Interlude: Dominican Junk Food

If there's one secret about me that's been revealed here in the DR, it is this: I am a closet junk food eater. It is difficult for me to admit this in public, especially given the fact that I'm studying to be a doctor and all. But no matter where I go, I can't help but be absolutely fascinated by the wide variety of  yummy snacks that people eat to clog their arteries.

So here's a whirlwind tour of the junk food of the DR. Unfortunately, I don't have pics of the "good" traditional junk food (a.k.a dulce de leche) that people *should* be eating when they visit another country. Nope--my junk food stash is the starving student's version, otherwise known as an emphasis on stuff that can be bought at the store or on the street for super cheap...:-)

1) Cookies



Dominicans love their cookies. That said, don't expect to find a lot of oversized chewy chocolate chip cookies a la Mrs. Fields. The hot, humid climate, in addition to the necessity of snacking on the run, has inspired a wide variety of sandwich cookies. My favorites are the "Mabel Mais" cookies in the yellow/red/white package, in the flavors Dulce de Leche and White Chocolate.

But what's most fun about cookies in the DR are the wild, zany flavors. The one on the bottom right is a pack of cream coookies with an orange filling. It was simply delightful--a bit like a cookie version of an orange creamsicle. My favorite "exotic" cookie, however, comes from the "Dino" line. These cookies definitely take the cake in terms of strange flavors, ranging from bubble gum to tropical punch. Pictured here are the green apple cookies, which taste surprisingly good. They also have the added benefit of imparting a green tinge to the tongue, hence the phrase "pintas lenguas verde" (paint tongues green) on the label...

2) Chocolate


So, I only have one thing to say: chocolate is not very impressive here in the DR. Most of the good stuff is imported from either the U.S. or Europe. I did try the Italian-manufactured Kinder "Bueno," which had chocolate-covered wafers with a smooth hazelnut filling. Being a hazelnut fanatic, I of course found these delectable, though I found myself unsatisfied by the relatively small serving size...

The other candy bar, "Mas-Mas" (more, more), which is made by a Dominican company, was much less impressive. Though it claimed to be milk chocolate, its texture was grainy and bitter. Indeed, the only novel selling point was its curious mix of ingredients: milk, raisins, and peanuts. The good news is that I paid about 14 pesos (a little over 33 cents), so at least I wasn't losing out on any money...

3) Chips (and salty snacks)



My somewhat hum-drum chocolate experience was redeemed by chips. Now this, the Dominicans do with style! I was delighted by the various salty snacks made of different starches such as yuca, plantains, and batata. There were also Pringles with a delightful "Limon" flavor, which was perfectly tart and zesty.

But by far the most exotic chip compilation was the "Mofongo Snax." It is patterned after the traditional Dominican "Mofongo" dish, which is pictured below:



For those who don't know, a Mofongo generally consists of mashed up plaintains, yuca, and fried meat. The chip version sought to recreate it through a mix of pork rinds, yuca and plaintain chips. Interesting concept, no doubt...

Well, that's all for the cultural junk food tour. Will return to serious posts shortly, but stay tuned for the next interlude of "food porn..." :-)

Day Twenty Three: Doctor for a Day

Most of you know that I am in my fourth year of medical school.This means two things:

1) I am purportedly at the peak of my clinical skills as a med student; and
2) I am absolutely terrified of the leap I will have to make next year when I actually graduate and have a "M.D." after my name.

As I approach the end of med school, I find myself torn between those two thoughts. On the one hand, I am excited to finally be able to take charge and provide direct care for my patients. On the other hand, it is terrifying to think that I must soon accept full responsibility for all of my medical decisions.

Nothing like volunteering in a relief mission to put things in perspective...

Earlier this morning, Adam, Ana, and I decided the best thing to do was to keep working in our respective areas so we could keep some continiuity of care for the patients. When I arrived back at the White Tent, I was greeted by the nurse I had worked with the day before, who immediately told me that our attending physician had just been assigned to go help with relief efforts in Port-Au-Prince. "It's just you and me today, I'm afraid," she told me. "Oh, and we have a new nurse today, who still has to learn the ropes. God help us..."

The significance of this didn't hit me until after I had helped the nurse take morning vital signs.

