Teaching Burn Rehabilitation in the Dominican Republic

Last week, a Physicians for Peace team of volunteers from Minnesota escaped the cold for a while to travel to Santiago and Santo Domingo in the Dominican Republic. They worked with medical professionals in the local hospital, teaching new methods in fabrication of burn compression garments and masks. Here are their reports from the field:

12 January 2009
 
The team arrived safely in sunny Santiago with all of our luggage and equipment.
 
The morning started with a meeting of all therapists, doctors, a seamstress and tailor, and others from both Santiago and Santo Domingo. We shared our individual goals and expectations of this mission and reached a concensus on our plan for the week. It was learned that the prosthetist/orthotist from Santo Domingo worked previously as an artist with the man who discovered a ‘larimar’ mine in the southern part of the D.R. This beautiful blue stone is only found in the Dominican Republic and has been a favorite purchase among the Minnesota team. The stone is named after the founder’s daughter Larissa and the the Spanish word for the beautiful sea, ‘mar’, thus larimar.
We broke into 2 groups to maximize our learning. One group went to evaluate and treat the burn inpatients. Both the physiatrist and the therapists demonstrated excellent comprehension of the patient’s needs and presented an appropriate therapy plan. The other group took a facial moulage (model) of Liz Rivers, the inventor of the plastic face mask for burn survivors, as a demonstration. After the morning coffee, snack and then lunch (they feed us well here), we began to prepare the model and fabricate the plastic face mask. We had both experienced and novice learners in the face mask techniques. It was clear after our face mask was formed that we really didn’t have the same plaster or oven to heat the plastic with which we were familiar. Everyone worked together to get us a variety of D.R. dental plaster to try to find the one that would perfom most optimally. After experimentation with various mixtures of plaster, water, and salt, we decided on an acceptable formula.
All 4 learners had an opportunity to ‘pull’ a face mask and cut it out to get the feel of the material. The enthusiasm of each of the participants was amazing; the group worked long after their day was finished and everyone is eager to begin again tomorrow.
 
Signing off for now,
 
Team Minnesota

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13 January 2009
 
Jana and Dr. Fisher made it to the hospital for rounds and beat the local staff there for the 8:00 start. Rounds begin and end with a prayer and a blessing. The burn unit physiatrist stressed the importance of
‘team’ rounds and checking in with the plan for the day as the Minnesota team strongly supported.
After rounds, the inpatient rehab team discussed specific patients and their care plans with the physiatrist and the rehabilitation therapists. Jana, the physical therapist from the Minnesota team, observed patient treatment and made recommendations for progressing the treatment plan for specific patients. Both therapists from the D.R. were eager to learn any new techniques.
Meanwhile, back in the outpatient lab, there were many projects happening simultaneously. Augustin from Santo Domingo taught Ana Ariceli from Santiago how to make a tight elastic shirt for a 4-year-old child with severe scars on his chest, back and arm. The boy was burned from hot coffee which spilled on him.
Another outpatient who arrived at the clinic, an 18-month-old boy who climbed on the table and spilled hot water on his face on 12/26/08, was fit with a compression headband to prevent scars from forming on his forehead.
Other therapists and orthotists were practicing making face masks and taking facial models. After some late-night experimentation in our hotel room, we figured out what we felt would be the best mix and formula for the plaster. The hospital engineer was able to get the plaster we needed today. A D.R. therapist aide volunteered to be the ‘model’ for us. The process involves holding still while your face is covered with a ‘frosting-like’ material and then covered with plaster strips. The nostrils are the only part left uncovered. He talked about not having any feelings or thoughts while waiting for the plaster to dry. He said his ‘mind went blank.’ Hopefully, he’ll be able to share this meditative technique with the kids he will be working with later.
 
