August 21, 2013

Today we had the chance to make our own cinnamon sticks from scratch. We were invited by Ceurvon, a Jungle Bay tour guide, to go to his house since he grew cinnamon trees in his yard. The tree looked like a normal tree until he described that cinnamon trees were a reddish tint, and thus we were able to find our cinnamon tree. 

Our next task was to find a tree that was easy enough to peel the bark and cinnamon off of. After finding the right tree we were given the responsibility of cutting down an entire tree, which mostly all of us have never done before. We cut down the tree with a machete, and for most of us this was the first time we had ever even held a machete, and carried it to the front yard for Ceurvon to show us how to harvest cinnamon. After cutting the tree down, we had to scrape the bark off of the tree using a knife. This task was somewhat difficult because we had to scrape off just a small amount since putting too much force and scrapping too much would reveal the underpart of the cinnamon we wanted to extract. The next step was to cut the cinnamon tree into smaller pieces and to section off how long the cinnamon sticks would be.  Next, we cut back layers of the cinnamon tree and took a dull knife to slowly peel back the cinnamon in order to make sheets. We brought back the sheets to Jungle Bay and laid them out in the sun to dry. The drying process typically takes about 2-3 days to fully dry and at the end of the process will give cinnamon sticks. 

Cinnamon has many medicinal properties, for example it may be used for weight loss, diabetes, insect repellent ingredient, upset stomach, runny noses, blood thinning properties, and much much more! After seeing how grueling the process of making cinnamon really is, all of us are able to appreciate the preparations that are available and already prepared for purchasing in the United States. 

After making cinnamon we continued on our tour to Tony's. Tony is a local resident of Dominica who has been farming for over ten years! All of his products are organic and he produces a variety of fruits and vegetables to sell to other locals, of which includes Jungle Bay. Tony's farm consisted of at least two green houses in addition to a multitude of land for farming. He gave us avocados from his farm and explained his techniques in farming. One of the interesting techniques were to grow cabbage above ground, of which his reasoning was to keep animals from eating his crop. We also noticed that with the above ground planting, he was able to use less soil and did have to worry about where rain water would go. After seeing all of his farm, we were able to learn about the importance of eating healthy and utilizing organic farming towards our advantage. We were able to learn about GM or genetically modified fruits and vegetables and why they were bad for us. 

After touring Tony's farm, we came back and ate lunch and were given the afternoon to finish our herbal scavenger hunts. Overall today was very educational. Being given the opportunity to harvest our own cinnamon taught us how hard it is to harvest cinnamon and to think twice about how much cinnamon costs in the grocery store in comparison to how much work actually goes into making dry cinnamon. The tour of Tony's was also a good learning opportunity since it taught us how to create sustainability in terms of farming in addition to the importance of eating healthy while emphasizing on Sam Raphael's philosophy of putting in hard work but getting rewarded in the end. Tony puts a ton of time, work, and sweat into his farm, and in return he helps to feed many people, including us at Jungle Bay, with fresh, healthy, and organic food.

Theresa & Bianca

Sea turtle sighting: August 20th

Last night we had the opportunity to go visit the beach where the NET program is currently active.  The NET program is working to protect sea turtles from poachers and the environment.  Turns out a turtle needs to lay nearly 1000 eggs for one turtle to survive! Simon, who currently heads the project as a volunteer, had hopes that a nest would be emerging last night.  However as he dug through the sand he realize that there would be no baby turtles that night.  We did get to see a mother emerge from the ocean and had a chance to pet her!!! Follow this link to read more on the project--http://www.avirtualdominica.com/seaturtles/.

                                                                            Enjoy! 
                                                                      Katie & Dani

LaPlaine Clinic- Tuesday, August 20th, 2013

Today we all passed on yoga to make it in time for our big day at LaPlaine Clinic. We got our things together and headed to our usual group breakfast. I am really going to miss all the fresh fruit and juices I've gotten accustomed to having here. On our way to the clinic, we stopped and picked up the pharmacist Kent. Today was my first time meeting him, and I learned a great deal. When we arrived at the clinic he introduced our group to the patients out in the waiting area. He also explained to us that it would be a slow day as there was no doctor today, and there was a funeral in the afternoon for a younger member of the community that most people planned to attend.
I learned that Kent is a government pharmacist and went to school in Jamaica for 4 years to become a pharmacist. He told us that some people continue their pharmacy education in Canada, the US or England; but he elected to return to Dominica to work. He works everyday and stated that pharmacists are always on call if a doctor needs a medication for a patient. He used to own a private pharmacy in his home, but it was too much work.
Kent also taught us about pharmacy in Dominica and about how prescriptions are dispensed to patients at the clinics. He even let us help him dispense and label prescriptions from patients.
Here is the process:
1. Patient comes up to pharmacy window and hands over their medical record (notebook).
2. Pharmacist looks in notebook to see what medications need to be refilled.
3. Medications are counted and put in plastic bags and labeled with patient name, drug name and strength, directions and quantity. Patients are usually given a 30 day supply.
4. A manual log book is filled out with the patients name and what medication and quantity was dispensed.
5. An inventory balance sheet for each drug is added on to.
6. The patient is given the prescription and counseled on it.
After learning how to fill prescriptions with Kent, I went and interviewed some patients in the waiting area. One of my patients was particularly interesting. She was 35 years old and at the clinic as a caretaker to an elderly woman who was there to see the dentist. She told me that she had no diseases, but she was showing signs of Dengue fever. She was given acetaminophen and would see the doctor if her symptoms of headache, rash and weak joints continued. She told me that she just moved back here from Canada, and had been living there for 12 years going to school. She told me that many of her friends left and went to college in the US or Canada and then got married and became citizens. She ended up having a baby in Canada but was never married so she was asked to leave a few months ago. She took her 5 year old daughter, but had to leave her childs father behind. She was hoping to find a way to move back to the US or Canada. She told me that in Dominica it is mainly the older generation who are using herbal medications and the younger people are using western medicine. She really liked how the medical system in Canada worked a lot faster and you could always see a doctor if needed. In Dominica she said it could take a month.
Today I tried to be more effective at the clinic by trying to ask the patients more about the herbal medications they use. Last week, I hadn't learned as much bush medicine so I wasn't as comfortable with it. Today I asked the patients more about these methods and learned a great deal. I gathered as much information as I could to prepare for my case presentations and tried to focus on the complete wellness of the patients, rather than just the medications they were taking. I also made recommendations for them to see the doctors at the next clinic for certain conditions. All in all, I think the clinic today was a great experience. I learned a lot from Kent about practicing pharmacy in Dominica, and I learned a lot from the patients about bush medicine. I am definitely learning many things here about alternative medicine, that I will incorporate into my practice of pharmacy in the US.
Susan

