LaPlaine Clinic 01/29/13

On Tuesday, we had the opportunity to visit LaPlaine clinic for the second time.  I met a young mother who was using bush medicine in combination with Western medicines to control her morning sickness. One of the bush medicines she was trying was a bay leaf infusion she drank as needed and she felt it was very helpful.  She also used mint candies and dry crackers to help settle her stomach. I felt it was a great opportunity to learn more about the bay leaf and its uses. Additionally, I appreciated how open she was about her use of herbal medications, as this is not an attitude often seen in the States.
My second encounter was with a young girl who had been bitten by a centipede and this had subsequently led to an infection. I counseled her on the use of her antibiotic and she quickly verified the directions and possible side effects. When asked what questions she had, she timidly told me that she was in pain and wanted to know what would work more quickly than the antibiotic to provide relief. I explained the antibiotic would take a few days to show signs of improvement, but some options would be paracetamol (Tylenol) or ibuprofen. I reviewed her medical file and noted that the doctor had not prescribed any pain medications. Understandably the girl was upset.  I wanted to help her and I recalled that I had ibuprofen in my bag. I spoke with the preceptor, quickly explaining the situation and asked permission to share my medication with the patient. He agreed and I was able to give her a few tablets and some instruction on further pain relief.  This was a previously unknown situation for me as I could not recall a time when a patient did not have access to a medication as 'common' as ibuprofen.  My simple encounter with this girl really drove home how limited medical resources are on the island. 
My realization brought about a conversation about medical donations with Kent, the local pharmacist.  Through him, we learned that medications can be sent to the island via the government as donations. However, if this is done the officials may redistribute items they feel will be more beneficial if they were located at the hospital or another district. This means that even though a package was labeled specifically for the pharmacy at LaPlaine, some of the items might not make it to Kent or his patients! I was disappointed when I learned of this attitude towards donations, however, I can also understand this point of view -- if there is a particularly rare medication a patient needs it may be better to have the supply centrally located so everyone will know where the medication will be.
The experience at LaPlaine clinic has opened my eyes to the issues facing many people in the world today.  Before my visit to Dominica, I do not think I ever would have considered a medication as ubiquitous (to me) as ibuprofen would be in short supply elsewhere in the world. This also made me realize that there are going to be many other necessary medications that are limited in Dominica. I will never take for granted all the resources available to us in North America and upon our return I hope the group continues to give back to those in need, both in Dominica and in our own local communities.

Courtney Thomas

Tuesday's Le Petit Savanne clinic day

Today was tuesday and that means clinic day. One group went to the La Plaine clinic while my group went to Le Petit Savanne's clinic. The last time we went to this clinic it was closed but today the district doctor and pharmacist were there so there was a huge turnout. I think we counted about 35 patients waiting there at one time. One of our preceptors said it was the largest turnout she's seen in 3 years. Upon arrival, the nurse made an announcement of our presence and that the patients could ask us anything. She was extremely hospitable and the patients were incredibly warm and more than happy to share with us; welcoming the extra help.  My first impression was that the clinic was very small; about the size of someone's kitchen and dining area in north America. The patients came in the morning and the nurse and doctor started triaging people based on the severity of their illness. I asked one of the patients how long they usually have to wait for and she said if she wants to go to the clinic, she plans on staying the whole day ... and yet none of them got impatient or complained.  After talking to the patients, it seemed like the most prevalent disease states were diabetes and hypertension. Although the medications are free, the supply is extremely sparse which limits not only which medication is prescribed, but also the amount. The pharmacy was the size of a small walk in closet but no one seemed to complain about that either. The pharmacist gave the patients their medication and kept track of the remaining inventory after every patient manually in a huge book. If a medication was not available, the patient could go to the city which is an hour drive away and purchase it at a pharmacy there which really hinders compliance. At the end of the day, the pharmacist would pack up what little medication she had and take it with her. It was shocking to see such little inventory. One of the patients I talked to was asking for GERD therapy and although we donated some PPIs, we didn't have anymore and so I had to recommend H2RAs or over the counter and non pharmacological therapies. Thus, although the island is very lavish and the people have plenty of food and water, medicine is what seems to be lacking as their health issues increase from the influence of North American culture. Hopefully we can teach them and help them in any way we can that is sustainable once we leave, but in the meantime, I've realized how important it is to keep sending even the simplest medical supplies such as bandages for which they are almost too happy to receive. 

