About Me

We are the student pharmacists, pharmacists, and staff selected to participate in the yearly International Dominica Pharmacy Rotation offered. We hope you enjoy reading and sharing our adventures. If you are interested in learning more - contact us at abronsdominicarotation@gmail.com

Tuesday, October 25, 2011

Dominica Experience Thus Far and Personal Impact

Good morning,

The first week spent in Dominica has created a different perspective for me personally. I have developed acquaintances with the staff at Jungle Bay, built stronger relationships with my peers, and learned a significant amount of knowledge from the people who have lived in Dominica for most of their life. An entire history of tradition and culture is unraveling before our eyes and it is quite incredible.

A concern I had before my travels to Dominica was my ability to maneuver the natural terrain of the island. Currently, I am recovering from a foot injury and am on crutches. The staff here at Jungle Bay are exceptional and their hospitality is well appreciated. I am thankful to be in the care of such wonderful friends. Despite my inability to participate in the magnificent hiking opportunities, I am quite satisfied with the activities I have been able to experience.

This past week I have attended two health clinics. I have had the time to speak with many patients about their health and immunizations.

The group also spent time with Moses, a local medicine man who practices Bush medicine. His knowledge of the number of plants and herbs on Dominica for medicinal use is phenomenal. He explained to the group people visit him and tell him about their symptoms. Moses is then able to identify a plant or an herb specific to their symptoms, which is outstanding.

We also attended the House of Hope for a day. Our objective for the first visit was to become introduced to the volunteers and children, interact with the children, and begin drawing murals on the walls. We plan to finish drawing and painting the murals this week during our second visit.

We also went to the capital of Dominica, Roseau, on Saturday for a Market Tour and hiking at Trafalgar Falls. The Market Place was particularly interesting. Many people there had fruits, vegetables, herbs, spices, and Bush medicine to sell. We also ate a local rerestaurant, Pearl's Cuisine, and visited Jolly's Pharmacy. The group will return to Roseau for the Creole World Music Festival at the end of this week. Our visit to Trafalgar Falls was incredible. The hiking trail to the pavilion looking up at the falls was mostly all steps and level ground. However, the rest of the trail beyond the pavilion descending to the falls and was more treacherous. There were wet boulders and other small rocks the group had to pass. Carlos was one of the guides on our hike. I was grateful for Carlos' help in guiding me up the steps to the falls. It was a challenge using the crutches up the steps to the falls, but the moment I saw the spectacular view my heart sank.  I realized the personal accomplishment I made and the determination I had in order to see the breathtaking view. He stayed with me at the pavilion as we both enjoyed the beautiful scenery of the two waterfalls. Carlos explained to me one waterfall produces cold water and the other produces hot water. Also, one waterfall is used for hydro-electricity. The sounds both waterfalls created was peaceful and taking the time to listen to nature was a reward in itself.


 

Delices School

At the beginning of last week we traveled a short distance up the road from Jungle Bay to a small town called Delices, where we planned to spend the day with school children. There were six different classrooms that hosted a breadth of age groups ranging from kindergarten to 6th grade. The school itself was made up of four different buildings closely grouped together, placed against a breathtaking backdrop. The class rooms were small, without artificial lighting, with walls marked by a honeycomb like pattern of holes for natural air conditioning. Roughly hewn wooden desks and chairs held uniformed children bubbling with the excitement of our visit. Tattered work books, composition notebooks, well worn pencils and erasers and water bottles were strewn across the desk tops. Large chalkboards framed the front of the rooms with varying lessons from the previous day still painted across their faces.

We split up into groups of two or three and each tackled a classroom. Hassan, Joshua and I took the first classroom, made up of approximately twenty 5th and 6th grade students. As their normal teacher had not come that day (an occurrence apparently commonplace here) we accepted the challenge of teaching the day's lessons; mathematics and social studies. The children were at widely varying levels of ability. Some were struggling with pattern recognition and additions while others were flying through long division and exponential functions. Regardless, they all shared an enthusiasm for learning and a strict behavioral code not often seen in United States children of the same age.