Beth’s observation as a first-time volunteer: Just want to let anyone who wants to go on a mission such as this know that there were several nights of planning by our Minnesota team prior to leaving. This included setting the goals of the mission, agreeing on a loose agenda, listing and gathering supplies needed, and a packing night when we packed the 200 pounds of supplies we were going to bring. Some of these were needed for the teaching, and some we will be bringing home for use on other missions. I am finding that one needs to be both goal oriented and very flexible at the same time. While we hope to complete our goals by the end of the week, each day is filled with many challenges. Sometimes the supplies you brought before are not able to be located, or supplies you asked the host to supply are not present or even available. The people you are teaching are not always available when you need them, or the lights go out for awhile. Lots of extra people are passing through the room and watching what you are doing to name a few. These are just a few of the unexpected things that can happen. This is all offset by the enthusiasm, energy, and warmth of the people we are working with. When you are teaching a new skill, suddenly you look up and there are several other people helping out, each wanting to get their hands on the project. I love the camaraderie and how freely people offer ‘touch’, caring, and compassion during their daily interactions.
 
We all work so well together and are having a great time both during the day and in the evenings.
 
Adios amigos, hasta manana,
 
Steve, Liz, Jana, Patty and Beth

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14 January 2009
 
What a great day! We had 3 outpatients who were perfect for teaching both scar and contracture management. The Dominican Republic team was able to continue practicing their skills making splints for legs, arms and a face mask on a 13-month-old child. In the U.S., we would take the facial impression under anesthesia, but here we had to take it awake. Luckily, we had the help of the prosthetist from Santo Domingo who has had experience taking models on young children awake. We were able to get a fairly good fitting face mask and the mom was willing to bring the child back on Friday for more work and to check in with her to see how things are going. This patient and her mom traveled 3 1/2 hours by bus from her home on the border of Haiti. We are breaking accessibility boundaries by providing these rehabilitative services here in Santiago instead of having her take the bus to Santo Domingo which is 2 hours further. This child also needed a custom glove. Luckily, we had 3 bags of custom compression garments donated by Bioconcepts and a pink glove in one of those bags fit the child perfectly – like a glove! There are also many opportunities to improve on the follow-through for outpatient visits, both with the doctors and with the therapists.
Dr. Fisher and Jana are working with the D.R. physiatrist and physical therapist on many things. We made some medical and rehabilitative suggestions.
We were so impressed with Augustin, the tailor from Santo Domingo. He has designed a compression glove and elbow sleeve which are extremely unique in design. We hope to publish a paper showing this effective ‘thumb’ design.
We have more ideas than time for the next 2 days, but as always, things will work out!
 
Adios amigos,
Jana, Patty, Beth, Ramon, Steve and Liz

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 15 January 2009
 
The team had a very successful and busy day. The highlights of the day for us were several:
    1) A five year old who was thermally  burned in a house fire 30+ days ago, and whose mother died in the fire, had not walked and was refusing to try. The psychiatrist and staff felt there was a significant psychological component. Once the wounds were visualized, we realized that increased compression and vascular support was required to improve comfort.  In the morning she walked 15 feet with a single ace wrap. With a double ace wrap,  the child stood and walked 75 feet with support of two people. She had little or no pain complaint. About an hour later she walked out of the burn unit pushing a toy, a distance of 500 feet. We were even impressed at the success of “double ace wrapping.” The burn staff of the DR was definitely struck with the importance of a very simple rehabilitation method.
    2) We were successful in contacting and cooperating with the Orthopedic department of the children’s hospital with stretching and and beginning a program of serial casting on a complicated 8 mo old child with knee contractures secondary to contractures. We also fabricated an elastic hand garment and a transparent face mask to minimize hypertrophic scarring. We believe this type of intensive follow-up interdepartmental effort was a good initial demonstration.
   3) We continued to teach and demonstrate the art of fabrication of face orthoses and garments. The Santiago team independently took the facial moulage and poured the mold with minimal verbal directions. They continue to demonstrate great enthusiasm and rapid learning. For only the second time since we’ve been training the D.R. staff, the tailor from both Santo Domingo and Santiago came onto the unit to measure a patient for compression garments to his lower legs. They have been working on the patterns and will fit the patient tomorrow.
  4)  There is an incredible opportunity for the physical therapist to be involved in the outpatient burn clinic. Today alone, we saw 5 patients from the clinic who needed rehabilitative interventions and will require many follow-up visits from the therapist to complete their rehabilitation goals.
 
