Needle Free Injection in the Dominican Republic

Day 22: July 1, 2007. Adios amigos!

2007-07-01T21:43:00.000-07:00

And so we’ve come to the end. It’s been a good time and we’ve all learned a lot. Not just about immunizations and needles but about this place and these dancing people and life outside of our industrialized gringo bubble in general. It was a great experience and we are very thankful to all the people who made it happen.

We’re also thankful to be headed home. We woke up bright and early this morning with a bit more energy than we’ve had at any of our recent 7am’s. The hotel taxi driver packed in our bags next to his trunk-loaded rigged-up gas tank, gave us a drive by tour of some this-or-that that Columbus had built, and we were on our way to the airport. 12 hours later we were all back in San Francisco… except for the luggage… which Delta somehow lost in Atlanta. We headed straight for a taste of our own comfy American eats and let me tell you, that was one yummy burrito.

Hasta Luego, Dominican Republic. Perhaps we will meet again someday…

-Rich

Day 20: June 29, 2007. No Interviews!

2007-06-29T15:04:00.000-07:00

Friday was our free day. No were done with interviews. We woke up relatively late, went to breakfast and had our respective meals. We were surprise to see more people than normal in the hotel’s restaurant. At times we thought that we were the only people living in the hotel, because we never saw anyone eating breakfast with us. After breakfast, we spent a good part of our morning planning our visits to the local bank and our last meeting with our collaborators. Time flew by visiting banks and organizing our paper work. This was followed by a late lunch from our favorite sandwich restaurant “Thesaurus” and our last meeting with the girls. The medical students and us reviewed our three weeks full of anecdotes, took some pictures and then headed out to our next meeting with our local P.I. in her hospital.

We had an eventful evening. We went to Rich’s favorite spot in Santo Domingo; La Plaza de la Hispanidad. This place is a wide open plaza, next to the water, with restaurants on one corner and a view to a small stage where a trio and traditional dancers perform. Sapun and I begin to feel creative with the camera settings and took some nice shots with the black and white settings. After going home to change our clothes we came back to go to a local dancing club next to the Plaza. Here we got to practice our Merengue and Bachata dancing skills at “Atarazana 9”. I must acknowledge that I was feeling a bit rusty, but I still had fun. Sapun and Rich can definitely show their skills on the dance floor!

-Azucena

Caption: A team picture and the view of Plaza de la Hispanidad in Zona Colonial

Day 19: June 28, 2007. Over.

2007-06-28T18:00:00.000-07:00

Today was the last day of the project in the DR. We spent the entire day at the PAI office just hhhhhanging around waiting to meet with the folks at the office to get our last bits of information about the immunization program. Following the emerging the pattern, we were given a 10 minute window to meet with the big boss, but we managed to squeeze more than 2 hours out of the meeting, AGAIN. That was sweet! He is a great guy who really believes in his work, and the country is lucky that he is running the immunization program. I think he should run for president, but he will need to displace Leonel Fernandez. Not an easy task.

Nevertheless, we filled in some remaining holes during this meeting and another meeting with the woman in charge of supplies and logistics for vaccine delivery. Included in our meeting with her was a “cool” tour of the vaccine storage in the refrigeration units and a tour of the supply room where needles and syringes are kept. We were all very impressed with the resources, organization, and bookkeeping in the storage facility. I definitely thought, “you know, I should really take better documentation of my supplies at work” to avoid the oft-had conversations that go something like “who took my…” More often that not, I just misplaced my own crap but wanted to blame it on somebody else. I apologize for the digression.

The end of the day was nice. We took pictures with most of the familiar faces in the office and said our goodbyes. It was a nice ending to the project. Let me rephrase, it was a nice ending to the research phase of the project. The next phase, data analysis, writing, presentation,…is just starting. No point in complaining about it because I signed up for all of it. A smart person once told me, “If your gonna go – go big or go home.” Take the comment as you wish. See you next time.

-Sapun

Day 18: June 27, 2007. This just in... the Americans have rescued us from needles!