~ Sincerelly Maria 

Monday, January 28, 2013

On Monday afternoon, we went to harvest cinnamon with a Jungle Bay staff member. I was glad that there was not as much walking involved in this activity because I was tired after the Boiling Lake hike yesterday, and it's been the activity I have been looking forward to the most on this trip. 

I tried every step to the process except the first, which was the chopping of the tree with a machete. I was too exhausted for the amount of effort that it would have taken me to try. There were a few of us who did not even know that cinnamon came from a tree. 

The next step was like shaving the outer skin of the tree with a knife. It was similar to the sugar cane we did last week, but I thought it was much harder. If you shaved until you saw a white color, you went too deep. 

After that, the staff member cut 6 inch pieces around the tree branch so we could get the knife under the top layer of the tree. It looked a lot easier than it was. Most of us couldn't get the piece off in one in order for it to curl like cinnamon sticks, but I had fun harvesting it!

We all got to take a piece of the cinnamon with us to dry ourselves. It usually takes a couple days to sit out to dry. I can't wait until mine is done so I can make some cinnamon iced tea like Jungle Bay serves because it is to die for!

Ashley Gulvik

          Today the group visited Pomme’s place.  Pomme is a 62 year old man who has spent the last 35 years of his life living entirely off the land of Dominica.  The hike we made to get to his home took well over an hour.  This path is the only way to and from Pomme’s home, meaning he has to make this journey on foot in order to get anywhere.  Pomme lived among the rest of civilization up until 35 years ago, when he started living his current lifestyle due to his religious beliefs.  Pomme told us how he felt living in the developing world.  He explained how to him it seems the more technology we develop and the more doctors we train, the more the world struggles and the more sicknesses spread throughout the population.  He feels the world needs to return to Eden, referencing the Bible and the Garden of Eden.  That is why he decided 35 years ago to “return to Eden.” 

          Approaching Pomme’s place after our long hike, I was struck by the beauty of his land.  The house he made on his own sits in a large, open valley, surrounded by mountains and streams.  Pomme’s garden stretches in all directions, full of colorful plants, herbs, and trees.  Pomme took us around his garden, showing us the various plants and telling us their uses.  Most were plants I had never even heard of outside of Dominica!  After our tour, Pomme’s wife served us a delicious Vegan meal prepared using some of the vegetables and herbs from the garden.  Even the bowls our stew was served in were made using calabash from the garden. 

          Pomme’s place was an amazing retreat for all of us.  His lifestyle is very different from our own, and gave us an entirely new perspective on life.  I understand and respect his views on the modern world and his reasons for living this way.  I also can’t help but ponder the concept of giving back to the community and to those around us.  Pomme’s lifestyle is one we could debate endlessly, but getting this perspective was an experience I know none of us will forget!

Kelsey

Weekend Activities (1/26 - 1/27/13)

Just like any other rotation we have the weekends 'off'. Jungle bay offers several activities for each day of the weekend. This particular Saturday we all decided to go snorkeling at Champagne Beach. This is usually scheduled during the week but since we are busing with rotation related activities during the week Jungle Bay worked with us and set up a trip to accommodate our interest in this particular activity. We were all very grateful and would have been disappointed if we didn't get to enjoy snorkeling in such a beautiful location. The weather was absolutely gorgeous! The sun was shining and it was the perfect temperature. Even the water was warm enough! It was definitely amazing to see the bubbles coming from the volcanic sea floor, which is how the beach received its name. It was like swimming in a glass of champagne at one point! The beach itself is not your typical beach and is very rocky. It is not the place to lie out on your towel. The water was crystal clear and a beautiful blue- prefect for seeing the coral reef and the variety of colorful fish. There were fish with rainbow colors, bright yellows, various shades of blues (which were my favorite) and numerous more combinations. Carlos, our awesome guide from Jungle Bay, found a hot spot for us to check out. The water coming from this area on shore was toasty warm- even boiling at the beginning and way too hot to touch! Unfortunately we did not see any sea turtles but it wasn't a big deal. The snorkeling trip was an awesome experience and we all thoroughly enjoyed our time at Champagne Beach!

