El Coco: Tierra verde y cielo azul (Part 1, Wednesday Week 5)

"Green earth and blue sky"

Last week marked the halfway point of my trip. It was completely different from any other week so far, because we spent it living in different rural clinics throughout the province of Las Hermanas Mirabal, which is about an hour and a half west of Santiago.

CIEE students (Asia, top row far left, Jessica, bottom row far left,
Denise, bottom row middle and me) and El Coco clinic staff

We were divided into small groups of two to four people. The three other girls in my group and I were assigned to the clinic in El Coco. The town has about 900 families and is very close knit. There were yuca, corn and plantain fields, but the fields are small so at most it's a 2 or 3 minute walk to a neighbor's house.

Scarlet and I!

Many of the other groups lived in their clinics, but our clinic didn't have space for that. We slept at the house of the mother of a woman who works at the clinic, but we ate, showered and kept our stuff in the clinic and just bought a backpack to the house every night. This arrangement was a little strange, but I'm very glad that we got to stay with a local family. Sylvia, our host mom for the week, was incredibly kind and generous. She treated us like her children and got teared up when we had to leave. Sylvia is taking care of her four year old granddaughter, Scarlet, and we also got to know her very well during the week. She loves to draw and play school. She "taught" us the Spanish vowels and numbers, and we taught her to write "perro" "gato" and "ratón."


We arrived at the clinic on Friday afternoon, but because the clinic isn't open on weekends, we didn't get to start working until Monday. We spent most of Saturday getting our bearings, trying out the kitchen in the clinic and playing with some of the local kids. On Sunday we went to a talent show in a nearby town, and then we went to Mass in the evening. The service was simple but very joyful. The towns are so small that one priest travels between many different churches--the service in El Coco was his fifth of the day, and the congregation spent about five minutes simply thanking him for coming to celebrate Mass for them.

On Monday morning, we started our clinic experience by organizing the medicine shipment that had arrived on Friday. Because it's a public health system, the medicines are all generic and arrive together--very different than the US! We recorded the arrival of each medication by hand (the clinic has one computer, but nearly all of the record-keeping is done the old fashioned way). It was worrying to see that the clinic had run out of many medications before the shipment's arrival, and even more concerning to realize that some medications hadn't been in stock for over a year. We also helped the doctor calculate her needs for the next month's shipment, even though she doesn't always get the quantities she orders. Trying to do basic arithmetic in Spanish was more challenging than I expected!

Making home visits to fill out fichas

On Tuesday, we conducted home visits with the doctors and other clinic staff to fill out fichas familiares. The fichas contain basic demographic information and health histories of everyone in the household, and also summarizes the living conditions of the family (type of walls, roof, floor, bathroom, water storage etc.) Most of this was already complete, but they are trying to computerize the records, so we had to go back to fill in missing information before they send the records off to be computerized. Most people were surprisingly fine with a large group of people showing up and asking to see their IDs and insurance cards and to know how many bedrooms they have and how they dispose of their trash. Every house, no matter how humble, has a stack of plastic lawn chairs for visitors, and at every house the wife/mother wouldn't be content until we were all seated. It was really nice getting to explore the community and talk to people in their home environments. There was a large variety of living situations but Dominicans in general seem to be content with and grateful for what they have.

We also got to observe the consultas or office visits or hang out in the waiting room whenever we weren't busy. The office visits were generally short, and most of them were for Chikungunya. Chikungunya is a viral illness transmitted by mosquitos that arrived in the DR in March or so. It spreads really quickly and is all over the news and pop culture (See the music video!) It's not fun to have, but the good news is it's not life threatening. The main symptoms are fever, headache, pain in joints, particularly wrists, knees and feet, and a rash. The main treatment is Tylenol, which is by far the most commonly prescribed medicine at the clinic. Unfortunately, a lot of people, (including some doctors!) believe that it's an airborne virus because they don't think it's possible that mosquitos are spreading it this quickly. This is particularly bad because the only prevention strategies involve avoiding mosquito bites (using repellent and mosquito nets, and eliminating standing water where mosquitos can breed), so if people don't believe the mosquitos are responsible the disease will continue to spread.

Chickungunya music video

There's so much more to write and I've already written a short novel, so I'll save the rest for another post!