Dear Future Dominican Rotation Students...

      I think one of most important things to think about when you're preparing for Dominica is actually mental preparation.  Yes, it's a completely different terrain from either Iowa or New York so you'll need to be in pretty good shape to keep up with the rigorous exercise associated with the activities, but I think the bigger thing is just to mentally prepare.  Chances are, Dominica is completely different than anything you've done before. It's not a vacation where you deal with the heat and rain for a few days and then leave, you are here long enough to have to adapt.  
      Bring your raincoat and put pretty much everything in ziploc bags - especially electronics.  Make sure the majority of your clothes are dry fit material because you will sweat... a lot. Bring 4-6 nice outfits for clinic days, but otherwise pack workout clothes.  We had a small bottle of laundry detergent to wash our clothes and brought a clothes line that we put up in our cabin to dry things out.  It is essential that you take care of your feet!! Test out your water shoes before hand to make sure they are comfortable to wear pretty much 24/7.  I got water tennis shoes make by Columbia Sportswear and they worked perfectly for me.  Along the trails, especially in the rain, some of the girls were getting rocks and twigs stuck in their Keens and had to keep stopping to dig them out since they aren't enclosed shoes.  
      Mentally prepare for the physical challenge of the rotation.  No matter how much you work out before hand, you are going to be pushed to your limits as far as what you can physically handle.  If you've got a positive attitude saying you're going to take on each challenge as it comes, you're likely to get through each one and learn a lot from it.  Do yoga in the mornings if you can.  Not only does it help stretch out sore muscles, but it gets you moving and gives you a little more energy to kick start your long days! 
      Have an open mind when learning about the herbals and natural remedies.  The people have a lot of knowledge that they're eager to share, so make sure you ask a lot of questions!  If you're like me, you might struggle to understand them at first, so make sure you pay attention, listen hard, and try to rephrase things if it seems like they didn't understand what you said.  I know we are told natural remedies are inferior to Westernized medicine in school, but these people use it all the time and seem to really benefit from it so try to push all the judgments aside and really learn from them and embrace their culture as much as you can!  
      Go outside of your box and try new things, especially regarding the food.  Everything is so fresh and delicious.  If you don't eat fish, try mahi mahi first... they told me it was the "gateway fish" :)
      One more note about living things... get used to things that crawl.  There are geicos everywhere and you'll see crabs, lizards, snails and other little things around your cabin.. Nothing will bother you, but there are nets above your bed if it makes you feel more comfortable.  I never used mine.  Just give them a name and make them your pets.  
      As always, if there's something you aren't comfortable doing, that's okay, but really try to push yourself if you can!! You will learn just as much about yourself in Dominica as you do about plants and natural medicine.  Lean on the other students when you need to.  You're a team, going through the same things together.  You'll become really good friends in a few short weeks, and sharing this experience will be something you'll always take with you!  Congrats on being selected, I hope you have a great experience in Dominica! 

Megan Schwartz 
University of Iowa College of Pharmacy
PharmD Candidate 2014

Today, we spent most of the morning at the local primary school in the town of Delice.  While there we all got in touch with our artistic sides and painted the library and a couple of the doors at the school.  We will be returning on Wednesday to finish up our masterpieces but here is a sneak peek!

Enjoy!

-Dani

Dear Dominica Rotation Student,

Congratulations on getting the chance to be a part of this great life changing adventure!  The island is the most beautiful place I have ever been to and offers many other amazing things.  My advice for you is going to come from 3 lessons I have learned thus far on this rotation.  

Lesson 1:  Be adventurous, going out of your comfort zone will allow you to enjoy the trip even more!

Before even leaving I had to make sure I had everything packed keens, Chacos, water bottle, flashlight, energy bloks, and lots of workout clothes and much more but do try to pack light.   I had to make sure  I was working out, they are not kidding around when they suggest this!  Once here I feel I have contacted my inner adventurer and have loved every minute of it!  Some of the adventures being my first international travel, hiking up mountains  every chance I got and trying new foods.  Each of the hikes they offer as daily excursions are a great way to push yourself physically and mentally!  In the Dominican culture herbal medicine is a way of life.  Alternatively, I know in most of our educations herbal medicine is not a large part of 'acceptable medicine' but honestly they must have something right because a women had lived to be 127 here on the island!  I have even tried a few remedies  myself to treat my skin since being here, and thus far they have worked better than anything else I have tried.  On a daily basis we have fruit and foods that have been freshly picked right off the tree or just dug up from the ground.  You will never find food this fresh anywhere else.  

Lesson 2: Be willing to learn about yourself and those around you

Dr. Abrons, the Albany faculty, the fellow students and anyone you meet while in Dominica is here for you and wants to get to know you as a person.  For example as soon as we got off the plane and there were people there greeting us from Jungle Bay with huge smiles and hugs for all!  I suggest taking advantage of the time you have here beacuse the time you get with some of these people is limited to your two week experience.  Even with all of the people I have met and gotten to know, I have still found this to be a reflective time to learn about myself. You get one chance to be here and decide what type of impact you are going to leave on this amazing island.  But the better question may be, what type of impact will the experience leave on you?