Since the condition of my ankles didn't permit me to join in on the Boiling Lake hike on Sunday, I was able to go whale watching in Roseau with Jill and a few other Jungle Bay guests. We were very lucky to have this alternative option to explore Dominica more! The weather was mostly cloudy and periodically raining. From the boat we could see it raining in various locations in Dominica. I was glad we avoiding most of this being away from the land but I felt bad for the Boiling Lake hikers! The boat left around 2pm with about 13 people so it wasn't too crowded. We headed out to sea keeping close enough to the coast for about 30 minutes when the crew decided to use their sonar instruments to see if they could hear any whales nearby. Unfortunate we didn't pick up any sounds beneath the water so we headed north for about 30 more minutes and tried again. Still nothing! Dive Dominica had about an 85% success rate but considering I am impatient I was starting to get my hopes up. We continued north for another 30 minutes and listened again. This time they could hear whales 1-3 miles toward the north, northwest and northeast. We continued north more to head in their directed and listened again. It seems like we were in the right area so we were told to keep looking since it they could be underwater for 30-45 minutes before surfacing for air. The captain gave this information to another sightseeing boat and told them to watch since they might be heading their way. After about 5 minutes the other boat informed us they spotted the whales and we headed on our way to see them closer! Luckily the whales were still 'socializing and catching their breath' when we arrived. There were two sperm whales ahead of us... Moby Dick whales as the captain said. This was my first whale watching experience and I was super excited to see whales so close. It was awesome! They were apparently females since the male whales will leave the warmer waters while the female whales don't. They were about 30-40 feet in length, about half as long as the boat. They casually swam for a few minutes before diving down for more food. After several minutes we were able to find more whales and catch up to see them. The boat was about 50 feet from the whales so it was a great view. We saw about 4-5 whales total since and were able to follow some since they did shallow dives where they resurfaced several minutes later before taking the deep dive for 30 or more minutes. One whale even swam right beside the boat giving us a great show. We were able to see the whale under the water while on the side of the boat and were right there for the deep dive that followed. All of this happening maybe 30 feet away! It was an amazing sight to be able to see the whales so close and personal. They were so beautiful and I definitely could not capture it on camera. After that whale it was about 4:30 and we started heading in, arriving to shore around 5:10pm. It was rumored that the trip last weekend saw 20 whales but I was just so glad we had to chance to see one that the 4-5 we watched was awesome, especially since I didn't think I would see anything halfway through the trip. I'm very grateful I had this opportunity. Such a wonderful day with the whales!

Sarah S :)

Boiling Lake (1/27/13)

It's Sunday and we as a group have been lucky enough to be a part of the Jungle Bay family for a week now.  As it is the weekend, we get to experience some of the natural beauty this island has to offer and today we are all eagerly anticipating the hike to the boiling lake which is the second largest boiling lake in the world and one of Dominica's greatest treasures.  With all our lunches packed and with enough water we began our trek with the hour long drive to the base of the boiling lake.  To me the excitement actually began with the drive itself as the scenery associated with the drive allowed me to further understand why Dominica is known as the nature island of the Caribbean.  Along with the multiple attractions on this island, the untouched landscape and beauty is reason enough to attract tourists from everywhere.