2007-06-27T20:59:00.000-07:00

Today we had a couple of special treats… 1) we got to visit a provincial office and hospital in an area outside of santo domingo called Bani and 2) I was on tv. All of our research thus far has been in Santo Domingo proper, though we did make it out to the rural area last week. But this was our opportunity to actually check out the injection safety scene in another province. In some ways we were able to confirm what we had been seeing and in some other ways we were entirely more confused by our results. Either way, we all had a good time.

I had the pleasure of interviewing the provincial health manager who turned out to be very enthusiastic about finding innovative ways to improve health in resource-limited countries. He recommended a book called “Why are some people healthy and others not?” by some Canadians which talks about basic lifestyle things other than curative medicine that contribute to health like a clean living and work environment, safe food, community responsibility, and, of course, preventative measures. That last one must have got him really stoked about our needle-free technology because he had arranged to have a local tv crew come videotape part of our interview. Surprise! It was pretty cool though. There was a reporter and two cameramen from a local webcast tv station called peraviavision.net (Peravia is the actual name of the province we were in). The clip was streamed live on the news that night and was absolutely hilarious to watch. Hopefully I will find a way to get a copy of it sometime soon.

Tonight we had one extra treat and got to cross off one of the very important items on our DR to-do list… we went to see a movie in English with Spanish subtitles. Now I know you can do this with most DVDs these days but there was something cool about doing it here, especially while we are trying to learn Spanish. The choice of movie made it all the better as we went to see Pirates of the Caribbean… in the Caribbean! Sweet. As expected, I slept through most of the movie.

-Rich

Day 17: June 26, 2007. Remembering old times

2007-06-26T09:37:00.000-07:00

On this day our week began to slow down a bit. We had answered many of the questions that we had collected with time. Today we had UNICEF on our list. To our surprise we discovered a part of town that we hadn’t seen before this was called Parque Mirador; a long strip of land in the middle of town extending from east to west very close to the shore. We visited the facilities which very well kept and looked very much a U.S. building. It had high security, strong A.C. and without doubt very strong coffee as well. Our meeting went on for a while. After we finished we headed to Spices, a Mexican Restaurant, where we enjoyed D.R.’s version of Mexican food. I must admit it was very good.
Plaza Lama the big superstore was very close to Spices, so we walked there. We just went to buy chocolates to give away for the interviewees, but we ended up spending more than two hours buying gifts, CD’s and remembering old times watching Michael Jackson Thriller video, which seemed to have a wide audience. Many people stopped for more than 3 minutes in front of TVs section just to watch this well choreographed video. It wasn’t until we had checked out that we realized we were supposed to buy more chocolate than what we got, but the amount end it up being sufficient for the next day. At night we decided to cook at home, make spaghetti and enjoyed our Merengue CD’s just acquired from our much appreciated Plaza Lama\

-Azucena

Day 16: June 25, 2007. Blackouts

2007-06-25T23:20:00.000-07:00

Today my day started early, around 2am I needed to call a cab so that Keith, Rich’s friend could head back to the airport. Calling a taxi here is a full chore in itself, phone operators speak very fast and you have to be able to communicate fast in a short amount of time and the caller has to be able to understand which unit they are sending and what color is the car to make sure that the service is safe. After this small task, I went back to bed and in the morning the three of us, Rich, Sapun and I headed out early to our meeting. This was our first interview day without Mike in the team, but this was a different set up as well. We were all meeting one of the main policy makers in the country together, instead of splitting up like we did in the areas the week before. Tito was happy to see us this morning. He was actually kind of chatty. We arrived to our meeting site early for our 9:00 a.m. meeting. We met the main policy maker as well as a couple of technicians. We were very excited about completing these meetings.

Next we went back to PAI and ate from “La Livia”, a nearby local food restaurant. We had rice, some meat and our much loved tostones. Our next meeting of the day required some preparation as well. So after a brainstorming session, we had a meeting with our main collaborator. Our half an hour meeting turned into a 2 1/2 half hours, but we learned lot. We felt like we had accumulated enough knowledge for the day. Something interesting that I had noticed in this particular day is that blackouts occur so often throughout the day, that people don’t blink or stop when they happen, they just keep going on with their meetings. This happened twice during the day. This is part of the D.R. life. This night we had a mellow dinner, ate delivered pizza and begin to wrap up.

