Thursday, July 10, 2014

break-bone fever, bent-back fever and malaria, oh-my!

When I first came to the DR ten years ago, I was given a course in tropical diseases - it was a general "going-overseas" course, so a lot of the diseases we learned about didn't even really apply to my part of the world, and really, THANK YOU WORLD. Some of those things - worms that bore through the heels of your feet and end up in your blood stream, scorpions that sting, snakes that bite - are enough to give the most seasoned outdoorsmen nightmares.

The Dominican Republic doesn't even have a malaria problem (though occasionally you'll hear of malaria in Haiti). As far as mosquito-borne illnesses go, malaria was the scariest for me. Afterall, I had recently read The Poisonwood Bible.

I have since learned that malaria is not nearly the most painful or even the most widespread of mosquito-borne illnesses. 

Dengue Fever - often referred to as break-bone fever - is common in the DR. It is transmitted by a special, of course, type of mosquito and everyone once in awhile the country's emergency rooms fill up with infected humans. It is marked by high fevers, diarrhea and vomitting and an intense pain in the joints and bones. There is no treatment, and is often deadly - especially for small children and the elderly. 

Doesn't sound terrible, right? Some fevers, dehydration, and in the end you (probably) live? Perfect.
Except you can't take pain killers stronger than tylenol, and the only other relief is simple re-hydration by IV. And the pain can last for days and days. 

Dengue hasn't reared it's ugly head recently - at least not in epidemic status.
No, in fact, I haven't heard one story of dengue for months, but mostly that's because a new disease arrived in town about two months ago.

Chikungunya Fever.
Lovingly referred to in Africa as bent-back fever because the pain is so strong it forces your back to hunch over. Bent-over. 

Same mosquito, different disease. Pleasant.
Not as deadly, apparently, as dengue fever, but far more uncomfortable - high fever, vomitting and diarrhea, intense pain in the joints and bones and, for added drama, a bright red rash that covers the body. 

We're not really sure if it's run through our house yet, but I'm going to bet on no. We all got some intense fevers, and I was pretty uncomfortable - but no rash, no intense bone pain. Amely, we think, had strep throat and so I'm sure that's also probably what Samil had. I probably just had pregnancy-whiny-ness. Katherine, Amalio's cousin, was down for the count for three days, but also didn't have the bone-pain. Amalio, of course, was left unscathed.

The gross-ness did make it's way through school - our attendance dove into the ground in June. I had parents in the office, waiting in line to tell me that their kid was sick. And our cook, our has-never-missed-a-day cook was out for three days because she literally could not put her feet on the ground to get out of bed. 

Earlier this week, a friend called to tell me that her two month old son had the chikungunya and could I recommend an ER? (Hi, Janet!) I recommended the ER I always use. I told her that I don't really buy into any of the pediatricians there, but we've always had a decent experience (with the exception of Amely's chicken-pox visit) with the doctors in this particular one - and as an added benefit, it's just busy enough to inspire confidence but not so busy to frustrate. 

I have never waited in this particular ER. ever.
I swung by on my way home from work, to check on her and the baby because medical care can be overwhelming here. I imagined she was on a bed, getting checked or waiting to get checked. She was standing in the triage area, with a thermometer under baby's arm because there was no where else to go. There were at least 25 people waiting in line - even pregnant women were waiting in line (unheard of for preggos to wait in ANY line in this country) because there were just so many people.

She was sent home with the indication to hydrate and continue acetometophen treatment. There's not really much else to do. 

I'm hoping to avoid being a statistic this time around - it's predicted the 85% of the island will be infected, and that it will be a worldwide epidemic, not limited to tropical regions. It's worse for newborns and the elderly. If you're traveling to the Caribbean, make sure to bring mosquito repellant and apply liberally to avoid bites. The specific "breed" of mosquito is more likely to bite during the day (instead of at dawn and dusk like "normal" mosquitos) and looks different than the mosquitos that most non-tropic-natives are used to (a little bigger, front legs are higher than hind legs, and are striped like a tiger). DO NOT take any pain medication except acetometophen (I don't know how to spell that), because Advil and others can make it worse. And, if you do get sick, hydrate, hydrate, hydrate!

