Sunday, February 27, 2011

The Big Move

I have finally made the move to my own casita or little abode, and although it is only 10 feet away from where I was living with my host family, it is symbolically an enormous leap to freedom. The neighbors struggle to wrap their minds around why on earth I would want to live alone; they ask, aren’t you scared? won’t you be lonely? was Suni mistreating you? To which I can only respond that Americans are accustomed to a bit of privacy and independence, both of which are foreign concepts in an average Dominican household. It would be an understatement to say the dwelling was a “fixer-upper” but having scoured the town for other houses, this was my only option. I therefore spent two month’s living allowance making the house moderately impervious to the elements and equipped with a dazzling latrine and bathing shed. At times I was tempted to just knock the house down and start fresh, that way I could design a shaded back patio. However, that was decidedly too costly and so the carpenter and I collaborated about which parts of the house were only moderately destroyed by termites and thereby deemed good to go and which needed replacement. I am very pleased with the construction and really believe that the repairs will hold out for my following year of residence. Si Dios quiere!
The latrine, although not as nice as the composting beauties I plan on building in my community, is certainly a step-above what most people are currently using at their homes. And, I am lucky enough to have one at all. This was a big point of contention with my landlady and next door neighbor who kept insisting that we should not bother making my latrine usable; I could just use her indoor bathroom. However, with my propensity for unexpected parasitical ailments, I assured her it would be more comforting to me to have my very own crapper. My latrine sits smack in the middle a pig sty and a smoldering pile of trash, which somehow seems very appropriate. The trash and the latrine are daily reminders and encouragers to pursue my sanitation projects in my community.
I spent the better part of last week painting my home. All of the neighboring DoƱas had an opinion about what the all-important color palette should be. What should have been a fun and easy-going task turned into a headache as countless women would come over, take one look at my painting style, tsk tsk, and say not so quietly, well looks like the Americana doesn’t know what she’s doing. Give me the brush! I really didn’t know there were so many mistakes one could make painting a house until I did it under the watchful eyes of my neighbors. These women are experts mind you. Those with the money to do so, repaint their wooden homes twice a year, once for Easter and once at Christmastime. They did not approve of my economical use of paint (although I was the one who had bought it and could not afford to buy more). However I was quick to say that lots of neighbors had half painted homes, but they assured me that it was far better to have the front of your house coated with lots of paint and leave the rest unpainted than to my style. Also, they had me buy gasoline to mix with the oil based paint and we mixed lots of water with my water based paint. It seemed like we were giving the house an eggwash rather than a fresh coat of paint, but I found it was easier to follow their orders than to argue.
In other news, last week I attended a medical mission in Santiago. A team of ear, nose, and throat doctors came from Loyola University Hospital in Chicago to perform a week-long clinic and surgeries. As a Peace Corps volunteer, whenever a group of doctors comes to various hospitals, we are offered the opportunity to help out by translating. I have been interested in doing a medical mission for quite some time and finally got the opportunity to help out. I traveled to Santiago last Saturday and began right away translating in the clinic. The team of help from Loyola was about 45 people including surgeons, anesthesiologists, medical students, O.R. nurses, audiologists, and medical technicians. There were 4 Peace Corps volunteers, two Dominican medical students, and two bilingual American doctors. We saw 80 patients a day in the clinic for five days. The majority of cases were children that needed their tonsils and adenoids removed. We also saw quite a few adults with thyroid problems, hearing loss, and various neck cysts or goiters. I was really intimidated at first because although I am quite comfortable with my “street” Spanish, deciphering technical details of an illness is a little different. I could not settle for just catching the gist of the conversation; rather, details determined whether or not the patient was eligible for surgery. Not only that, medical Spanish is not in my repertoire. However, I learned quickly and was soon rather comfortable interviewing the patients about their breathing problems, their medical history, etc.
