Introduction to the Authors

Buenos días! My name is Rose Kalala and I am going into my second semester of the nursing program at Towson University with a French minor. I am from Silver Spring, MD and I am 20 years old. When I am home I love to spend time with my family and friends and play basketball and rugby. I am very excited to be going on this study abroad trip, mostly because it will be my first time in a Spanish-speaking country. I love being immersed into a new culture and learning as much as I can about those who differ from myself.

Bienvenidos! My name is Kirstie Geier and I am approaching my last semester in the nursing program at Towson University. I am from Parkton, Maryland, but I have gone to school in Towson since pre-school. I currently work as a Nursing Assistant in the Pediatric Emergency Department at Greater Baltimore Medical Center. I have a strong passion for pediatrics, and hope to work as a nurse in this field when I graduate in May. I also love spending time with my family and friends when I am not studying or working. My hobbies include running, snowboarding, or cheering on the Ravens! I am beyond excited to begin my study aboard adventure in the Dominican Republic. I cannot wait to immerse myself into a new environment and experience a different way of life.

Hola! My name is Crystal Croom, I am a junior at Towson University studying chemistry. I am originally from Silver Spring, MD. In my spare time I enjoy the company of my family and friends. I also love reading and trying new things. I almost did not apply to study abroad, but the deciding factor was “why not now?" This study abroad was to fulfill a core requirement, but will be well worth it. I could not wait for our departure date! Everything about this trip seemed exciting; I would be learning about healthcare while immersing myself in the culture.

January 2, 2015

Hotel Riazor
Photo Credit: Kirstie Geier 

Kirstie: My travels to the Dominican Republic (D.R.) were lengthy, but thrilling at the same time! I was mostly excited to soak up the warm rays of the sun and escape the freezing Maryland weather! I was also anxious to immerse myself into a new culture and broaden my worldview. I felt as though my view of the world was very limited to my experiences in the United States (U.S.) and I was eager to grasp a sense of how other cultures function. I remember my biggest worry on the travel day was that my luggage would go missing. Luckily, even with the layover in Atlanta, my luggage and I safely arrived in Santo Domingo. I slept most of the flight, but was awake and alert once we approached the landing strip in the Dominican Republic. From the moment we arrived, we were introduced to the concept of “Dominican time.” We waited in the airport for a long period of time for CIEE, our study abroad program, to gather its participants and the bus to arrive. We were informed that the culture here is very relaxed and things rarely happen on time. This concept is in direct opposition to our American frame of mind, which values punctuality. When we arrived to our hotel we immediately had to exercise our flexibility, as our hotel was overbooked and we were moved to another hotel. Another aspect of the culture was portrayed, as plans are constantly changing and we were told to be ready for anything. Fortunately, the new hotel we were relocated to, Hotel Riazor, turned out to be a very nice facility. We were also introduced to Xaivier and Roalqui and the CIEE center. Our last part of the day’s agenda was dinner at the Garden Café. At first, I was hesitant to try the dinner that was placed in front of me, which was a traditional meal here in the D.R. called Sancocho. It was a soup with vegetables and beef with a side of rice and avocado. After my first bite, I could not put my spoon down. Sancocho was delicious! The first day was exhausting after all the long travels and getting settled in, but I was still excited for what the trip had in store and could not wait for the following day!

Sancocho meal
Photo Credit: Crystal Croom

Crystal: As I arrived in Santo Domingo on January 2 was slightly bumpy, but I was happy to arrive at my final destination. The first change I experienced was the one-hour time difference. Luckily, another classmate and myself were on the same flight and we thought we would wait for the rest of our classmates, but we unaware that they were at another terminal. As we took our time waiting for the rest of the group, a women from baggage claim came to find us to let us know they had our bags waiting for us in another location. This was a pleasant surprise, as I thought they would just throw our bags in lost and found, rather than come notify us. The women that found us for our bags also lead us to our group who were waiting on the other side of the airport. I was thankful for her help and kindness. As we exited the airport, we approached a bus that looked as if it came straight from the 1970’s, which I thought was pretty neat. As we made our way to our original hotel the sights of the new city I’d be staying in for the next 17 days were amazing and eye-opening. When we arrived to our first hotel, we were immediately introduced to the relaxed culture of the Dominican people. Our hotel that we were supposed to stay in had been overbooked and we were forced to make other arrangements. We quickly learned the Dominican culture goes with the flow and we had to learn to adjust to this lifestyle, as we would possibly encounter many changes and road bumps during our trip. Our hotel accommodations were taken care of and we were finally able to settle into our new place Hostal Riazor. We would be having a welcome dinner at the Garden Cafe, where we’d get our first taste of Dominican food. Our first meal was Sancocho, a soup that is comprised of vegetables and meat. It was a very pleasant start and I was excited for the days ahead.