Lesson 3: Have an open heart and open mind

This was my motto for the whole rotation,  I knew that if I had thins kind of attitude I couldn't go wrong.  A large part of this rotation is philanthropy and giving back to the community by donations, patient education or even something as simple as painting a mural on a wall you can make a huge difference.  An eye opening occurrence happened on my first visit to one of the clinics when Kent--the districts pharmacist-- wasn't able to fill a patients prescription for aspirin, a medication we have readily available in the states.  Along the same lines I was floored to find out patients are often given only 10 insulin syringes for a whole month, and they use them until the needles are dull.  Hard lessons like this make me appreciate what we have offered to us and pushes me to want to help the clinics in any way possible.  Sometimes with what little the may seem to have in our eyes the people of the island are the happiest people I have met!  Not only are they happy to be here they are even more excited to meet us.   

These lessons are just a few of the number of things I have learned but are the ones that stand out most in my mind!   I have enjoyed my time here so much and I am hoping to get the chance to return someday!  One last thing to make note of their is a schedule they run on here it's called "Caribbean Time", also known as everything will get done eventually so you have to be flexible.   

Best wishes in your future endeavors,

-Dani Harris

PharmD Candidate 2014

Dear Future Dominican Rotation Student,

Congratulations! You have been given an amazing opportunity to grow not only as a student pharmacist, but also as a human being. This will be the rotation that has the greatest impact on who you are when you walk across that stage at graduation. You will push yourself physically, intellectually and emotionally in ways you have never imagined; and the tremendous impact on your life will never be forgotten.

Here is some advice for the rotation that I can leave you with:

Packing: Plan on wearing mostly active wear. I recommend gym shorts and wicking under armour shirts to keep you the coolest. Bring roughly 6 cotton dresses and skirts for clinic days. Keens are essential and you will wear them almost everywhere you go, but you may want a pair of dressy sandals for the clinics. Bring any medications you can see yourself needing as supplies are limited here. You will also want two bathing suits, some various toiletries and a notebook for recording everything you learn. A water bottle and plenty of gatorade packets are also essentials.

Donations: Bring as many supplies as you can. Almost everything you can think of is needed. Among the most popular would be diabetic supplies, bandages and bandaids, antibiotic and antifungal creams and OTC analgesics. Everything you bring will be put to great use and be extremely appreciated.

Resources and the Health Fair: I would recommend making handouts on issues that women of all ages will be interested in, as they tend to show up much more than men at the event. Try to make your activity colorful and hands on to attract attention to it. People are extremely interested in learning from you so bring as many handouts as you can. Pretty much any game that you play with the kids will go over well, they truly enjoy your company more than anything else.

Clinic Days: Work up the courage to go and talk to patients. They are extremely receptive to you and value all the information you can give them. It is easiest if you create a "Patient Data Collection Sheet" to bring with you and use it as a guide in your patient interactions. This way you will also get the information necessary to complete case write ups later on. Patients carry around a notebook with all of their medical information in it, so try to look through them as much as possible. Be prepared to take blood pressures, pulses, respiratory rates and to give immunizations. The staff are very grateful for anything you can help them with.

House of Hope: Before you arrive here, try to keep the mindset that these people are in a place where they are cared for and loved. It can be a little shocking when you first walk in and see everyone, but try to stay positive. Paint uplifting sayings and pictures on the walls as it really brightens the place up and has an impact on the lives of the patients as well as the volunteers. Don't be shy in being around the patients. They crave interaction with you even though they cannot communicate.

Herbal/Bush Medicine Component: Keep an open mind. Forget what you learned in school about not recommending anything that isn't FDA approved. Realize that the majority of medications you work with today came from plants. There is a high efficacy associated with many of the herbal medications so ask as many questions as you can, take pictures and write down what you learn.

Physical Activity: Be prepared for this before you come. You will be walking up steep hills almost everywhere you go (even to your cabin). Try a challenging hike like Paix Bouche, if you can. You will feel very accomplished for doing it. I really recommend starting the day with morning yoga as it will help stretch out your muscles after all the hiking you do.

Miscellaneous: The food is great at Jungle Bay and they kitchen staff really work with you if you have any special requests. It is important to wear sunscreen whenever you are outside as the sun is really strong here. If you do get burned, ask for aloe at the front desk and they will give you some leaves of a plant. This works much better than the aloe in bottle that we are all used to, so don't bother bringing that along. Bring some sort of motion sickness medication with you (Transderm Scop patches or meclizine) even if you don't normally get motion sick, as the roads are quite narrow and have many turns.


In summary, the most important thing you can bring with you is an open mind. If you immerse yourself in the experience fully and leave your comfort zone as much as possible, I can promise you that it will be life changing. This rotation will help shape you into the pharmacist you become, but more importantly it will change you into a more open and compassionate human being.

Enjoy!

Susan Kane

Pharm D. Candidate, Class of 2014
Albany College of Pharmacy and Health Sciences

Dear Future Student,

This trip has truly been life-changing for me, in the small amount of time that I have had in Dominica I have learned so much about the culture, their practice of medicine, as well as many things about myself. This rotation provides a great experience to learn about herbals and what they can be used for especially since the patients on this island are used to using those types of therapy. Additionally, some of the time that you are down here you have opportunities to go to some of the clinics here in Dominica, in many ways their routine doctor visits are similar to that in the United States, but at the same one thing that stuck out to me was the healthcare provider's access to medical supplies. Things like alcohol swabs weren't available at some of the clinics, so it truly makes you appreciate what we have in the United States as well as the ability to access what we need, when we needed. 