Translating is an art. I am not trained in it, but I did my best. I learned that how you ask the patient something really determines the answer. Questions such as “do you experience lots of pain” almost always elicit the answer “yes, lots”. And “where does it hurt” usually receives the reply “everywhere”. Listening to the patient is exceedingly important and I found that it was usually what the patient said in passing, under her breath, that was the determinant factor or whether or not the patient was eligible for surgery. For instance there was one instant of an adolescent girl who complained of a small cyst at the base of her throat. The med student after doing a lengthy interview and physical exam was unable to locate a cyst where the girl complained of the problem. After calling in the head E.N.T. surgeon who concurred that there was no problem I translated to the girl that the doctors did not find a problem and that we were not going to perform surgery. The girl frowned and complained; she asked, then why does my throat leak water when I play volleyball. When she said that the doctors reexamined her and found that the sweat gland under the skin had not developed correctly at birth and surgery would be performed to remedy the problem. I could not believe that we were so close to sending the girl away. I learned a lot about communication this past week. Even knowing Spanish fluently does not necessarily mean that communication will occur. I think that so much that is communicated is unspoken or subtly hinted at. However, at the end of it all, I found that listening to everything the patient said, even what they muttered in passing, asking open-ended questions, and being extremely patient with long-winded impertinent information was the key to success.
On Monday morning surgery began. I had the opportunity to “scrub in” and hang out in the O.R. The surgeons were all great at explaining in detail what they were doing and why to me. I mentioned at the outset that recently something had piqued my interest in a medical career and most of the doctors were determined to win me over onto team doctor. I was amazed at how relaxed and comfortable the surgeons were. Listening to hip hop and chatting while performing invasive surgery seem to be diametrically opposed activities, but, I learned that is not the case. For me, the most interesting surgery to watch was the surgeries performed on the patients who require kidney dialysis. One of the surgeons performed multiple fistula surgeries in the arm, connecting artery to vein. In addition to hanging out in the operating room, I worked a lot in pre-op consent and post-op care explaining to patients and parents the medicine and warning signs of infection. We were all staying at a Jesuit mission house that has a small clinic attached. We worked long days, starting operations at 7 A.M. and finishing at 8 in the evening. However, the doctors and med students always wanted to go out dancing and drinking after the long day of work. It was great fun experiencing the Santiago nightlife with the group.
When all was said and done on Thursday evening, the Loyola team had performed 122 surgeries. It was an impressive feat to watch the specialists come down with all of their equipment and perform their work in a limiting environment. Most of the patients that we saw did not have a medical history with them and many had never been to the doctor. Not only that, there were quite a few patients who take medicine but could not remember the name of it or why they take it. The worst case that happened last week occurred when a mother denied the existence of asthma in her three year old son who was getting his tonsils removed. The problem lies in the fact that oftentimes, the patients are coached by Dominican health promoters how to answer the questions in a way that will better guarantee surgery. Denying asthma in her son (whether intentional or not) seriously jeopardized his health. In post-op, the boy went into respiratory failure and was ambulanced to a local hospital when it was determined that his condition was too serious to be treated at our tiny clinic. Most of the patients we saw were poor and had traveled rather far to enjoy the free services of the American doctors.
On Friday, a few of my fellow volunteers and some of the Loyola medical students were invited to a swanky apartment owned by one of the Dominican med students’ brother-in-law at a beach in Cabarete. We drove up to the north coast, arriving Friday evening, danced the night away and spent Saturday evening at the beach. It was really fun seeing the country with Dominican tour guides. Because the two medical students are well-educated and come from a very different segment of society than lives in my rural campo, it was a great learning experience to hear all about the D.R. from their perspective. I especially enjoyed traveling with them. Every time I have left my community it is to travel and spend time with fellow Americans and volunteers and therefore, it was a welcome change to experience the beach and the country with locals. It did not hurt that they know how to have a good time, own cars, and let us stay at their 8 bed beachfront pad.
Having such a stimulating, intellectual, and hands-on experience at the medical mission this past week has made it especially difficult to return to the slow-paced life of the campo. Conversation has returned to stating the obvious and commenting on whether or not I gained weight in my week away. However, I trust that I will readjust and get back into the swing of things shortly. I have to remind myself that I would not have performed nearly as well as a translator this past week had I not spent so much time in the campo gaining a rich understanding of the culture and customs of the people in the Dominican Republic. I guess listening and sitting for hours on end is finally manifesting its benefits. Cultural understanding is a complicated, multi-faceted thing and cannot be learned overnight by reading a book; rather, it must be lived and experienced. In my case, I am learning it by living among Dominicans, cooking their food, mopping my home like they do, peeling my fruit like the locals, and slowly adding more and more sugar to my beverages. I am learning what it means to share in the joy of other people and why sometimes family and a slow-paced life fulfill a very different part of the human spirit than fast-paced achievement. I miss the fast-paced but I am beginning to appreciate the balance of both ways of living. And no matter how slow life in the campo can be, the music will always elicit booty-shaking rhythm and dance.