Upon arrival to the base, those of us who wanted walking sticks were given them and while writing this blog upon completion of the hike I can honestly say that I was really really glad that I decided to take that stick for reasons which will be explained later in this blog if you keep reading :).  The hike began at a reasonable pace with fairly flat ground in the beginning, then began the never ending stairs up the mountain.  It was at this point where I required plenty of breaks to keep up, but individuals wanting to do this hike must remember to always go at their own pace as after all it's not a race instead a hike of self-accomplishment.  Once on top of the mountain, we were greeted with pineapple from our friendly guide, Brother.  It was probably the best pineapple I have ever had in my life, maybe because of sheer exhaustion or perhaps because the pineapple was really that good, honestly it was probably a bit of both.  Throughout the hike thus far, there were many areas to just stop and enjoy the endless beauty of the landscape surrounding us, and I highly suggest that people do stop to just look around.  We then headed down through the many many stairs to the valley of desolation which again was a site to remember and also the area where we all received our very own sulfur facials from the surrounding land, courtesy of Brother.  At this point we were almost there, but yet so far away, well at least it felt like it, but we had to keep going as we didn't make it this far for nothing.  It was just a little while longer till we saw the famous boiling lake of Dominica.  Half an hour later and we were finally there with the spectacular view of the lake that was literally boiling and now had a place to enjoy our lunch before beginning the trek back.  It was during the trek back that I hurt my right knee due to the multiple downhill stairs we needed to get through to get back and it was then where the walking stick became my third leg.  Although last in the group to end the trek back, I did feel a sense of accomplishment that I managed to complete this extreme hike and was rewarded at the end with a cliff jump over a gorge which was probably the most exhilarating and rewarding part of the whole hike.            

Overall this hike became more of a test of endurance, strength and will power more than anything else but definitely an experience I will cherish and take with me.  To anybody willing to take on this challenge, a hike I definitely recommend, the only advice I can give is to keep pushing yourself and never give up, as the self accomplishment you feel upon reaching the boiling lake is satisfaction enough on top of the incredible, breathtaking views of the valley of desolation and the lake itself, not to mention the hot spring and the gorge in the end with the cliff jump for all you daredevils willing to try (although I highly recommend it for everyone to at least try it, after all you only live once).  Upon completion of this hike, I am even more driven to get myself into the fittest shape possible and take on even more challenging hikes.

Pearl Martis    

Friday Afternoon's Drug Free Rally

After a busy day at the health fair, we stopped in Petit Savanne where the local school was hosting a drug-free rally. Several students, teachers and parents walked from the elementary school to the health center promoting a drug-free community. They carried catchy signs saying 'Do pot your brain will rot' and 'Leave the joints to the bones!' The teachers led the crowd in chants during the entire walk. When we arrived at our destination, several people spoke to the children on the consequences of drug use and how to avoid going down that road. Even Dr. Abrons was asked to speak out for the cause!

The rally was a great chance to connect with the people of Petit Savanne on a closer level. The experience reminded me that we all face similar problems, even if we are oceans apart. The rally was similar to the D.A.R.E. program so many of us went through in school. I am glad to see the children here have the same support!

I am so glad we were invited to this event. It really helped us submerge ourselves in the local culture an connect with the community around us.  It gave us a better understanding of one of the social challenges that Dominica faces and how they are working together to overcome it.

A big thanks goes out to the people of Dominica for being so welcoming during our stay here!

Bridget Sterling

New Health Clinic Visit January 24, 2013

January 24, 2013. 

Today we went to a new health clinic for this rotation and were able to talk to patients that were waiting to be seen.  I spoke to one lady who was there for follow up on a new blood pressure medication she had been given the month before. Another woman was there to get refills of her medication and also because she was experiencing some constipation.  She was pretty upset because the pharmacist was supposed to be there so she could get her medication but he wasn't able to come that week.  There is only one pharmacist who takes care of all the health clinics in a district. He carries around his medication supply in a suitcase.  He tries to visit each clinic once per week unless there is a special problem.  The poor guy hasn't had a day off in 2 years.