Santo Domingo
Photo Credit: Rose Kalala

Rose in Santo Domingo
Photo Credit: Crystal Croom

Rose: My travels to Santo Domingo were a little different than the rest of the group. On the 30th of December, my family and I traveled to Ottawa, ON, Canada where we often celebrate the New Year with my father’s side of the family. Since I would already be in Canada, I decided to book my flight out of Ottawa’s airport. I left in the evening of the 1st to arrive at 5 am in Santo Domingo with a connection in Newark, NJ. The first flight was very smooth and I slept most of the way. The layover in NJ was a little over 3 hours. I got some dinner and went to my gate well before boarding time, which ended up being a good thing because the flight boarded early and we were able to take off 30 minutes before scheduled. This flight was a bit bumpier; therefore, I watched a movie instead of sleeping, which was not the best idea. I was exhausted when I arrived to Las Americas Airport, although my excitement kept me wide awake. I traveled through customs with ease and my bag was one of the first to come out. Since I was arriving early, I had arranged to be picked up by my classmate, Steve, who had arrived a week early for vacation. I am really glad I planned my arrival the way I did because I was able to see the city from a different angle before the rest of my classmates. He still had to pack his things up so we stopped by his hotel, which had an amazing view of the city and an even more breathtaking sunrise. Coming from the Canadian tundra it was so nice to feel weather above 50 degrees. Once we packed up his things and got some breakfast, we left the hotel and headed for the waterfront. We planned to visit Steve’s golf caddy at a golf course about 30 minutes away. Driving in the D.R. was a completely different experience than in the U.S. Stop signs are suggestions and turn signals are replaced by honks of the horn. The most intriguing aspect was the mere functionality of the traffic here. The roads and each person’s way of driving appeared to me as complete pandemonium, but was practical and an accepted norm for the people of the D.R., it was something they were accustomed to, which was an idea I enjoyed. We got to the golf course and met the caddy, Francisco, who seemed very nice. For lunch we decided to eat at (and on!!!) a beach, Juan Dolio, that Steve had gone to the previous week with Francisco. Francisco tagged along which was nice because he knew where he was going and he spoke fairly good English. He also helped translate and taught me a few simple words. After lunch, we explained we had to meet the rest of our classmates at our hotel and we all thought it would be interesting for Francisco to meet the rest of the group. We stopped at his house so he could change out of his work uniform and his neighborhood was really a sight to see. Off of the main highway, we entered a small dirt road and small, simple shacks and houses surrounded us. There were many people, of all ages, outside and in the streets, which was nice to see. I did feel a bit uncomfortable driving through in such a nice car without being able to offer the people that I encountered anything more than a smile and a faint “hola.” Hopefully, the saying “a smile goes a long way” holds some truth. We soon left his neighborhood and headed back to Santo Domingo where we encountered the rest of our group at Hotel Maison Gautreaux, and our trip had finally begun!

January 3, 2015

Steve in front of the CIEE center
Photo Credit: Rose Kalala

Haitian child
Photo Credit: Rose Kalala 

Rose: For our first full day in the Dominican Republic, we took a tour of the CIEE Study Center and had three sessions of orientation. The orientation included a general introduction of CIEE, an overview of health, safety, and security, and a glimpse of Dominican culture. In these sessions, we learned an abundance of new and important information that pertained to our stay here for the next 17 days. Maria Gonzalez, the Resident Director of CIEE Santo Domingo, presented about Dominican culture, which I paid close attention to, as our class has a heavy focus on culture. What I found most interesting, is the existence of a racial divide in the Dominican Republic, similar to that of the United States. Maria explained that racism is a big issue and that a considerable amount of prejudice exists towards darker skin tones. She explained that many Dominicans associate dark skin with Haitian or African ancestry, which is viewed negatively. She broke down the racial divide and explained that each complexion was associated with a name categorization, but that these names (or races) were not considered derogatory, despite the fact that lighter complexions often experience more privileges than darker-skinned individuals. I found this idea very puzzling. Rubio/a for example, was explained as someone with blonde hair, blue eyes, and most of the time, fairer skin, whereas moreno/a is used to describe someone of darker skin tone. As Maria explained these terms, she also reiterated many times how they are not considered offensive or prejudice, but are just used culturally to describe one another. This simplification of the meaning behind these terms did not sit well with me. It seemed that she was denying any correlation these “descriptors” have with the prevalence of racism in this country. In my eyes, the labels placed upon these people causing them to be treated differently, further fuels the division between the people in the country, resulting in racism that plagues the people of the D.R. When Maria was explaining this, I thought immediately about how this related to the issues of colorism in the U.S. such as, the "light-skin vs. dark-skin" phenomenon. This made me realize that colorism is still a challenge across the globe, and is not unique to one place.