My advice to you, as a future student of this rotation is to come here with an open mind. You will do things you thought you would never do as well as see things you thought you would never see. I would come prepared to, in a sense, act like a sponge and absorb as much of this country as you can since you only get two weeks here. I also advise you to know your schedule ahead of time, although here in Dominica things may not always go as planned, I have found that at least having an idea of what is planned really helps in preparing you to learn the night before. Also, it forces you to become flexible with things since they may not always work out. Additionally, I think it is important to get to know your roommates ahead of time to be able to have enough time to learn about their personalities and adjust. It is also nice to know your roommates ahead of time so that you can divide up who will bring what in order to make packing more manageable. Lastly, I recommend to just have fun and do as much as you can here. I did a few of the hikes and don't think my trip would've been the same had I not done them. The staff here at Jungle Bay are amazing and possibly the nicest people you will ever meet. They take the time to get to know you and take care of you in a way almost like family. I rolled my ankle during the first hike and the staff here checked on me everyday until it got better! 

Dominica is truly a special place and I hope to come back some day. You will have an opportunity to learn about the culture, but the one thing I learned from this experience that has effected me personally was to appreciate what you have. Many of the people in Dominica have very little, but some how manage to make the best of everything in their paths. In the United States we take many things for granted and never fully appreciate how lucky to have many of the things we do. Being able to collect donations and provide them to the clinics was a great feeling and  one that I haven't had the chance to experience very much. Being in Dominica makes me want to pay it forward in the future, especially to areas where they have little, yet appreciate any type of help we are able to provide. 

Oh... and one more thing, when the preceptors encourage you to work out before the trip, LISTEN TO THEM! Although I don't think you will ever be trained enough for the hills in Dominica your body will thank you for preparing them! I would find the biggest hill in your town or city and walk it at least once a day or do the elliptical or stair-master in stead. I worked out almost every day and still felt like I could have done more before coming.

Theresa

Dear Future Dominica Rotation Student,

Even though you will spend two weeks communicating together as a group before you start on the great journey to Dominica, I hope that this letter will help you to prepare and give you a better idea on what to expect when you arrive.

Dominica is a very beautiful island, everywhere you go you are surrounded by plants. The people here utilize many of these plants everyday and they are very knowledgeable about their uses. In school we did not spend a large amount of time learning about alternative medicine, but you will learn so much about many different herbals and their medicinal uses. Walking around Pomme’s house and garden is a great experience. It is truly amazing to see just how many fruits, vegetables, herbs, and plants that he grows there. It is even more amazing that Pomme can identify each and every one and tell you what it is used for. Even aside from Pomme and Raphael (who will show you how to make coconut oil), everyone on the island is truly a resource for learning more about herbals. Although we have only been here for a week so far, I am much more open to recommending herbals to people.

Healthcare in Dominica is much different than in the United States. Each town has a health clinic and those clinics are heavily relied on by the residents, despite having scarce resources. Participating in the clinics really puts things into perspective. The pharmacy areas are so small compared to what we are used to; in some of the clinics they are not much larger than a closet. The variety and amount of medications available is small as well. It really hurts to see patients not getting the medication they need, or having to reuse syringes and lancets because the pharmacy is out. If you can bring things to donate or organize some sort of donation supply drive, I would highly suggest that you do so. Over the counter items that we take for granted, such as aspirin and clotrimazole are hard to come by and will be greatly appreciated.

The people in Dominica are so friendly and welcoming. Riding around the streets, almost everyone will wave as you pass by. Whether it be at Jungle Bay or the people you talk to at clinics, everybody is open and willing to talk to you. I would say really embrace this experience and be willing to ask questions, talk with, and listen to everyone. The kids you will interact with are also very nice and a lot of fun to be around.

I also just wanted to share a few more tips that I think will be helpful. First, it is no joke that you have to exercise before coming here. There are some hikes that are optional but some are required as well. Don’t let the hikes scare you though, I had never gone on a hike before coming to Dominica but I still went on some of the hikes, which I was very proud of. Besides being able to participate in hikes, you will also need to walk up to your cabin several times a day. Some cabins are located higher up the hill than others, and some have up to 157 stairs up, so definitely try to prepare for that. Also make sure that you have a good, comfortable pair of walking shoes that can get wet. Second, don’t worry about the food. I am a very picky eater but the food here at Jungle Bay is actually pretty good. There is a good variety on the menu and the kitchen staff is usually really accommodating. The dessert is amazing, so always ask what’s on the dessert menu before ordering an appetizerJ. Third, as far as packing goes you will need a couple of dressy outfits such as skirts or dresses for clinic days, but other than that workout clothes are what you will spend most of your time in. The weather is hot and oftentimes it will randomly rain so be prepared for that.

Lastly, I just wanted to say that you should expect to be pushed out of your comfort zone to some extent on this trip. Everyone’s level of comfort is different, but you will do something you are not used to doing at least once on this trip. For me, I never expected to be doing things like dancing Jing Ping at dinner, or riding around Petite Savanne advertising the health fair with a microphone, but I did. It is sometimes hard to go out of your comfort zone, but just do the best that you can and try to have fun doing it.

I hope that you enjoy this experience as much as I have. If you have any questions or just want to talk about this rotation feel free to contact me.

Good Luck!

Bianca Cannavo
ACPHS Class of 2014

When in Dominica

Dear P4 student,

First off - Congrats!  You have almost made it, this is the home stretch.

Ironically, that is something I have told myself many times since I have been in Dominica.  It is hot, you will sweat (all day everyday), you will discover new muscles you didn't think you had and you will try many new things.  Needless to say, you will be taken out of your bubble.  You will learn many things about the culture of Dominica, about how a place can do so much with so little and most of all, you will learn about yourself.  