The last patient I spoke to was a young woman in her early 20's who had asthma.  She had recently purchased a nebulizer from Jolly's Pharmacy located on the other side of the island.  She was at the clinic to learn how to use her nebulizer and how to prepare her medication for it. Instead of prefilled vials like we are used to in the U.S. the patients of Dominica have to measure out doses themselves.  The patient had been given a 20 mL bottle of salbutomol and a 1L IV bag of Dextrose 5% and Sodium 0.2%. She was to measure out 1cc of the salbutomol and 3 cc of the Dextrose for each dose. I was able to demonstrate the easiest way to measure out the salbutomol with the dropper bottle and we provided her with a syringe to measure out the dextrose.  As I was counseling her on how to use the nebulizer we put it together and prepared a trial dose using just NS, also drawn up from an IV bag. She was pretty quick to understand and did not hesitate to ask any questions. It was great to be able to do my part and give the doctor and nurse more time to see other patients and to let the patient be able to have a shorter wait.
It just continues to amaze me how self sufficient the Dominicans are especially when compared to Americans. In the U.S. we are pretty spoiled with the dosage forms and availability of medications. These people have to manage their medications themselves and prepare their own doses. In addition, they carry around a complete medical record with them of every clinic visit and what medications are prescribed. I am not sure that my patients back home would be able to handle that kind of responsibility. I think that it may result from the lack of accessibility to healthcare. They appreciate it more and are more receptive when the doctor is only available once or twice a month.

House of Hope 01/24/2013

Last Thursday, we were given the opportunity to work with the House of Hope here in Dominica. This is a home that cares for the mentally and physically disabled of the island, especially children who have no one else to provide for them. When we reached the house, it appeared similar to the others on the street, but there was no well-kept yard for anyone to enjoy -- the yard was barren and littered with rocks. Upon entering the home, we were welcomed by the staff and a few of the residents. A quick tour showed us a very tidy living area and a number of bedrooms. When we turned to head back down the hallway, one of the youngest residents, Melissa, grabbed my hand and wanted me to walk with her. I did this for a while and just as quickly she latched onto another member of our team wanting to walk with her too. Guided by Melissa, we returned to the main living area to learn what we could do to help the house. We decided to decorate the walkway leading up to the main entrance to make it more welcoming.
The team felt it was important to leave words of welcome and encouragement and images that would brighten the residents' and the staffs' day. Closely observed by Melissa, the team painted brightly colored dragonflies, flowers, butterflies and hearts for the residents. To make the yard more appealing we also decorated some of the larger rocks and left messages of love, peace, and hope.
When we finished painting the walkway, we offered to help the staff with the children As it was lunchtime, one team member helped feed Melissa while others danced with those who had already finished eating.  I truly wish there had been more ways for us to help -- it would have been wonderful to know that we had helped to lighten their work load, even if it was only for an hour.
As we watched the nurses care for the residents of the House of Hope, we could feel how dedicated they were to the children.  However, it was surprising to learn just how dedicated they are. Upon leaving, we were informed that the staff is unpaid for their labors at the house and frequently they are working there on their days off.  Truly a labor of love!
Another aspect of the staffing that took me by surprise is how reluctant they were to tell us what they needed to care for the residents.  It took very careful questioning and sleuthing to determine what products might be most helpful upon our return in April. There was very little provided in the way of resources for the staff or the children, but they did not complain. When directly asked what they needed, they honestly could not think of anything!  It took some intense prompting from our team to get the ideas rolling as to what would be most helpful, and even then all we could coax from them was diapers, aprons, and gloves! I compared their behavior to what I have seen in the States and I was astonished. If people from North America had to work with such limited resources, they would have been demanding all kinds of products and complaining about the long hours and lack of pay!
I was glad to have been a part, however brief, of the lives of the residents of the House of Hope. It was rewarding to interact with the children -- hearing their laughter and seeing them smile was a great way to spend the morning.  I know that I will always remember the House of Hope as a welcoming place with wonderful staff who truly love the people in their care.  I am also going to strive to keep their attitude toward limited resources in my mind. The nurses did not feel as though they lacked anything; they carried on with what they had. While this made me want to help them, it also serves as a benchmark for me personally.  If they can manage to care for so many with the limited resources they have at their command, I can also manage my tasks with what I have been given. I hope our decorations remain on the walkway as long as the impact of what I have been shown stays in my heart.