Dominican Police Station
Photo Credit: Crystal Croom

Crystal: Creating, enforcing, and obeying laws are a significant part of American culture, therefore; I expected that this would stand true in any government, but I was proven wrong. During orientation, Maria made it a point to stress the fact that the law enforcement is corrupt and lacks efficiency here in the D.R. She even shared a few stories about her past students that had a problem with law enforcement. Both of her stories included Dominican police stopping and searching her students because they assumed the student had large sums of money due to their American ethnicity. We were also taught about the different types of law enforcement that we would encounter. She informed us of various types such as traffic cops and government guards. She also shared that it was important for us to show respect to the police officers here in the D.R. The police officers do not receive a large salary, thus they take they power and standing seriously, and will take unnecessary actions if they feel they are disrespected. This behavior that Maria enlightend us about speaks to the corruption that exists in the D.R.’s law enforcement. It is also frightening to think about, because if an emergency were to happen, I could not trust that law enforcement would be able respond effectively.

Dominican girl headed to her quinceañera
Photo Credit: Kirstie Geier 

The Cathedral of Santa María La Menor

Photo Credit: Kirstie Geier 

Kirstie: After our orientation to the CIEE center, we ventured through the Colonial Zone, which is located in Santo Domingo. We were given a tour that included a vast history, as the Colonial Zone is one of the oldest European settlements in the Western Hemisphere. Many of the structures and buildings of the Colonial Zone have been there since they were first constructed, giving this place a unique architectural appearance. This important historical site is home to many landmarks and significant occurrences in the history of the Dominican Republic. One landmark in particular, The Cathedral of Santa María La Menor, is still standing in the Colonial Zone and is the oldest cathedral built in the Americas. Religion plays a huge role in the Dominican culture; clearly stemming from those that first arrived to colonize the island. El Calle el Conde is also a popular street lined with shops and ancient buildings that we were given time to walk through. During our free time in the Colonial Zone, we saw a young Dominican girl dressed beautifully for her quinceañera. This a special tradition in the Dominican culture to celebrate a young girl’s 15th birthday. Friends and family are invited to participate in this celebration and there is food, music, and dancing. Usually, quinceañeras are a celebration of the wealthy population, as they are a costly affair. In regards to health, the Colonial Zone had many stray dogs wandering around the premises; including, a dog with the name “Choo-Chi” that decided to jump on the train and enjoy the tour with us. The issue with stray dogs is their lack of cleanliness and retrieval of vaccinations to protect them from contracting dangerous diseases, such as rabies. These diseases can be spread to humans and thus, result in detrimental health outcomes. Also, these dogs are living among the streets, are not bathed and could have fleas. The grand presence of stray dogs is a norm of the Dominican culture, but could be dangerous to the health of the society.

January 4, 2015

Ruins of the sugar mills
Photo Credit: Crystal Croom 

Crystal: Hidden among the neighborhoods on the western border of Santo Domingo, lie the ruins of once functioning sugar mill plantations. Unfortunately, we were informed that the operation of these plantations used to rely solely on the work of slaves. These sugar mills provided the foundation of the D.R.’s economy during its colonization. Milling sugar was a huge source of income during this time period, as it was exported to England and other countries. There were several large plantations in the southern part of the Dominican Republic. We had the pleasure visiting two plantations. The first location we visited was Parque Mirador Oeste. We were able to see where the plantation owners lived, and they even had a church built on their property. The church was not overly large, but it only had to provide space for the family and maybe other visitors. We even discussed where the sugar cane was processed, stored, and shipped away. This first location was right next to the water; therefore, it easy to visualize how the sugar was about to be shipped away. The second location we visited was Palave Manor. This plantation was not as visibly close to a body of water, but that definitely did not stop production and exportation. This plantation showed had ruins of where the sugar cane was processed and where the slaves worked. The plantation even had an intact slave quarters. A beautiful mural was painted on a wall surround the plantation that demonstrates the hard work of the slaves there. Learning about the history of the sugar mill was very interesting, and it was beneficial to see exactly what Maria was teaching while being there.

Mural at the sugar mill ruins
Photo Credit: Rose Kalala

Mural at the sugar mill ruins
Photo credit: Rose Kalala

Rose: The most shocking part of today’s experience at the sugar mills, was to see the ruins with our own eyes, and still be informed that the majority of Dominican people deny the existence of slavery as a part of Dominican history. I was appalled when Maria told us that even the schools do not teach about slavery when discussing the history of their country. In general, most people are ignorant to the fact that slave owners established this country. As we entered the second sugar mill, I noticed a beautiful mural along the concrete wall that fenced the property. The mural, (shown below) made of chalk, depicted several slaves chained together.

Shackles used for slaves at the sugar
mill ruins
Photo Credit: Rose Kalala

This visual made imagining what the sugar mill might have looked like hundreds of years ago much more realistic and in turn, much more emotional. It made me feel better that someone was knowledgeable about the history and did not deny the existence of the great suffering that occurred here. I also was hopeful the message of the image would be passed on to young Dominican children and eventually the country’s view of their history could possibly change. My experience at the sugar mills made me more thankful for our country’s recognition of slavery and the legislation that followed.

