October/November 2012 – Reflections on Clinic Visits, Church Needs Assessment

Research Travel & Culture                                                                                                                                                               

Autopista (Interstate) Duarte leaving Santo Domingo during one of our many travels.

Zipping along highways to visit physical therapy clinicswas a common routine during this research season.  Roads have a lot to tell about a place.  They were well paved around the capital and anywhere else “important.” Though often pot-holed, trafficky and trash-lined, there was asphalt and the maddening promise of speed.  Life was slow, painfully and bumpily slow, while careening through the rural, dirt-road towns with our shocks complaining from the back seat.  Our nights in campo mountain towns were delightfully cold and quiet, challenging our well-tested assumptions that Dominican culture is akin to VERY loud music.

Processing data to give identity to the PT profession in the DR. We have already began using our preliminary results to improve how projects are designed.

Despite the countless hours of data assessment that visiting clinics inevitably brought, we enjoyed the weekly travel and gained a deeper appreciation for both the nature of Dominican physical therapy and nature itself in the DR.  We finished our last clinic visit in mid October!, and are excited to present the preliminary research findings at a physical therapy conference in San Diego in January.

 

Physical Therapy Development: Story of the Profession

It is fascinating to piece together the story of an emerging health care profession, and particularly, what influences its growth.  Unsurprisingly, the start of physical therapy (PT) in the DR emerged from the efforts of a family affected by the polio epidemic in the 1960s.

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Societal understanding for the needs and concerns of people with disabilities began to grow, along with a greater understanding of the preventative and conservative management of many other diseases.  Compassion soon melded with business and the role of institutions in PT education and patient access to care became apparent.  In the early years, once the need was identified, clinics often paid for untrained staff to go to Mexico or elsewhere to receive basic technical level training in physical therapy.  Now that the country has 2 bachelor’s level programs, the difficulty has been encouraging businesses to care about quality of care, and to seek out staffing with higher qualifications rather than accept a more rote or technical form of physical therapy care.  Insurance companies, international included, are the newest to the scene and are making their voices heard.  Some are requiring bachelors level staffing for reimbursement, and others require therapists to document what they are doing for the first time.  In recent years, therapists themselves are attaining enough education to begin to advocate, educate and articulate their own understandings of what high quality rehabilitation services are, and that is an exciting place to be.

Observing and conducting hour-plus interviews with staff has provided excellent opportunity for the interchange of ideas between ourselves, therapists and administration.  It is grounding us in a more thorough understanding of health care realities. We are glad that many along the way encouraged us to take this long, bumpy road that may be termed “development”, with the hope that it should expose us to the deeper roots of the situation, that when tapped (or kicked or watered or listened to), may be a part of lasting positive change.  Pray for wisdom on this journey in our cultural, societal encounters living life with the dear folks in the Dominican Republic.

University News

At PUCMM university with Cristobalina (left) and Margarita (right), during a weekly curriculum meeting.

Seven months of biweekly meetings have produced a final revised physical therapy curriculum at PUCMM university.  Now we must review course content and objectives one by one!  This otherwise tedious task has gone quite smoothly and enjoyably due to a growing friendship with the dedicated department head, physical therapist Elsa Margarita.  Relationships make a big difference in life, do they not? The next steps may be more difficult; identifying or equipping professors with the skills to teach the enhanced curriculum in the year ahead.

Church Needs Assessment

After hearing about our experience with the health care needs assessment, the Mesoamerica region of the Nazarene church approached us in September to develop a needs assessment tool for use at 28 sites in Central America and the Caribbean islands, including some countries new to the Nazarene church.  The goal is to promote listening to the voices of the local church, and incorporate the realities of economic, health and social indicators into making relevant decisions for new ministry projects.  We want to be an effective, listening, relevant church, and this is quite a challenge!  Now that the tool itself is complete, we will perform this assessment at 2 cities in the DR sometime next year. Please pray for wisdom and discernment!

Personal Notes

We continue to make gains in settling into our identities as North Americans in a low-moderately developed country.  While we have gained a lot of insight into healthy living through relationships with both foreigners and locals, please realize with us that this is a never ending process of adjustment, and hold us in your prayers.  Our reality as strangers in another place always becomes more apparent on holidays and when we talk to or see family and old friends.  Nick celebrated 31 years on October 20th!  And we will travel ‘home’ for our first scheduled visit to the US this December and January.  We are SO excited to be able to see many of you during our travels.

Junior and his sister Rosy say thanks to everyone who supports their ministry.

Shortly we will report on our financial outlook for 2013, and are so grateful for your practical presence with us throughout 2012.  Thank you so much for joining with us in life and work here!  Despite our shortcomings, it is very encouraging when hopeful things come from the collection of all of our prayers, talents and efforts.  As Junior says, Thanks.

En Paz,

Nick and Laurie

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