Courtney Thomas

Tuesday, January 22nd LaPlaine Clinic

Today, half of our rotation group got the privilege to help out in a clinic called “LaPlaine Clinic” located approximately 15 minutes from Jungle Bay. Immediately upon entering the busy clinic you could recognize the differences compared with clinics in the United States. The pharmacy took up a very small corner of the clinic and had only a handful of medications. For example, for diabetes there were only three options: insulin, glyburide and metformin. The pharmacist would carry the medications in a suitcase as he traveled to different clinics. As pharmacy students we had the opportunity to help patients fill medications as well as conduct patient interviews. Patients would have their prescriptions written in a notebook which they carried around with them. The pharmacist would then take the patients notebook and fill the medications and record the medications used on paper since there were no computer systems available.

Conducting patient interviews was a great experience. It allowed us to learn more about the patients’ background and medical history. The story which touched me the most occurred while conducting a patient interview with a young boy and his mother who were waiting to visit the doctor. After speaking with the little boy and his mother I learned that the little boy was suffering from an itchy rash on his legs which he said he had for months.  While examining the boys legs I saw many black large welts which I thought resembled a fungal infection. The little boy eventually got to see the doctor and got a prescription for terbinafine, clotrimazole and clorpheniramine. Unfortunately, the pharmacy did not have either of the antifungal medications available therefore the patient only left with clorpheniramine (which as we know will not help with the fungal infection). The only other option for retrieving the medications would be to travela far ways to a private clinic where medications were much more expensive. Visiting the LaPlaine clinic really opened my eyes to how much we take access to proper health care for granted in the United States. We must continue to donate medication and supplies to underserved populations and be grateful for all that we have.

Ashley

Health Fair at LaPlaine Clinic - January 25, 2013

Today our group held the health fair at LaPlaine Clinic. This clinic is the largest of the ones we have visited and therefore has an area where we were able to set up tables and chairs for the health fair. Everyone had a particular disease state that they were in charge of. These included cardiovascular disorders, diabetes, respiratory disorders, and gastrointestinal disorders to name a few. We prepared resources that the attendees could take home, such as brochures and handouts. Some students also prepared interactive displays such as a cardiovascular darts game, diabetes word search, and straws of varying diameters that attendees could blow out of to simulate respiratory disorders.

We had a steady stream of attendees arrive throughout the morning and all the students were very enthusiastic in talking to them about the various disease states. In particular, I noticed that a lot of attendees were very interested in having some guidance on what they should be eating to maintain a healthy diet. They wanted to know whether aspects of their Dominican diet were in line with controlling their disease states. This is where the nutrition booth came in very handy, as one of the students had prepared some resources on nutrition and how to portion your meals. In particular, I spoke to a man who was concerned that the American diet was being assimilated into the Dominican culture and was making them unhealthy. He also asked me about diabetes and how to control it better. I empathized with him and praised him for being so proactive in maintaining his health. I suggested some food options for him and also referred him to the nutrition table for more information. He seemed to be quite content and interacted with many of my fellow students afterwards.

In the afternoon we mainly had groups of elementary school children come in. We shifted our focus more on ensuring they had a good time. Instead of speaking about our various disease states, we instead prepared some coloring stations for them. We focused on the theme of “healthy food” and had them draw their favorite foods into the “plate” we had drawn for them. The children absolutely loved this activity and we had just as much fun assisting them. They also really loved the oral care station where they were able to put a pink stain on their teeth and then brush their teeth afterwards to demonstrate the amount of time it takes to properly brush your teeth.

Overall the health fair was a great success and everyone felt a sense of accomplishment. I in particular was very humbled by everyone I met, and am in awe of how some of them could endure so much but have no complaints. They are just happy to be there talking to you and learning more about their disease states. The health fair was a rewarding experience and one that I will not soon forget.