After lunch we rearranged our groups and laid out a pharmacy practice activity for the children to enjoy. We had bottles of oil, syrup and water to demonstrate partition coefficients, emulsions, viscosity, density and even glitter to demonstrate suspensions. We had acquired "arro root" fresh from Jungle Bay to serve as an edible ointment base. We had children crush up Smarties (trituration) and then mix it into the gelatinous root base (levigation). Many of the children enjoyed the activity. Personally, I was paired with Krissy in the kindergarten classroom and the children had a difficult time grasping the mechanics and concepts of the activity. But they really enjoyed the sweets! Afterwards we had the children draw, color and complete word searches while we regaled them with lessons borrowed from Katie's Kids (medicine is not candy!). The day was closed with physical fitness activities which included soccer (futball), bowling, obstacle courses and wall ball.



The children really enjoyed having us there. They learned most of our names very quickly and followed us with keen curiosity. They especially enjoyed using our cameras, playing games with us and touching Krissy's hair. It was a memorable day for everyone and I believe we had a positive impact at the school. I've uploaded several images at the beginning of this post; Hassan teaching mathematics, a shot of the school against the mountain and a group photo taken by a young boy at the end of the day.

Monday, October 24, 2011

Health Fair: Group Picture

Boiling Lake: Group Picture

Boiling Lake


            I hope all is well; I am having a wonderful time in Dominica, learning a lot and having wonderful experiences.  Yesterday I went on the signature Dominican hike to Boiling Lake with our guide Brother and my fellow classmates Hassan, Michael, Josh, Krissy, Rachel, Brittany, and a couple staying at Jungle Bay, Matt and Bindy.  I have to say I was extremely hesitant on going after hearing about the level of difficulty; after finally just putting my mind to it, I somehow had the courage to just do it.  

            We left Jungle Bay at 7:30 a.m. and then started on a ninety-minute drive to the destination.  The hike itself up was a little over three hours long each way.  I decided to pace myself as I knew it was going to be a long way and I kept myself hydrated and well nourished. When we made it to the top of one of the mountains, I was at a loss of words; the view was breathtaking and I was amazed at what I was overlooking.  We hiked a little further and Brother face painted each of us with the sulfur from the ground. 
           
            When we finally made it to the Boiling Lake, I felt proud of what I was able to do and was in aw of the view.  Brother had told us the water was over two hundred degrees, (don’t worry none of us took a dip in the water).  The lake was simply incredible and cannot be described unless you actually see it in person.  We all sat overlooking the lake for a while and ate our lunch and taking it all in. 

            On the way back we stopped and swam in the hot springs and let me just say this was, awesome!  It felt like I was sitting in a hot tub, the water was warm and there was a waterfall that you could lean up against and it felt like you were getting a back massage.  The way down took just as much time as it did going up, but once I finished I was proud of what I had done.

             It was a great learning experience and I learned that I could really accomplish anything I put my mind towards.  The hike and the views were spectacular, even though it was a long and at times exhausting hike; I took some time to reflect and really just made the most of my experience.  I think everyone really enjoyed this experience and Brother was a great guide and took good care of us along the way.  To anyone that has not yet completed this hike, I recommend that you do and put it on your “bucket list!”  

First Health Fair in Dominica

Today was the first health fair ever held in Dominica. Patients had been recruited to come to the clinic by posters that had been hung in various loations such as churches and across various clinics. We counted approximately 60-70 patients who came through and listened to our expert topics. It was refreshing to see how much information patient's knew about various disease states that either them, a relative or friend may have had.

Overall the fair went extremely well for being the first in this country. At around 12 refreshments and snacks were provided at the fair by Jungle Bay.

Patients were extremely interested in learning and taking various handouts from us at our individual stations. It was nice to haev people be interested in our presentations. They were also greatly appreciative of the donations that we brought down and provided to them.

In addition to presenting our expert topics to patients there were other services available such as HIV rapid testing, immunizations and massages.

We came up with a few ideas that may be beneficial to future clinics such as: bags or folders for patients to take things home with them. Possibly more space for the students to spread out so that we can spend more time with more peopleand laminated signs for specific disease states for patients to know where to go. Have students with similar topics have booths next to each other for the ease of the patients.

Petite Savanne

On Friday,  we had the opportunity to visit another school.  This school was located in Petite Savanne and had students from pre-K to sixth grade.  The children were thrilled to see us when we arrived.  We were greeted with lots of curiosity and questions.

The morning was filled with medication safety and pharmacy education.  It was a fun and energized adventure!  The children really loved just engaging with us and were estatic to get the chance to read to us. The day was concluded with some physical activity games we had prepared before arriving on Dominica.

It was interesting to compare this visit with our previous stop at the Delice school.  There was a strong religious aknowledgement before and after lunch and what seemed to be more respect for discipline and order at this school. It felt like there was more emphasis on learning to read and write and the children were quite active and happy to be working with us.  Nevertheless, even reflecting back on the Delice school, I am pretty impressed with the overall effort being put forth on this island.  I have been to several other countries where there is not even a building for school to be held in.  Overall, there are differences between the schools here in Dominica but the opportunity for schooling is much greater than several other developing nations.

Saturday, October 22, 2011

Pharmacy in Dominica

Today we went to Roseau where we experienced the market and also the pharmacy "Jolly." At the market we all picked up different items. Bridget and I bought many products used for cooking such as bay leaves, nutmeg and cinnamon sticks. After the market we also went to Trafalgar Falls and experienced the hot and cold water falls. We were able to swim in various areas of the falls that included hot and cold temperatures. The water was very clear and clean. I(Nicole) swam in the water for the first time and feel as though I have gotten over my water phobia for the time being!

At the pharmacy we were able to see just how different shelves were arranged compared to our over the counter medications in the US. There were many cream products such as betamethasone and retin-a that are sold over the counter in Dominica but only available as prescription in the US. They also sold tylenol with codeine over the counter. It was interesting to see how different restrictions are on certain medications.

Friday, October 21, 2011

Jungle Bay Staff

While here in Dominica after our trip to Palm's Paradise I haven't been feeling very good. I have to say that the Jungle Bay staff (JoAnna, Justinian, Sam, ..etc) have been so wonderful. They have made me ginger tea for my upset stomach, given me coconut water to help rehydrate me, and even made me special food to help settle my stomach. It feels so nice to be taken care of in such a way when I am so far away from home and just want to curl up in my own bed. I really appreciate everything they have done and it has made my not feeling well a little easier to deal with. I never thought that coming down to Dominica to learn about bush medicine would become literal for me - well, I can say that the ginger tea is very spicy and must be sipped in small quantities and the coconut water is very refreshing. I am very thankful for the expertise of the wonderful Jungle Bay staff!

Petite Savanne School

Today we ventured to the Petite Savanne School where we split up into pairs, organized the donations and met the "on-duty" principal.  This school was very well organized with 3 levels, grades including pre-k until 6th grade.  The children were very excited for us to be there and welcomed us with open arms.

We each gave a presentation on "Katy's kids" to our respective classes, this time adding honey into our ointments as a wetting agent.   This addition seemed to work out with more success.  The children seemed to have a good knowledge base of what a pharmacist does as well as various bush and western medications, including Paracetamol and Benadryl.  After our presentations, we gave the kids pencils, erasers and stickers and they were very appreciative for these gifts.  We also did our physical fitness activities which included an obstacle course (with bowling added to it this time) and a soccer game.

Upon leaving, all of the children gave us kisses and hugs including papers that stated "I love you miss".  This was very touching and reminded us of the reasons as to why we came to Dominica for this rotation.  It was very sad to leave, but we are going to keep in touch with the children and send them pictures after we return to the US.  Today was a day that we will remember for the rest of our lives.

Thursday, October 20, 2011

Our Visit to Pomme:





As referred to in the post directly proceeding mine, our group's adventure for today included a trip to see Pomme, a man dedicated to preserving a natural-method of life. Pomme, who touts that he is largely self-sufficient and rarely (if ever), spent the greater part of his mid-morning and late afternoon describing for us the methodologies that define his life.

The trip to Pomme's was a journey within itself. We waded through three streams, and over one river to begin the climb up-to the mountain path that led to Pomme's residence. Our guide was Brother, an employee of Jungle Bay who stopped often to explain to us much of the local flora, such as cinnamon bark, guava and star-fruit. When we finally reached Pomme's, he greeted us with a hearty hello and led us to his dining table, where we dined on some of the fruits picked in his garden.

We then went on a tour of his land, and were constantly amazed by the awesome preservation of nature that was displayed by Pomme. There was no wasted space, no giant-screen TV, no heaps of garbage strewn about. The area seemed un-real, almost as though it was impossible that such a place could still exist on this planet and in such perfect harmony with human civilization.


It was with heavy heart that we left Pomme's Paradise. As we reflected, we compared our methodologies of living with Pomme's and noted how while we were focused on finding specific cures for illnesses, Pomme focused on holistic methods for living he felt encouraged a healthy life-style. The lesson we walked away with was one that encouraged us to consider our patients on a level that encompassed not only their clinical presentation, but their lifestyle, religion, behavioral patterns, and over-all health in order to better target a general improvement in health.

Moses the Herbalist



Yesterday afternoon the group visited an herbalist named Moses at his home in a rather secluded valley of Dominica. Moses sent us out into the farms and trails surrounding his home and asked us to identify various flowers, fruits, herbs and plants. The group scattered around the area, grabbing this fruit and that herb and this weed, all trying to differentiate the various species (which, to our American eyes, tend to look a lot alike!). A few of us meandered a good distance from Moses' home, finding a beautiful series of streams that intertwined like so many lengths of thread into a single cascade down the mountain-side. Our group slowly found its way back to Moses and supplicated approval of our choices. Vervain, Ginger, Cinnamin, Cocoa and Aloe Vera were amongst the samples collected. Moses described, in intricate detail allowed only by an unusual expertise, what each sample was used for. Stomach upset, headaches, colds, cough, menstrual cramps, asthma, blood pressure, chest pain and even nightmares were counted amongst the conditions treatable by our herbs. Beyond the somatic, Moses carefully stressed the spiritual importance of these products. Purging of negative energy and potent protection from evil are often times sought from these herbs.

At the end of the afternoon, Moses stressed the importance of herbal and other holistic treatments to the people of Dominica, historically bereft of physicians of any specialty. These natural remedies were, to a large extent, both the first and only line of therapy. As Dominica changes, and Western influences (both positive and negative) alter the fragile fabric of tradition, the dependence on such remedies is not so obligatory. Yet their importance, heritage and use does not appear to have significantly declined. Moses would tenaciously contend that these herbs and remedies are the primary reason for the unique and impressive longevity of Dominican citizens - and there may be some substance to his claim. Yet overall, Moses agrees that the general healthy lifestyle practices, both from diet and exercise, found in Dominica contribute greatly to their longevity. This was a point powerfully supported by the hike to Pomme's Paradise the next day.


Wednesday, October 19, 2011

House of Hope



Today, we divided into 2 separate groups where each group made "sock puppets/stuffed animals" and also went to the House of Hope to make the patients' days brighter. My group consisted of myself, Peter, Krissy, Dara and Rachel.   Peter and I specifically sewed together a Zebra to the best of our ability.  We will have to place a picture up online when possible!  Our group decided to stencil and paint the two bathrooms with the themes of "jungle" and "stars/moons" and also the outer balcony with leaves and flowers. We will be returning to the House of Hope in approximately a week to finish painting for the patients, to spend more time with them and show them we all care.


Most of us also trekked up "Paix Busche" which is approximately 3 1/2 - 4 miles altogether but up a very steep terrain. I unfortunately only made it up 1/2 of the way because I did not condition myself to walk up mountains, but my goal is to eventually make the entire mountain by the end of our 2 week trip!!


Tuesday, October 18, 2011

LaPlaine Clinic


Above you are the faces of some of the patient's at the Laplaine Clinic. In the background stands Michael, discussing methods he can use to further benefit the patient's at the Clinic with Kristen, our mentor.

Today's day was varied, and challenging. As the five of us entered the LaPlaine Clinic ,we were greeted by the smiling faces of our patients'. The doctor residing over the clinic ushered us into the corner and proudly announced to the patients, "These are the health-care professionals I told you about! They will teach you about some of the problems that may bring you here! Listen to them!"

And with that, she was off. We were whisked into the front of the room and asked to present the topics we had spent the greater part of the last few weeks "Becoming the experts" in, and thus spent the next our discussing topics such as hypertension, Chronic Kidney Disorder, wound management, immunizations, and nutrition. Our patient's listed with rapt attention, nodding their heads in approval when they understood and asking questions of us when they didn't.


The next hour played out the scene I mentioned earlier. We spoke with our patients, interacting with them, asking questions and obtaining relevant medical histories. Although we met only briefly, we established relationships that we feel will be integral to the professional character we will develop as our careers blossom.   Gratitude for our contributions brought a fierce joy in the servitude for our patients, and we all walked away from the experience feeling blessed for the opportunity.


Lastly, we spent an hour working with the local pharmacist, Kent. From him, we learned the difficulties of a pharmacist in Dominica, and how his job branched out into much more than simply the dispensing of medication. He recounted a story to us wherein the previous week he had been asked at 3:00 A.M. to provide hospital for a clinic in a nearby-village when they had an unexpected delivery late into the night.  Out of curiousness, we asked if this meant he was on call.

Laughing, he looked at us and said, "No, I'm not on call. I'm simply there whenever I'm needed."

Reflections on our First Day of Clinic

99%. That is the percentage of Dominicans that are immunized. The United States does not even rate that high.Why, what is the difference between Dominica and the United States?
Is it the smaller population? Probably.
Could it the tireless devotion of the health care practitioners? Maybe.
The most likely answer is the relationship between the health care practitioners and the population. There is a mutual trust. The patient trusts that the health care practitioner will heal; while the health care practitioner trusts the patient will take their medication.

Our group saw that today at the Petite Savanna clinic. The clinic, which is nothing more than 7 pews, an examination room, small pharmacy, and nurse quarters, began the first step of the 3 part process of vaccinating over 25 patients against hepatitis B. We, the student pharmacists and Dr. Abrons, helped by drawing up doses of the vaccine and by giving the patients valuable information in regards to tropical diseases, nutrition, arthritis, pain, diabetes, and dental care.

It was beautiful. Healing took place. Not in the ideology of treating the disease, but in prevention of disease. Although this seems counter-intuitive, especially in a world where disease treatment, not prevention or cure, equals revenue, it is where pharmacists are needed the most, in the barely known territory of public health.

Thursday, October 13, 2011

Making an Impact


Reflecting on yesterday’s discussion I really feel I want to make an impact on the students going through school behind me.  I have learned over the years that I and other students really focus too much on getting an “A” and not growing in our profession by experience.  Over the past couple of years I have discovered that the best way to make pharmacy school worthwhile is to relax and enjoy what you do.  I think the greatest experience a student can have is to enjoy his/her time in school and do activities that they enjoy.  If one makes these choices it will open doors to career paths that bring excitement to the student and introduce one to people who enjoy similar events.  Overall, I hope to impact others by living and enjoying what I do in life.  We are always amazed when we see people happy to do what they are doing but at the same time we struggle to know what makes them happy.  Life should make you happy.

Wednesday, October 12, 2011

Reflection


I thought today’s discussion was very beneficial.  It was mostly able to get me thinking about the benefits of living a healthy lifestyle, the importance of exercise and how to effectively manage my time.  As a student pharmacist I feel proper diet and exercise are very important, as the health benefits are endless.  Lifestyle modification is often the best way to make changes to avoid various medical conditions and having to take medications.  I think it is very easy to say this to our patients we see in the pharmacy, but to actually do it ourselves is another thing.  I find it is important to have the right mentality to eat right and exercise regularly.  For me it makes me feel better about myself and often decreases my stress level.  I think being able to share my own experiences with others will hopefully make a difference in their lives. 

Time management is something most individuals struggle with on a daily basis, and I myself am guilty of this.  I think the best way to improve on this is just to get constant reminders of how to effectively manage time.  Just having the discussion today gave me better ideas of how I can make improvements in my everyday life.  Whether it is making a list of things to do or trying to prioritize things of importance.   We all have busy lives and have often so much going on; I think it is important to just take one day at a time and know that you will get things done if you just take your time and try not to stress over it too much.  

Career Reflection

Today we spent some time discussing how we can develop our careers as we get closer to becoming pharmacists.  Part of the discussion focused on time management; specifically, we talked about the importance of finding time for ourselves.  I think this is an important aspect of our lives to consider; we will be working very hard at our careers, and it is important to take time to recharge and relax.  We also talked about some of the paths we will be able to take.  What I think will be helpful for me will be to take the pharmacist.com career paths quiz.  It is helpful to know that not everyone takes a direct path to end up where they are.  I hope that over the course of rotations I will be able to figure out a perfect fit for myself. 

Krissy Wright

Reflecting on our careers paths; where we are and where we’re going

The question appears simple enough - why are you in pharmacy? For some, the answer is quite clear. “My parents are in pharmacy” or “I have family in pharmacy”. Sometimes by chance of a high school job that turned into a passion or a counselor that guided your direction. For some people though, as is true for myself, we meandered into pharmacy; our eyes upon the broader goal of helping people and making a difference. And even then there are some that choose pharmacy out of pure pragmatism. It demonstrates one of the fastest tracks to a doctorate of any profession, it is routinely listed among the nation’s most trusted and lucrative professions, and although less and less so, five years ago the profession was also in tremendous demand. There is no absence of reason to embark on a career in pharmacy and when asking a group of student pharmacists why they’ve chosen pharmacy, you’re likely to get a myriad of responses.

What is uniquely true about pharmacy, however, is that of the nearly endless paths that may bring us here there are an equal number of paths that bring us onward. Contrary to a well-ingrained community misconception, only a fraction of pharmacy students will end up behind a counter at Walgreens.  From retail, hospital, clinical, administrative, sales, compounding, research, consulting and academics there is a veritable deluge of opportunities that often threatens to drown new graduates in indecision. And even within these categories hide a host of specializations that may further serve to tailor your work into exactly what you’d like to do. Ideally, student pharmacists would be well versed in the opportunities ahead of them, but even within our circles lies an unspoken and yet powerful ultimatum; retail or residency. It is a common and yet unfortunate truth that many new pharmacists are well along a chosen career path before they realize just how many opportunities they have. The college does an acceptable job of opening student eyes to the entire breadth of pharmacy but the unspoken ultimatum tends to cloud their vision, even then. The best thing is for practicing pharmacists, veterans in their chosen paths to mentor students on their options; warning against pitfalls and exposing them on opportunities previously unknown.

Future Career Ideas

Today Dr. A discussed many ideas/options as to what we could do in our near future as registered pharmacists. Though there are many career paths we can go down, it is very nerve-racking and even scary to decide what would be the best choice for me as an individual.  I feel as though the correct path for me is to apply for a residency, with the hopes of getting a residency for next year and in the future be a clinical pharmacist.  Dr. A opened my eyes up to a ton of different ways to figure out the many different paths even a clinical pharmacist could choose, and also the resources to help in applying for a residency.  I mostly enjoyed our talk regarding our future careers because it helped me realize that I do not have to have a definitive idea as to what I want/need to do after graduating in May, I need to just focus on what would be the best choices for me to start thinking about my future(yet so near) career.
I also enjoyed learning about the people in Dominica and how healthy some of them are, living to be over 100 years old.  It goes to show you that though all of the new age amenities that we have now are convenient, sometimes you need to think about your health and take the hard way such as walk more or go up flights of stairs instead of using elevators.  This definitely re-inforces the fact that I need to continue my yoga practices and my many other ways of exercising.

Reflections on Health, Work Ethics, and Our Futures

Triage, a French term meaning to sort, is an excellent way to describe my life. Every day I have to sort out what is immediate, what needs to be done today, and what can wait until tomorrow. This triage mechanism is not static, but fluid and dynamic. For example, when charged with writing this blog, I shifted my priorities to complete this and moved other priorities (e.g. removing the air conditioner from my room) down. What I learned from the discussion today is that I am not the only one that this system. That makes me feel good; I know there is strength in numbers. 

Paying it forward, an ideology Dr. Abrons taught us is an excellent concept that I hope that I can use when I graduate from school. The idea is to give back to someone what has been given to you. I believe this concept is similar to my own ideology which is as healthcare professioanls we are tasked with cultivating a generation of healthcare professionals after us. It is my hope that I can help teach a more compassionate, more intelligent, and better team members than my generation.

As what I want to do with my life: I know I want to become a physician and practice in family or emergency medicine. I would like to sub-specialize in palliative care. But like with all things, only time will tell.