Front-line engagement: Reports from the DR

Members of SOMOS conduct field work and in-home medical visits in Paraiso. By Matt Harrington.For the third time, members of the William and Mary community traveled to the Dominican Republic to offer medical services and to address long-term health-related concerns through research. Following are first-person accounts from the field.  —Ed.

Jan. 9: Saying goodbye and looking ahead

Saying our goodbyes in the community is difficult, and the looks of shared affection will be long remembered.  We see the desperate needs of the residents, and they see, I'm sure, our sense of helplessness in not being able to do more. There is "coco y aqua" (coconuts opened with a machetes) to provide sweet water as a special gift from the school principal. There are pictures, smiles, and hugs all around.

We've learned from our research and from intense conversations with local residents. We've learned from a visiting engineer who works from the world bank—and happens to be Ayesha Shalkaut's father.  Senior (and first year SOMOS student) Victoria Ryan encouraged her mother (Sandra Becker, MD) to join us, and she brought her expertise as a family practice physician.  Freshman Lamar Shambley is making his first international travel and was extraordinary as a medical translater for our providers who don't speak Spanish. Layla Soberanis, also a SOMOS first-timer, was among our best field interviewers and was touched by what she saw in the community and the homes. John Pothen (freshman) is deeply distressed with the personal ethics of dealing with beggars, and his mind is filled with ideas about work that can build on our ongoing community health efforts. John Weeks lost his voice and still managed to conduct field interviews and serve as a medical translator in the clinic.

Irene Mathieu, returning from last year, brought bags of shoes to distribute to the people and returned with a level of commitment that is the model for our sustainable efforts.

Kristen Corcoran and Jake Milnor are new to the project this year, but they seemed like veterans after only a few days.  Their background in Hispanic Studies has been critical to team attempts to understand the larger culture in which we live and work.  Brett Roth, our resident Patch Adams wannabe, keeps the group laughing, making certain that we never take ourselves too seriously.  And now, the "advance team" will lead most of the students on to another adventure, traveling together to see other parts of the Dominican Republic and taking a few well-deserved days of holiday.

On his final night with us, President Nichol spoke with students of his vision for the future of the College. Listening in the warm Carribean night, students were deeply taken with his understanding of the College they love and inspired by the grand prospects that lie ahead. He sounds a familiar theme:  There is much that is good about W&M, but in the end, it is the students who push us to the next level of excellence in much that we do.

Mark Ryan ('96, co-founder and medical director of the project) and I couldn't agree more.  As we leave, we're certain that we could have done more and better, but we're confident that working with the SOMOS students will help us to find the way.

David Aday, faculty advisor

Jan. 6: Mucking and learning with the president

Rain again and the field research and medical teams return to the clinic tired, wet, sticky, and with a strong sense of accomplishment. President Nichol has mucked along with us through roads and paths that, with rain, offer up a nice soup of mud, litter, and pig excrement. In the barrios, residents dismiss our muddied shoes and trousers and insist that we come inside. They would feed us and offer snacks if they had even the smallest prospects of doing so. Our presence, with some of us being noticeably larger than the locals, brings the population density inside to a level that is nearly intolerable in these make-shift wood, tin, and cardboard shelters. Schembri and Harrington find stroke victims, some as young as 30, who need medicine, information, and advice. They provide prophylactic parasite medicine and vitamins -- and compelling expressions of compassion.

Mohammad Torabinejad, 2nd year student and a member of our advance team, was part of a small research group that worked in the community in the summer. Everyone knows and loves him and his mere presence opens doors and hearts throughout the community. Progress sometimes is slow as we move through the barrios because everyone wants to spend time with "Mo" and to express their deep affection for him. He will play a critical role in future years as we find ways to help organize this atomized village where people display varying levels of alienation.

After a late dinner, we follow our ususal custom and make our way to the "plaza" where we can sit out of doors on concrete stairs, share our victories and frustrations, and enjoy being together in a wonderfully beautiful physical setting. Students listen enthusiastically as their president offers encouragement and support, and speaks with extraordinary insight into the intricacies and promises of this novel project in research, learning, and service. And, in turn, "Nick" listens to the ideas, concerns, and aspirations of students more determined -- and likely -- to change the world than any I've known in nearly 30 years at the College.