-Azucena

Caption: An order of “Tostones” (fried plantains), part of our current diet… tasty

Day 15: June 24, 2007. Uneventful

2007-06-25T23:10:00.000-07:00

Mike left for the airport at 7:30 this morning. He was ready to go home (as we all were) because the last two weeks were extremely exhausting. For a short while, I was a bit envious because I knew that we were all ready to sleep in our own beds. His departure put a bit of a downer on the day, but we were determined to have fun with remainder of the day and check out a beach on the Southern coast of the island.

Around 1 pm we found ourselves on a “2^nd class” bus on the way to Boca Chica, a small town just west of Santo Domingo. It was raining during the ride to Boca Chica, which made us all a bit apprehensive about lounging on the beach for the remainder of the day. When we arrived, the scene was WAY different than we expected…Not only was it not raining but there was huge, free (sponsored by Brahma Beer), outdoor concert. Imagine the Stern Grove festival in San Francisco but add Spanish rap music, lots of Mamajuana (a Dominican rum concoction meant to take you to a happy place), a much rowdier crowd, and most people speaking a language that you don’t fully understand while others were speaking a language you’ve never even heard. It was a scene, thousands of people hanging around with open bottles, a crowded and dirty beach...just about the polar opposite of what we experienced in tranquil Rio San Juan the weekend before.

After adjusting to the madness, we managed to sit down for about 1 hour before El Lapiz, the pencil- a famous Dominican rapper, came to the stage, and the entire crowd started charging the stage. This large migration of people got a bit crazy and prompted us to c’est la vie to Boca Chica and get the hell out there. It was not a bit too soon as it looked like there were COPS trying to contain the scene shortly after we left. We quickly hopped back onto the gua-gua (I mean bus) and were on our way back to the safe city of Santo Domingo. Our blissful feeling about Santo Domingo lasted all of about 15 minutes as we had a strange encounter with a couple of biker-folks while we walking home.

To blow off the steam from the day, we came home and decided to enjoy $20 Cuban-Dominican cigars while consuming refreshing Presidentes. This was a nice ending to a crazy day. Now back to needle-free injection???

-Sapun

caption: Boca Chica beach party. A little different than we expected.

Day 14: June 23, 2007. Baile! Baile!

2007-06-25T23:09:00.001-07:00

This morning my buddy Keith flew into town from New York to hang out for a couple days. Nice. We all started the day with the “walking tour” laid out in our trustful Lonely Planet guide. A quick and easy way to see a bunch of old fortresses and stuff. Also had a hilarious run in with some kids trying to shine our shoes. Keith and I, as usual, turned that into a kind of game where we had to keep moving our feet as they were reaching for them. That kind of turned into a little dance which the kids started doing too. Don’t worry, I ended up giving them some pesos and we all had a laugh (see pictures).

In the afternoon, we were invited to a private club from one of our local buddies. We spent most of the time swimming in the two pools that were connected with underwater tunnels. It was lots of fun. Sapun made it all the way from one end of the large pool to the other underwater! Way to go Sapun!! It’s very interesting to see the dichotomy of lifestyles in this city… the people enjoying the sun at the pool and those shining the shoes of some crazy dancing tourists. I guess you can say that about any city but I’ve just never personally seen such a wealth discrepancy in one place, not that I’m particularly well traveled. Anyway, that’s a conversation for some other time…

We went tonight to a dance club/restaurant called Retro. I think it’s great that everybody in this country can dance in pretty much any latin dance style. And they love their latin music here. As do I which is fortunate because it seems you hear it at every hour of everyday here. When we got there they were playing standard bar music… a mix of raggaeton and American pop. After a few minutes of this, the music switched to merengue and pretty much everybody in the bar grabbed a partner and started dancing perfectly (gringo’s excluded). I swear it’s like we’re in the middle of a musical like 42nd street (Calle 42) or something. Pretty awesome. After a while the music switches back to popgaeton. We heard a similar rotation in Rio San Juan last weekend except they mix another kind of latin dance called bachata in between their merengue/salsa. Bachata is like their “country music” but with much more hips and a lot less hee-haw. All in all it’s nice to see a place where straight guys have permission to dance.

