a successful summer. My time is drawing to a close and I am beginning to pass the baton of this program to Jewel, the nurse practitioner that is coming at the end of August to replace me. But I want to be selfish and keep the baton and keep doing what I'm doing! I keep thinking and constantly repeating "It's not fair, my work has just begun!" And although I feel like my work is finally starting here-the walls are finally coming down, my relationships are finally growing deeper and more rooted in trust and friendship, the way of life here becoming more normal, the direction of this program and my work more clear and focused- I must return to the US and finish my Master's in Public Health Program strong.  As much as I want to believe that my work has just started here, the seasons are changing and there is a time for everything. It's Jewel's time to continue this work and my time to continue to prepare myself by studying and working so that I may become even more equipped and prepared to continue work such as this.

 1There is an appointed time for everything. And there is a time for every event under the heavens—
2A time to give birth and a time to die;  A time to plant and a time to uproot what is planted.
3A time to kill and a time to heal;  A time to tear down and a time to build up.
4A time to weep and a time to laugh;  A time to mourn and a time to dance.
5A time to throw stones and a time to gather stones;  A time to embrace and a time to shun embracing.
6A time to search and a time to give up as lost;  A time to keep and a time to throw away.
7A time to tear apart and a time to sew together;  A time to be silent and a time to speak.
8A time to love and a time to hate;  A time for war and a time for peace.
 9What profit is there to the worker from that in which he toils?10I have seen the task which God has given the sons of men with which to occupy themselves. 11He has made everything appropriate in its time. He has also set eternity in their heart, yet so that man will not find out the work which God has done from the beginning even to the end. I know that there is nothing better for them than to rejoice and to do good in one's lifetime; 13moreover, that every man who eats and drinks sees good in all his labor-- it is the gift of God.…
Ecclesiastes 3:1-13

I turn to this passage often as I find myself anxious about getting my life "started" and continuing the work that I believe I am called to do. But for now I know it's time to return to Birmingham and to school and finish my Masters degree strong and then see where life takes me and where God directs me! 
So as I attempt to reflect and better put into words my experiences here this summer, please read the below report that I actually submitted to UAB to receive credit for my internship:

Working as a public health intern with Project Hearts this summer has been one of the most rewarding experiences of my life.  Living and working here in the Dominican Republic I often feel as if I’ve been caught up in the rhythm and passion of the country, swinging from positive to negative, from challenge to success, from excitement to tranquility and all of the emotions and outcomes in between.  It’s as if my sentiments emulate the sway of my hips when I dance merengue or the ever-changing tropical weather.  This way of life is a little unsettling at first if you aren’t prepared for the turbulence, but after awhile you find the rhythm that reminds you to be patient, celebrate your successes and persevere through your hardships; a constant undulation.

Upon my arrival I immediately learned that flexibility and patience would be key to my success here.  I came to the Dominican Republic knowing very little about the organization I was going to work for and believing I would be doing a “water project.”  I thought I would be preparing the local communities of Baitoa through education and community assessments for the installation of wells after my departure.   As is typical here, this was the original plan, but when water began to flow (however sporadically and unreliably) from the city through their pipes to the local houses, constructing wells was no longer the greatest need.  However, based on the data collected by local organizations and the work of Kristin Olson (the intern last year) it was evident the people were still concerned about their quality of water and sanitation in the area so our attention shifted to a more sustainable way to address their water issues and any other future issues and concerns. The solution was the development of a community health leader program for the area.

As this became the new focus of my internship I immediately shifted my attention to creating the basis for the program, the basic infrastructure and ability for it to become a sustainable program with the aid of grants, local and international organizations, educational materials, and most importantly community ownership.  This fits into the mission of Project Hearts (which we refined and developed the three pillars as a team while I was here- I was able to help with organizational development and training in addition to my public health focus) to develop individual and community awareness and leadership through participatory community projects and activities to better the quality of life in Baitoa.  Our foundation is supported by the 3 pillars of HEALTH, EDUCATION, and ECONOMIC DEVELOPMENT around which all community projects and activities are centered. Our Vision is simple: To better the lives of the people of Baitoa so they may live dignified and fulfilled lives and learn to help themselves.

I started with the goals and objectives of the program which are as follows:

The goal of this project is to improve the overall health of the Baitoa communities and develop community leadership skills. The CHL program also serves to advocate and organize community health leaders. This will be accomplished by completing the following objectives:

• Educate and train approximately 10 community health leaders (two elected by community leaders in each community)

• Develop specific education modules in community water, hygiene and sanitation, nutrition and cooking, maternal and child health, family planning, first aid, cardiovascular health, etc.

• Provide 3-4 monthly group education sessions in each community served.

• Establish water and health committees in each community.

• Visit homes with high-risk community members (infants and young children, pregnant women of child-bearing age and pregnant, and the elderly) and the infirm.

• Make the leadership program a sustainable community-driven program for primary health care.

• Educate the community and maintain their health, prevent disease, prevent complications thereof and recognize warning signs of disease, especially in children. (Ex, diarrhea, malnutrition, respiratory illness, febrile diseases, ear problems, eye, and throat diseases, infectious disease etc.).

• Finally, avoid complications and reduce unnecessary hospitalizations and preventable diseases in Baitoa.