Maria holding "tuatua"
Photo Credit: Kirstie Geier 

Kirstie: Throughout our tour of the sugar mill ruins today we were amazed with the beauty that once existed, but we were also could not forget the horrible mistreatment that many suffered to maintain these plantations. During our tour Maria, the director of CIEE and a native Dominican, shared various methods of traditional medical practices common among the Dominican culture. One of the plants found among the grounds, called “tuatua,” was once used due to its laxative effects. The leaves from this plant were placed in tea and given to those in need. Eventually, it was discovered that “tuatua” was harmful to the body, causing liver damage. Maria also played traditional music commonly used for healing in the Dominican. This music was referred to as “palos.” Traditional medical methods and practices are still widely used among the culture here in the Dominican. The vast utilization of traditional medicine can be attributed to the widespread poverty that is present in the D.R. Many individuals cannot afford or access modern medicine, and as a result, utilize the resources in which they can obtain. Our next activity on the agenda was to spend time on the beach. Along the way, we encountered a roadblock that signified a protest occurring in the town we were visiting. The town was actively striking because they did not have access to running water at the current time. Unfortunately, this is not rare occurrence in the Dominican Republic. Many individuals do not have access to clean water because it is a developing nation, which greatly increases their chances to contracting illnesses. One major illness that they are likely to contract when drinking dirty water is cholera. Cholera can lead to poor health developments, and if large amounts of people do not have access to clean water this could cause an extensive health crisis in the D.R.

Protestors in the street
Photo Credit: Rose Kalala

January 5, 2015

Photo of Dominican homes
Photo Credit: Kirstie Geier 

Kirstie: Due to our evolving schedule, we were able to venture upon our overnight expedition early in the week. Luckily, our excursion was to the wonderful, eco-friendly Caño Hondo. During the long, bumpy, four-hour trek to this glorious resort, we were able to see many areas of the Dominican Republic. We passed various styles of homes as we traveled through rural and urbanized neighborhoods. The trip to Caño Hondo provided us with an eye-opening experience to the true poverty that many Dominican people suffer. The places that many Dominicans considered their homes would be characterized as a shack due to their unsteady and incomplete structure. They also lacked sufficient space for the individuals living there. These homes are not safe structures due to their instability and open-concept. They are easily collapsible in a rainstorm and their open style allows the entry of many insects such as mosquitoes, which can carry dengue or malaria, a harmful disease to human health. In the urbanized, poor areas the people lived in close proximity to one another and the homes were strikingly small. This could lead to the sharing and spreading of harmful diseases and illnesses.

Dominican man traveling by donkey
Photo Credit: Kirstie Geier 

These homes also do not have running water and hinder the family’s access to clean water, which has negative effects on their health. They have a greater chance of contracting an illness related to dirty water like cholera. Also, in the more rural areas I noticed that their main form of transportation was by horse or donkey. The presence of cars was minimal. From a health perspective, these individuals have no easy or quick way to transport to a hospital or clinic. Especially in the case of an emergency, these people would struggle greatly to obtain the medical attention they needed. It is clearly evident that the vast amounts of poverty in this country hinder the people in many ways, especially in regards to healthcare.

Picture of the water from inside the cave
Photo credit: Crystal Croom

The group on our hike!
Photo Credit: Crystal Croom

Crystal: Today we were told that we would be going on a hike and visiting a few caves that contributed to the beauty of Caño Hondo. The hike was described as moderate, and would be about a 1.5 miles. As we started our hike, we immediately realized that the trail would be muddy and slippery because it rained the previous evening. The unstable ground beneath us greatly added to the difficulty of the hike, as many of chose our steps wisely to avoid falling in the mud. In the beginning of the trail we passed a lot of cows, some were caged and other were out roaming around. Soon after the start of our hike, our guide informed our group that we would be entering the forest area and to take note of differences the forest encompassed from the area we just left. The first noticeable difference was the decrease in temperature due to the shade provided by the trees. Also, the forest contained more hills for us to climb. Throughout the duration of the hike many of us slipped or needed a break to catch our breath! By the end of the hike, we had determined it was actually 4 miles long! I believe that the Dominicans’ labeled this hike as moderate because of their active life-styles. On the other hand, Americans, such as ourselves, would have rated this trail to be more challenging and rigorous, due to our reliance on transportation and less active-lifestyles. The active-lifestyles of the Dominican people can positively affect their health, especially in regards to the cardiovascular system. As the hike ended our tour of three beautiful caves began. Each cave was completely different from the others. The first one was more open to the sky but you had to walk through many crevasses. The second cave was enormous and contained many cave drawing that had stories and meanings behind them. In the third cave there were different sections and there were pools of water that gave the setting a peaceful tone.