Some things I recommend doing before the rotation starts.  Look into the rotation as much as you can.  I know for Albany students this may be difficult because Dr. A is not on our campus.  However, Kristen Felthousen is a fantastic on campus resource, I went to her and asked her so many things.  She really helped me get prepared for this rotation.  Get a pair of shoes that are good for walking in water, on rocks, up hill and that are comfy.  You will do more walking just going to and from your cottage than you are used to.  Speaking of walking; exercise, exercise, exercise!! You literally cannot get enough exercise in before this rotation to prepare you.  If you have a hill near you that are can walk up, do it as often as you can starting as soon as you know you are going on this rotation.  Go to the gym and put your machine on an incline and up the resistance.  Pack wisely.  You will need both nice clothing and workout clothing for this rotation, more workout clothes though.  Girls, bring as many sports bras as you own, you will wear each and every one.  Pack a clothing line to hang in the cottage and let things dry/air out.  Bring an extra water bottle or 2, you will want as much water as you can get while you are here!  You will want a little self care med kit with things like Meclizine, antibiotic ointment, Tums, Ibuprofen, Loperamide and whatever else you can think of that I didn't list.  Bring Ziploc bags for everything you want to keep protected.  Get a price quote on copies, and don't go more than 3 pages per expert handout - trust me the price sucks.  Bring things like granola bars, candy, Shot Blocks and Gatorade packets.  You will want them all the time and they really do help.  

Some things I recommend doing while on rotation.  Do every activity you can, take lots of pictures and have fun!  Do not be afraid to go outside of your bubble, challenge yourself.  Trust me, after walking up 1300 feet in about 30 minutes and living to tell you about it, you will feel great!  Ask lots of questions.  Whether you don't understand something or want to know something ask about it.  No question is a stupid one.  Share your food and try everything you can.  Count the steps to your cottage.  Talk to everyone you see.  The culture here is such that everyone talks to one another and shares what they can.  Everyone is so friendly and that gives us all the more reason to want to talk to them and help them.  Most of all, keep an open mind through everything and stay positive.  If you have any issues talk to whoever you feel comfortable talking to and get it worked out ASAP.  

Enjoy the rotation and best of luck!
- Michaela
michaela.gardinier@gmail.com    

Letter to Future Pharmacist

Hello Future Pharmacists to Dominica!!!
I hope you are excited for a new adventure.  Dominica was an experience I could never have imagined.  The island is one of the most beautiful places I have seen yet and contains the friendliest people.  I noticed in talking to other visitors that everyone found the people of this island friendlier than most other places.
I'm sure you have a few concerns in providing pharmaceutical care in a foreign country.  Fortunately, people here do speak English; that being said, it is not necessarily easy to communicate.  You really need to focus on being able to make your information understandable to a lower educational status than your own.  This is something we constantly face at our jobs but it was easier to see here because people are more open about talking to you about their health and they are truly knowledge hungry.  I really encourage your to step outside of your box and walk up to them and start talking, they also have a lot of information to share with you if you are brave enough to ask.  It is good to keep in mind that a lot of their bush medicine is closely related to the vitamins and supplements people ask for in the United States.
I know I had a lot of packing questions when I was preparing for my trip and I'm sure you do too.  Firstly I would encourage your to pack light.  You do not need much while staying at Jungle Bay.  I would strongly encourage leaving your computer and iPods at home.  It is very hard for us to live without our instant communication, but it is a good challenge for you to do so.  You might just find out how nice it is to have someone to talk with face-to-face.  It is also good to help you relax and forget your hectic life for a while.  Secondly, I would recommend good walking/water shoes.  Dr. Abrons will recommend buying the Keen water sandals.  They are good shoes however I often had crud building up in the toes on hikes.  Perhaps look for a water shoe without holes in it.  Lots of work out shorts and tops that will dry fast.  I choose to pack very light in a backpack and wash my clothing as I go and that has worked out very well for me.  Lastly, she will tell you to work out--really cannot stress this enough.  Any type will help, although I don't think anything could really have me prepared, especially having just gotten back from the Boiling Lake hike.
If you only take one piece of advice with you on your trip I hope it is to simply be a sponge; soak up at much information as you can, ask as many questions as you can.  They love being able to share with you want they know.  Most importantly relax and have a good time.

Katie Hassebroek
I can be reached at kmhassebroek06@ole.augie.edu if you have any questions.

August 16, 2013

Today we had a health fair at Petit Savanne health clinic. All of the rotation students prepared handouts covering various health topics such as women's health and pregnancy, wound care management, diabetes, hypertension, hypercholesterolemia, renal dysfunction, children dosing, smoking cessation, tropical diseases, pain management, and urinary tract infections. At the clinic Pap smear screenings and HIV testing and management were also offered. 

Roughly 76 local residents came out to our health fair after Katie and Bianca advertising the event the night before. Cooking demonstration were also provided by Jungle Bay to help patients learn how to make healthier decisions and cook healthier. 

The health fair was held from 10:00 am to 2:00 pm, and students were able to provide patients education regarding the various topics. The patients were very receptive in receiving information and kept students busy throughout the four hours. Students also kept children busy by playing and demonstrating scientific experiments with the children. Bubbles, alkaseltzer gas formation, and filtration were games that were shown to the children. 

The health fair today was extremely successful. We were able to provide almost 100 patients with education and materials on common disease states in Dominica. It was a life changing experience to see that the community members of Dominica were so appreciative of all of the donations we were able to give. To the people in this country, even when the simplest things aren't available to them, they make do and still live an amazing, happy life, I personally feel that many of us, including myself, need to learn from the people of Dominica and truly appreciate everything that we have in front of us rather than expensive cars or big houses, but rather live our lives simply and happily!

Tonight during dinner we were given the opportunity to experience Dominican culture. Singers and dancers sang and played music that was native to Dominica. The dancing was called "jing-ping", and the performers sang and dance, then gave us the opportunity to learn the same dance. It was nice to learn their culture and their songs and their type of dancing seamed more "jumpy". One of their dances I noticed was similar to the waltz and was considered one of the easier dances. Other dances were face paced and up-beat, which the characteristic of being up-beat has been a common characteristic in the Dominican culture.