            After conducting literature reviews and using local community assessments conducted by Project Hearts’ partners, as well as the little data available by the government on the Dominican Republic I finished creating the framework and potential curriculum of this program beginning with a focus on leadership development, the human right to health and then moving into the most basic and essential determinant of health: access to clean water.  Before I could start with these training sessions I sought the support of the communities to begin the program. I literally went door to door speaking with key leaders in the communities of Baitoa to bring them to a meeting to discuss the programs goals and objectives.  That first meeting I was incredibly nervous but at the end the community leaders received the program well and with lots of enthusiasm! They were to then return to their communities and choose community health leaders.  Almost immediately those leaders had found potential CHL’s and the trainings began every week for 3 hours. As noted above, we began by developing an appreciation and an understanding of the importance of a healthy community, the human right to health, the roles and responsibilities of being a CHL, and their own expectations for the group. We then progressed to talk about water and sanitation, discussing what germs are and how they cause diseases, different routes of transmission and the absolute necessity of clean and healthy water in a community and how it can be used to prevent and even treat diseases. 

Based on my research we then talked about the most prevalent water-borne and water-related illnesses in the Dominican Republic.  We had guest speakers from the company Filter Pure that distributes locally made water filters made of clay, carbon, and silvery powder.  The guest presented the water filter and trained the ladies (the group of CHLs are all women!) on how to sell them.  This is a project that Project Hearts has promoted as an independent project for a while but it is now being nested in our CHL program. This way the CHLs are responsible for educating their communities on water and offering them methods of purification and filtration that they learned in the classes (of which the water filter is the ideal) and give them a more well-rounded understanding water and its necessity. In addition selling the water filters provides the CHLs a bit of income and incentive to reach as many people as possible.

Another powerful experience for the group was when the Director of Project Hope in the Dominican Republic, Teresa Narvaez, came to speak about the CHL program they have in the capital and how important they are in the promotion of health.  Some practical skills they learned were how to combat diarrhea in home with oral rehydration therapy, how to construct a tippy-tap which is an easy hand washing device, and what to look for on a home visit to ensure the family is practicing safe water and hygiene practices among many other things.

After finishing the water module we transitioned to nutrition as a form of disease prevention and promotion of healthy lifestyles. I did this by using the case of unclean water and baby formula as a potentially dangerous and life-threatening combination. This serves as the perfect link between water and nutrition as we began to focus on the first 1000 days of a child’s life and the centrality of clean water and healthy food (breast milk!).  We then moved on to discuss the “plate method” of regulating a person’s diet and conducted a scavenger hunt in the area to try and find foods that contain certain vitamins and minerals that we talked about during the class.  This area is an extreme food dessert with no fresh fruits and vegetables (except for beans, bananas and mangoes) within miles.  The nearest grocery store is 40 minutes away by car, which is financially impossible for anyone here to reach.  The idea of the scavenger hunt was for them to possibly realize that they do not have access to however they have extremely fertile land. 

The problem of the food desert became another side-project of mine as we began to plan for a model community garden to demonstrate how to sow a garden with a variety of appropriate fruits and vegetables here.  We laid the building blocks for this project for when a short-term mission team comes later in August. We finished our discussion of nutrition by discussing healthy body weight and exercise and how you can check to see if a child is developing correctly.  Although I was only able to cover leadership development, water and sanitation, and nutrition, I feel that these subjects really laid a strong foundation and understanding of the completeness of health according to the World Health Organization’s definition that we discussed with the CHLs at the onset of the program. The WHO define health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” of which I think this program has already begun to promote and embody.

The Community Health Leadership Program was my main focus while I was in the Dominican Republic, but I also started a teen health class that was held twice a week where we covered much of the same material that the CHL classes covered but focused more on the science base of health issues as well as self-esteem and leadership skill in the teens. I actually saw some of my greatest successes in this group as my passion is to work with children.  I also wrote a grant proposal for the CHL program and helped with a water filter proposal and a fuel-efficient stove proposal which will be nested within the CHL program.  I had the privilege of meeting with several organizations and individuals who will be essential in the continuation of the CHL program, including working with Project Hope, Filter Pure, Surge for Water, and Profamilia, Peace Corps, local school principals, the local Mother’s club, the Mayor and CORASAAN (local government run water company).  Working together we are starting to create a strong network to support Project Hearts’ pillars of health and education

I obtained my personal goals and objectives by using the present resources and knowledge in the area, my own knowledge and expertise, and resources such as “Where there is no doctor” to establish a stable and long-lasting community health leader program. Some other personal goals I had were to connect local and international organizations, write grants and seek funding, increase community awareness of water and other health issues at all levels of the social ecological model of which I feel extremely successfulI feel successful in the completion of this internship and these MPH competencies but by far my greatest success, which I can not even attribute as my own success, was the discovery and unleashing of each community health leader’s innate potential to be a powerful change agent.  Despite the challenge of not receiving IRB approval from the DR due to time restraints and the irresponsiveness of their IRB, lack of funding and resources, and difficulty in changing ingrained habits and beliefs.  I had to come over physical and figurative barriers such as the terrible roads (no one can go anywhere when it rains here because the roads wash out and the main mode of transportation is by foot or on motorcycles), overwhelming fiscal barriers in a developing country, and of course the language and cultural barriers.  One cultural barrier that was most challenging was the idea of a commitment and a responsibility to be somewhere at a certain time.   Dominican time is always a few hours or even days behind and even if you agree to meet someone somewhere or do something at a certain time and place, it is very likely that someone may cancel last minute or just not show up.  Temporality is a major issue and life here in general takes longer. Despite these challenges and the ups and downs the successes were far greater.

On field visits to the CHL’s houses to discuss their work, visit houses together, and learn more about them and their needs, I was pleasantly surprised to discover that these women had already been taking care of their communities for years before the start of this program. Whether it was going house to house to check on people or organizing community meetings, these women were already leaders but this program allowed them to own a more formal position in their community, learn about specific health issues in their area and provide them appropriate and applied ways to combat them. 

At the end of it all I can look back and see the tangible and intangible progress that occurred while I was here.  I learned about community development as a whole and public health’s integral piece of this very challenging puzzle towards sustainable development.  I have discovered my passion thanks to this internship and believe that this was a real-world public health experience.