Pictographs on the walls of the cave
Photo Credit: Rose Kalala

Robinson starting the fire
Photo credit: Crystal Croom

Explanation of the pictographs
Photo Credit: Rose Kalala

Rose: At the end of our tiring hike, we took a boat to two different caves. The first was called “Cueva de la Linea” and here we got to see several, centuries-old pictographs painted on the walls of the cave. Our guide explained each one and their significance, which was very interesting to hear as we examined each, almost faded, drawing. The resort utilizes one of the drawings for its logo, as it means “welcome.” These caves were really amazing to experience because they have been there for many years, hold so much history, and still influence the lives of people today. Another aspect that I found very interesting during our first day at the resort was that fact that it is extremely eco-friendly, on the surface, with limited hot water, recycled natural material to construct the buildings, and a natural pool, yet we noticed many unnatural practices. For example, that night we had a bonfire and one of Cano Hondo’s employees started it for us. To start the fire, he used oil (probably old cooking oil) and styrofoam and plastic cups...not very eco-friendly if you ask me. This shocked non-eco-friendly practice shocked many of us students as it was directly against the resorts motto. Their eco-friendly practices can have great benefits for the environment of the D.R. as well as positive health outcomes for many. Unfortunately, the behavior we witnessed at the bonfire was not safe or eco-friendly and could cause harm to the environment and thus, this negatively effects the health of the Dominican people.

January 6, 2015

Kirstie picking up trash!
Photo Credit: Crystal Croom

Crystal: Today we took a very pleasant boat ride to a small beach, where we participated in a service-learning project. We helped rid the beach of a great deal of garbage that was present. When we arrived at the beach there were a group of fishermen collecting their catch and untangling their net. We all gathered trash bags to begin gathering the waste. I noticed that there was a lot of styrofoam trash along with glass bottles. It was also interesting to find shoes soles in the sand. With about 17 of us, we all collected at least one bag of trash. The beach seemed a lot cleaner when we were done. Our project most likely benefited the wildlife the most, because the trash will not get pulled into the water, which is their habitat. In addition, the fishermen benefited from our help, if the trash does enter the water it will keep the sea life healthy and their catches plentiful. I really hope the fishermen appreciate a cleaner beach, even though I believe they are the ones who caused so much trash.

Tisha, Steve, & Collin picking up Mangroves
Photo Credit: Rose Kalala

The location where we planted Mangroves
Photo Credit: Rose Kalala

Rose: My favorite activity from today was the other service-learning project we participated in, which was the planting of Mangrove trees. After the trash cleanup, we rode the boat to a swampy beach with basically no sand and endless Mangrove trees. My classmates, Tisha, Steve, Collin, and I all volunteered to go retrieve baby Mangrove trees for the rest of the group to then replant. The soil that the trees were planted in was extremely soft and we had to stay close to the roots of the trees for support to avoid sinking! We each collected 20 Mangroves and trekked back to the boat. It was quite an experience! We left this location and rode the boat through a small body of water lined with Mangrove trees on either side. We eventually stopped at a dead end that seemed to have fewer trees than what we had previously seen. Our guide then informed us that this would be where we would plant the trees. The trees were rooted in water, which required each of us to hop out of the boat in the dark water and dig! This left most of us with mixed feelings of nervousness and excitement. We were given a stick to help guide the root under the water and into the soil. This activity was like nothing I, or most of my classmates, had ever experienced. Not only were we trying something new, but we were helping the environment. We learned that Mangrove trees have some really excellent properties that make them especially good for the environment and clean air quality. For one, they are a habitat for many species. Secondly, the leaves of the trees take carbon out of the air and they reduce the amount of heavy metals in the water. I was shocked by the many benefits that Mangrove trees had to offer. Their benefits relate to the concept of health; especially, their ability to help maintain a better air quality, which is crucial for positive health outcomes in any population.

Sunrise at Caño Hondo
Photo Credit: Kirstie Geier 

Kirstie: Sadly our wonderful excursion in Caño Hondo had to come to end. The weather on our last day was not too promising, as it was teetering back and forth from raining to beautiful sunshine. Due to the rain, we had to leave the resort on time because our bus driver was concerned about our safety on the roads during our long trek back to Santo Domingo. The poor structure of the roads and their inability to drain rainwater correctly could create treacherous conditions for those traveling by car during the rain. The roads are also not lined with many lights, which adds to the endangering conditions during a late night drive and unfavorable weather conditions. These issues present many Dominican people with health and safety risks on a daily basis, especially if the weather is poor. Thankfully, the weather stayed sunny and we made it back safely to Santo Domingo before dark.