-Rich

Caption: Keith and I make friends.

Day 13: June 22, 2007. I am an old old man

2007-06-25T23:09:00.000-07:00

That right, today is my (Mike's) birthday. We celebrated by going to Santo Domingo's area IV to interview local administrators and nurses. The office was quite a bustle when we arrived -- this weekend is the big Dengue Campaign throughout the country. Earlier in the year, the DR has had a small Dengue outbreak, so they are fighting back SESPAS style by flyering the country and distributing some sort of gravely substance that people are supposed to put in their water tanks to prevent mosquitos from multiplying. To prepare for the campaign, dozens of volunteers were in the office packing posters and filling baggies. A lot of these people had worked during the Vaccination Week in the Americas campaign in August. Azucena and I had a chance to interview several of them about their experiences and how needle-free injectors could be used in campaigns.

In the evening though, the celebration began. We joined our Dominican Friends at a local eatery, which, of course, also was a Meringue bar. The place was kind of like Max's Opera Cafe, except that instead of all the waiters singing, they danced Meringue and did neat stunts like spinning around on the top of a bottle (hey Rich, do you have a picture of this). I believe this place was chosen though by our Dominican friends because of their excessively embarrassing birthday ode, which involved the entire wait staff crowding around me singing at the top of their lungs while banging on drums with the AV system on full blast for support.

We topped off the night by going to Nowhere...as in the club. It was a sweet place in the Zona Colonial -- they had fully club-ized a 17th century building. I got my dance on and we called it a night.

caption: A sticker being passed out for the Dengue campaign. I believe the text translates as: "Chlorinating your water tanks is hot!"

Day 12: June 21, 2007. Mixing it up

2007-06-21T17:39:00.000-07:00

Day 12 in the D.R. looked a bit different today. Every morning, after breakfast, we have to bargain the taxi fare to our schedule location of the day. After getting fed up with prices, we decided to spice up our routine a bit today, by teaching our hotel driver that we didn’t feel like getting ripped off this morning. Instead of using his services, we called a local company cab to take us. Tito, our regular taxi driver was not very thrilled about our scheme. He just nodded and looked away. I’m sorry Tito, we just had to do it; maybe you will give us a better price the next time.

We headed to our central meeting location and met with our local translator. Then, continued on to our first interview, learned some new things and witnessed the preparation for a Dengue campaign going on. Putting on a campaign takes a lot of community work. Since this campaign didn’t involve any vaccines, this one had to be coordinated correctly to teach people to clean their water containers to keep any mosquitos from growing in stagnant water and then developing Dengue from mosquito bites. On our way to our next meeting of the day, we decided to have chicken as the main ingredient for our meal. The new concept at the fast food chain was having three drink choices for the combos, either, soda, fruit juice or Presidente (D.R.’s national beer)…and I thought the U.S. was innovated.

An international NGO was schedule for the afternoon. Afterwards, we felt like being tourists, so we decided to head over to a restaurant close to El Conde (Turists’ central). At the restaurant, Mike enjoyed some pechugas al ajillo (chicken breasts with garlic), Sapun had nice vegetarian meal (finally!) and Rich ordered his much anticipated Chivo Guisado ‘Goat Dish’. This was a delightful restaurant and a nice end to a very much assorted day.

-Azucena

Caption: Mike and Sapun posing with the famous Juan Pablo Duarte

Day 11: June 20, 2007. Freedom of speech

2007-06-20T22:39:00.000-07:00

We switched gears today compared to yesterday and spent the day talking with 2 NGOs, the Japanese International Cooperation Agency (JICA) and the United States Agency for Internatinal Development (USAID). A welcomed change for today was that we were actually able to control the flow of the meetings. On a typical day, as soon as we start the needle-free demonstrations, the flood gates open, and we get bombarded by about 10 people.

We showed up at JICA at 9 in the morning and our contact pretty much let us ask all the questions we wanted for around 2 hours. We learned a lot of interesting background about Japan’s involvement in the DR health system and about their current projects in the DR immunization system. The JICA office was in a very nice building that had a very nice view and Air Conditioning so we were in no rush to leave. Our lead investigator in the DR also joined us today, which was nice because it gave us 2 translators/investigators in addition to the 3 gringos.