Ever since the heart-warming exchanges from yesterday's time in the tent, I found myself looking forward to any sort of patient contact I could have. Taking vital signs was a good excuse, since it allowed me to lay hands on every patient and at least impart a little laughter to their ordeal by speaking to them in my horrible Creole. Today, however, things were different from the moment I found a patient who had a slight fever. What resulted was the following exchange I had with the nurse:

Me: "I think this patient is feverish. His temp is 100.8."
Nurse: "Oh...okay. I'll make a note of it and tell the doctor when she..."
Me: "Wait, I thought the doc was in Port au Prince today."
Nurse: "Oops, you're right. So...what do you think we should do?"

I looked back at the nurse to see if she were joking. When she stared back at me in all due seriousness, I snapped back to attention. We ended up giving him Tylenol as I asked the patient questions and looked back in the chart for clues. Silently, I found myself cursing at the haphazardly-organized charts, which contained patient notes scrawled on everything from napkins and index cards to legal-sized paper. When all was said and done, I couldn't figure out if he had a new infection from his leg wound, or if he was developing a clot in his leg. Both scenarios were quite possible, but unable to do anything else at the moment, I decided to check back on the patient later and move on.

Over the course of the morning, I would move back-and-forth between the feverish patient, another patient with severe eye pain, as well as a post-op patient who was severely nauseated. I found myself particularly concerned with the eye pain patient, since I was able to see a huge area of pus that seemed to ooze out of her pupil. It was clear to me her eye was badly infected...perhaps to the point that she might need IV antibiotics as well as an opthalmologist to save her eyesight. Not knowing what else to do, I ran to the pharmacy and grabbed a couple of bottles of antibiotic eyedrops from a bin I had seen a couple of days before. Inside, I prayed that she wouldn't lose her vision...or more importantly, that my small intervention was the right thing to do.

As if in response to my silent plea for help, a doctor did manage to stop by our tent late in the morning. The doctor, who in reality was a second-year family medicine resident on her first day of duty, had just been appointed "medical director" of the tent patients that morning and was making rounds to get to know everyone. When I told her about the eye pain patient, she seemed very concerned. After examining the eye itself, the doctor sighed. "Don't worry," she told me. "What you did certainly did not harm her, but I think she needs an eye specialist. Who knows if we're going to be able to get one out here..."

After that, the doctor left, leaving me to fend for myself for most of the afternoon. During this time, the nurses and I managed a patient with a near-syncopal episode during physical therapy, a woman who was having a spontaneous abortion, and the post-op man from the morning (who began vomiting that afternoon due to lack of a proper bowel regimen). Things were amazingly chaotic. As I ran to the pharmacy, drew up my own IV meds, administered medication doses to patients, and tried to work together with the nurses to make sure everyone was stable--I gained a whole new level of appreciation for the potential experience I would have next year as an intern.

But just as I was getting too complacent with my new role as an ad-hoc attending physician, I made the crucial mistake of forgetting a key lesson: "always expect the unexpected." Indeed, the winds around the tents had been picking up that entire afternoon, beating aggressively against the walls of the tents as they coursed through the area. My tent, the White tent, shook dangerously with each passing gust. It was the flimsiest of all tents, and I could see the patients and their families cringe with every movement and swaying of the tent.

As I was drawing up a final set of IV meds, a particularly strong gust of wind came through and knocked down a huge wooden bench of supplies that had been anchoring the tent down. Boxes fell directly on my ankle, causing a sharp pain in my foot. I watched helplessly as the wind buffeted the wall back and fourth. At one point, I glanced down at a male patient who was trying his hardest to have a bowel movement on the bedpan. "Is the tent going to fall down on me?" he asked me slowly in Creole, holding tightly to his bedpan. "I don't know," I responded gravely, not quite knowing what else to say.

Luckily, several other volunteers had heard about our plight and offered to help put new stakes in the ground so that the tent could stay put. And my foot was fine...only amounting to a number of superficial abrasions. By the time the nursing shift ended at 8pm, I saw the real attending physician enter the tent out of the corner of my eye. Apparently, the group from Port Au Prince was able to come back earlier than they thought.

