August 2011- Hand-washing & Prepayment for healthcare

Dear family and friends,

We and our surrounding community survived hurricane Irene without any problems in Santiago!  Thank you for your emails and prayers on our behalf!

View from the roof of our home

Since you last heard from us, we have settled in to our home, evidenced by newly planted tomatoes, lettuce, zucchini, moringa trees and a berry plant in pots on the balcony.  We also have a beginning handle on the cultural nature of business, relationships and schedules in the Dominican Republic.  Trials and errors are molding us into more flexible, patient, and ultimately Dominican-like people.  Our lives of ministry are multi-faceted these days, summarized in patient care, research, and supporting the church’s child sponsorship ministry.

We are enjoying treating a handful of patients in their homes.  Gloria was home bound for two years after a simple fall on concrete.  She had no major complications from the fall, but pain persisted, and she was unable to afford conservative therapy and pain management.  From disuse due to pain, Gloria now has severe arthritis and a biomechanical knee deformity that will likely need a total knee replacement.  Unfortunately, we know of no Dominican surgeons performing this surgery, and she cannot afford the upfront costs even if the surgery was available.  Despite the need for surgery, she can now achieve her goal of returning to church, after we provided a strengthening program and procured a donated cane for decreased weight bearing and pain relief.  We are excited for the improvement in her social, emotional, and spiritual life!  In the mean time, we contacted an orthopedic surgical team called Operation Walk-Boston, to see if she will qualify for surgical management.  Gloria’s is one of the more simple cases.  Please pray for the majority of people in the DR who can’t pay for basic or emergency health care due to upfront costs, and the effects this has on the society as a whole.  By upfront costs, we mean that one needs to buy the stitches and bring them to the hospital before they will stitch you up.  Unfortunately, once people do finally access services, the staff and facilities are often underequipped to provide what we know as quality care.

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This is exactly the focus of our current needs and assets assessment: what are the underlying reasons that people do not receive health services in the DR, and what is limiting the advancement of these services, specifically in the area of rehabilitation?  This will clarify our work as we support Dominicans in their struggle for health.  After reviewing research, we found sparse information addressing rehabilitation in theDominican Republic, so hope to publish our work so that other global missions and development communities can use it too.  We are collaborating with colleagues atCreightonUniversity, reviewing research, listening, and reflecting.  As excited as we are when individuals like Gloria get better, we would much rather see her need for surgery prevented by early, Dominican-provided care.  We are so glad to participate in supporting Dominican therapists as they seek to grow in the quality and scope of practice they provide, while easing accessibility of care for the many people who need it.  We are hearing how we can best support them and have a greater impact through our research.  Pray with us for this slow process of development.

We participated in a meeting of a coalition of organizations to begin implementation of disability rights. (Notice people with visual, physical, and hearing disabilities leading!)

Additionally, we are coming alongside the staff and kids at the church’s child sponsorship development center.  Laurie gave a lesson on hand-washing and cholera after the Bible lesson several weeks ago. We are glad to see hand-washing now embedded into the regular rituals.  The next challenge remains in providing the 25 kids with drinkable water at the meal, as the tap water comes with bonus opportunities for cholera, hepatitis, and multiple intestinal delicacies.  Ever-present are the basics of the health needs, evidenced in the open sewage running under the bridge next to the church.  Pray for us as we listen and brainstorm with the children’s ministry workers on these issues.

Below are a few more activities from the last 6 weeks:
Advocacy work: meeting with a group of 30 faith-based and NGO groups supporting people with disabilities.  Focus: Dominican government accountability to the many wonderful promises agreed upon at a world conference on disability in 2008, and ways that we as agencies can act on the promises additionally.
• Participating in a rare physical therapy continuing education course & surveying the participants in mid August
• Visiting and hosting church and community members; participating in new cell groups at church
Teaching English to the pastor’s son.

We are enjoying the variety of work in this relationship-building and assessment phase.  We expect to be interviewing stakeholders in the rehabilitation community within the month and to be completed around December. Then clinical and education work will pick up, while church projects continue.  Nick has really enjoyed starting sandal-footed running again, and has found groups of Brazilians & Haitians who play soccer.  As always, we love your notes, pray for you often, and need your prayers.

With gratitude and in peace,

Nick and Laurie

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