Visit to Princess Margaret Hospital (PMH) and last Roseau Trip

Dr. Abrons here again.  To round out our posts, I thought I'd update you on our most recent days.  We took a recent trip to Roseau to Princess Margaret Hospital or PMH.  Princess Margaret Hospital is one of the few hospitals on the island.  We got to spend time with Mr. Erol Thomas, who is the Chief Pharmacist for the Country of Dominica.  Mr. Thomas allowed us to visit both the inpatient and outpatient pharmacies.  Here, unlike in the rural health clinics, computers are used.  The difference from the US is that the computers use an access type program more for inventory purposes.  You do have the capability of searching by patient.  However, you don't get to view a patient profile and there are not interaction checks.  The hospital had access to a much larger supply of medications. There were even some medicationsthere that are currently on backorder in the US.  It was interesting to see where all of the medications were purchased from too.  For example, there were medications from Israel, from India, and largely from Canada.  In fact, we got asked at the hospital if we were Canadian.  The students and I helped prepare prescriptions, and counseled on prescriptions as well.  A great experience, and we were also able to make a connection with a Dominican anesthesiologist.

After the rotation day, we went and purchased a traditional Creole outfit.  I've been here now 3 years for Creole festival and each time make more and more friends.  I promised this year that I would dress in the celebratory attire. 

Then, the owners of Jungle Bay, Sam and Glenda, and I took the students to Creole in the Park.  This is a cultural festival that is sponsored by one of the local cellular phone companies - Lime.  I hope that the students say it provided added exposure to the culture of Dominicans.

Tomorrow, I'll have the students post on lessons that they'll take away from this experience.  I always realize many things about myself when I am here and try to make at least one change for the better.  Last year, I gave up drinking Diet Coke.  This year, I've promised Sam and Glenda that I will make more time to relax and exercise.  Each day that I've been here (with the exception of the last few since we've not been near Jungle Bay), I've started this task by walking the mountain, Paix Bouche.  "Paix Bouche" means "Keep Quiet" in Creole and is an apt name for this mountain: it's supposed to leave you so breathless from the climb that talking is not an option.

Safe and Sound In Dominica

The students are safe and sound in their cabins- enjoying a weekend day of relaxation before we return to the states.  Today, we have another significant experience - a tropical storm.  I thought I would post for those parents and loved ones in the US who may be worrying about us.  We are safe and sound right now at Jungle Bay.  We have good shelter, good company, and good food.  Although Tomas is now considered a Hurricane elsewhere in the carribean, it is currently only at Tropical Storm level in Dominica.  Right now reports are saying that it should pass overnight, and we should be on schedule to depart the island tomorrow at 3:45pm tomorrow.  We'll keep you posted and let you know if any changes in travel plans are made.  Safety first.

Best wishes to all-
Dr. Abrons

Painting the house of Hope

Hello everyone,

So today we got the opportunity to go back to the House of Hope which is a establishment set up to help take care of the mentally disabled. As you can see from the "before picture" there was not much to the walls, only plain white. So we decided to help out by making the place more lively! As you can see from the before and after pictures that there is quite a difference. This was a great way to end our trips to the House of Hope on this rotation, and hopefully future students would be able to continue our work.

- Tyler and Anthony

Health Benefits of Cinnamon

Cinnamon is one of the oldest known spices in the world.  It is either used or sold as sticks or ground into powder and used in many drinks and bakery products.  Other than being used as a culinary spice, cinnamon is thought to have many medicinal purposes.  It is an anti-oxidant that is known to have positive effects on blood sugar, indigestion, the common cold and many other things.  In Dominica we learned that cinnamon is used for abdominal pains, diarrhea, the common cold, and relieving nausea and vomiting. It was used by ancient practitioners, such as Dioscorides and Galen for sore throats and cough, while it was used for arthritis and inflammation in folk medicine.  Recent studies have shown that cinnamon does in fact lower blood sugar levels by up to 25% when taken in higher doses.  Studies have also shown a moderate decrease in cholesterol and triglyceride levels with increased cinnamon intake.  Although cinnamon has been granted the status of “generally recognized as safe” (GRAS) by the FDA, substantial amounts of ground cinnamon can be unsafe due to the cinnameldehyde, which is the oily constituent that gives cinnamon its smell and flavor.

- Sara, Beth, and Jess

La Plaine

Today we went back to the La Plaine clinic (the home base for the pharmacist). It was a slower day at the clinic because everyone in Dominica is getting ready for their annual creole festival. The people in Dominica are very excited for this upcoming event so in return many of the people skip out on going to the clinic. This gave us a little more time to talk to the pharmacist Kent. He is a very nice guy who jumps around to all the different clinics in the area. He is known by everyone and is heavily relied on in the community. One thing that I in particular noticed that was very different from the way we fill prescriptions in the US is the process a Rx goes through before it goes out to the patient. In Dominica a book gets given to Kent and he looks at it and decides what he has and what he doesn't have. Then he writes on a little plastic baggy the name of medication, the name of the patient, and the directions. He then gives it to the patient and counsels on it. There are absolutely no computers involved in this process, only paper and pens. There is no other person there to help him, he gets no double checks, and the only way he can look information up is in a drug book. This was just a crazy concept for me to grasp. We have become extremely reliant on technology in the US it is hard to think that there are people out in the world that don't have easy access to these types of things. There is no computer telling him that there is a drug interaction, or that they have an allergy. He has to rummage through their book to determine these things. It makes me think about how convenient we have it back home. It is just amazing to me that Kent works like this everyday!
-Beth-

Pharmacy Differences

Where should I start?  Since arriving in Dominica we’ve quickly realized that many aspects of pharmacy are significantly different from what we are used to in the US.  For starters, we take everything for granted!  Can you imagine working in a pharmacy with no computers?  Keeping track of tablets in a notebook??  The pharmacist solely relies on his own knowledge and a few pharmacy textbooks.  I would have to say that the extensive role of the pharmacist in Dominica differs the most from a typical pharmacist in the US.  Here, there is only one pharmacist for multiple villages so he has to travel with a suitcase full of medicine to a different clinic every day.  On top of his traveling, he has many more responsibilities that fall outside the realm of pharmacy.  He draws blood, makes house visits, and is on call all the time.  When an emergency arises he either makes a house visit or goes into the clinic.  Can you imagine being on call 24/7?  Everyone in the village knows who the pharmacist is and they don’t hesitate to go to his house or ask him questions when they see him on his days off.  Because the nurses and doctor are in the clinic as well he often see patients and helps make recommendations based on the severity of the problem and what medications he has available at the time.  All in all, the pharmacist here plays an extremely multifaceted role in the healthcare system in these rural areas of Dominica.  I have no doubt that without him many people would go without their much needed medications.

- Jess

Pharmacy in Dominica

Today (Tuesday October 26th) we went to visit the La Plaine health clinic again. This time we rotated roles in the clinic where some of us would sit alongside the doctor/nurses and the rest of us would go into the pharmacy. Today I was in the pharmacy and was able to see how the pharmacist dispenses prescriptions, keeps track of the medications, how he orders supplies, etc. The dispensing of prescriptions is a lot different than how it is done in the US. Everything is done manually and there are no computers to look anything up. One thing that really stood out in my mind as being way different than the US is that the prescriptions from the doctor are written in the patient's note book. The patient must bring this notebook with them everytime they visit the health clinic as it contains all of their medical information. The patient then brings the notebook to the pharmacist who dispenses the prescribed medications. There are lots of times when the pharmacist does not have a particular medication as the supplies are very limited. If they are available, the pharmacist will count out a week or two worth of medication and pour it into a plastic bag where the directions, the patients name, and the name of the drug are written on the bag. The pharmacist would then document this in a very large book where he would write the patients name, the medication dispensed, and the quantity. It is also hard to believe how limited they are on medications and how a lot of the time the patients can't even get the medications they are prescribed unless they go elsewhere for them and pay out of pocket. The government pays for everyones prescriptions if it is something that is supplied by the health clinics.
-Sara-

Pharmacy here in Dominica

One major difference I notice from the practice of pharmacy here as compared to the States is that their is no private/government run insurance companies that you bill for a prescription.  If a patient goes to the health clinic in their village the medication (although VERY limited in drug variety) is free of charge to them.  However, if the health clinic pharmacy does not have the prescribed medication, the patient has to go into Roseau and get the drug.  If they go to Roseau, they must pay for the prescription out of pocket.  You can most closely compare this to formularies in the states.  The government will supply a certain amount of drugs to each village health clinic (such as captopril, amlodipine, metformin, glyburide) and forces the patient to pay for other medications that the health clinic does not have in stock.  From what I have encountered, the government supplies the bare minimum to treat each different disease state with only 1 or 2 drugs for each disease, and the amount they give is very limited.  Today for example the clinic ran out of metformin tablets which if that happened in the States I feel like customers would be very angry and definitely not understand how you don't have enough tablets.  But the people here understand that supplies are limited and sometimes must go a week or two without their metformin!

-Anthony

Delices

Today we went to the Delices clinic and got the opportunity to educate and just simply talk with the patients in the waiting room. Since we didn't know exactly where the clinic was we stopped to ask a lady walking on the side of the road. She said that she was walking there so if we would give her a ride she could show us where it was. She introduced herself as Lucy and was a very kind woman. When we got inside the clinic I started talking to her right off the bat. I gave her one of my handouts on high blood pressure because she had mentioned to me that she has both hypertension and diabetes. I gave her a bit of education of Hypertension and she seemed to really appreciate it. The more we go to these clinics the more you notice that the main health problems in Dominica are Hypertension and Diabetes. Lucy said that she takes a medication for High Blood pressure and insulin for her Diabetes. We talked about how it is sometimes hard for her to take her high blood pressure medication because she cant feel any symptoms of the disease. She loved the fact that we were there. She said it is motivation to keep taking her meds. She said sometimes she feels discouraged and its nice to have some extra encouragement! I am glad that the patients we see are happy to have us and feel as though they are learning valuable information from us!
-Beth-

Delices Health Clinic

Today (Monday Oct. 25th) we visited Delices health clinic and helped educate the patients on different disease states such as BPH, hypertension, cholesterol, skin infections, and diabetes. When talking to the patients, I noticed that there were more females in the waiting area than males which I thought was interesting. I talked to one woman who had just got out of the doctor's office and walked into the pharmacy room to get her medicine. She tested positive for H. plyori and had an ulcer in her stomach. The doctor decided to prescribe her metronidazole, clarithromycin, and omeprazole. The pharmacist did not have clarithromycin and omeprazole to dispense so he was only able to give her metronidazole. I counseled her on the effects of drinking alcohol while taking this medication and told her to avoid drinking any. She stated that she has had stomach problems in the past and that this one seemed to be the worst.  She did not state that she had any other medical conditons, but seemed to be interested in all of the handouts we were given out. She said that her sister has hypertension and diabetes and asked if she could have some information on those two disease states and wondered how exactly one would get diabetes or hypertension. She stated that diabetes does run in her family so she makes sure to get her blood checked every so often. She also seems to be very consistent with coming to the clinic for her annual check ups. It is soo great to be able to talk to all of these different patients because they really are truly interested in what we are talking to them about. It is also very interesting to learn about all of the different herbal remedies they use and how these medications are different than what we use in the US. It is just so amazing how happy these people are and how eager they are to learn.
-Sara-

Delice Health Clinic

Today I had the opportunity to talk to multiple people at the Health Clinic, however one woman stood out to me more than others.  I first introduced myself to this woman when we stopped to ask for directions.  She was walking on the side of the road and she said she was going to the clinic as well so we offered to give her a ride.  Once we arrived to the clinic she went on to tell us that she has hypertension, although controlled by medication, as well as diabetes.  She was thrilled to speak to us and wanted to learn as much as she could about the two disease states.  We went over handouts that we had made prior to our trip with her and she asked numerous questions throughout our discussion.  She also gave us a good insight into the Dominican culture, especially when it comes to taking prescription medications.  She said that most of the people she knows don’t like taking medications when they don’t feel sick, as is the case with hypertension.  She admitted to us that she often feels this way as well but was thankful for our explanation as to why it is important to take the medication every day.  She said that since she started talking high blood pressure medication and insulin her blood pressure and diabetes have been under control.  She said that she knows these two disease states are prevalent within her country and wishes that everyone understood the importance of early diagnosis and management, as all too often she sees her friends and family members get very sick because of disease state complications.  She was extremely happy for her good health and was thankful that she is still able to make the long walk to the clinic once a month.  Overall, she was a very positive and motivating person!

-Jess

Trip to the Delices Health Clinic and Primary School.

Hello everyone,

So today we visited the Delices Health Clinic as well as the Primary School (meaning grades 1-6). There we got to educate patients on a variety of topics. (Diabetes, Hypertension, Cholesterol, Skin Infections, BPH). Personally I got the opportunity to discuss at length to a couple individuals about cholesterol; what it is, how to manage it, what the numbers mean, and how is it treated. Whats great is that the people here are so curious about the various disease states, and have many different questions to ask. Despite being more geared toward cholesterol it is not uncommon for me to talk about the other disease states that the other students are focused on, making this a great learning experience.

The second part of the day consisted of visiting the Delices primary school. There we got to donate some school supplies/books for the library, and interact with the children at the school. This is most likely one of my favorite parts of the rotation as we get to interact and answer questions from all these kids are as curious about our lives in the states as we are of their lives here. We also got to discuss pharmacy in general, what it takes to be a pharmacist, the importance of studying, and medication safety. We then go into a question/answer session where the kids will ask us something, and vise versa. Its a lot of fun, a great experience, and  you feel really good about yourself when your finished.

- Tyler

Patient at the Delices Health Clinic

Today we visited Delices and helped educate the patients in the health clinic on various disease states like skin infections and hypertension.  With our time spent there, I encountered a patient who's child has had an itchy rash on his legs and arms.  She has been treating it with a product containing the drugs neomycin, beclomethasone, and clotrimazole cream.  She states that the rash may have come about from the child playing outside in the dirt or possibly their pet dog scratching his skin and causing some sort of bacteria to enter and causing this.  I discussed with her about properly cleansing the skin and making sure to apply the cream as directed by the physician.  After we discussed her child's condition, we talked about skin infections (like ring worm and dengue fever), and she actually educated me on some herbals to use to help treat rashes.  She said that the peel from a papaya can be applied to the skin to help treat rash which  I was unaware of.  We also discussed about dengue fever which hit the island hard in years past but is well controlled today.  This infection is caused by a mosquito that if infected with bacteria and bites you can cause excessive bruising under the skin.  The mosquito she said appears black with white stripes that lays in dry containers and commonly bites at dusk.

-Anthony

Basil

Today (friday Oct. 22) we went to Roseau (the capital of Dominica) to visit with Catherine who is the local herbal store owner. She showed us all of the different types of herbals and what they are used for. In her little shop she has a bunch of products such as bath salts, mud masks, cocoa butter, herbs, teas, etc. that she sells to the public. She also puts some of the herbs in a brown cardboard box to dry them out. While we were there she told us a bunch of different stories about some of the herbs that she feels really work for her and also help with certain illnesses. One herb in particular that I thought was very interesting was basil. In Dominica they use basil to help with fullness and flatulence. It is also used as a diuretic and helps with ear aches, colds, and joint pains. One of the things that I found interesting while learning about all of these herbs is that many of them are used for lots of different indications. We all have a book on the plants of southeast Dominica and this one in particular was not in the book which I found to be interesting. There are different herbs that are grown in different parts of the country and the ones that we all saw today seem to be different than the ones we have in our books. I just couldn't believe how something that seems so simple like basil can be used to help with all of those different things. Catherine seems to really strongly believe in using all of these herbs and it was so amazing to see how they are all used and how many people actually use them.

Today we went to visit Sam’s(owner of Jungle Bat) aunt Katherine who has a shop with a whole bunch of natural medicines. She described to us what each herb was used for and the importance of it. In many cases each herb had many different indications. She also went on to tell us stories about both herself and different individuals who use these herbs. When we first arrived the very first compound that she showed us was called Nettle oil. She described how this was used to fight fungal infections. Dr. Abrons asked if it was something that you typically drink to cure the infection but she said “No Mon, its something you apply.” So we learned that you use a little bit and apply it to the affected area. She also said that many people use it on razor cuts. She said that many people will get their hair cut and the razor is not disinfected so it creates a cut which turns into a blister. This particular compound was very interesting to me because of the fact that it was not listed in our book that we have of Dominica’s plants and herbs. Katherine seems to know something the book doesn’t and swears that it works. She is currently trying to figure out a way to make it into a cream or ointment form so it is easier to apply. Hopefully we gave her some good suggestions on just how to do that.

Rosemary

Today we drove down to the capital of Dominica (Roseau) and met Catherine who specializes in herbal medicines.  She has a wide array of herbal plants along with different oils, soaps, and nicely scented bathing salts.  She explained to us that herbal medicines need to be taken during the waking hours because a majority of them need to be what she quotes "agitated" in order to have an effect on the body.  Thus, if you were to take it at night right before you go to sleep, the body wouldn't be able moving thus the herb wouldn't live up to its maximum benefit which I thought was an interesting fact.  So the herb I'm going to focus on is Rosemary.  This shrubbery evergeen leaf has a very aromatic smell to it, and is commonly used by Dominicans to help with hypertension, dyspepsia issues, loss of memory (dementia), and acts as an anti-oxidant which includes the anti-oxidants carnosic and rosmanic acid.  Catherine stated that you do not want to take rosemary every day, because it can cause some excessive bleeding.  So avoid using if you are on any type of anti-coagulant therapy, or have gastric ulcers.  The rosemary is commonly made into a tea and you would drink this herb.

-Anthony

Nutmeg

Nutmeg is a locally-grown spice that is used in many seasonings around the world.  It comes from an evergreen tree and when the fruits are fully grown they split open and release a dark brown seed with red wrapping around it, also known as mace.  Mace can also be used as a spice, often having a stronger flavor than nutmeg.  Once dried for a few days the nutmeg seed itself can be heard rattling when the nut is shaken.  The shell can be cracked open and the nutmeg can be grated and used as seasoning for many local dishes and drinks.  Nutmeg can also be used as an herbal medicine for numerous ailments.  Today we had the opportunity to spend time with Katherine, a local herbal shop owner, who explained to us what many of the local plants and herbs are used for medicinally.  According to her, nutmeg can be used for either hallucinations or diarrhea and vomiting.  I also referenced a book entitled, “Plants of Dominica’s Southeast” which stated that a nutmeg seed can be placed under a person’s tongue to reduce the severity of stroke symptoms.  It can also be used to help with digestive problems and can increase circulation when taken regularly. 

- Jess

Getting more in depth with herbals

Hello everyone! Today will be another double post since I never got the chance to post yesterday.

So yesterday (10/21/10) we visited another health clinic. This one was much smaller, but allowed more 1 on 1 opportunities with people from the community. It was great as everyone there was very interested in the information that we brought with us, and I feel everyone was about to talk about their respective topic in depth with multiple individuals. Another neat thing to point out is that I now have in ability to ever complain about not having enough space inside the pharmacy. The "pharmacy" in this clinic was the size of a closet, with not enough room for even 2 people to not bump shoulders.

Lastly, I have to mention the state of one of the patients that we met. This was a very very intense experience might I add. So we had an man come in who was very friendly, out going, nothing at all seemed wrong with him. What we didn't know is that this man has sickle cell disease which roughly 10 years ago caused a nasty decrease in blood flow to his legs which in turn caused necrosis of the skin engulfing his entire right shin, and a fist sized hole in his left. Anthony and I both had the chance to see this up close, and let me say that this wound was not your average sore. This man has been living with a wound the size of his entire shin for about 10 years that went as deep as the bone. He walks roughly 1/2-1 mile every other day to the clinic to get this cleaned, and the only pain killer he takes for this....Ibuprofen....I am in awe....

Today (10/22/10), we had the opportunity to go back into the capital city of Roseau to visit a herbal remedy specialist named Catherine. This woman had expansive knowledge regarding herbal medicines, and we were fortunate enough to be able to spend a couple hours with her going over some basic remedies, her life and beliefs, as well as sample some of the herbs she had freshly picked. I will give you a small example, of one of the herbs that we went over; Cayenne Pepper.

Cayenne Pepper (also known for its primary ingredient Capsicum) is a reddish pepper that is commonly used for both culinary and alternative medicine. Its uses range from stimulation of digestion and stomach muscles to promoting improved circulation to the peripheries, and protecting the stomach against certain medications such as Aspirin. Cayenne is also used topically to help with conditions such as arthritis, neuralgia, and muscle pain. The pepper itself is rated at about 30,000 -50,000 heat units on the Scoville scale, which is actually a more mild pepper. To give you a sense of scale, police pepper spray is labeled at roughly 8-9 million heat units while a Jalapeno Pepper is about 3000-8000 units. The vegetable itself is rich in Vitamin A, and includes Vit. C, B6, K, Manganese, and some fiber.

Overall another great day, and i'm looking forward to the weekend thats for sure!

Thanks everyone!

Tyler

Most Meaningful Experience Thus Far

Personally, the most meaningful experience to me took place today while we were visiting the House of Hope.  At this home, which is very appropriately named, five disabled children and one disabled adult are taken care of around the clock.  None of the children can speak and some of them can’t even walk.  We had the opportunity to spend time playing with the children and boy what a humbling experience it was!  I’ll admit that all five of us students were a bit nervous when we first walked into the room but I think after realizing how lovable these children were our hearts melted.  It takes an extremely special person to work with and take care of disabled children - and even more so in a country where basic equipment such as wheelchairs and bedrails aren’t available.  These special people preserve the health and well-being of the otherwise abandoned children, and they do it all with a smile on their face!  Without a place like this, these kids wouldn’t survive on their own and would otherwise be left for dead.  Being able to relieve these caregivers of their duties for just a few hours this morning and spend time with the children meant so much to me.  A simple giggle or smile from a child like this can go a long way!  I will forever be grateful for what these children and caregivers taught us today.

- Jess

My Most Meaningful Experience

Wow, where do I even begin!! There have been sooo many meaningful experiences that I have had throughout this rotation that it will definitely be hard to pick one. For me, I think that one of the things that touched my heart the most was seeing how happy all of the kids at the La Plaine elementary school were to see us when we got there. All of them crowded right around us as soon as we got there and the smiles never left any of their faces the whole time we were there. I felt so good about everything we have done at that point and I right away felt like that was where all of our efforts showed the most. They were so happy to get those stress balls we brought down and all of those children's books! They were so cute about it and right away grabbed the books to immediately put them on the shelves. I have never felt so loved before by so many kids. None of them wanted to leave our side and I think that for me, it really made me try and put myself in their shoes and think about how grateful they are for the life they are living now. That is the attitude that I want for myself and for my family in the future. Be thankful for what you have, and enjoy each and everyday like there is nothing in this world that is holding you back from anything. I have also realized how much I truly love and adore kids! I have never really had a strong opinion on whether or not I want to have kids in the future but after experiencing all of the love and excitement in those kids we saw the other day, I don't think there is anything that compares to it. For me, this is what has touched me the most because I felt like if nothing else, just being there and showing all of those kids the hard work we have put in to get to this point in our careers, hopefully makes a lasting impression in their hearts.
-Sara-

Most Meaningful moment

The rotation in Dominica has certainly been an experience to remember to say the least, and it hasn't even been one week yet. It seems as though we are learning so much, not only about their health care system but about the island in general. As for my most meaningful moment, I would have to say it was getting a hug from each and every kid in the classroom  at La Plaine primary school that we went to talk to. I felt a sense of self worth knowing that they appreciated and were interested in us "Americans". As soon as we arrived at the school these kids were beaming from ear to ear with smiles. They couldn't be any more happy to take pictures with us and it was so cute that they just wanted to see what they looked like after they were taken. It just goes to show how much different Dominica is than the U.S. Nowadays in the U.S you see most children in their age groups with a cell phone and even possibly a camera. We have become so dependent on electronics you sometimes don't stop to think that another part of the world might not be as fortunate to have these things. For some of the children it was almost as if they had never seen a camera before. It was amazing to share something new with them. We also brought donated books to the library to help fill their scarce shelves and I didn't think they could get any more excited but I guess it was possible. We all asked them if they like to read and a unanimous yes came out of their mouths. It was incredible that we could help bring happiness to their day just by simply being there and showing interest in them. My hope is that by being there and talking to them about what it took for us to get to pharmacy school and the importance of school, they will look up to us and try hard to reach their career goals, whatever that may be! The hugs at the end of our visit only made me realize that my hope may come true!
-Beth-

Reflecting on Dominica

Hey everyone,

So this is just a little change of pace compared to my typical posts. Tonight I just wanted to share with everyone my current feelings about this island, its people, and the culture that I have been exposed to over the last couple days. There is a laundry list of experiences that I have been a part of; beautiful hikes, amazing waterfalls, wonderful people, and breathtaking environments. Though there is one aspect of this that does stand out to me more than others, it is the fact that I have been so humbled by the people of this country. Being here I have realized how much that I have been taking for granted the lifestyle that has been handed down to me. The internet, running water, power, cars, cell phones, TVs, Mp3’s, medicines, foods, everything and anything that I may use on a daily basis that no one here has and the fact that most are completely fine and happy. Of course many may have never been exposed to such products in the first place, but the fact that a person can live a meaningful and productive life without the accessories that we use so often just puts me in a standstill. I begin to ask myself, can I begin to live a life that is simpler? A more stress free life? Maybe, possibly, in all honesty the lifestyle of the people of this country is rubbing off on me. I find myself being more relaxed, walking more slowly, being less “high strung” in instances where I may be. I guess I’m trying to say…that to say any one part of this rotation would be more “meaningful” then another would be a crime against the true testament of what this country has done for me. (Which is very impressive since it has been such a short amount of time). I signed up to this rotation and came to this country to help make a difference in someone’s life. To help bring supplies, updated information, and my own knowledge to make an impression and improve the lives of people who may not understand things that I know. What I have found though that the impression is less on them, and more on myself. The truth is…the life that I hoped to change is less of someone else, but my own…. Alright enough reflecting, time to go to sleep. See you all tomorrow with more updates!! J

- Tyler 

My Most Meaningful Moment Here in Dominica to Date

Of all the different places and things I have encountered thus far here in Dominica, I would say that what has been most meaningful to me was the time we spent at The House of Hope.  It was very disturbing for me to know that after seeing these people who have either been abandoned at a young age or grew up as orphans with mental disabilities or have physical handicaps, that there was no place for them to go to get special care around the clock.  What Mr. Alexander has established in his community (in what is supposed to be his retirement years) I think demonstrates the close-knit community here in Dominica with the philosophy of helping others in need even when you get no other benefit from it, other than knowing you are doing such a wonderful thing to help somebody else who really needs your attention. 

What specifically hit home most for me and is my most meaningful moment to date here in Dominica was actually when I got the opportunity to feed "Darcy" lunch.  Darcy suffers from cerebral palsy (a neurological disorder that affects body movement and muscle coordination) and she is immobile.  When I originally applied for this rotation, I included how interested I was to help out at this house because it brought back memories of the time I spent with my grandmother who got very sick and eventually became blind in the nursing home.  She required above and beyond care of what the nursing home staff could do, so there were times I would feed her and just talk to her about life.  My grandmother, someone I admired very much, was always helping others. Working with less fortunate individuals reminded me of my grandmother and made me feel inspired to continue this type of work.  The time we spent today at The House of Hope was a very humbling experience and I appreciated every moment we had in interacting with them.

-Anthony

House of Hope

Today (Wed. October 20th) we went to visit the kids at the House of Hope. The House of Hope was funded for under privileged children with mental disabilities. There are currently 6 individuals in the House of Hope with the youngest at age 6 and the oldest at age 53. One of the girls has cerebral palsy and can only lay on her back. She cannot move her limbs very well and needs to be carried from place to place. There are also two orphans sisters that are around the ages of 38 and 40. These two girls are not able to take care of them self and they did have a mother who loved them dearly and did not want them being cared for by anyone else. She passed away not that long ago leaving the two girls behind with no care. Another little girl is blind in both eyes and also cannot walk. She can sit upright but tends to sway back and forth trying to keep her balance. There is a 6 year old girl in the house who had previously lived in the hospital for 5 years because her mother had just left her there. The last girl in the house is the oldest of them all (53 years old) and has some sort of a mental disability that they are not quite sure exactly what it is. At a young age she had just stopped growing and is very tiny. She used to live with her sister until her sister could no longer take care of her anymore. We brought with us a bunch of supplies to donate to the kids at the House of Hope such as books, magnetic letters, crayons, dry erase boards, diapers, flash cards, etc. The kids seemed to really love the bright colors of everything we have brought so we decided that next wednesday on our last visit, we are all going to take turns teaching the kids some sign language words while the rest of us will decorate and paint the walls of their rooms. Right now the rooms are all white and since they love color so much, we all thought that this would be a great opportunity to give them something more to look at and enjoy. A few of us also all took turns feeding some of the kids lunch. We would help out and spoon feed the little girl with cerebral palsy who could not move at all and also showed her some of our colorful flash cards that we had brought with us. None of us really knew exactly what to expect from visiting the house of hope but now I think we have gotten a much better understanding on just how much care these children need and so for our next visit, we will do all that we can to brighten up their lives and give them as much of our care and support as we can.
-Sara-

Visit to the House of Hope

 

Hello everyone,

So today we had the opportunity to visit the House of Hope. This establishment is set up as a place for individuals (specifically children) with mental disabilities whom have no-one to help take care of them. We came here to learn the purpose of the House of Hope and its history, assist the individuals who take care of the children on a day to day basis as well as interact with the children. This was an amazing experience as these children, despite their disabilities, were so friendly and so outgoing. The building itself is beautiful, and was just finished being built last year. All residents of the House of Hope shared a bedroom with one other, the place had two bathrooms, as well as a living room and kitchen. What was most concerning though was the lack of entertainment or colors throughout the living areas. Therefore to help out, our group will be returning next week with paints, pictures, and outlines to help decorate and liven up the area. Each resident at the house will be tailored to differently, as some may be more amused by a picture of a specific animal, or by a specific color. We will also be working with sign language to help the workers communicate with the residents. Hopefully be making more people aware of this establishment, we can maybe promote outside assistance to keep this place running smoothly. Every donation does count, as these individuals are the neediest of the needy. Overall this was another amazing experience, and I look forward to returning next week and helping decorate and work in the House of Hope. 

- Tyler

LaPlaine Health Clinic & Paracetamol

Today we vistied a nearby town called LaPlaine where we interacted with the people in the health clinic.  I personally got to work the majority of the time in the pharmacy with RPh Kent.  Many shocking things I encountered that differs from the way we practice pharmacy in the States include: having to log every prescription by hand which included the quantity of the drug for reordering purposes, physically writing out a pharmacy label to put on a plastic bag where the drugs were being dispensed into, drugs can take up to 3 months to get when ordered, syringes for injecting insulin are given in quantities of 5 per month per individual in order to conserve the quite limited supply the island has so basically you are forced to reuse syringes, and a lot of prescriptions were forced to be changed to whatever the pharmacy had in stock.  Kent also gave us a tour of the clinic and included a maternity ward for emergency purporses, a counseling room for newly diagnosed HIV patients, and a room which included a refrigerator for storing the vaccines.  The most common disease states in Dominica included HTN, DM, mental illness and skin infections.  Kent said the majority of mental illness is from illegal drug use (marijuana and crack cocaine) and alcohol abuse.

A drug that Dominica has that I was unfamilar with was a drug called paracetamol.  After doing a little research I discovered that this drug is the same drug as our "acetaminophen".  Paracetamol comes from chemical names for the compound: para-acetylaminophenol and para-acetylaminophenol.  Paracetamol is also available at a strength of 500 mg, which is comparable to our acetaminophen strength.

-Anthony

October 19th

Today we all woke up around 7 am and did yoga first thing in the morning. It was very relaxing and a good way to start the day. Then we all got ready and headed the the La Plaine clinic. We all had different roles while there. Some went and helped the pharmacist dispense and counsel while others worked side by side the the doctors and nurses. You wouldn't believe how different everything is here in Dominica. All the medical supplies that we take for granted back the U.S. they either don't have or have a very limited supply (things such as needles, medical record charts, lancets, bandages, etc). For each patient that visits the clinic they have a composition book where they record their problems and the different medications they have been taking. After we were done with the clinic we went to the La Plaine primary school. There were kids ranging in age from about 5 or 6 to about 12 or 13. When we got there you couldn't even imagine the excitement on their faces. They were extremely curious to learn who were were and why we were there. We started off giving them stress balls that we had left over from the health fair and those things went like wild fire. The kids were going crazy over them. I think they were excited to just get something new! It was so cute! Then we got to play with them and interact with them a little bit outside. We started taking pictures of them and they absolutely LOVED it. They were all dying to get their pictures taken so they could look at them after. Then we went in to two different classrooms of different age groups and talked to them about why we became pharmacists, what it takes to become a pharmacist, and the importance of medications and schooling. They all seemed very interested in what we had to say and had a lot of questions for us. We told them that we would be back next week and they were all very excited. Before we left one little girl came up to Dr. Abrons and gave her a hug and then made her way around the group. This sparked the interest of all the others and before we knew it we were getting hugs from EVERYONE in the class. It was adorable. It made us all feel really good and appreciated. We then went into the library where we met Allegra (who is a part of the peace corps) and helped put the books that we donated on the shelves. It was nice to see how excited all of the kids were to get these new books. I asked them if they liked to read and they all gave a unanimous YES! When we returned back to jungle bay the girls went on a "walk" with Nancy (the outdoor activities coordinator). I say walk in quotations because the walk was more like a hike. It was on the road near by, but because Dominica is such a mountainous island the hike was straight up. It was pretty tough but rewarding at the end. All in all it was a great day and it felt good to bring some smiles to peoples faces.
-Beth-

Visiting the health clinic, and a local school.

Hello everyone, 

So today we visited the La Plaine health clinic and believe the school -( not sure if was in the same town or not ). I worked along side the doctor and shadowed/made recommendations to patients. Let me say that this is nothing that I have ever seen before. Patients charts are not what we are used to in the states, but just notebooks that they carry around and give to the doctor. Medications are extremely limited (i.e. Oral diabetic drugs include only Metformin, and sulfonylureas that I don't think we even use anymore). The types of complaints that I saw were actually quite common to what we see; tonsillitis, HT, diabetes, eye cataracts. Pretty interesting, and the visits are very one on one and not rushed at all. The patient will go inside the Doctors office, sit at the desk and the doctor will exam/counsel from his/her own seat. 