Feeling thankful, I heaved a sigh of relief, gave the attending physician an account of what had happened that day, and left the tent, grateful to come back to my role as a fourth-year medical student.

Day Twenty-Two: "Help Me and I'll Help You"

We woke up today to an eerily beautiful Sunday morning. It was, in fact, the prettiest morning I had seen in quite a while. The sun hadn't yet come up completely as I walked out on the hospital balcony, feeling at peace amongst the subtle gradient of blues, purples, and reds that caressed the sky. A faint breeze rustled the tents below--a refreshing change from the strong winds that frequently blew sand into our eyes in the heat of the afternoon.

Ana and I were joined by Adam and our new attending, Dr. Fowler, last night. We had decided before going to bed that we would float around the next day and go wherever help was needed. As it turns out, there was finally enough help at the pharmacy for all of us to be assigned to the tents or to the ICU for the entire day. And so, Adam was sent to the Brown tent to help Rhianna (the resident), Ana went to help out Dr. Fowler in the ICU, and I sauntered off alone to the White tent.

My mind flashed back to some of the experiences I had had during my afternoon in the Brown tent the afternoon before. As much as I wanted to go in and help the patients, a part of me hesitated at the thought of subjecting the patients to their daily routine of painful wound dressing changes and physical therapy. It was heartbreaking to see them cry and wince as I ripped off bandages and rinsed their large, open wounds with saline. And it was equally hard to watch as the physical therapists came in, fully ready to give their "tough love" as they pushed, pulled, and tugged at the patients' arms and legs--desperate to infuse function back into those injured limbs amidst their screams.

So it was with somewhat mixed emotions that I entered the White tent to meet the patients for the first time. But to my surprise, many of the patients were gone. When I asked the nurse where everyone was, she answered, "Why, they're at church, silly! It's Sunday..."



Directly to the right of the White Tent sat an old Chapel, which had since been transformed into a "makeshift pediatric ward" for the interim. There were crowds of people spilling out of the entrance. To my amazement, I saw row upon row of patients in wheelchairs and crutches, singing and clapping happily in rhythm as their pastor led them in song. Many of them were people I had just seen the day before, laying weakly in bed and moaning in pain as they did their daily physical therapy. But there they were, transformed right before my eyes, smiling and rocking gently from side to side to the music.

I couldn't help but marvel at the healing power of religion.

The church service lasted for the entire morning, creating a major hiccup for nurses wanting to administer meds and for surgeons who needed to take their patients to the operating room. Thankfully, the patients' high spirits were contageous enough that no one overreacted. For me, it truly was the perfect day to become acquainted with the White tent. I took my time helping the nurse with vitals, dressing changes, and medicine administration, pausing numerous times to talk to patients in my limited Creole.

There was one patient, in particular, who took great sympathy to my attempts to learn her language. Her name was Katherine. She was a thin, spunky 19-year old who had sustained a fairly extensive crush injury to her left leg, as well as a nasty gash to her thigh that had since become badly infected. As I carefully cleaned her wound--a task that caused her great pain--she would divert her attention to improving my pitiful Creole. It got to the point that she refused to acknowledge me when I spoke in English, preferring to speak to me slowly in her language until I got the gist of what she was saying.

"Ede m ede ou," Katherine pronounced gravely to me, as I finished wrapping her bandage. (Help me and I'll help you).  I simply smiled to show my gratefulness, to which in response, she smiled back.

I would eventually work for twelve hours that day before heading back to the pharmacy to help inventory the medications. Leaving the tent, I felt a strong feeling of awe at the sense of community that was so present among the patients. Indeed, this communal respect had always been there to some extent. But somehow, it had been amplified in an unforgettable manner by the intimate sharing of faith that had taken place during that morning's church service.

I, for one, was glad to have been included...no matter how briefly. For the first time during my time in Jimani, I went to bed feeling strangely refreshed by the day's work.

Home Sweet Home

So it's been a couple of days since I've returned from the DR. I've got many posts to catch up on, but I have to say--it's wonderful to be home and away from the constant symphony of honking horns in Santiago.

I'm still catching up with a slew of projects that have accumulated while I was away, but I will still continue updating the blog with posts from the last part of my trip.

Stay tuned...