Tuesday, July 8, 2014

never a dull moment.

On Sunday, I took the kids to the beach with our friends, The Rousculps.

The nearest beach is only about an hour from our house, and I'm very sad to tell you that we do not visit there often enough. It is a beautiful, Caribbean beach with waters as azul as the sky, and as warm as ocean water should be. The beach sand is white and soft. And.

And we can go there in January. Or March. Or really whenever.
But we don't.
Because we apparently do not know how to take advantage of what we've got.

Nevertheless, on Sunday, we went.

The water was beautiful, the sun was out. And, of course...

thank god it's not a baby! just a dead puffer-fish!
Josh wrestled with a barracuda. At first, he thought one of the kids had rammed into his leg, but when that "kid" bit into his trunks and tried to steal them, he put his hand down and felt a long, sleek fish that was pretty big.

Rebecca and I made friends with a sweet little girl, no older than 18 months who just wanted to eat our cookies.

And then! a dead puffer fish appeared in the water, and it was like a scene out of Dominican Baywatch -- you know, the slow motion of the entire beach running toward the lifeguards pulling a drowner out of the water onto the beach -- the entire population of the beach ran toward the brave swimmers carrying a dead fish out of the ocean, including a woman who dramatically dropped to her knees and praised God when she realized that it wasn't a drowned-child.

Overall, it was a great day. Just enough drama to keep it interesting and just enough energy to knock the kids out on the way home! (well, just the boys - Zora and Amely were all about their fantasy land).

On the way home, we pulled over to a road-side fruit stand and Josh got 5 avocadoes and a bucket of mangoes for less than three dollars. And that bucket of mangoes has SIXTEEN mangoes in it.

Friday, July 4, 2014

on reading.

Volunteer Anne Pelsser read to students
three times a week for an entire semester.
We miss you Anne (and Pierre!)
I've said - quite frequently and to anyone who would listen - that most of the problems that we've dealt with in starting and running a school are not the problems that I foresaw. I expected irresponsibility with payments, lack of concern from parents and maybe some teacher truancy and attendance issues. There are some inherent problems due to the demographic that the school serves, but overall, I guess I expected some semblance of teacher preparation and training - after all, all but one of our teachers (the 3-year old class teacher) are trained, professional educators.

I've known that there is a deeply entrenched literacy poverty in the Dominican Republic - even among the upper class - that affects how our children think and learn. There are no public libraries and most schools - again, even in the fancy private school - are lacking books. Sure, there are text books, but there is a deficiency in any other type of text: few story books, few non-fiction books, few encyclopedias.

What comes with this lack of actual physical reading resources is a lack of understanding of the real, profound importance of teaching kids not just to sound out words, but how to actually read - to comprehend, to question, to analyze the words that are on the page. But, how does one even go about switching something so ingrained culturally?

Samil was in first grade this year. He fought learning to read - he dug his heels in and absolutely refused to practice. Homework was a dreaded task - for everyone involved. The "reading" that was happening was phonetic, and from what I could decipher consisted in sounding out long lists of words.

No sentences. No pictures to describe sentences. No stories.
Lists and lists of words.

As far as technical reading goes, the method works. The student learns basic phonetic combinations of consonants and vowels (ma, me, mi, mo, mu), and then combines those sounds into simple words, building upon the previous sounds learned.

What happens when the student has to not only decode words, but decipher meaning in sentences? Or read a story and figure out the meaning?
Learning the phonetic sounds using scoops of ice-cream!

It's tragic.

One of the first teachers who worked at school - teaching three year olds - told me that she didn't have time to read stories to her students. That she needed to be focusing on far more important skills, like making sure everyone was sitting at the right table. Another told me that, after reading one story book, she just didn't have time for something the students aren't interested in. She taught four year olds.

