WMMMC: Beyond duffel-bag medicine

Ever since the William and Mary Medical Mission Corps' (WMMMC) first excursion to the Dominican Republic village of Paraiso three years ago, students have been determined to do more than "duffel-bag medicine." Setting up one-week clinics to treat the symptoms of harsh lifestyles seemed too sporadic, too disconnected from the service-learning culture they had embraced at the College. They turned to research by adding ethnographic studies to their project. Their goal is to transform a community by listening to and by learning from its members.

"This is not a game. This is the real deal," explained senior Christopher Lemon, WMMMC director of undergraduate affairs. "The clinic is just a Band-Aid right now. Our medical clinic runs for one week. In order to be sustainable, we have to make sure that the community feels our presence for the other 51 weeks as well."

Toward that end, in January, WMMMC team members spent as much time collecting data for their four ethnographic projects as they did treating patients and dispensing medicines. Of the four ethnographic projects, two were in-clinic and two involved "walking down the hill." One in-clinic questionnaire sought to determine what people expected from the clinic and what they perceived the community-health issues to be. A second survey polled patients who were exiting the building about their satisfaction with the services and their perception of the volunteers. Outside, students used global positioning system technology to map individual homes and streets in the village in correlation with the flood plain and areas of poor water quality. The second community study involved a random sampling of homes to determine, among other things, what social and physical problems were considered the most pressing and what members were turned to for leadership.

Back on campus, students are waiting for the results to give direction to ideas they already have been kicking around—ideas such as training lay health-care workers and sending them out with blood-pressure cuffs and stethoscopes to provide year-round monitoring, establishing recycling programs as a way to bring local leadership and money into the venture and creating nutrition programs. The most pressing problem, however, is how to ensure that the clinic itself is serving the entire community.

"Simply put, the community is on a hill," Lemon explained. "You have people who live on top of the hill, and you have people who live in the flood plain. Basically you see a stark disparity in socioeconomic status as you go down the hill."

At the bottom of the hill, people live from paycheck to paycheck, according to the students. Their shacks seem to have been pieced together from scraps. Their livestock roam through the mud streets and yards. Their children play among trash.

"As we examined the ethnography, a lot of those at the bottom of the hill were saying they work so hard to feed their kids that they don't have a second to stop and walk up the hill," Lemon said. "Those are people we really want to incorporate next year."

As would be expected of a project that distributed $25,000 worth of medicine among the 650 Dominican patients during a weeklong visit, the clinic has been embraced by the village of Paraiso. Junior Ayesha Shaukat said there is instant affection. "When I first went into the clinics, there was a line of people outside. I walked in and this lady came up to me and said, ‘I love you, I love you' over and over again."

There are tensions as well. Senior Matthew Imm, WMMMC clinical affairs coordinator, found himself in the uneviable position of telling people they could not see the doctors due to a lack of time and of medicines. "It seems that some people see the clinic as a way to exploit our involvement in the community and are determined to get their share," Imm observed. "There were several people who really stretched this to the max by showing up every day and demanding to be seen or by bringing many different sets of children to the clinic each day. It makes you question nonetheless the effect we are having and in some moments puts a bitter taste in your mouth."

Imm looks to the studies to help the WMMMC address those tensions. He was pleased that two of the alumni medical personnel, Mark Ryan ('96) and Patrick Schembri ('87), who volunteered in the clinics were able to walk down the hill to conduct in-house visits. "This sort of personal interaction between doctors and patients is exactly what builds trust and relationships," he said.

Imm and Lemon say those relationships are key to sustainability; Lemon said that they already are working. When one of the scheduled U.S. internists had to cancel at a late moment, friends in the Dominican Republic found a Dominican gynecologist and a Dominican pediatrician to take up the slack. "It showed that the community is trying to participate and trying to help us," Lemon said.

For Lemon, however, the extent of the community's acceptance was exhibited last summer. He had returned to Paraiso to pursue further research for his senior honors project. While taking water samples from the river, he and two other students found themselves being robbed at gunpoint. The assailants, wearing masks, pushed the students to the ground, took their equipment and then forced them into the river.

"We swam across the river while they got away, then we jumped back into this river we were testing for fecal coliform," Lemon said. On shore, two local youth who had been following the students helped them back to the village. "When we got back to the community, these kids said they recognized the people who had robbed us," Lemon continued. "We said, ‘Go home and don't say anything.'" The principal of the village school, however, insisted that the robbers be brought to justice. "She went door to door until she found these kids; she got the names of the people who robbed us and they were arrested," Lemon continued. "She said she wanted justice to be done so that the clinic would return."

The WMMMC received an unexpected boost this year when College President Gene Nichol accompanied the group (see sidebar). His presence generated widespread interest not only in the project but also in the sustainability concept.

Nichol's presence was seen as an endorsement, according to Lemon. "It was like a statement saying that we need to be culturally competent in the kind of service that we are doing," he said. He enjoyed watching the president in the field, whether he was serving in the pharmacy or accompanying the researchers down the hill. "He wasn't just observing from afar," Lemon said. "But for me, the greatest joy was seeing the joy on his face as he realized that he is in charge of an institution that is producing individuals who are going to be the leaders of tomorrow."

The presence of David Aday Jr., professor of sociology at the College, helped to ground the group. Aday, who ensures that the students have the appropriate academic research tools to help them understand the community, provided a calm assurance for many of the students who have come to recognize him as a model researcher. As they looked to him, however, his eyes were on them.

"It began to occur to me as I worked with the students—the students opened my eyes—what happens when they are involved in doing this kind of interview work," Aday said. "As they're getting answers to questions that can help us help the community, they're asking, How do you dispose of your human waste? How do you wash your body? Where do you get the water to drink and the water with which you prepare your food? What occured to me was that now when a person shows up in the clinic, it is not somebody with a rash but it is someone whom they have seen in the home. It just occurred to me that ethnography has enormous power to help students understand the human experience."

Lemon says he believes that the students are very aware of what they are learning. "On the surface, this does look like a medical service trip, but every student is bringing unique skills to the table and can take away what they want," he said. "Both the volunteer and the beneficiary are learning and benefiting. When we have that kind of reciprocity going, our concept is working."

As to where the students will take the lessons, there are few limits. Sophomore Katie Ball, a returning WMMMC volunteer, said, "It's hard to see the poverty, but I think it's a wake-up call. It's really important to get a tangible sense of how much of the rest of the world lives; that way you can come back and have a realistic view about how you can help and how you can make it better."

Shaukat agreed. "I really learned the empowerment of being part of something so large, and I learned the fulfillment of helping those less fortunate," she said. "Now I understand that if one cannot use his or her education to help those less fortunate, then that education has gone to waste."