After our meeting with JICA we ate a Bordersesque place called Thesaursus. Very nice bookstore/café where we got Panini style sandwiches and coffee – a little taste of the US in the DR (also a nice change from the Criol/Chinese food that we had the day before). Following lunch it was off to the USAID office to have a meeting in English. YES!!! Azucena got a break, the gringos could lead a meeting. We were free from our cage. Everybody was excited. The meeting went well. We mostly talked about USAID’s involvement in improving the management of injection waste (needles) in remote areas of the DR.

The evening was quiet. We ate mac’n cheese and watched TV with our new remote control that allowed us to sit more than 5 feet from the screen - ahh, paradise.

-Sapun

Caption: View of a nicer part of Santo Domingo from the JICA office.

Day 10: June 19, 2007. Mall Madness

2007-06-19T22:38:00.000-07:00

We managed to do a lot of good interviews with nurses today. Started out at a fairly high-traffic vaccination center that had 5 nurses working at a time. We broke up into two groups so we could do 2 at a time. Without officially deciding this, we seem to have come up with a standard split of the group when we need it… Mike goes with Azucena while Sapun and I go with our local translator. I think this is because Mike and Azucena have a limited tolerance for mine and Sapun’s sometimes-random curiosity when it comes to questions we ask. We’re more likely to do random things like get an “area manager” (a pretty high-level position) to practice training a “coordinator of programs” on one of our devices. Or get a tour of the local incinerator. We get a kick out of stuff like that.

We also went out to a very rural area which was great to see. Not quite the same as visiting small town Iowa (which I also very much enjoy). A lot of very small somewhat-rundown houses surrounded by sugar cane and people sitting outside in the sun. And one small hospital/clinic with a single doctor and a single nurse that work there. The nurse was nice enough to let us interview her (the area manager had called ahead). I’ve actually been pretty impressed with how well the vaccination centers we’ve been to have been maintained and stocked with sufficient supplies, even this one. They even have plenty of the pretty little yellow safety boxes for disposing of needles. I wonder if it’s like this farther away from Santo Domingo (we’re only ~30 minutes away). If only we had the time… and could convince Mike to drive again in this country.

We had lunch today at a mall foodcourt and thought it was the best thing ever. The mall was a lot like one you’d find in the US. I found it funny (though not unexpected) that we’d be so stoked to be eating at a mall. It’s like somebody from Alabama coming to San Francisco for a while and quickly growing tired of fancy pants green food options and running for a Denny’s (which I also very much enjoy). Anyway, I enjoyed my taco bell-esque burrito.

-Rich

Caption: Babies are smart

Day 9: June 18, 2007. Hot, hot, so very, very warm.

2007-06-18T20:47:00.000-07:00

The sun was hot and the air was humid as we stepped outside our apart-hotel this morning at 7:30 AM. Today we were off to Area I, the easternmost district of Santo Domingo. Our team is starting to get in the groove of the interviews. Azucena and I met two women who coordinate vaccines in the area and were able to get a lot of useful information about the structure of the administration as well as good feedback on the needle-free injection. After our morning meetings, the four of us piled into the back seat of a truck Dominican style (Dominicans have an entirely different answer to the question “How many people can fit into a car?”) and headed to lunch at a local “asian fusion” restaurant, a Chinese/Creole cafeteria style joint. After lunch, we headed to a local hospital to talk with the vaccine nurse, before heading back home to catch up with our interview write-ups. Tonight – Italian food on the water!

-Mike

caption: Rich, Mike, and Sapun cruising the Malecón on the way to dinner.

Day 8: June 17, 2007. D.R. History 101

2007-06-18T20:46:00.003-07:00

After a very warm night without Air Conditioner and only a ceiling fun operated by sporadic electricity blackouts, we enjoyed a refreshing night sleep, much needed after a long week of work. Our hotel had a small balcony view in the back and an open third floor view to gorgeous crystal waters accompanied by a fresh breeze. Since it was Sunday we were expecting a mellow, quiet day in the city, but it looked like it was pretty much alive with people walking on the street and going on with their daily chores.

