A Mother's Wish/La Tinajita

¡Miau!

Yesterday I went up to A Mother's Wish, a rural clinic/preschool run by Diego and Rita, two Americans. To get up there, I hopped in a guagua, which is about the size of a VW bus - three rows in the back, and a row in front with the driver. Now, imagine a reasonably full bus of this size. It would have, maybe, four people per row, and two up front with the driver - 15 in total. Mine had 21. Chugging up a steep mountain. Welcome to the DR!

Diego and Rita have set up an amazing health system that covers all the C's of good primary care (comprehensive, coordinated, community-based ... I think there are 5 C's in total, I made this mnemonic for an exam, but clearly it hasn't stuck too well.) The clinic, Pequeños Pasitos, reminded me of Paul Farmer's Zamni Lasante clinic in Haiti (Diego and I were actually talking about Infections and Inequalities within fifteen minutes of my arrival). Both provide top-notch lifetime care for the communities they serve, with undeniably successful results (Zamni Lasante has virtually eliminated tuberculosis deaths in their catchement area, and Pequeños Pasitos has lowered the infant mortality rate to zero). This is a labor-intensive primary care, one that involves frequent household visits and careful monitoring. It is also rather contentious. Critics often deride Farmer's approach as unsustainable and unrealistic, one that misses the big public health picture for the minutiae of individual health problems. They point out that small clinics, no matter how successful, cannot ever reach enough people to improve overall health of a country. I tend to fall on the Farmer side of this debate. I think that the big picture, big policy public health proponents are too disconnected from the actual experiences of poor patients. Nevertheless, I think the debate is the most important in international public health work today. I'm really excited to work at Pequeños Pasitos to get a firsthand view into this kind of care.

I have been looking for somewhere exactly like this to volunteer. My time is definitely not filled with my project. I've been doing a lot of waiting around, which has made me incredibly stir-crazy. The plan now is to go up to the clinic Monday night, teach the preschoolers Tuesday morning, help with the girls' club Tuesday afternoon, come back up Thursday afternoon for the other girls' club, and stay into Friday to work in the preschool and clinic.

It is unbelievably beautiful up here: lush green hills dotted with palms:


I immediately was put to work (so nice after 2 weeks of bumming around Santiago!) helping to build a smokeless stove for a local family. Here you can see two of the other volunteers, Eddie and Andrea. Eddie is a nursing student and Andrea is finishing up her MPH. She's here helping some engineers do a study about water filters. We had a great time having public health shop talk, complaining about IRBs, etc.

Our handiwork

The little girl who lives in the house. The stove will save her from breathing in the smoke. The kids here LOVE to have their pictures taken!

Everyone came to watch us work.

I also tagged along while Andrea and Rita held two community meetings in a very, very poor town, La Tinajita, to describe the water filter project. I was really impressed by how enthusiastic members of this community were about participating.

This guy especially liked the camera...

... here he is imitating me taking pictures.

The meeting was in a colmado, or corner store.

Here Andrea and Rita are explaining how the filters work.

Introducing Flor, a very ugly but endearing Chihuahua.

So tiny!

Later that night I went to a bellydancing show with Eddie and Caleb, Diego's son - Caleb's girlfriend was the emcee. The pictures didn't turn out great, but here is one of the dancers: