When Lisa Fitzgerald learned she would be going on a home visit to see a man who is an above the knee amputee, she said, "Honestly, it was a little overwhelming. It was my first day here. We all piled into a car. I don't speak their language and I was afraid I might not get something right or miss something that I should know."
     

When we sat down to discuss her experience she recalled approaching the bend in the road where she saw a huge gully with a tiny little house perched on the edge of a very steep cliff which dropped off into a deep ravine. Her eyes were immediately drawn to a little wooden window where the "cutest man with the sunniest face was hanging out and waving to everybody who was driving by." Lisa didn't know it, but the moment she crossed the threshold into his tiny casita, it was her  life that was about to change. "The moment I met Juan Perez", she said through misty eyes, "forever changed my life and how I will look at the rest of the world. I just remember looking at him and thinking, wow, there's a ray of sunshine coming out of that house."

 

Juan lost his limb, and the other leg has shriveled over time, as a result of diabetes. He uses his hands to move around on his bed. He is completely dependent on people in his community to take care of him which includes dropping off a meal or providing clean clothing.

    

Lisa paused as she stepped into Juan's world and then realized that he has just one small mattress. "His bed is pushed up against a window, the opening where he leans out, and that's where he lives his whole life." That's Juan Perez's window to the world. When Lisa talks about the interior of his little house, she says," All you see is him, his face and his smile. You don't see the rest." After interviewing Lisa, I can only imagine that all Juan Perez saw when Lisa Fitzgerald walked into his world was a ray of sunshine beaming right back at him.

 

Lisa, a vibrant and caring person, wears a smile just as big as Juan's. A student in the BSN program at USM, she is very interested in pursuing a career in home health care. She says, "This trip has just reinforced that that's the path for me. I've given my heart to this trip. You know, I think that's the best thing I have to give. I'm amazed and I have grown as a human being from this experience. I feel very fortunate."

 

Lisa took a moment to reflect on what she has learned from this mission and how she has changed. "I've learned that maybe it isn't OK to just stay home and be involved in only your life and your own little neighborhood. Maybe it's a good idea to look across borders and see other people in the world and think about them. Even if that's all you do, just keep them in your thoughts and in your prayers. That would be a good thing to do. It's important to think about your neighbors throughout the world not just your neighbor down the street. I guess the thing that will change the most about me is I will never again think that my life stops at my hometown. There is a lot to learn and a lot to do.  One person can make a difference. You can make a difference. One small moment in time can ripple out and make changes that go on forever. Juan Perez did that for me."

Over a late afternoon cup of tea, a ritual for her, Margaret Ellis told me what had drawn her to participate in her fifth mission with Partners. "I've always been interested in different cultures and different places in the world, and this program fit my interests because it was a nursing student program and I like teaching. Plus, I could give direct care, and it was in a whole different type of environment to what we are used to." As she reached for a shortbread biscuit she added, "Well, my friend, Cindy Robertson, a physician up in Skowhegan, and I would talk about it every year but, I wasn't able to go until I retired."

 

Margaret grew up in the Channel Islands of Great Britain and since she was twenty-six has lived in America, most of the time, in Maine. Since her retirement she and her husband Tim, a former volunteer for Partners, have been splitting their time between Maine and Montana. When she's not with us in the Dominican Republic, Margaret works occasionally with Indian Health Services. "I've been to the Navajo Nation three times and this past summer I was working with the Haida people in Hydaburg, a remote village in southeast Alaska on the southwest coast of Prince of Wales Island."

 

Margaret fulfills a number of roles with Partners. "I really function as a mentor and as an educator for the nursing students. I am a nurse practitioner for nurse practitioner students. I have very high standards of what I expect students to be able to do to give good care. I try to instill with students a sense of pride in their work and accomplishments and that the bottom line is patient care."

 

Whether it's how to properly hold an otoscope or how to calm a colicky baby, Margaret enjoys sharing her knowledge on the clinic floor. "I think that my strength is that I'm a little uncompromising" she chuckled, "and I feel that the students who really have success in the program often are the ones who have a sense of their own increased standards of care.  Across the board in this program, Cindy and I have tried to increase the quality of care to the patients."

 

Margaret has experienced a lot of special moments on her missions with us."One day in Pajones", she shared, "this really elegant, lovely woman told me about how much this program meant to her but, more so, how much the people in this area just rely on us and it helps them feel better." Her other special moment involved a student who needed a little direction at the beginning of the mission. After spending some one-on-one time with her, Margaret said, "The next day I just kind of watched her blossom. It was very rewarding. I've been doing these trips for five years now. There's always a moment when there's the "aha" moment for a student, if they are really focused."

 

Although some days were long and the work felt overwhelming, Margaret always remained upbeat. "I feel good about this program. We went back to working with a team of students and for me that's the most fulfilling thing. I enjoyed watching the students progress each day and gain more and more confidence. Establishing that mentor relationship with them so I knew their strength and weaknesses was very important to me. I could really focus on helping them gain confidence and strength in their clinical skills. This was a great student body."

 

When I looked across at Margaret to do this interview, I knew it would be difficult to capture her spirit, her inner light, and her graciousness. She brings more than years of technical skill and teaching to this program. She has enriched the experience for so many co -workers and students. She's like the afternoon cup of tea I often shared with her. She gives a "lift" to all of us when she returns to the "ranch" after a hard days work. She's a special treat. Margaret has steeped the mission in her wisdom and insight. She is the perfect infusion of humor and wittiness. When we are at Fusimana, we can't brew a pot of tea as we might at home, but I always feel I've had a proper cup of tea when Margaret is around the table. She is her own special brew, her own unique blend. Tea, like Margaret, can be described in many different ways: distinctive, sprightly, delicate, fragrant, strong, bright, unique, sophisticated, fine quality, and elegant. Pick one. Now go brew yourself a cup of nostalgia.

Nothing could have prepared Gretchen Appleby for her first clinic.  She was still excited when we sat down to chat about her experience. "It was an incredibly overwhelming and emotional experience for me to find something like that on my very first day with my very first patient", said Gretchen. "They hadn't found it. Since they had referred her to me for her shoulder pain, she ended up telling me about this, so I was the first person to find that enlarged node."

 

Gretchen, a student in the Athletic Training Program at USM, plans to go to graduate school after she receives her degree in May. Part of her education requires familiarity with general medical conditions, but she had no idea she was about to put that knowledge into use in the first clinic. "That first day was a big day", she stated. Still emotional from the experience, she described what happened: "In this case, this woman just happened to tell me about it. I was just doing a history on her shoulder and she ended up telling me about the lump. She called it the `little ball' that she had on her shoulder." What Gretchen found was a lymph node that had been enlarged for over a year. It was an important discovery, one that may have saved the life of the first person Gretchen helped in the Dominican Republic.

 

Her discovery highlights the importance of the addition of the Sports Medicine (muscular skeletal) component to our clinics. This year we had six Athletic Training students, joined by volunteers, Mary Berg, PT and Mary Connolly, ATC. They worked their magic under the direction of Ben Towne, Program Director of Athletic Training Education in the Dept. of Exercise, Health & Sport Sciences at USM. Ben is also the Safety Director for PRHDR and is responsible for founding the Sports Medicine Group for our medical missions. They were able to evaluate, instruct, and advise patients with muscular or skeletal problems. Before, we were only able to offer a mild pain reliever for muscular skeletal aches and pains. Gretchen observed, "You know the problem is deeper than any medication can fix."  

     

When asked what attracted her to this program, Gretchen answered, "I've caught the travel bug." She traveled to Australia and New Zealand several summers ago. "After that I've just always wanted to travel around the world, see the world, and be a global citizen. Being able to do this combines two of my greatest loves: my love for travel and then my love for what my career will be. Also, I want to just help the people who need help."

 

Gretchen was selected to be part of a team that hiked several hours in deep mud and rain, hauling equipment and supplies into Los Hobos, a remote village. Exhausted, she drew upon her inner strength and reserves to see patients for the next three hours and then, hike back out. To this she says, "I knew that I had to just dive into it and just do anything that I could. I came to the Dominican Republic with a positive attitude and just ready to work. I think a lot of people come on this trip with that attitude. We put in a lot of long days.  We're all really tired, but then once the clinic starts, it's on, and you go."

 

"This has just been the best elective I've ever taken. I've noticed a change in the way I communicate with the patient and my confidence in what I'm doing. It's hard to believe that I've made these improvements in only 8 clinics. At the end of every clinic, I know I've learned something that I will be able to apply to and further enhance my clinical skills."

 

Before heading back to the gazebo she added," the Dominican people are fantastic. They just look you in the eye and smile.  You hold their hand. You just make that human connection. We didn't need to talk. Their culture helped me to be able to just sit back, relax, and let things happen. I know now that I'll be able to make a human connection with anyone on the planet."

"After my very first clinic I thought I had made a great decision coming here because even though I just had one patient, it was wonderful and very thorough. She was very lovely and kind. I knew, right then and there, that I had made the best decision coming on this trip. Cole Carrieiro is a senior in the Bachelor of Science and Nursing Program at USM. His positive attitude and entertaining evening vignettes that he often shared after dinner provided some very light and often funny moments as the group reflected on their daily experiences in the clinics. We will all remember the night he exclaimed, "I saved a village!"

 

Cole recalled a special home visit with a woman who was wheel chair bound. "This very beautiful woman, who has been through hard times in her life, welcomed us wholeheartedly into her home." Surrounded by her whole family, he continued, "She greeted us with an open heart, open arms, and then, a kiss good bye. It was just beautiful to really get a whole sense of this. It's not only what you read in a text book. It's true, and I was really glad to have that experience."