-Joanne

Introduction to Herbals of Dominica

This morning the group went to visit Moses, a well-known local herbalist.  First, Moses showed us how he harvests and processes sugarcane.  The group even got to take turns juicing the cane, and we were all rewarded at the end with a drink of the sweet juice!  Moses talked about the importance and benefits of eating and drinking naturally, and how by consuming the unnatural foods and drinks, we are in a way putting diseases into our bodies. 

After our sweet treat, Moses showed us around his garden.  The garden and all of the plants within it were beautiful and unique.  We would stop throughout the garden so Moses could explain to us what each plant was and some of the uses of the plant.  It was amazing to hear how every plant had a purpose, sometimes even multiples purposes! 

Some examples from Moses's garden:

• Lavender - often used for cold and fever
• Coconut oil & bay oil (mixed): to prevent and treat bug bites
• Aloe - cooling, soothing gel for many skin conditions (burn, bites, etc)
• Leaf of life - used for eczema and for treating a headache
• Cayenne pepper (swallowed whole) - helps with inflammation, disinfecting, and promoting a healthy immune system and GI system
• Mangosteen (skin & leaves infused with saw palmetto): treatment of prostate cancer
• Sage: very effective for sore throat
• Lime (mixed with water): helpful for chest congestion

Overall, our visit with Moses was very educational and gave us all a new perspective on healthcare.  Herbal treatment is not something we have a lot of exposure to back home.  I personally benefited from the visit, as I came with over a hundred sand mite bites on my lower legs.  Moses cut an aloe leaf open and generously applied the gel all over my lower legs.   Aside from feeling cool and soothing, I didn't think the aloe would do much for me.  However, I had an eye-opening experience when one of the group members pointed out the red/orange seeping from the bites about ten minutes later.  At first I thought I had hit something and was bleeding, but when I asked Moses, he assured me this was normal, and that the aloe was leeching the venom from my body.  "Yes, you were very infected," he told me as he looked at my legs.  It was amazing to not only learn about the herbalist way of life, but to experience it first-hand and see the benefits right before my eyes!

Learning about the herbals from Justin was a wonderful activity to start off the rotation! He was so knowledgeable about the land and plants. He talked a lot about aloe and its uses. After mango season, many natives will have a 'cleanse' with aloe tea because mango is considered to heat up the body while the mango helps cool the body down.

The group was able to use this time as a team building activity as well because of the hike that we went on after Justin's talk. We all had two plants to look for so everyone was helping everyone. At one point three girls went to look for the casava plant that a person along the road had told them was 'over in that direction.'

Some lessons that we learned were how to help each other. Having more than one set of eyes is useful, but we need to slow down our lives and enjoy the scenery. We passed almost every plant that each of us was assigned to on our hike, but none of us have pictures of both of our plants.

From talking about aloe tea to pointing out the starfruit tree on the hike, I learned to appreciate the importance of sustainability and preservation of the land.

Ashley Gulvik

Why is it important to talk about medication safety?

It is important to discuss medication safety with children because many medications could easily be confused with candy. Today we had an activity with the children in the Delices elementary school where we showed them an item and they had to guess if it was a medicine or candy. It was amazing how many of them thought some of the medications were candy.  We had excellent participation and the kids were very enthusiastic. It is very important for them to understand that they need to check with adults before taking any medicines and that they need to be careful when taking anything that they think might be candy. Many medications now are flavored or have sweet coatings and unique dosage forms like gummi vitamins and it is really important that more care is taken when taking them. Because they are small, it doesn’t take much for a child to overdose. I feel that today’s exercise with the kids was well received and that they did learn some of the danger.

Why is it important to do a fun activity when teaching children?

            By making learning fun, children will remember it more easily and it makes them more relaxed and attentive. With a memorable activity the information can remain with the children longer and have more importance.

What can we do in the future to make these visits even better?