David Aday, faculty advisor

Jan. 5: Packed clinic and sources of water

The clinic is in full swing and we've seen more than 400 patients, mostly young women and their children. We seem to have more than usual of the ever-present "grippe," a general syndrome that involves flu-like conditions, lack of energy, and assorted pains in the stomach and head. It seems mostly like a malaise reflecting a general sense of helplessness and despair. President Nichol has helped some in the pharmacy and patient registration, but spends most of his time with our field research and medical house-calls teams.

The field research team is focused specifically on describing residents' problems in accessing clean drinking water. Our research proposal calls for a large sample to ensure that we can draw reliable inferences that will inform our very first non-clinical community intervention project. At the end of the first day, and with the help of the work done by the advance team, we have interview and observational data from more than 60 houses.

More importantly, it has become clear that problems must be understood and solved in different ways in the different barrios that comprise Paraiso. For example, in some barrios, people get water in their homes through the government operated "tuberia," pumped through very small underground pvc pipes. The water is contaminated and salty and, for most, comes only about twice a week. We observe the water system fairly easily in some places because pipes have been exposed through erosion and run above ground, mended occasionally with black rubber tape. People in most of the areas buy drinking water when they can afford it, paying 20 to 50 pesos per gallon. In some barrios, many people report that they store their water in the plastic bottles in which it is purchased, but in others, residents have devised less secure storage containers.

In Paraios Segundo, many residents have significant difficulty finding money to purchase water, so more of them depend on rain harvesting, though their ability to effectively treat the water for consumption is highly variable. In other areas, more residents have sisterns to store and treat delivered water.

Our roving medical providers (Patrick Schembri, '87 and a physician's assistant and Matt Harrinton, '05, co-founder of the project and now a third-year medical student at UVA, travel with our research team to see in their homes patients who are too sick to walk to the clinic. This is critically important because we're beginning to get the word effectively to the community that we intend to help everyong in the community -- not just those who have the resources to ensure their place in the line of our school-based medical effort.

David Aday, faculty advisor

Jan. 3: Settling in

We arrived yesterday to sunny, 87 degree weather.  After some hours waiting for everyone to gather in the airport, we made our way to our hostels -- students in one and professional staff in a second.  With five doctors, one physician's assistant, two registered pharmacists, 13 undergraduates, and me, we constitute a motley crew of enthusiastic travelers.  We'll spend the day today counting and sorting pills, bagging them with labels and instructions.  We'll go to the community to make sure that the clinic site is ready and that things are in place for the research effort.  Our advance team (Jim Donecker and Laura Olsen, senior co-leaders, and Irene Mathieu and Mohammad Torabinejad) have done outstanding work in preparing for the trip, notifying community residents of the clinic days and hours, and meeting with local community members.  They have conducted more than a dozen interviews in preparation for the intense effort to understand problems with access to clean drinking water.

We're looking forward to President Nichol's arrival tomorrow.

It's another beautiful day in paradise and there's much work to do.

David Aday, faculty advisor

Jan. 1: Final thoughts upon departure

Our senior leaders, including Jim Donecker and Laura Olsen, have been in the DR for several days now.  They are the advance team, setting up the clinic space, distributing leaflets announcing the clinic, identifying residents who will require medical house calls, and beginning interviews for the "clean water" project.  The rest of us will arrive in Santo Domingo tomorrow afternoon.  President Nichol will join us on Friday.

This morning, I received an email from Jason Starr, one of the project co-founders and the (now) alumnus who is responsible for my involvement in the project.  He offered the following observation, which I have to say fairly characterizes my experience as well:  "Had I not helped start this program, I wouldn't have been qualified to join it."  We have witnessed a project taking on a life of its own, and though I lead the "foundations" seminar, I find myself running full speed to keep up with the students who own and operate this remarkable effort.

David Aday, faculty advisor

Additional related content
W&M News story: WMMMC: Beyond duffel-bag medicine;
Video feature: Aday ponders civic-engagement success.