After a nutritious breakfast with eggs, coffee and juice we headed out to a long 5 hour drive back South to Santo Domingo. The trip was very pleasant; Sapun and Rich gave us short D.R. History class from our handy Lonely Planet guide book. This was very useful and practical. As we drove through the country, we noticed that the majority of the city signs are sponsored by Brugal, D.R.’s famous rum,...interesting. We saw many rice plantations, a fallen horse (kind of odd!) and nice dark green trees. This was a restful day, except for the evening when we had a long and very much needed meeting, interrupted by phone calls and some other distractions. After a Pizza Hut dinner and top ramen soup for me we got ready for another long week.

-Azucena

caption: Sapun, sleeping on our way back to Santo Domingo

Day 7: June 16, 2007. "The Beach"

2007-06-18T20:45:00.000-07:00

Ahh, the weekend. After a week of getting up at 6:30 am and going to bed around 2 am, we could hardly wait to hit the beach in Rio San Juan. We spent the bulk of the day at Playa Grande, one of the nicest beaches in entire country, and were not disappointed. This beach was deserted with less than 100 people inhabiting the hundreds of yards of sand. No people, lots of sun, sandy and warm beach, and NOT Santo Domingo = relaxing. No offense to SD.

Upon arriving at Playa Grande, Rich rented snorkeling gear from Ricardo, a local proprietor of fine aqua gear and beach furniture. We snorkeled for all of 1 hour before Rich lost the goggles for his set, and we spent the next 1.5 hours looking for the goggles over a vast maze of reef that he “remembers” swimming around. All the reefs looked the same, and it’s pretty much impossible to navigate around looking for small goggles. After failing miserably, we resorted to baking in the sun for a few hours until we got hungry and decided to get a margherita pizza at this local joint back in Rio San Juan. Much to my dismay, we learned a new lesson: the pizza toppings included the standard tomatoes, garlic, and mozzarella in addition to the ever prevalent ham. Once again our other project, Analysis of the Sustainability of Vegetarians in the Dominican Republic, is receiving failing marks. This is looking very bad for me in the future…

The rest of the evening was dedicated to learning the dance steps to Bachata and Merengue at a neighborhood bar. This place was essentially a large open space with chairs and tables oddly positioned around the space and people dancing in the open area between the furniture. Merengue seems to be the main dance music in the Dominican Republic, and is quite fast, but Bachata interruptions break up the Merengue sets to allow people to catch their breadth and use copious amounts of paper towels to soak up all the sweat. We all relished the opportunity to make fools of ourselves on the floor and announce that the gringos had officially arrived in the Dominican Republic. Until next time.

-Sapun

caption: Mike, Carol (DR med student), Azucena, Sapun, and Rich working at Playa Grande

Day 6: June 15, 2007. A day at the navy base.

2007-06-18T20:29:00.000-07:00

Somehow, Azucena and I found ourselves at the medical center of Santo Domingo’s Navy Base this afternoon. The director of immunizations at the area we were at this morning thought it may be interesting, so we went along. My philosophy when traveling abroad is that when someone asks you to do something, you go along with it (Kate, this is not directed towards you!). So there we were, presenting to about 8 military officials piled into the medical director’s office. One great thing about doing this project here in the DR is that we are understanding the culture from an entirely different perspective than if we were simply touristing through.

Speaking of touristing through, we decided to do just that, and headed to the town of Rio San Juan on the north coast. A town that was stated to be a short 2 hour bus ride (thanks, Lonely Planet) turned out to be 6 hours in our car. I was nominated to drive our stick shift Chevy Aveo, and all I have to say is that hurdling through Dominican roads at midnight is quite the adventure. We finally reached the town, and were quite pleased with our hotel, jutting out on a rocky point, surrounded by the Caribbean Sea. Ah, a weekend for some much needed rest.

-Mike

Day 5: June 14, 2007. Super Ice Creameria

2007-06-18T20:28:00.002-07:00

We finally had a full day of people willing to talk to us!! If you’re looking for a welcoming area in Santo Domingo, I recommend Area 7. Ask for “that lady who demanded her chocolate gift”. She’s nice. After a bunch of interviews in the Area office, we headed over to a hospital in the area to interview the medical director and two vaccination nurses. All more or less friendly and all had input. Maybe we’re getting the hang of this thing. Maybe we’re getting better at choosing our audience. Either way, its nice to actually be talking to people. Or, should I say, talking to Azucena who in turn is talking to people.