 
Liz and Beth’s view from our balcony:
Liz’s and my room has a very small balcony overlooking a bustling street. I spend a few minutes overlooking ‘our’ street in the morning, after work, and then again before bed. Two dogs live with their owner outside of a business. The dogs are frequently sleeping in the corner of the building on the sidewalk and the owner is usually outside on a lawn chair or inside the business – he may be a guard or perhaps the owner? Then, there’s the woman who sits on her piece of cardboard on the sidewalk asking for money – she’s very feisty. In the evenings, there are vendors cooking their wares in a pot of hot oil. Lots of people are passing on the street and the traffic is constant as well as the horns. Motorcycles dart in and out of the 2 lanes of cars. It’s become a friendly, familiar scene, and I’ve grown fond of our little neighborhood.
 
Last day tomorrow! We’ve got lots to do and several patients coming for more therapy.
 
Adios,
 
Patty, Steve, Jana, Beth and Liz
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 16 January 2009
Again, the day was jam packed with planned and unplanned activities!!!  The Santiago 4 face mask team and Minnesota team started right away at 8 AM re-pouring to get the impression to make a new model for the young boy’s new face mask. The Minnesotans did enough of the process this time to assure a high quality plaster positive model. Ana A and August started right away finishing my experimental right hand glove. It confirmed again that their machines cannot  sew children’s gloves. These machines cut the fabric, so if it gives proper vascular support, the seams tend to tear apart. But I wore my glove all morning, and it is a better example of acceptable support to improve healing and decrease scarring. They measured an outpatient for a new garment that  helped the person stretch out his contracted shoulder and elbow, since he claimed he could not move. Nina and Steve worked with him and made considerable improvement in just the half hour it took to get his new design of garment.
The team made a very nice, well fitting face mask for the young boy and made arrangements for him to return to Santiago for revisions in 3 weeks. He will return to Santo Domingo in 6 months because he is growing so fast that he will need a new impression and model at that time.
Liz worked on getting the momentos for each of the persons we worked with and a letter in English and Spanish to thank them for their dedication, passion, and investment in this training. We passed them out while both teams drew up closure of work with the patients. Then we all had lunch and did  a little ceremony to pass out their certificates of attendance. They cheered each person, everyone had photos, and then everyone cried, hugging and kissing. We changed to street wear and set off to pack up all the equipment we need to use at the next country or burn center. Then we re-focused to plan the next couple of days’ adventure. It is 2AM, so I will pray this blog is coherent!

 
Adios,
 
Patty, Steve, Jana, Beth and Liz

Dominican ‘Resource Mothers’ Visit US

 

“Resource Mothers” Altagracia Luna and Kissairis Rodriquez of the Dominican Republic visited the United States for the first time last week on a trip to Physicians for Peace headquarters in Norfolk, Virginia. Altagracia and Kissairis have played an important role in establishing the “Resouce Mothers” Program in the Dominica Republic with the support of Physicians for Peace. During their visit, they were able to tour a local children’s hospital and meet women who do the same type of prenatal education and mentoring here in the US. In turn, we benefited greatly from learning about their experiences in working with mothers in need:

 

“As Resources Mothers, we help the people of the barrios we live in. We go out into the barrio, door to door, and find girls who are pregnant, and need help and advice. We are trained to teach young women about all the ways they can have a healthy pregnancy and a healthy happy baby. We help them keep away from drugs, alcohol and tobacco, which are common in our community. We accompany the girls to their prenatal check-ups, visit them at their homes, and advise them and their family how to have a healthy pregnancy.  We also advise them how to eat well, even when there is so little to eat, because of their poverty.  We help them to learn how to nourish not just their body but also their soul so they can deal with all their worries and fears.”

 

“All of us Resource Mothers are thankful for the opportunity to be part of this program. Every day, I thank God and Physicians for Peace for the chance to help my neighbors and my barrio. We feel that we are changing the lives of the girls we help. We are changing the lives of so many people for the better. In the first year of the program, 94 healthy babies were born, and we feel like we are a part of all of those families. And it has changed our lives as well! The Program has motivated me to go to Medical School in the Dominican Republic. In a few years I am going to be a Doctor. Thank all of you for making all of this happen.”