Theresa

8/15/2013

Today Dani, Theresa, and I visited the Rivirie Cyrique clinic while the other group visited the House of Hope. This clinic was much smaller than the LaPlaine clinic that our group had visited earlier in the week. Kent was also at this clinic but his pharmacy was not much larger than a closet and all of the medications that he had with him were packed in a medium sized suitcase. We took turns dispensing and counseling with Kent, assisting the nurse, and listening in on the doctor’s conversations with the patients. Similar to LaPlaine, all of the people that we interacted with were very friendly and very willing to tell us about their health. At LaPlaine, we didn’t have the opportunity to be in the rooms with the nurse or doctor so we were very excited to experience that aspect of Dominican healthcare. It was very interesting to see that the doctor tried to incorporate herbal remedies into patient treatment plans. One patient in particular had high cholesterol so in addition to starting the patient on Simvastatin, she also told him that adding more garlic and avocado into his diet may help as well. For me, this was a good example of how to integrate both sides of medicine. After we returned from clinic, some of the group rode with Justin and Joanne throughout Petite Savanne to publicize tomorrow’s health fair. We are hoping to see and interact with lots more patients!
-Bianca

Let your emotions take the lead

Today a group of us went to the House of Hope, not far from Jungle Bay.  This has been, by far, the most rewarding experience for me on this rotation so far.

The House of Hope is a place where handicapped children and adults can live, if their family cannot or will not take care of them.  The house is run off of volunteers and donations.  Sadly, Dominica is weak when it comes to mental health and because of this, no one knows what is wrong with the girls who live at the House of Hope.  Needless to say they have no therapy of any sort, not even speech therapy.  Which is really sad because I am sure these girls would love to be able to communicate with us more than they do.  The only real communication they have is touch and whatever noises they make.  

When you drive up and see the colorful drawings outside the buildings it warms your heart.  Then you walk inside, meet the residents for the first time and you truly do not know what you are feeling.  It is impossible to put the feelings into words, because they are mix of so many emotions.  You are sad to see the residents, you are happy when you look at the paintings, and you are grateful when you think of what could have happened if they did not have House of Hope.

The goal of my day was to help give the residents a better life.  At first I had no idea what to paint or even do.  I went to see and interact with each resident, which was tough at first because I was not sure to approach them. Then Mrs. Boyd and I just wandered out to the deck and added to another painting.  After some thought we decided to add a quote to a blank wall "Laughter is the best medicine".  Next, we went back into the house and got to help feed the youngest residents of the house, Melissa and Marissa.  Melissa was so much fun!  In the middle of eating she grabbed my hands and pulled them around her, and then turned around and climbed onto me.  I let her out of her bed for a bit and all she wanted to do was clap my hands together.  She was having so much fun!  

Melissa really helped me to see the true meaning of the House of Hope.  You have to go into the entire House of Hope experience with an open mind, you cannot even think about what you want to paint.  You just have to walk in, interact with the residents, and let your emotions tell you what to do from there.  I wish that everyone could have as good of an experience as I did.  I have to say, I am sad we are not going back again!

- Michaela    

       

Wednesday, August 13, 2013 - Herbals and Coconut Oil Activity

We started the day with yoga at 7:15, followed by group breakfast.  We then headed up to the main reception hall to gather and get ready to head to Raphael's home for a lesson on herbals.  Upon arriving, he first showed us around his yard and pointed out countless plants and explained their medicinal uses and preparations.  He also cut up a calabash, which we later used as bowls.  A couple examples that he pointed out to us included ginseng which can be made into a tea to boost the immune system, and miracle fruit which is used to make everything sweet (becoming more popular in chemotherapy patients that are having difficulty tolerating food.  We also saw firsthand why cashews in the US are so expensive.  We saw that only one nut grows on each fruit and they are time-consuming to prepare for consumption.  Our next activity was preparing coconut oil.  We started by grating the coconut (on a homemade grate made from a rear view mirror of an old truck) and then added water.  We then squeezed the coconut by hand to extract the milk from the coconut.  Then the mixture was strained to separate the water/milk from the pulp.  This was then boiled to evaporate the water off.  A thick cheese would form on the bottom of the pot so the oil was transferred to different pots several times to avoid burning this cheese and to further evaporate the water.  When the bubbles stopped and the pot was silent, we knew only the oil was left.  This was allowed to cool off.  The oil is pure if it is clear and not brown.

While the oil was cooling, Raphael and a couple of his many children took us to their garden just up the road from his home.  Here he showed us his extensive bay leaf crop and explained that this was his main source of income.  After pointing out a few other important herbs, we headed back down to his shed to pour the coconut oil into small bottles for us each to take home.  The process for coconut oil preparation was different than we had expected because we didn't expect to have to grate the entire coconut in order to extract the milk from the pulp.

There are many uses for coconut oil.  Some include: weight loss, high cholesterol, diabetes, and boosting the immune system.  It is also use topically for psoriasis, dry skin, and is often found in cosmetics.  The coconut oil was our favorite part of today's adventure because we got to see the entire process from start to finish, and even got to have a hand in making it.

We returned back to Jungle Bay for lunch and the herbal scavenger hunt.  We all worked together to identify our assigned herbs and plants.  For the most part, we were successful in finding these things on our own (with our books) but for a few of them, we did have to rely on hints from Justin.

Today, we learned a lot about herbal medications, most things explained for the first time because this area of health is not taught in traditional pharmacy schools in the US.  We are generally told to avoid herbal remedies  because they are considered inferior to Western medicines and are not regulated by the FDA.  We have come to respect herbal therapies and preparations a lot more since seeing them first hand and hearing their benefits explained by Raphael.  It is clear that they must have some real benefit and not just placebo effect because these remedies have been used by the people of Dominica for hundreds of years.