I found a cell biology book in Spanish today. It was rad. I took a picture of some stuff en Espanol related to my thesis project (dineina!). I think I’ll put it in my thesis. It’s going to be awesome.

We went to a grocery store tonight called Plaza Llama. We’ve been to a few grocery stores already but this one was enormous! It was like a Walmart ate a Super Target. You can buy ice cream there and carry it around the store with you. It’s delicious! Somebody should be selling ice cream at the entrance of every grocery store in the US. I’m serious. It would make the boring job of grocery shopping that much more fun, like going to the county fair. That's especially true on an oppressively hot and humid day like today. I wouldn’t be opposed to funnel cake at the laundromat either but I don’t want to get ahead of myself.

-Rich

Caption: Sapun es muy importante.

Day 4: June 13, 2007, Flying Solo

2007-06-18T20:18:00.000-07:00

Maybe it was the lucky number 13 (…Sapun, I’m being sarcastic) or the rain, but we had a rough start this morning. Overall the full day went ok, better than what we had expected after what happened in the morning. I’ll start from the beginning. Cold water showers forcefully woke up most of us (except me, hah!), and having low water pressure didn’t help much. Anyhow, it was sufficient enough to get the soap away before we went to our favorite waitress for breakfast. The expressions on her face when she said, “lo mismo de ayer” was completely blank and uninterested, so we were all anxious to see her reaction this morning. We had the same eggs, ham, toast, café con leche, but the waitress greeted us with a pleasant smile, which was surprising, the only item that gets to be varied is the fruit juice, and this is usually delicious the best tropical fruits are grown here in the D.R. island.

This morning was our real interview outside of PAI, so we were nervous. We made it to the office on time after we got trapped in traffic by everyone trying to cross the intersection simultaneously. Then we proceeded to walk to the next building where our 8:30 am meeting was going to take place. Just as we stepped out the door, it started to pour. Maybe this was a forecast for our meeting, for which all I can say is that the peak of that storm happened in that small room. On the bright side of things, we learned how to improve our approach for future interviews. We headed back to our office, met for while with our collaborators, and brainstormed new ideas.

Hours later, we ran some great interviews with clinicians in the children’s hospital with the help of our collaborators and called it a day. The day couldn’t have had a better end as we enjoyed our dinner on a patio overlooking the Caribbean with the sun setting in the west. And together we walked back to our hotel to enjoy a nice evening of typing and chatting.

-Azucena

caption: Mike's back is soaked, except for where his backpack was masking the rain.

Day 3: June 12, 2007, Sink or Swim

2007-06-17T18:46:00.000-07:00

Today was our first real day of interviews. As Rich said yesterday, we had agreed to run pilot interviews with the entire PAI (abbreviation for Expanded Programme for Immunizations in Spanish) office. While this is our “home away from home”, it was definitely intimidating to run a pilot interview session with the entire office. It felt like we were thrown into a deep pool, but I guess that’s the best way to learn. We either sank and fall flat on our faces, or swam and they’d tell us that we are ready to venture into new facilities for more interviews. It’s only our ENTIRE project riding on this one pilot study no big deal…

To add pressure to the situation, we began by speaking to the whole group at once – about 15 people –about the benefits of NFI and drawbacks of needles and syringes as if they didn’t know (it’s always hard when you tell experts about their own fields). Allow me to digress for one second, when I say “we spoke”, please understand that I mean Azucena because the rest of the gringos are OK (Mike) and poor (Sapun and Rich) Spanish speakers. As it were, Azucena did a great job of describing all of our introductory material about NFI, and they seemed pretty interested in what she was saying.

After Azucena completed the intro, Mike and I were in charge of demonstrations to show how the devices work. Mike’s demo went quite well, and they seemed impressed by the device and its ease of use. However, my demo was a different story because I couldn’t get the package open for the ampule. This was so embarrassing, and I felt pretty dense. My feeling was later confirmed when I was told that the head honcho said, "you’re losing points” when it happened…Not a good impression to leave with the person in charge of our collective fate.