 

Their compassion and dedication is an inspiration to everyone at Physicians for Peace, and we hope they will come visit us again soon! 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Report from the Caribbean – Day 7

Photographers Stephen M. Katz and Chris Tyree continue their reporting from the Caribbean, where they are now in Haiti.
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“Imagine the government of the United States introducing a bill to raise the minimum wage 114%. Corporate CEO’s and industry leaders would pitch fits on news talk shows. Lobbyists would wear moat-like pathways between congressional offices. Threats of higher prices for everything would spark panic among consumers.

Now imagine being a common laborer where the minimum wage is two dollars. A day. That’s right – 10 dollars a week, 40 dollars a month, 480 dollars a year. Welcome to Haiti. The poorest country in the Western Hemisphere.

Port au Prince is chaos on speed. Few places you go don’t smell of garbage or urine or pollution. Roadways are blocked by mounds of trash three feet high or throngs of people selling everything from raw sugar cane to used pants to scraps of metal.

Ramon, Chris and I arrived in Port au Prince this morning – Friday, March 1 – and went straight to St. Vincent’s, an orphanage/orthopedics clinic/school for handicapped children/child social services. And that is the way many of these aid centers are – slashes. There is so much need in Haiti that nearly any facility opened to those less fortunate – 95% of the population – is completely overwhelmed. At St. Vincent’s blind children wander the hallways, their eyes clouded over the way my 96-year-old grandmother’s look. Kids missing an arm or a leg or both are helped down long narrow hallways painted a mossy green by other children. They are all brothers and sisters. Rooms full of mute teens wave uncontrollably to strange white faces pointing cameras.

When the recess bell rang, half of the children raced to the cement courtyard. They stood around in their blue and white-checkered shirts eating bits of bread and drinking juice from plastic bags. There was no kickball or soccer or jump rope. Those activities are far too luxurious. The other half remained in the classrooms – too much trouble negotiating the dark cement stairways to simply stand around somewhere else.

One little boy named Joseph sat in the middle of the third classroom on the second floor. Some of the other children were playing with a set of blocks. They were pink. Most of the paint had chipped off. Joseph just sat there. Two classmates darted past him in a game of tag. Still, Joseph remained motionless, a cone for the others to races around. A little girl tried to coax Joseph to play with her. He wouldn’t. When the bell rang to mark the end of recess though, Joseph sprang up to his knees exposing his twisted lower legs and feet. Dragging them behind him, he scurried to his desk where he sat some more. Motionless.

Today, many of the students were learning math. Chalkboards reminiscent of the 1930’s were filled with addition and multiplication problems. Faded equations from the prior lesson still visible. No money for erasers. Some children were clearly engaged in the class. Others sat in the corners – some in cold, steel wheelchairs, some in wooden seats with mismatched legs – staring off. Daydreaming? What was there to dream of?

The lucky ones leave at the end of the day, going home to their families, many of whom live in old shipping containers down in the favela. The rest live in rooms at St. Vincent’s – seas of rusty bunk beds – only to wake up the next morning in the same terrible place.

When I asked the director what it was that St. Vincent’s needed from PFP he responded without hesitation, “Everything.”

Report from the Caribbean – Day 6

Volunteer photographers Stephen Katz and Chris Tyree continue their work in the Dominican Republic.
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“Rafino, 49, didn’t travel much beyond a two or three block radius in the Vietnam Barrio of Santo Domingo – named that because it’s like a war-zone – after he lost his leg 17 years ago in a motorbike accident. Local doctors tried to use a traditional method to save the leg, which later became gangrenous and was ultimately removed. A couple of years later he lost his wife too. She walked out on him, leaving him to care for their two boys. One is mute.