Susan Kane & Megan Schwartz

Le Plaine Clinic Visit 1

This blog entry is dedicated to Katie Hassebroek for being there for me while climbing Paix Bouche ("pay-bush)!! Pictures will be uploaded at a later day!

Today, my group of Jane, Jessica, Theresa, Bianca and myself, ventured South of Jungle Bay to the LePlaine Health Clinic. Once there we ventured into the clinic with our supplies and a large group of patients excited to discover why we were there visiting them. Present at the clinic today was Kent the pharmacist, 1 doctor, 2 nurses and a dentist with their staff. After we got settled we joined Kent in the pharmacy a small room with a sink, fridge, counter, non working computer, 3 cupboards full of medications along with more in containers along the counters. The room was only the size of approximately 10 feet x 10 feet--note that is by my estimation. Kent was very open to sharing the story of his journey to becoming a pharmacist and the role that he played in the district. This description I'm about to share only briefly summarizes the type of role he fills and his commitment to the district over his 20 years as their pharmacist! He is the only pharmacist for the district--of the ten total on the island--serving 5 health clinics, orders both medications and medical supples for the clinics he serves, compounds some of his own medications on a bi-weekly basis in order to have them on hand in the clinics, makes home visits and stays at the clinics until the last patient is seen and gone. This may not seem like much different form a pharmacists ordinary scope of practice but for him he visits each clinic only on a weekly basis, he must travel to each of the clinics each day, is on call 24/7 for emergencies and non-emergencies, and even has patients coming to his home. He has enough vacation built up to be on leave for 3 months! But due to the lack of staffing he has not been able to use his well earned vacation time.

Pharmacies in the Caribbean are set up in a way that all of their allotted funds go into a joint purchasing account in order to allow the islands greater purchasing power. Once they ordered the drugs get distributed amongst the islands and their clinics. Kent only places a drug supply order once every 2 months and sometimes still does not receive all of the medications he requests. For example diazepam and phenobarbital have not been available to him because there needs to be some sort of special ordering license that has been in the process of being approved since 2011. The island has a universal healthcare system set up where patients can go to clinics receive basic care and medications at no cost. So what to do when he doesn't have a medication? Well the patients have the opportunity to travel an hour and half to Roseau (the capital city) in order to pay for their monthly maintenance medication in the private sector out of their own pocket. Most times patients can't afford the cost of the medications or the trip to Roseau.

After our first discussion time with Kent he introduced us to the patients in the waiting room and why we were there. He informed them we were all students from the U.S. here to be a source of information for all of them about any health or medication questions they may have. As soon as he was done, we had our first patient approach us and ask if they were supposed to form a line or if we were going to come around to them! Each of the three students (Bianca, Theresa and I) started circulating around the room interacting with as many patients as possible and performed patient interviews with almost all of the 20 patients in the waiting area. All of the patients were very receptive to us being there and they were willing to share anything with us. Sometimes communication was a barrier due to understanding the "accents" and differnt usage of terms. As we neared the end of our time with the patients we re-entered the pharmacy and asked Kent a few questions about the patients we had talked with. We were all amazed at his ability to rattle off a patients whole medication list just by knowing their name! Along with that he was knowledgeable about their past medications as well. The clinic had come to more of a lull as we departed after our amazing afternoon with Kent at the LePlaine Clinic! I can't wait until our next clinic day at the Rivirie Cyrique Clinic!

 Enjoy reading! -Dani

Welcome to Dominica!!