January 7, 2015

Health pamphlet in Creole
Photo Credit: Crystal Croom

Health promotion posters at DIGPRES
Photo Credit: Crystal Croom

Crystal: Today we had the pleasure of learning about the members of DIGPRES and its role in the Dominican community. DIGPRES is an acronym for Spanish words, but is basically the general directory of health promotion and education in the Dominican Republic. If translated correctly, their mission is to create a healthy lifestyle and environment in the population through the regulation and conduction of actions that involve health promotion and education to the public. DIGPRES created various pamphlets and educational posters to educate the public about various health issues, such as dengue, cholera, chikungunya, or malaria. These posters included the symptoms of the many diseases and prevention measures. They were also displayed in a basic manner that required minimal education to understand, giving them the ability to reach numerous people in the Dominican population. DIGPRES also had handouts and posters on health promotional activities and practices for the public to enjoy. They also know that there are many Haitian immigrants so they also make promotional booklets in Creole so their message can reach everyone. Various committees were established within DIGPRES to focus on certain health topics of concern in the Dominican Republic. We were given the opportunity to meet with some of the members of the breastfeeding committee, and they shared some of the information they give to the public. The members of each committee work hard to educate the public about various health issues and health promotional practices. They enter many communities and neighborhoods to reach as many Dominicans as possible. Unfortunately, DIGPRES is a government-run organization, and minimal government funding is given to healthcare in the D.R., making it hard for DIGPRES to fulfill their mission and vision.

Breastfeeding Committee
Photo Credit: Kirstie Geier 

Kirstie: DIGPRES had many resources to help educate and promote the practice of breastfeeding in the Dominican Republic. Their breastfeeding committee worked diligently to reach as many individuals in various hospitals and communities. They would speak with expecting or new mothers about the multiple benefits of breastfeeding for the mother and the child. They also handed out pamphlets for the mothers to keep to or to help reinforce their education. Their teaching may include how to help the newborn to “latch on,” proper diet when breastfeeding, proper positions to hold the baby during breastfeeding, and how often to breastfeed their child. We were informed that recently the presence of breastfeeding has decreased in the Dominican Republic due to the heavy amounts of baby formula advertisements and the stigmas surrounding breastfeeding, such as the women appearing less attractive to their husbands. The commission has worked hard to have laws mandating formula companies to clearly display what is in the formula and in the Spanish language. The labels also must be simple and not overly attractive to the consumer.

The students and leaders of DIGPRES in front of DIGPRES
Photo Credit: Xavier

Lastly, their commercials have to say that breastfeeding is the best choice for the mother and child and formula is the alternative method when one is not able to breastfeed. The establishment of a breastfeeding committee portrays a positive aspect of the healthcare system in the D.R. Their understanding of the importance of breastfeeding reflects positively upon their education regarding healthcare. If their committee is successful, the widespread practice of breastfeeding will have a positive health outcome in regards to maternal child health amongst the D.R.

The students with the Dominican doctor
Photo Credit: Xavier 

Rose: Today we got the chance to meet a Dominican doctor who gave a presentation that included an overview to the health systems in the D.R. We learned how the system has similar objectives to the U.S., but with different implementation techniques. He also explained some of the challenges that the D.R.’s healthcare system faces and some possible solutions. The challenges included: infectious diseases, the Haitian-Dominican border, the prevention system, lack of incentives for healthcare providers, unsafe punishment to healthcare providers (extra work hours), and inadequate health conditions. The possible solutions he presented included: border control, promotion of cardiovascular screenings, cancer prevention, salary improvement, fewer work hours, and the abolition of absurd punishments. These all seem to be serious problems with feasible solutions, but because of a corrupt government, it is even more difficult to instill political change. Unfortunately, one theme that we continued to see is the blaming of Haitians for many of the D.R.’s issues. This theme was present at DIGPRES and also in the doctor's presentation. Almost all of the prevalent infectious diseases that were presented to us were explained as brought over by Haitian immigrants. It was interesting to hear this interpretation of how the diseases have been spread when such an explanation was almost illogical for some. It seemed that perhaps culturally it was more accepted that the Haitian immigrant population was responsible for carrying the prevalent diseases and bringing them from Haiti to the D.R., than to accept that some of these diseases may have come from within the Dominican Republic’s borders.

January 8, 2015

A technician at the level three hospital cleaning the endoscopy equipment
Photo Credit: Kirstie Geier 

Kirstie: Today was an exciting day because I was able to have a first hand experience in a hospital outside of the United States. The sights at this level three hospital were intriguing. The hospital and healthcare differed greatly from that of the U.S. The U.S. has an unlimited amount of resources to provide healthcare, which allows them to administer an elite level of care. As a result, my expectations of healthcare were greatly heightened and skewed. My exposure to this level three hospital in the D.R. opened my eyes to the different scenes and practices that occur in healthcare facilities other than the U.S. This specific hospital was a regional hospital and the mainstay of healthcare for hundreds of thousands of individuals in the surrounding areas. It is classified as a level three hospital, which means it has almost everything to offer in regards to healthcare specialties such as emergency rooms, pediatrics, gynecology, surgery, diagnostics, a lab, labor and delivery and others. The hospital, like many places in the Dominican Republic, was very open and not enclosed like our hospitals in the U.S. Although the fresh air can be therapeutic and beneficial to patients, the open air and doors allows for entry of many insects. Mosquitoes are very popular in the Dominican Republic and can carry diseases like malaria and dengue, which are harmful if they spread them to humans when they bite; therefore, the open system may be detrimental to patient health as well. One method in particular that also caught my attention was their process of sterilization of equipment for colonoscopies and endoscopies. Their sterilization process differed greatly from ours in the U.S. and was not as strictly sterile. From my eyes, the sterilization processes they utilized in the D.R. were not as rigorous compared to the U.S.; however, they created functionality with the resources they had and provided care to their patients in need.