When I first met Rafino just over two years ago, he was seated on a paint can in front of his mother’s green shack, where he and the boys eventually moved. His entire world, and that of his children, existed in one room. No bathroom. No kitchen. Just two tattered, stained mattresses with small piles of clothing and other odds-and-ends cluttering a space no more than 10 feet by 8 feet. It was his prison and his palace.

I made several photographs of Rafino perched on the rusted can that afternoon, before I even noticed he was missing his left leg. As I walked closer I smiled. He didn’t return the smile, but nodded his head ever so slightly. Though at the time he was 47-years-old, deep lines – a dried riverbed – across his face made him look 58.

He struggled to stand as I extended my hand, steadying himself and shaking at the same time. Although he was on a concrete step he was still several inches shorter than me. I asked Ramon to inquire whether or not he had a prosthetic. We were both shocked when he pulled out an artificial leg he had made himself with wood, the type of rubber used as a moisture barrier on roofs and a piece cannibalized from a partial prosthetic leg a friend had found. He demonstrated the contraption for us. Still his gate was labored, with a severe, awkward limp. Ramon took down his information, promising to arrange for him to be fit for an artificial leg. I’m sure Rafino wondered if this was just another hollow promise.

Yesterday, Ramon, Chris and I spent the day following around a small group of PFP’s Resource Mothers. The program is designed to educate 15 to 19-years-olds, in the first sixteen months of their pregnancy, to adopt lifestyles that ensure a successful birth and healthy baby. The Resource Mothers themselves are members of the community and have children of their own.

As we approached Arelis’s home – one of PFP’s nine Resource Mothers – Ramon called out to me “you remember the man with the leg he made for himself?” I nodded. “He lives just here,” pointing to the green shack I quickly recalled. As we parked just a few yards away, Rafino walked out. Walked out. No limp. No faltering. As his gaze adjusted to the bright Dominican sun and fell on Ramon he immediately threw up his hands, smiling like a child would smile at a brightly colored balloon. Before long the man of so few words just two years ago couldn’t wait to share with Chris and I how the mobility of the new leg has changed his life. Today, instead of scratching together a living and begging for money, Rafino collects and recycles bottles. He also earns money by shining shoes. Fancy shoes. The kind worn by people who don’t live in the barrio. Both tasks made possible by something most of us take for granted – walking. Walking free.”

Report from the Caribbean – Day 5

The continuing experiences of volunteer photographers Stephen M. Katz and Chris Tyree, as they travel in the Dominican Republic and Haiti for PFP.
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“Would anyone fall in love with her? Could anybody find her attractive? Should she even dare to dream of marrying one day? All questions familiar to many young women, especially those disfigured the way Ireline was.

At the age of twelve the lively Dominican held her brother’s waist tightly as the two zigzagged through traffic. It’s a common site. And the type of accident they were involved in is all too common as well. With roadways on which two lanes swell into four and driving is more sport than transportation, cars and motorbikes are foes. The emergency room at the public hospital in Santo Domingo sees nearly as many amputations as appendicitis. The fingers on Ireline’s brother’s right hand were severed and Ireline was flung into traffic. When she awoke in the hospital, her left leg was gone.

The barrios of the Dominican Republic are difficult to manage with two legs. Steep concrete stairways – tentacles stretching from the busy roadways above – creep down hills often slick with oily water and sewage, to shacks the poor call home. Pathways pitted with ruts and strewn with rocks wind through a dizzying maze. As a child going to school, and later an adult searching for work, Ireline navigated the obstacle course on a pair of rusting crutches.

But the day Ireline sturdied herself on those crutches and walked into the Asociacion Dominicana de Rehabilitacion (ADR) – the orthopedics and prosthetics center where PFP runs its Walking Free program – not one, but two dreams came true. She has been fitted for a prosthetic leg and eagerly waits for the day she can once again walk on two legs or dance the Pachete and not rely on bracing herself with her arms and hands. And with her arms free, she can walk proudly while holding the hand of her husband Monely. The athletic man, himself a double amputee, stole her heart when he worked in the back room of ADR making orthopedic shoes for children.
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Report from the Caribbean – Day 4

Another update from our volunteer photographers Stephen M. Katz and Chris Tyree, in the Dominican Republic.
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“Today’s blog will be a bit shorter than the previous three. I apologize for that, but I think you’ll understand. It’s just past 1 a.m. and Chris and I started this day – Tuesday, February 25 – at 6:30 a.m. I just finished uploading 16 photographs for the blog, so from my calculations I have already sent 16,000 words.

