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

Thursday, May 9, 2013

Future Companions



Dear future rotation student,

Congratulations on being selected to embark on an eye opening rotation on the beautiful island of Dominica. Not only will you be learning about another culture, but also about yourself too. You’ll learn that no matter how much cardio you do prior to going, it still probably wasn’t enough. You’ll find team building exercises informally through hikes, at clinics, and at the House of Hope. Many times its mind over matter (like Paix Bouche, - you’ll understand when you get here) and be prepared to think out of the box. Be cognitive to the way people live off the land and that most of them travel by foot unless they can get a ride. The people are friendly and do not be afraid to approach them with open arms (literally though because they give lots of hugs here!) You’ll find nothing but warm hearts and scenic views during your stay. Enjoy the refreshing food and atmosphere while you can because the two weeks will be done before you know it! 

Best of luck!
Aimee

Monday, May 6, 2013

A busy clinic day at Riviere Cyrique

On Thursday, I got to travel with Hassan, Griffan, and Aimee to Riviere Cyrique, another small rural health clinic that is to the north of Jungle Bay. As is typical with clinics here, we were unsure of what to expect; last week, there were only 2 patients, both of whom had wounds to treat. This day turned out to be a general clinic day, and the waiting area was packed with patients from infant to elderly.

We introduced ourselves and talked a bit with some of the patients, but most were uninterested in one-on-one discussions, so we spent the majority of our time rotating between the nurse, the physician, and the pharmacist. While in the room with the nurse, I got to hear her assess the patient's history of present illness, take vital signs, and decide whether or not the patient required a visit with the prescriber. She carefully asked each patient what medicines he or she took, and often had to ask multiple times whether that patient had remembered to take those medicines that morning. One patient in particular made me sad because she seemed to have some untreated dementia and was simply lonely, and I wish that I had more time and resources to help her. She could have used a pill box, some counseling, and definitely someone to care for her at home. Unfortunately, things like pill boxes are difficult to find in Dominica.

In spending time with the physician, we were asked drug information questions, discussed therapy recommendations, and got to know one another on a more personal level. We also saw some bedside procedures, like changing of a suprapubic urinary catheter, which was an unexpected event in such a clinic setting and allowed a great opportunity for questions about protocols and how they handle medical devices. The physician also helped us relate better to the patients and translated when they were difficult to understand. My favorite patient of the day was an elderly woman complaining of pain on her head. After some questioning, we realized that the scalp pain was likely from years of carrying heavy loads on her head; we would have never thought of that in the US, but here in Dominica, it makes a lot of sense because that is a common way to transport goods without a vehicle. It was definitely a moment of culture shock!

I also got to spend quite a bit of time with the pharmacist. This was an excellent opportunity for me to ask him questions about his resources, how he manages stock (he traveled to the clinic with a suitcase full of medications and some cardboard boxes with supplies, but cannot take more than that with him from the La Plaine clinic), and about pharmacy practice in Dominica. Because the medications are heavily restricted by government ordering, the sourcing changes frequently: his medication stock comes from all over the world, including India, Canada, the USA, and China. I was particularly intrigued by some of his stories of counterfeit medications that he found, how he reacted to them, and how he tries to prevent his patients from receiving such counterfeits. Pharmacy practice in the public sector in Dominica is tough. This pharmacist is basically on duty 24/7, and has to come in to the clinic for emergencies outside of normal clinic hours and takes patient phone calls on his cell phone. I have so much respect for the few, dedicated pharmacists in Dominica whom we had the opportunity to meet. It not only makes me grateful for the work environment that I have here in the States, but helps me see even more poignantly where I can help improve patient care (and make their jobs a tiny bit easier) from across the world.


Jessica S.

Moses Day 2 and Tea Parties

On Wednesday, May 1st we went back to see Moses. I couldn't get the pictures to upload while I was in Dominica so I had to wait until we got back.

Since Jackie has already given you the details of how the coconut oil is prepared, I'll provide some pictures (thanks to Hassan for taking them!) of each process.

Step 1: Open up and clean the coconuts. We had about 14 coconuts to use and surprisingly, they don't really make that much coconut oil.
 

 
Here is Eric cutting out some coconuts
 

Step 2: Shred the coconut
Here we are working hard together to shred the coconut -
we may have snuck a few bites of coconut here and there too :)

Step 3: Mix the shredded coconut with water and squeeze the milk out of it. Strain the excess coconut strands.

Griffan and Moses squeezing out the milk

Step 4: Boil until the water is completely boiled off. May add cinnamon leaves or other herbal remedies for smell. Moses also added plantains which keep the oil from boiling over.
Our creation

Step 5: Stir

Christina stirring


Step 6: Place into bottles and add bay oil.


Moses prepping the bottles

Step 7: Enjoy :)
Our finished product


Although it sounds pretty simple, it is a lot of work! Like Jackie said, there were 6 of us shredding coconut at the same time and we still didn't finish all 14 coconuts.
It was a really fun experience but I'm not sure I can imagine doing that every day -- it's really labor intensive. It makes you appreciate the amount of work that goes into it. I personally had no idea how coconut oil was made and was certainly a little surprised to find out.

Part 2: Tea Parties
After we came back from making coconut oil with Moses, we met up with Justin and Joanne to learn about some herbal teas and sample them.

They made a ton of teas and I think we were all pretty full of liquid by the time it was over but it was interesting to learn about the different uses of each herb and it tasted pretty good too.

They started off with some cinnamon tea which is delicious -- I put a bit of honey in mine for some added sweetness which was so good! They say cinnamon is used for women with menstrual cramps. We also had spearmint which is good for gas and is a great decongestant. We tried rosemary tea which is also used for menstrual cramps. We also tried 3 finger leaf tea which was bitter but some of us actually really liked the tea, myself included. The basil tea was a really strong tasting tea and can be used for sleep. There were quite a few others that we tried on top of these but I just wanted to name a few of them to share some knowledge.

By Wednesday we only had 2 more full days in Dominica and I was already pretty sad it would be over soon. Although my friends and family were missing me back home, I was really sad to be leaving. I wasn't sure how life-changing the experiences were going to be but was/am shocked at the differences in myself when I was there and when I came home.

Aubrey

Pomme's Paradise


On Monday we went to go see Pomme at his Paradise. Pomme is a man that lives in a clearing surrounded by mountains in the middle of the Dominican jungle. He grows all of his own food (fruits/ vegetables) and herbs, and raises goats, chickens, and horses. Pomme lives in a similar fashion that Moses does in that they both grow their own food and are very resourceful with living off the land. Pomme however, is completely off the grid. He and his wife do not have electricity running to their house, and they also have very little, if any modern items. Another difference between Pomme’s Paradise and where Moses lives is the accessibility. Moses lives at the trail head of the Victoria Falls Trail and cars can come all the way to there. On the other hand, Pomme lives quite a ways from any roads. On the way to Pomme’s we had to cross multiple fields and rivers, and climb up a steep, stone walkway. It took our group around one hour and fifteen minutes to reach his land and house. It is quite possible that we were slower on this hike because many of us hiked the Boiling Lake Trail on the previous day which was a six and a half round trip hike.

Pomme had a strong opinion on health and felt that prevention should be the focus. He mentioned that Doctors and Pharmacists make money prescribing and selling medications that help treat diseases, but not cure or prevent a disease from occurring. I feel that this is a very important concept that many of us in the modernized western cultures sometimes forget about. Many of us do not take time each day for personal time and to unwind. Also, when we are in a crunch for time, many times our own health is put on the back burner. Going along with that, stress can cause and exacerbate many health conditions and is something that everyone should learn how to control. Pomme also spoke about he feels that we as human’s need to get back to how Adam and Eve lived. We only need food, shelter, and clothing to survive. Everyone wants more and more stuff, but many times we do not stop and think about those who are less fortunate and do not have at least one of the three necessary things for survival. Pomme said that we need to get back to loving our neighbors, wherever they may be found. This was the biggest message that I have learned during this rotation.

I’m sad that there are only four more days until we have to leave Dominica!

Eric

Wednesday, May 1, 2013

Preceptor Perspective; Hassan Sheikh


Hello! My name is Hassan Sheikh, and I am a former student of this rotation returning as a preceptor for this specific module. Both times I have taken up this role, I have been genuinely amazed by the effort brought forth by each group of pharmacy students as they advance toward their goal of licensure. As someone who just went through this process over a year ago, I am humbled to provide my meager experiences with the newest batch of students.

Returning to Dominica always brings with it a mixed bag of emotions. With each subsequent visit, Dominica has begun to feel more and more like home for me. Treks to my cabin which I initially found difficult, I now enjoy. Cultural traditions and habits which eluded me on my first visit now make a bit more sense, although, I obviously have an incredibly long way to go. On the other hand, the enjoyment I feel at being back is always coupled with the responsibility I feel toward helping Dominica’s health care system to develop as much as I am able. I feel blessed to be surrounded by such a strong team of dedicated individuals, and am looking forward to the good work we can all do together in Dominica.

One of the key differences this rotation has for pharmacy students that is unlike most other rotations is that there is essentially no time spent “off” rotation once students set forth in Dominica. The nights are used for reflection over the day’s events (often after dinner), and the weekends are generally dedicated toward exploring island through the various forays provided by the wonderful staff here at Jungle Bay. These explorations allow students to develop a sense for the native culture, which is crucial to developing the patient/provider communiqué that is vital for any positive therapeutic outcome.  These excursions allow students to better grasp the culture and environment of the populace they are currently treating, and it is through this understanding that they can truly shine as health-care providers.

As the rest of the week progresses, I am excited to see how the students will continue to shine as fine examples of health-care providers. They have already impressed me with their integrity, compassion, and drive toward excellence and it is my hope that together, we can serve the Dominican People.

Coconut Oil and Herbal Tea Tasting

This morning we traveled to Moses's home again. For those of you who aren't familiar with Moses, see  posts entitled "Moses, Plants, and the Sugarcane Press" and "Moses the Medicine Man!". Today Moses walked us through the process of creating coconut oil. Coconut oil is popular in cooking, as a massage oil, and as a hair treatment. The process took us a few hours and was hard work, but the reward was several small bottles of our very own oil.

The first step was to obtain, cut open, and clean several coconuts. Next we used cheese graters to shred the coconuts into tiny pieces. This was tiring for our hands and was definitely the rate limiting step of the process, even with 6 people shredding at a time! After we had enough shredded coconut, we added some water to the bowl and used our hands to squeeze out the juice. We put the juice in a large pot on the stove and started to boil it. We added 13 cinnamon tree leaves and a few plantains. After several minutes of boiling, we were left with a cheese-like substance (which Moses instructed us was good to spread on toast!) and our coconut oil! The oil was poured into small bottles, and a small amount of bay oil was added to each bottle.

The process of making coconut oil was definitely more intensive than I had imagined! It took everyone in our group along with a few of Moses's friends to get the job done. I can definitely appreciate the cost of coconut oil after experiencing the time and hard work that goes into making it! It was amazing how many coconuts it took to produce a relatively small amount of oil.

After coming back from Moses's and having lunch, we had an herbal tea demonstration/tasting session. Justin brewed several different herbal/bush teas including cinnamon, spearmint, ginger, basilic, and some that I don't know how to spell! Some were better than others... my personal favorite was the spearmint. Again we were all impressed by Justin's knowledge of the different herbs and their uses. It seems that every time we talk about these different herbs we learn about new uses for them.

Well, that's all for now!