Nonetheless, after a rough demo, people were interested and they stuck around so that we could interview them in smaller groups. Mike and Azucena interviewed four people, Rich and our PAI helper interviewed two people, and I was flying solo with one person. You can imagine how my interview turned out – but you’re wrong! I was able to effectively communicate with my subject and have a broken conversation about the devices and learned quite a bit. Definitely one of those experiences where I nodded a lot and didn’t understand too much, but I think that everybody has to go through that with a foreign language. It can only get better from there.

Anyhow, by the end of the day, the office personnel were pretty pleased with our work and helped us set up meetings with other health facilities and local governing bodies around Santo Domingo. We passed the test!

Now off to the real world….

-Sapun

Day 2: June 11, 2007: Analysis of the sustainability of vegetarians in the Dominican Republic

2007-06-17T18:39:00.000-07:00

After surviving the thunder storm, we headed down for our free breakfast at the hotel. Not quite service with a smile but some decent huevos and some delicious café. Then we were off for our first meeting at PAI (Programa Ampliado de Inmunización). We have been very fortunate to have a lot of support there. They’ve been nice enough to offer us an office at the PAI headquarters. We even have a phone. It’s nice.

At the initial meeting we met with 4 people from PAI and our main collaborator from Hospital Infantil Robert Reid Cabral. It quickly became evident that Azucena was going to do most of the talking for this study since my Spanish vocabulary has disappeared since my last Spanish class in 1996 and Mike and Sapun aren’t quite confident with their skills yet (they’re actually quite good). Anyway, we made due and got a lot accomplished. The plan is for us to do a practice interview at PAI tomorrow with people who work there and then to start real interviews on Wednesday. The nice folks at PAI will setup meetings for us with the Ministry of Health area managers, who then will hopefully set up meetings with the clinicians in that area. I hope that all works out.

I’m starting to feel like we’re in an (obscure) adventure movie or role-playing game where we interact with various characters on our journey to find some magic potion or something. Some of them we’ve heard of before and even communicated with (like foreshadowing in a movie) but then you come face to face with a character and you start to understand their role and why you should talk to them and why they want to talk to you. This afternoon we met with a woman I will call “The Oracle”. It turns out she may have been responsible for getting PAI on our side and facilitating the whole project. And she gave us 2 gold coins. I’m just kidding.

Sapun has begun his study “Analysis of the sustainability of vegetarians in the Dominican Republic”. He has already run into some trouble. At lunch he ordered a cheese sandwich and asked the guy, “solamente queso?” and he said “si” and then brought him a ham and cheese sandwich. For dinner, “the girls” (two local med students we are working with) brought over some takeout mofongo (mashed plantains) and asked for no meat on one of them. That, of course, was interpreted as no extra meat on the side, which came with the rest, but still plenty of meat in the mofongo itself. Zing! Hopefully this gets better or Sapun will have to start eating grass.

-Rich

Day 1: Arrival in Santo Domingo.

2007-06-11T06:01:00.000-07:00

We are here! After a short stop through in an overcast New York City, we arrived in Santo Domingo at 2 PM this afternoon and took a cab to our hotel – the Plaza Colonial not far from the Zona Colonial, the old colonial district of the town. We strolled down el Conde, the pedestrian district to grab some dinner. Rich and I had a Dominican specialty – Mofongo – a fried mix of mashed plantains and meat. Sitting out on the street drinking our Presidente Cervezas seemed to be just the thing to do for a Sunday evening. Sundays in Santo Domingo are quite quiet. Most of the stores were closed, even in the touristy district.

This evening our Dominican medical school collaborators stopped by our hotel to discuss plans for the project – we are planning on meeting with them again tomorrow. Tonight, Azucena was fairly certain that the apocalypse was upon us, but it turned out to be a massive thunderstorm, which in turn set off all the car alarms in the city! Tomorrow, we are going to the immunization program at SESPAS, the public health division of the Dominican Republic.

caption: Azucena enjoying her Mango shake at dinner.

-Mike