As Chris and I shared a quick dinner this evening at the Pizza House along the walking road that runs through the Old City of Santo Domingo, we had a chance to reflect on the day. Aside from the fact that Dominicans put cherries on their Hawaiian pizza, what struck me most was how Charles Horton’s often used motto about teaching a man to fish rather than giving him a fish proved to be so true today. I mentioned in yesterday’s blog that I accompanied PFP’s Walking Free mission to the Dominican Republic in November of 2005. I remember well a young man named Victor Diaz who absorbed with excitement the training he was receiving by the PFP volunteers. He eagerly followed each of their suggestions and hung on their every word. So when we arrived at the Asociacion Dominicana de Rehabilitacion – the orthopedics and prosthetics center where PFP holds the training – I was thrilled to see that the man enthusiastically training the new technicians was no other than Victor himself.

Five men huddled around Victor as he demonstrated how to ensure that the casts made from patient’s limbs would produce the most secure and comfortable fit. A little filing here, a bit of shaping there. Soon the blob of clay-like material looked identical to the limb from which the cast was made. His spark clearly hasn’t faded and the trainees were as engaged with him as he was with the PFP volunteers two years ago. One might imagine that years from now one of these young men may be training future technicians and the cycle of teaching and learning and healing that Dr. Horton dreamed of so passionately will live on.”

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Report from the Caribbean – Day 2

A 2nd report from volunteer photographers Stephen M. Katz and Chris Tyree, currently on assignment in the Dominican Republic, shooting documentary footage of our activities.

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“It’s hard to believe that with all of the diseases and maladies in developing countries, the number one killer in the Dominican Republic of people between the ages of 15 and 49 is motorcycle accidents. For those who survive, these accidents claim countless limbs and leave people maimed and disabled, unable to work or care for their families.

With no real public transportation system and the price of cars and even taxi fare out of reach for most families, the roadways of the DR are filled with scooters and motorbikes. All day today – Sunday, February 24 – Ramon Lopez, Chris Tyree and I traveled to and from Santiago, Moca and La Vega and only twice did I see a person using a helmet. We were astounded to see how many people would typically squeeze on one bike. It was nothing to see two or three. Sometimes four, even five, often including a young child or two. On our way back to the hotel this evening Chris cried out, “We have a new record.” Six. Six people teetering on one bike. With traffic signals considered ‘a suggestion’ and few streetlights, it is no wonder that this has become a crisis.

This morning’s first stop was the emergency room at the one public hospital in the city of Moca. Four beds crammed into a room roughly 10 feet by 20 feet. Within minutes, two separate car versus motorbike victims were whisked into the room. One with head trauma, among other injuries, and one with significant abdomen trauma. On another bed was a boy, no more than five-years-old, who nearly sliced off his finger when trying to cut his kite out of a tree with a machete.

After covering the emergency room and trying to make images on the roadways to illustrate the issues of uninforced motorbike laws, we sought out a cockfight we had heard was going to be held near one of the barrios. It was a great opportunity to document one of the cultural activities that is very DR. Scores of men crowded the indoor ring, while still others gathered in small enclaves outside drinking green bottles of Presidente beer and catching up on the week’s gossip. We stayed for only a few fights. The last ended in a draw.

From there, we traveled to La Vega, the capital city of the neighboring province – also called La Vega – to document another cultural aspect of life in the DR. There, as well as in Santiago and Moca, the month of February is the time for Carnival. Each Sunday, between roughly 4 and 7 in the evening, the streets come alive with music and costumes and revelry to match that of Mardi Gras. Among the throngs of carnival-goers – walking a nearly mile-long route around the main square – are bands of costume clad teens. Faces covered in elaborate masks – lions, dragons, devils, skulls – bodies covered in shimmering and colorful robes. All dance to music pulsing from refrigerator-sized speakers spaced along the parade. And all carry objects that look like Nerf footballs attached to a rope. Before the days of polyester these were inflated, dried goat bladders. Participants sneak up behind unsuspecting spectators and whack them in the bottom. Most laugh, some yelp and rub the impact site as if to wipe away the sting.