Loving reading is an acquired skill. Loving stories is, too.
Unfortunately, there just hasn't been an emphasis on reading as a means to better educational quality. It is so hard to incorporate simple reading into the curriculum because neither the parents nor the teachers understand the importance. Sadly, I don't think this is a Dominican Republic problem. I think we're taking the joy out of reading for most kids - be it for lack of exposure, or for forcing test-based-reading, or for just not providing quality texts.
There are some awesome organizations on the island that are working hard to enhance the culture of reading for our kids. Check them out:

Amely loves reading story books!
FUNDEBIBO - is an organization that works to train librarians and other "resource-arians" and to promote literacy in the Dominican Republic. Based in Santo Domingo.

Lleva un libro en la maleta - is a grassroots movement to motivate people to bring a book, many books and/or school supplies with them in their suitcase when they visit the island and then donate them to schools that need them.

Fundacion Mahatma Gandhi  - is located in Las Terrenas - a beautiful beach town on the Samana peninsula and offers library services with more than 7000 books to the community.

Biblioteca Comunitaria Dr. William House is, of course, my favorite literacy program on the island. Located in San Francisco de Macoris, the library offers programs ranging from story time to English classes to art hour.

Thursday, July 3, 2014

Emergency (part 3)

Last March I had a health scare. It started with just a little shortness of breath, tightness in the chest and, overnight, escalated to not being able to breathe. I got  up in the morning and even got in the concho with Jewel to go to school. Half-way there, I knew I wasn't going to make it. Could we please just go to the emergency room of that terrible public hospital by school? Surely, being located next to a burning landfill they'll have the resources necessary to deal with a respiratory issue. We got out of the car, walked down to the hill to the ER entrance and asked our way in. It looked promising, until we got to the intake "desk" and they asked if I had a mask. No, I don't have a mask. I'm dying here and you are asking me about a mask? I didn't even know what in the world a mask had to do with anything - I don't suffer from breathing problems. The intake woman told us we needed a mask; they don't have any, we'd need to buy one from the pharmacy.
you may or may not get emergency care
from this very experienced doctor

The problem? It was only 7:30 and the pharmacy doesn't open until 8. Meanwhile, I couldn't breathe and I was scared. Instead of playing the game - mostly because we had no idea what the rules were - we walked back to the avenue, paid a concho to take us to a private clinic in the city and hoped for the best. I got nebulized twice that day and even after a few minutes on the machine I felt like a new person. I didn't pay more $40USD for the treatment and emergency care, but $40USD is a week's salary for most people.

Luckily for us, we've not had any real emergencies - Amely's ear bleeding, my one-time breathing issue, a few night-time/weekend fevers, some stitches - and the emergencies we've had have not been very serious.

Emergency medical care is laughable in public centers, but it is not any better in the private clinics. There is no "emergenc-ology" - most of the docs working in ERs are the doctors who just don't cut it anywhere else. From what I understand, the "emergencies" that are generally presented are so routine that it is not necessary to have specialty doctors waiting around. The occasional car accident or burn victims call in the on-call doctors.

Emergency care is generally cheap - especially because, with insurance, it covers all of the medications that they give you, plus the bed-fee and doctor honorarium. We paid just $16USD when Amely had the chicken-pox - which included a salmonella test, blood and urine tests and an IV of saline solution plus anti-vomit and fever-reducing medicine (don't even get me started on all of that). A friend of ours spilled a pot of boiling water on her lap and the bill for all of the services she received was $60USD, for what she reports was pretty decent medical care.

A visit to the local, public hospital to get stitches
for one of our students.

I visit that tragic public hospital far more frequently than I would like to admit, but considering the lack of resources, the doctors and nurses in the ER are polite, receptive and good at what they do. I've taken numerous students for stitches and the service is quick and as painless as stitches can be. And it has never cost us one cent. (In fact, the antibiotics, triple-antibiotic cream and tylenol that we have to purchase in these situations costs less than $3USD). Now that I know most of the emergency care nurses and intake personnel, we get nice service (and a lot of our students have reaped the benefit of a good relationship with these people).

Obviously, I don't have any serious emergency experience here (and for that I'm thankful), but basic emergency care isn't terrible - and I guess it really depends what you call an emergency. Make sure to steer clear of the public centers unless you know the people who work there, but remember that just because a place is swanky or costs more, doesn't mean you'll be getting better care.