The school visit was just awesome. The kids there were so excited to see us, and was unlike anything I have ever been apart of. We walked into the school and all the kids were yelling "Hello!!! Hi!!! and were waving to us" They were so interested in everything about us, and LOVED pictures. They loved having pictures taken of them, posing for them, looking at what was taken, and of course taking pictures. We then talked to the 6th and 4th grade classes and discussed the importance of school as well as what pharmacy is about to the students. It was a great experience overall, and I can't wait to do it again next week. 

- Tyler 

Roseau, The boiling lake, and the visit to POM

Hello everyone,

This will be a semi-long post due to me covering the past 3 days. So lets get started!

So on the 16th we had the opportunity to visit the capital of the country Roseau, and take a quick trip to Trafalgar Falls. The morning started off from what I remember beautiful, and the car ride being about 45 minutes. FYI, and I will most likely post more in depth about this in the future, the roads in Dominica are rough. and I mean...ROUGH. Anyways, we got into Roseau which in itself is a beautiful city. We had the opportunity to go through the market, buy some wares/fruits (I got all my little gifts for people back home), and got to eat at a restaurant named Pearls to try some Dominican food. I had what was called a smoked chicken calallou. Which...uh....didn't exactly look very appealing, but tasted okay. After the city we took a trip up to Trafalgar falls, which was absolutely beautiful. The hike down was fun, and fortunately was not too challenging. The falls themselves were awesome, and what was even better was the presence of the natural hot springs/pools. Much, much better then any hot tub. Then after you could hop down and cool off in the many pools that are further down from the waterfall. Overall a very great way to spend your Saturday.

On the 17th Anthony and I partook with 3 others on the boiling lake hike. This is labeled as "extreme" in difficulty, is 14 miles in length overall, and you traverse 3 different climates. Those 3 climates include rain forest, a kind of arid plateau, and a desert scape in the valley of desolation. Each having their own obstacles and rewards. The valley of desolation is in the last leg of the 1st 3 hours it takes to get to the boiling lake. In a nut shell, you are walking through a active volcano. The area smells of sulfur (you get used to it very quickly), and there is boiling fumes of sulfur deposits spitting up everywhere. Very neat. We even got the chance to put the sulfur mud on our face, which apparently is great for your skin. (it is). The boiling lake itself was amazing, it basically is what the name says. A huge boiling lake, 2nd largest in the world. We then after a quick lunch got to go the entire way back. Overall the hike was not incredibly difficult, my prior workouts strengthened the muscles that are worked the most for this kind of hike which of course are your legs. The one part that I found the most challenging was when we had to basically climb an entire mountain from the very bottom to the very top. Words cannot even describe the challenge of that part. At the very end of the hike we had the opportunity to jump into a awesome cold pool which leads into a gorge which leads to a waterfall. I fortunately had my underwater camera, because nothing is more cool then swimming in basically a cave with a couple open tops that show the rain forest above. I'll post those pictures when I get it all developed.

Today (the 18th), and the first day we started our rotational activities. We got to visit a man named Pom and his family on his farm. This was great because this individual is a pure blood Dominican who lived completely off the land. (no electricity, no plumbing, etc...). It took a hour long hike to reach his house, as we had to climb up a steep slippery mountain and cross a bunch of streams and a river. (good times). When we got there we were welcomed with opened arms, were initially treated to some star fruit (sour, but good), and discussed with Pom his life and lifestyle. We discussed Dominican culture, how health is maintained, what herbs he might use to treat certain aliments, as well as how many children Dominican women have on average. (that number being 10-12...wow....). He showed us around his farm, and we got a close look at numerous types of fruits. Star fruit, breadnut, breadfruit, cocoa, periwinkle, oranges, tangerines, nutmeg, bananas, soy, sesame seeds, and many others. There was also a huge assortment of many different flora which I got pictures  of. Overall a very fun and exciting trip.

Alright so thats it for today, I'll post the link to the pictures from our trip to visit Pom! Thanks!

http://www.facebook.com/album.php?aid=2080651&id=14003277&l=8a341a06a

- Tyler

Roseau/Victoria Falls

Yesterday (Friday October 16th) was our first full day in Dominica.  We got up early and left by 8am for Roseau which took about 45 minutes to get to.  In Roseau we got to see all of the fresh fruits and vegetables in the market along with little souvenir shops we stopped in along the way.  Before lunch we were also able to visit Trafalgar Falls which are two waterfalls of both hot and cold springs. It was amazing to feel the difference in temperature from one stream to the next. On the way back from Trafalgar Falls we stopped and had lunch at Pearls in Roseau which was quite the experience! We all had dishes that we weren't familiar with and even looked different than our typical cafe meals but it was great to try something new! A few hours after we got back we were able to hear the jungle bay story told my Glenda which was also very interesting to hear. She talked a lot about the country of Dominica and the lifestyles of the people in Dominica and also how jungle bay got started.

Today (Saturday October 17th) we left around 10:30 for the Victoria Falls hike. It was nice that the drive was only 7 miles away from jungle bay.  We rode in the jungle baby again to Victoria Falls like we did on friday to Roseau.  When we got to the falls we got to say hi and talk with Moses (junior) who is known as the "medicine man". The hike was soooo amazing! We crossed the white river 4 times to get to the falls and also climbed over many rocks and boulders along the way.  There are no words to describe the beauty of the falls. Once we got there we were able to swim in the water below the falls and the force of the water was so strong it almost felt as if we were in the middle of a hurricane. It was so freshing to get to this point and be able to swim in the water. Once we got back from the hike about 3 hours later, we had lunch and sat by the pool for about an hour since we won't be able to do much of this during the week. Around 4pm we went to a drumming class and each had the opportunity to try different beats on the drum used in traditional Dominican music. It was a lot of fun but we realized how difficult it is to stay in a constant rhythm. We also used this chance to talk to our teacher about his perspective on Dominica and a little bit about his background.  He gave us a really good feel about the different kinds of music in Dominica along with their daily lifestyle.
-Sara, Beth, Jess-