Although the majority of this week will be spent covering the medical and economic issues that those in need struggle through, I think this afternoon was a great way to ultimately temper those somber images with sites and sounds of the people of the DR enjoying life.”

Report from the Caribbean

A report from volunteer photographers Stephen M. Katz and Chris Tyree, currently on assignment in the Dominican Republic, shooting documentary footage of our activities.

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“Long days are the norm when photographing these global health projects and today – Saturday, February 23 – was certainly no exception. But let me start from the beginning.

Chris and I left Norfolk Friday morning on a 6 a.m. flight to DC. From there we just made it out in time before the icy weather wreaked havoc on air travel in the Northeast. With a brief stop in Miami we were on our way to the Dominican Republic. Our trusted friend and guide Dr. Ramon Lopez met us at the airport. Before we even got our bags he was plying us with rum and cokes made with the DR’s much loved Brugal Rum. For the record, neither one of us could finish our first drink.

Chris and I gave ourselves a half-hour to freshen up and we were down in the lobby of the hotel planning our first several days here in Santiago. We set a bold agenda, but the passion we all share for communicating the needs of the people here will most certainly keep us moving forward. Today we started by visiting the Community Center of Fundacion Sol Naciente in Moca, a town 20 km southeast of Santiago. Doctors saw several patients at the clinic. One in particular stole our hearts. Eleven-year-old Lilibeth Reyes Brito fell on her head when she was just 3-years-old. Since then she has suffered from daily seizures. She is unable to go to school and lead the kind of life we would want our own children to live. Her only hope for stopping the daily torment is surgery, a kind that is not available in the DR. Our hope is to find a surgeon elsewhere who is willing to make the trip here to help Lilibeth.

From the clinic we visited a barrio called Sal Si Puedes, loosely translated “leave if you can.” I have visited many barrios throughout Latin America and it is always the same situation. Barrios are literally the sewer for the rest of the community. All barrios are at located at the lowest point of a town or city – typically where a stream or river flows. The end result is that all the garbage and sewage and waste travels down culverts and drains into these people’s homes. The smells are overwhelming and the filth is unimaginable. Still, the people always seem to maintain a sense of dignity and kindness to strangers with cameras. Chris and I watched children playing Puntair with a Trompo or top. The game follows the same general rules as marbles.

After a quick lunch of rice and beans with some chicken and fried plantain, we visited another barrio. This one was called La Espanola or La Punta – the point – depending on whom you asked. Men played dominos and children tugged at strings attached to kites fashioned with sticks and plastic bags. Again, the people were warm and friendly, many inviting us into their homes, typically simple shacks built from palm wood and corrugated steel roofing material.

We left the barrio to drive into the countryside a bit to see if we could find anyone working in the campos, or farms, surrounding Moca. We came across several children playing baseball in a field using a large branch as a bat and who knows what as a ball. The boys delighted in showing off for Chris and I. As the sun was beginning to set, we raced back to a village just outside Moca to document a political rally. In a couple of months the DR will hold its presidential elections and in this region, tonight was the beginning of the campaign for the favored incumbent President Leonel. The DR follows the same presidential protocol as the United States – two four-year terms. Purple flags waved from motorcycles zipping up and down the square. Young couples danced to traditional music and older men huddled together holding large bottles of Presidente beer. Local politicians gave speeches but for most this was simply a Saturday evening party.

Now I am back in my room downloading several gigabytes worth of work I shot and Chris is in his room doing the same while nursing a bad cold he brought with him from the States. Still, it was a good day. The first of many, we hope. Each image we can capture that helps the folks back home understand the needless suffering of so many, we pray is one step closer to making the lives of children like Lilibeth the kind that every kid deserves.”