            It felt as if the visit went pretty well. The kids were able to remember the visit from the previous rotation and seemed to recognize that the candy/medicine game was coming along with a prize. The first activity was the game with the candy vs medicine and for correct answers the children received pencils. Then we had small group discussions and took the children outside to play games. Finally, we read to them before their day was over. I feel that the sequence of events would probably be better if the pencils had been given later in the day. Many of the children were running around with sharpened pencils during game play and several of them lost their pencils or they were broken. I am not going to go into the obvious dangers here.

           While I enjoyed spending more intimate time with the kids, some ideas for improving the activities may have been to provide more information to the rotation students about how the actual visit was going to proceed. I know I was surprised about the small group discussions and was really struggling with things to discuss with the children on such short notice. Perhaps a list of discussion possibilities would have been helpful. I feel that that may have been helpful with game play as well.

            I thought that it may have been fun to have a short song about pharmacy that they could learn and then repeat later. This would make it something that the kids would enjoy and remember. Overall, the visit went very well and I don’t think that the kids realized that we may have been struggling slightly. I really enjoyed the visit and the kids were wonderful and so enthusiastic.

Jill Zimmerman

Clinic, cases, & healthy eating

Today was a clinic day for the pharmacy students.  As we arrived in the clinic, we met both the pharmacist & the nurses.  I continually impressed by their kindness & willingness to allow us to work with them.  Seeing the students counsel and talk to patients warms my heart.  I often see a simple discussion of the weather or interests lead to the establishment of a bond.  We are often ask if we like Dominica & if we would move here to help out more often.

Today we also discussed patient cases.  It brought up a great discussion about things such as the ability to monitor patients frequently or how to see if a condition is controlled by simply assessing the  absence of signs & symptoms for certain conditions.

Lastly, we had a cooking class with Joanne.  I love to here the whispers of disbelief that the yummy soaps they enjoy are fat free & low salt.  This was particularly wonderful since we talked about a diet called the DASH diet which among other things encourages patients with higher blood pressures to restrict their intake of salts.

A heartwarming thing is how many of the other guests begin to discuss pharmacy & health with us & ask for ways to become involved.  I know that we all hope that even small gestures will make this world a better place.

Today the students and I learned about herbal therapies through doing a herbal scavenger hunt.  The students will post a reflection on this activity as well as their visit to Delices schools.  We hope you enjoy.

Best wishes-
Dr. Abrons

Preparations:

Why are we going to Dominica?

As we go through our checklists to make sure we've remembered everything, it's easy to sometimes the forget the greater context of the adventure we are soon to embark on.

Yes, this is a rotation.
Yes, we are only spending two weeks in this country.
Yes, the skills we have might seem limited compared to some of those we are traveling with.

Each and every individual going on this trip however, has something to contribute. Something only they can make better. Through cooperation, we will learn much from all those whom we meet in Dominica, and likewise we'll hopefully contribute much in the short-time we have.

We're going to Dominica to do as much good as we can. Lets all do our best to keep that perspective!

Pre-Travel Preparations January 2013

It's January 2013 and again we'll travel back to Dominica, West Indies with a group of student pharmacists to work in rural health centers as well as learn about alternative medicines.  Additionally, and probably my favorite, we'll get to spend some time in the local schools talking about paths to our chosen profession.  It is amazing to see the impact that this can make.  I often when having a frustrating day look at a picture that one of our student pharmacists took last year on the trip.  It's a picture of a group of primary school aged kids in Delices raising there hands.  They did this in relation to the question of "Who Wants to Be a Pharmacist?".  I probably should mention here that they also raised there hand when asked who wants to be a superhero.  I like to think that this can only mean one thing - pharmacists are superheros?  Each year I also look forward to seeing the experience through a new set of eyes and learning new experiences with my now extended Dominican "family".  It continually amazes me and makes me feel blessed that no matter how much I give there - I always feel like I am getting more from the experience.  It helps me recharge as a pharmacist remembering why I chose to go into this profession.  It forces me to slow down and smell the roses.  I am glad to share this experiences with you whether you are a part of my pharmacy family or immediate family.

Here's to a bright future and hopefully better things to come.

Best wishes always-
Dr. A