 

When I asked Cole what had drawn him to participate in this trip, he smiled, "Many, many things. I've always wanted to take a trip to a Spanish speaking country because I fell in love with the language after taking it in high school. I wanted to go on this trip to provide medical care to the people in the villages, to enjoy the atmosphere, and just to experience the beautiful culture that they have here." Then he chuckled and added, "Also, to take a break from the snow!"

 

Cole reflected on what he learned about Dominican culture as a result of three home visits. "I got a really great understanding of how these people work in harmony together, how they work with each other and for each other. It was just beautiful and I love this culture here. It's changed me. It's also made me be very aware and I'm very thankful for what I have.  I've learned so much. It's changed me in one thousand ways."

 

Like many of the participants in the trip, Cole gained more than clinical skills. He also experienced personal growth. Although the word "shy" is not an adjective that comes to mind when you observe Cole in the clinics and at Campus Fusimana, he shared, "One thing for me personally is I've always been a very shy person. I've always been very business like and tried to avoid getting too comfortable with people and getting to know them just because I'm always on the move and on the go." However, the moment Cole arrived, he decided to try something a little different. "I tried being a little bit more personable. I've always been friendly, but I tried to be more open and inviting. I tried to get to know people and become good friends with them, and that definitely helped me."

 

Cole found that he learned something about patience as he settled into "Dominican time." "I gave a sense of patience to a lot of my colleagues and kept their spirits going because this is a culture shock for a lot of us, especially for me. I'm not the most patient person at home when the power runs out and resources run dry." Although there were frustrating times without power or hot running water, Cole found comfort in the warmth of the Dominican people and the beautiful views that surrounded him. "I thought it would be very important to remind each other this isn't the time for complaining. We are very lucky to be greeted by these people .It's a beautiful moment and I think people got it. We just got it."

 

Cole has a message for anyone who is thinking about going on the trip and might be feeling a little anxious about it. He, too, confessed, "I was a little apprehensive. I lived at home throughout college and I haven't moved away from the nest egg. This is my first trip away. You know at first, I got cold feet." Now that he's heading back to Maine, Cole grinned and said, "It's very sad.  I don't want to go. I'm not quite ready. The trip has been nothing but positive and great. I think everyone owes it to themselves to come out here and take a break from the cell phone and the internet. Come here to spend time getting to know your peers well and to experience something very, very different. It's a luxury spending time with patients and people and learning new things without the pressure of the time clock."

 

"Bev" is a student in the BSN Program at USM and will be graduating in December of 2010. She feels that many of her clinical skills were reinforced during this mission. "This was the first opportunity to have a consistent hands-on going from theory to practice. The consistency for me has been critical and I gained that by having to accelerate though the day in terms of pace. It's more than I expected. It's what I wanted and it's more than I expected in terms of completing this."

 

Bev's blue eyes lit up when she talked about many experiences she has shared with the Dominican people. She observed, "It's far more than a cliché, that it's a gift that these people allow us to be this intimately close to them as a stranger. It's so lovely of them. And there were many special moments. My heart is here."

 

Bev admitted that she felt challenged at times. "There have been many highs and lows which make it absolutely more valuable in the long run. I feel there is no way to read about this type of experience  Having been immersed, completely immersed, in this different culture, in the rigors of the schedule and the language barriers and being a novice, all of these elements made for a very dynamic challenge."

 

She quickly added, "It's been that meaningful. But as well I've had a lot of fun. I've enjoyed being the clown that's inside of me as well and I've trusted that that's OK and have fun. We've had a lot of fun."

 

Ultimately, Bev feels her life has changed by the experiences she had in this mission. "I feel as though I'll be different because I've now had the chance. It's going to allow me to simplify. It's going to allow me to remember the value of listening in the moment. It's going to reinforce and help me to remember. It's given me a solid grounding for accepting myself so much more. I've gained more confidence, professionally, academically, and emotionally as well."

 

As our interview came to a close, Bev used a beautiful metaphor especially appropriate to our location as she reflected on what this opportunity has meant to her. She said, "The learning curve is different for each student and it is infused with perhaps fear and lack of confidence which I visualize as a mountain. I'm in the foothills of a large mountain that I'm starting later in life. Having had more fear in the moment, but being supported in that fear, I am attempting to start the hike up that mountain. While I was here, I passed over that hump. I feel my heart here."

Thanks to all of the Peace Corp volunteers who interpreted for us and served as our cultural brokers. We couldn't have done it without you!

Thanks to Rebecca Marvil for providing Beverly's and Cole's pictures (also pictured, Margaret), to Mary Berg for providing Lisa's picture, to the person who provided Gretchen's picture (also pictured, front row (left to right): Robyn DiFrancesco and Jasmine Quarles; back row (left to right): Gretchen Appleby, Ben Towne, Rolinda Mitchell, Amber Shorty, Mary Connolly, and Chelsie Eugley)and to Anne Grimes for providing the Peace Corp volunteers' and Margaret's pictures.

Thank you to Katherine Peña, Editor, for creating this issue of the PRHDR newsletter and for updating the website.

Finally, thank you to all the volunteers and students for sharing their stories!