Most of the Iowa students started their adventure at midnight on Thursday the 8th of August.  We traveled to Davenport where we collected the last member of our crew, Theresa.  We arrived at Midway airport at 5:30am and boarded our flight at 8:30.  Finally at 10pm on Friday the 9th, after a detour through Orlando the Iowa crew met up with everyone else in San Juan.  We had a grand reception from our taxi driver which included snacks of all types and a video a video of Puerto Rico...for our total of a 5 minute taxi ride.  The next day we finally met everyone in person and headed off for our flight to Dominica!! Flying into the island was beautiful.  I had definitely never seen anywhere so lush and green.  We landed and were greeted by the crew from Jungle Bay who drove us 90 minutes to our final destination.  While Dominica is a small island it takes very long to reach everywhere because you have to maneuver large hills. The island has about 91 miles of coastline and almost 5000 feet of elevation.  Once at Jungle Bay we were each assigned our cabins.  My roommate, Michaela, and I have 157 stairs just to reach it!!! And that is after a sharp incline we climb.  We will definitely be in shape at the end of the journey! The view from my cabin is of the Atlantic ocean-It's okay to be jealous.  I was really surprised to experience how early the sunsets here.  Then at Jungle Bay we were allowed to relax and recuperate from our travels with a delicious meal.  
The next day, Sunday, much of the island was closed so we were allowed to participate in travel activities. The day started with a surprise awakening at 5am with the sun in my eyes.  Glenda teaches a beginners yoga class every morning at 7am of which we all participated.  We decided it was a real treat because she sings at the end of class everyday.   We then headed to Mero Beach which is a black sand beach.  You read that correct, the sand is actually black.  Apparently it is because the island is made of volcanic rock. We swam in the Caribbean Sea and play sand volleyball--ish; we are not very good.  It was a great day, and I got to cross something off my bucket list that I did not know was there!
Monday we hiked to Pomme's Paradise.  Pomme is a farmer.  He was born on the island, moved to another island, and finally landed back to his homeland.  The law in Dominica is that if you live on the land for 12 years you own it.  Pomme said he has lived there 30 some years.  He has a very large farm with a very large variety of plants, much larger than we would ever see in the states.  He can tell you what they all are and where of them have originated from as lots where imported to try and develop them as a cash crop of Dominica.  There are several reasons why this has never been successful which I will not go into here.  Not only does Pomme have lots of fruits and vegetables, he also has a plethora of herbs which he can a medical use for each.  While to most of us westerners this seems like useless information, however, it is good to know that last year the oldest lady in Dominica died at 127 years old!!  She never used western medicine.  Now you are probably thinking that this is good genes, or good luck.  You may want to think again there are a lot of islanders who live to be very old and look very young for their age.  Pomme has not been sick for years, but if he is he just has to walk to his garden to find his medicine.  (Pomme also provides much of the produce for Jungle Bay which is a eco-lodge.  Simply said that means that they support the community and protect the environment.) 
Pomme had very interesting ideas on health, as you can see from above.  He also has interesting ideas on life that we could all use more of.  He does not claim a religion but is a God-fearing man.  He lives almost a 5 mile hike (up a mountain) from any road.  He strongly believes we do not have enough face-on-face contact in the world anymore and has choose to not have any internet of phone services of any kind even though he does have cellular service where he resides.  He loves to have people come and visit him so he can sit and talk with them, I even got him to sing a song for us! His ideas on life I most easily related to the Dahli Lamas in that we are all humans and we need to have compassion and love for all humans.  We need to take care of one another because we are all we have.  It was very refreshing to discuss this with him because I think we all too often forget how important and wonderful a life is. 
Monday night we heard Sam Raphael, the owner and creator of Jungle Bay, told us his story about how the Eco-resort was developed.  Dani will be posting a summary of his story later.  I highly recommend reading it.  Sam is an entrepreneur by trade and has a lot to share.  
Today, Tuesday the 13th, the students were split into two groups.  One group headed to a main governmental health clinic in the LaPlaine district (Dominica is split into 10 districts).  The group I was part of headed to a smaller clinic in Petite Savanne which is only about a 15 minute drive up the road.  Once we arrived at the Medical Clinic we were lucky to witness the community helping each other out.  There is a church in Petite Savanne which the medical clinic works hand-in-hand which.  The church wanted to give back to the clinic and donated a water purifying system and some other equipment for use.  After the ceremony we were introduced and gave our donations of medical supplies as well.  Dominica is a developing country and there is a lot still lacking in there health care.  (Of specific note they are always in need of more diabetic supplies.  If you would like to help out you can go to https://www.choosefreestyle.com/select-your-meter.html and select the Precision Xtra Blood Glucose and Ketones monitoring system and they will send you one for free which we can then forward to our patients in Dominica.)  I had the opportunity to interview several patients and assist them in their health care; they are very open to talk to everyone and really want to get to know you.  Patients in Dominica carry their health record with them in a note book.  This note book is where all important information is kept.  It is also were most of their prescriptions are written, they then present this book to the pharmacist who will fill their prescription with medications provided by the government if they have them.  What I mean when I say 'if they have them' is that being a poor country the government has to spread the medications they do receive, which is very small, between the 10 districts.  If the pharmacist, who has to travel between clinics with all the medications, does not have a medication the patient can purchase it from a private pharmacy. 
Talking with the pharmacist was saddening.  Besides having to carry their small inventory with them the pharmacist does not have a computer system to keep track of their inventory.  They take a large book with them and keep track of how much medication they give to each individual patient.  Needless to say I think that sounds like a lot of work, and hopefully you never need to go back and find information because you will be staring at that book for a long time. 
After interacting with the pharmacist I assisted Nurse Moyes.  I took blood pressures, pulses, and respiration, I even had the opportunity to give a hepatitis B shot!
It was truly amazing to see how grateful the people where that we were there to help them and that we brought donations.  I talked to a beautiful women in her 80s who was almost blind and deaf and she just kept telling me she praises God everyday for what she has.  It was really surprising to me to see how much the people depended on their religion for their health, another aspect we have grown to neglect in western cultures. 
Tonight a group of us hiked up a mountain which in English is "close your mouth", there is a Creole name for it but I will not try to spell it here.  This hike was 1300 feet up a very steep hill, I'd estimate a good portion of it at a 60% incline, and we reached the top in 35 minutes!!  We didn't stop there though, once we arrived back at Jungle Bay we headed out on a trail called Zom Zom which was the original name of this land when Sam bought it.  We did not complete the whole trail however because we were already hiking back in the jungle in the dark.  
This is just a short synapses of what I have experienced so far.  There will be more to come.  --Katie Hassebroek

Pomme's Paradise

We survived our first hike!

Yesterday Brother took us to Pomme's place.  We drove about 45 minutes or so up through Paix Bouche until we reach the entrance to the trail that leads to Pomme's land.  On the way Brother taught us a little about some different plants, we sampled cocca plum, and teased the sensitive plant.

When we reached Pom's Place - out of breath and tired - it was beautiful!  We were greeted at his house by Pomme himself and Justin (from Jungle Bay).  Justin prepared a lunch for us of stew and roasted breadfruit.  The stew was delicious!  We talked with Pomme about his lifestyle and it just blew my mind.  He found the land while walking and decided it looked like a good place to live.  He showed up with nails and a hammer and everything else he used to build with was gathered from the land.  He has been working on his paradise for about 36 years and told us it is still not done.  He has no neighbors, so whatever land he wants is his.  It was amazing to hear him talk about being sick.  He said he cannot remember the last time he was sick.  How often can we in the US say that?  When someone is sick, it is common for them to go into the backyard, pick an herb and prepare it.  When we would run to the doctor, they just pick the herb from the backyard.  Not to mention, where ever you walk to you are walking up hill.  Some people walk for hours up and down hills to get to where they need to go.  Just the walk up 157 steps to get the cottage was a work at times, so all that walking must do wonders for their health!

I think the most important thing I saw yesterday was how self sustainable Pomme and many people of Dominica are.  It just blew my mind that he was able to do almost everything on his own.  The trip to Pomme's really made me think twice about how I live my life and how much I really do not know!

- Michaela