Entrance to the ICU at the level three hospital
Photo Credit: Crystal Croom

Crystal: In addition, while on our visit to the level three hospital, I noticed that the intensive care unit (ICU) had very strict rules. Overall having restrictive rules aren’t uncommon, but I had my own thoughts as to why some of the rules were in place. The ICU at the level three hospital had visitation from 3:00 p.m. to 3:30 p.m. I thought was very short compared to some of the visitations I have encountered in ICUs in the U.S. In addition, I thought we would all be able to go inside and get a look at how the ICU was set up. Sadly, only three students were able to go inside for no longer than a minute. These was upsetting because I really wanted to see for myself what it looked like and compare it to St. Joseph’s hospital. Even though I wasn’t able to witness the ICU for myself, my thoughts on why they had these rules in place meant that they were taking the highest precaution possible to avoid dangerous exposure to their patients, which was a positive aspect of the hospital’s healthcare practices. In opposition to the rules in place for the ICU, it was assumed that with inpatients on units other than the ICU, that family members of the patients were with them while admitted. When we further discussed this topic, I found out that because of the lack of nurses it was up to family members to aid their loved ones back to health. This meant helping the patient bathe, eat, go to the bathroom, and make sure they were taking their medicine. We were informed that family plays a crucial role in healthcare here in the D.R. and their presence has an important part in attaining a state of wellness.

People trying to enter the locked unit at the
level three hospital
Photo Credit: Rose Kalala 

Locked unit at the level three hospital
Photo Credit: Rose Kalala

Rose: One of the most overwhelming aspects of the hospital was the level of security present. We witnessed security guards (a lot of them armed) at almost every entrance. Barred gates, similar to those in a prison, controlled crowds. This sight was very shocking for us students. It was hard to understand why a place like a hospital, which to us is a symbol of care giving and helping one another, would also be home to symbols of violence and inequality. It was explained that families’ frustrations often times turn into aggression and that is why these precautions are necessary. I only began to somewhat understand this when I witnessed a woman arguing with a security guard at an open gate. She was trying to come into the unit, but they would not allow her for some unknown reason. She started to holler and that is when the security began to close the gate on her so that they could be sure she could not enter. This made me wonder how and why these measures of security even came about and since when did they become necessary. There are so many factors that contribute to the aspects of the health system that need improvement, it is hard to really judge one part of the system without taking the circumstances into consideration.

January 9, 2015

Kirstie in the exam room in the level two hospital
Photo Credit: Crystal Croom

Sign for the vaccination room at the
level two hospital
Photo Credit: Kirstie Geier 

Kirstie: Today we visited hospitals classified as level two hospitals, which means they do not have all the healthcare services and specialties to offer as a level three hospital. These specific hospitals did have an emergency room, a lab, pediatrics, simple surgeries, and other specialties; however, it was much smaller than the level three hospital we previously visited. The first hospital we visited was extremely crowded and busy. They had many beds per room and separated the men from the women, which is a cultural practice. This was also in place due to the limitations with the infrastructure in the healthcare system of a developing nation. They had consultation rooms for their certain specialties, like pediatrics. They also had a small area for children to receive their vaccinations. Unfortunately, one of the hospitals did not provide follow-up care or appointment dates for the children’s series of vaccinations or next vaccination. The responsibility of ensuring their children receive vaccinations falls into the hands of the parents. This can be an issue because the parents may not have the education or understanding of vaccination series or when the children need to get their next vaccination especially, with a lack of record for their child.

Sign at the level three hospital
Photo Credit: Rose Kalala

Rose: Today we also met Dr. Elisa Fernandez, a Dominican OBGYN who started her own private practice in Santo Domingo not too long ago. She spoke to us about many issues surrounding women’s health in the D.R. including, teen pregnancy, abortion, maternal mortality, and legislation on breastfeeding. She completed her residency and an internship in the Unites States and spoke English. Her presentation opened a lot of our eyes to the realities that Dominican women face everyday. Although this is changing, Dominican women see a lot less support through the above mentioned issues than women do in the U.S. Teen pregnancy rates are much higher and resuming education is not a right, but sometimes refused; women do not have the right to abortion, but are subject to severe punishment if they do abort a pregnancy; maternal mortality rates are very high (160 deaths for every 100,000 births) compared to the U.S. (<10 deaths for every 100,000 births); and reproductive rights, including breastfeeding and paid maternity leave, are all issues being pushed for improvement. All these topics are very heavy and hold a lot of important information that not only speaks on the healthcare system of this country, but also speaks on this country’s culture, which is very important for us, as foreigners, to learn about and understand as future healthcare professionals.