Boiling Lake Hike

Today Tyler and myself had the luxury to hike at the Boiling Lake.  This hike is considered very difficult by Jungle Bay degree of difficulty, and is roughly about 14 miles in length.  With this being my very first hike I was very nervous but figured I would test my boundaries.  We arrived at 9am and the weather couldn't have been anymore nicer.  It was sunny and around 90 degrees farenheit.  As we began, we encountered about 60 foot vines hanging from a tree which I couldn't help but swing from.  The hike started off pretty flat, but as we progressed there were many inclines and declines.  The path included many small steps which made it difficult for footing.  We crossed a few rives and the rocks we had to walk on were quite slippery because they were covered in algae.  As we trekked along, the heat just got greater and greater because you were hiking upwards closer to the sun with no trees to cover it.  We came across iron deposits and sulfur deposits (which appeared red and white in color respectively).  The sulfur mud left from the stream we were allowed to put on our face and arms (which we looked like warriors ready for battle).  The sulfur mud is believed to help cleanse the skin.  We finally reached our final destination of boiling lake, and after we had reached that point I felt a great sense of accomplishment.  Making to that top of the mountain, it gave you a sense that if you put your mind to it you can do anything in life.  Now it was difficult because I had to put the struggles to get to this point behind me because we had to hike back.  Good thing our tour guide "Oakley" had given me a walking stick to use because it took a lot of pressure of my knees which started to ache.  All in all the hike took us about 6 hours and 20 minutes to complete which with this being my first hike I felt was a great accomplishment.  The ride home however was quite interesting.  I lost my lunch a few times due to car sickness (which after a 14 mile hike I was already feeling like crap).  Note to self: take Dramamine when riding in the van here at Jungle Bay because there are quite a lot of SHARP turns and winding roads which doesn't sit well with the stomach).  Once we drove back to Jungle Bay, we stopped at a roadside food shop and once I saw a bag of Cheetos and a bottle of Coca-Cola I was in my glory.  I had to get my American fix of snack and this made all the aches and pains go away!

-Anthony

Welcome to Dominica!

Hello everyone,

We safely touched down today, and let me be the first to say that words cannot effectively describe this country. There really is no way. It is just beautiful and pretty much awe inspiring. We took the car ride down to Jungle Bay through the native Carib territory, picked up some Cassava (thick bread made from the root of a plant that is mixed with coconut - tasty and very filling). We also got some of the most amazing views of the country on our way down . I'll post the link to the facebook page so everyone can see some of the photos that I have taken so far.
Alright, thats it for me. See you all later.

http://www.facebook.com/album.php?aid=2080535&id=14003277&l=9e86915d79

- Tyler

Arrived and Dominica and Waiting for Students to Arrive

Hello all- Dr. A here-
Erica and I arrived at Jungle Bay yesterday to hugs and warm wishes from our friends.  The drive was beautiful with a little bit of rain showers.  We stopped along the way in the Carib territory and had some casava bread- a tasty and filling treat.

Today the car - actually called a "Space Wagon" (no I am not kidding)- was delivered and we'll take a trip to the LaPlaine Clinicbefore the students arrive.  Slowly but surely handing out presents here to familiar faces. 

Spoke with Sam (owner of Jungle Bay Dominica)- to work on cultural competence tomorrow the students will have a trip to Roseau market (a traditional carribean market) and witness the beauty of Traflagar falls as well as try some yummy local cuisine.  Then, they'll hear the story of Jungle Bay - how it came to be and its role with supporting community outreach and improving quality of life.

Students-
I hope as you arrive that you appreciate the beauty surrounding you and reflect on just how different this was from home.  First lesson being, you'll walk everywhere.  You'll also be welcomed in to a global family.  I hope you remember what a blessing it is that we've been afforded opportunities to use our training to help others.  Safe travels - be respectful and we'll see you soon.

Best wishes always to all-
Dr. A

First layover in Puerto Rico!

Hello everyone! 

So our first stop before reaching beautiful Dominica is San Juan, Puerto Rico. Let me be the first to say that this is an awesome way to start our trip. Great weather (85 degrees, sunny) and a great hotel (check out the view from outside the hotel window!). There is no better way to spend a layover then sitting out on a hammock at night listening to the ocean. It looks like everyone was able to procure the supplies for our donations as well, so thats also some good news. Alright, so thats it for this one. Next post will hopefully come from me when i'm sitting down in the main hub of Jungle Bay. :) 


- Tyler 

Travel tips!

Hello everyone! 

So, with our trip departing in a couple days I feel that it is important that I at least put up some quick reminders on travel preparation. 

1) Shoes 

sneakers 

shoes for clinic

hiking shoes

2) Clothing

white coat/"dressy" clothes for clinical

outdoor clothes for hiking & swimming

jeans/sweater for the cooler nights

3) Toiletries 

toothbrush

toothpaste

floss

deodorant

4) Medicines

Scopolamine Patch if your at risk for getting motion sick

Ciprofloxacin if a stomach bug hits you

NSAID of your choice in case of headaches

5) Misc

Camera + Underwater disposable camera (optional, can get for roughly $20 at a drugstore)

Sunscreen

Bug Spray

Passport + Paper copy of your passport 

Sunglasses

Phone cards for calling (advise using skype if you have it for free phone calls)

Ipod/Mp3 for the flight

Laptop + Powercharger

Camera batteries + battery charger

Backpack for hiking

6) Dominica Supplies

Books

Diapers 

Presentation/informational material. 

In regards to traveling!

Make sure your at the airport at least 2 hours early, so for us that means between (6:00-6:15 AM)

Make sure your never alone! *buddy system*

Make sure never to accept packages from strangers! This is self explanatory, but people have done this before. 

So with that, I look forward to seeing everyone this Thursday. Enjoy and prepare early so your not stressing out. 

Also feel free to comment and add additional things that we should consider bringing down! 

Here is the Dominica website in regards to "essential travel information"

http://www.dominica.dm/site/travel.cfm

- Tyler