Filing system at the level three hospital
Photo Credit: Crystal Croom

Crystal: At both level two hospitals we visited today, we could clearly see that they lacked organization. What especially caught my attention was what I assumed was the patient filing system. The manila folders were stacked all over the offices. There was not any clear labeling or an organized structure compared to what we are used to have in the U.S., before computer filing. This could cause a lot of problems especially if papers are mixed up with different files. This could potentially cause misdiagnosis or the prescribing of the wrong medicine that could seriously harm the patient. It is shocking to believe that this is a functional system where they have every patient’s accurate paper work.

January 10, 2015

Fruit stand at Boca Chica
Photo Credit: Kirstie Geier

Kirstie: Today we were lucky enough to have a free day! Some of us elected to spend time taking in the sun on the beach! Nine students took a taxi to a beach called Boca Chica, which was about 30 minutes from our hotel. It was an interesting ride full of sights that further enriched our knowledge about the culture here in the D.R. The beach was breathtakingly beautiful. The crystal water met the white sand and the sun was high in the sky. Hotels lined the beach that attracted a crowd of people from many places all over the world. We even met people from Minnesota, which is not too far from home! There were also many local vendors on the beach selling a variety of items. We were constantly asked if we would like a massage, pedicure, Dominican music on tape, bracelets, sunglasses, or fruit. We also were finally able to drink coconut water out of the coconut! The vendors were very persistent with selling their goods, which is representative of their culture here and portrays their need to make a living. We were also informed by one of the locals on the beach to be careful and to not accept the first price we were given by the vendors, as they knew we were easy targets to rip off. The vendors were also giving full pedicures on the beach.

Boca Chica
Photo Credit: Kirstie Geier

Vendor at Boca Chica
Photo Credit: Kirstie Geier

As I watched them perform this service I could not help but think about how this related to health. The tools they were using to give the pedicures were not sanitized by any means. They also used the water from the ocean. As they moved from client to client, they did not leave the beach to clean their tools, they merely cleaned their tools in the ocean and refilled the same bowl for peoples feet with ocean water. This is a very unsanitary process, especially when dealing with peoples’ feet, which can carry bacteria, fungus, and other various items that can lead to infections. Pedicures involve the cutting of peoples’ nails and cuticles which allows for entry of these organisms into the clients, especially the entry of mass amounts because the tools were not cleaned as they moved from client to client. This practice could result in unfortunate health issues for each customer that received this service.

Entrance to the Toros stadium
Photo Credit: Crystal Croom

Students at the Toros baseball game
Photo Credit: Rose Kalala

Crystal: This evening we had the chance to attend a baseball game to cheer on Los Toros. We all knew that baseball is an important sport in the country so we all were pretty excited to attend the game. It was about a two-hour drive to La Romana, the hometown of the Toros. It took us a while to get our tickets, but we were finally able to make it inside. The stadium was medium sized, which I would describe as smaller than Orioles Stadium and bigger than Towson’s Baseball field. The stadium was clean and had nice fan artwork for the team. The game was not sold out or packed with people, but there was a good crowd of people supporting both teams. The Toros were not winning this game, but whenever they made a good play the crowd went wild. The Toros also had their own dance team who were very entertaining with their moves. To provide even more entertainment they had a marching band play to get the crowd even more excited. Towards the end of time at the game, a few adorable little boys came and sat with us for the remainder of our time. I think they just wanted to sit with us, but they were nice company. It was definitely a great experience to see how Dominicans act at their favorite pass time.

Rose: Today was a bit rough for me. I woke up feeling fine, but around noon I started to feel a bit nauseous and ended up starting a cycle of sleeping, then waking up to vomit, then going back to sleep, up until the time we were leaving for the baseball game. I knew the baseball game would be an experience I did not want to miss so I convinced myself that I was feeling well enough to go. Once on the bus, the nausea returned and I alerted my professors of my predicament and took some medication I had brought along with me to help relieve my symptoms. It was not until we were exiting the bus to enter the stadium that I started to feel better. Thankfully, by the time the game started, the medicine had kicked in and I was feeling much better. I was able to enjoy the baseball game with my class and witness some cultural differences between this event and American baseball games. It was A LOT of fun. One thing I noticed at the game that caught my eye health wise, was when my classmate came back with a hotdog from the concession stand and told us that the vendor had picked the hot dog with his visibly dirty bare hands, and slapped it in the bun that he held in his other, ungloved hand. It was almost comical how appalled we all were because we are so used to the sanitary precautions taken by people that handle food, especially at public events. My classmate decided to embrace the culture and eat the hotdog anyways and I was proud of her for that! :)

Panorama of the baseball game
Photo Credit: Rose Kalala