University Park, Pa. -- In March 2007, during Penn State's annual spring break, 27 people traveled to a remote corner of the Dominican Republic on a service mission. Included in the group were three Penn State faculty members, two College of Medicine physicians, one graduate student, three undergraduates and a newly accepted Schreyer Honors College student. Also contributing to the team were several State College business people, a newly retired biophysicist and a handful of State College Area High School and middle school students. Among the total were five different family groups, including parents with one or more children. In short, it was a diverse group with a wide range of backgrounds. Nevertheless, the trip brought these individuals together in a way unlike any previous spring break experience.
Michael Flanagan M.D., associate professor of family and community medicine in the College of Medicine, Penn State Hershey Medical Center, chronicles his experiences during this service mission trip.
This is the third of a four-part series of dispatches from the Rose of Sharon Orphanage in the Dominican Republic.
Day Four
We dubbed our fourth day at the orphanage, "Penn State Day" and we all wore our PSU T-shirts. I've heard that Penn State fans are found everywhere, and we certainly helped to make that true. This day also was important because we held our much-anticipated medical clinic at the orphanage.
Our goal was to screen all 60 boys for vision, followed by an evaluation with our nutritionists, and finally a full medical exam by a physician. In the end, each boy would have a medical record modeled after the Penn State Hershey Medical Center outpatient chart, and donated by the Department of Family and Community Medicine.
We started early by setting up a series of stations at the end of a long hall inside the orphanage. The middle-school students kept the boys occupied in an entry hall waiting area. By offering 10 pesos (about 33 cents) to each participating boy, we ensured that they would all show up for their exams.
At the same time we were careful not to bring eyeglasses with us during the vision screening. The last time the boys were screened for vision, a team of altruistic but naive American optometrists brought 400 pairs of donated glasses with them -- in case they were needed. The boys caught on very quickly, and consistently performed poorly enough during their evaluation to warrant a pair of stylish American eyeglasses. Eventually, the eye doctors caught on, but by then it was too late to turn the tide.
Our Penn State nutritionists, Jill Cox and Liane Roe, found that the boys were surprisingly well nourished. Though most were in the lowest 10th percentile for height and weight, few if any were malnourished. This was a tribute to the Americans back home who had been supporting the monthly food budget. In earlier years, team members would pack canned meat in their suitcases to help supplement the boys' protein intake, but that was no longer necessary.
The medical exams and history taking were successful only because of our Spanish-speaking Penn State students, three of whom acted as translators. Corey Hixon, a senior in engineering sciences, was invaluable as a translator in the exam rooms -- actually one room with a sheet draped across a rope dividing it in two. Many of the boys, who like Europeans, were all uncircumcised, needed instruction on proper hygiene. Asking Corey to translate these directions stretched his language skills beyond anything his Spanish teachers could have envisioned.
Most of the boys, while small for their age, also were relatively healthy. However, there were several cases that struck us as physicians -- Danzi, blind from cataracts and congenital rubella syndrome; Henri, wheelchair bound with untreated multiple sclerosis; and Paco, with the classic features of fetal alcohol syndrome.
Many of the boys had a fungal scalp infection. We had expected this after nearly three-quarters of them demonstrated the same thing two years ago. At that time, we took advantage of the opportunity to hold an outdoor public health class, introducing the boys to a new game called "shampoo." Before we knew it, 80 boys were running around an outside spigot with suds covering their heads. Fortunately, this time we also brought along an antifungal medication donated by Centre Volunteers in Medicine, State College's clinic for medically uninsured patients.
We also treated a few ear and eye infections and assessed several heart murmurs in advance of a State College dental team that will travel down later. One boy needed a hernia repair, and we were able to arrange for this at a clinic in San Juan.
Our most challenging but compliant patient, Oriolis, was slowly improving with his diabetes control. Daily insulin adjustments and blood sugar monitoring, mid-morning snacks and teaching proper insulin administration all worked to improve his diabetes.
Likewise, the construction crew continued to make progress on the dining hall. By the end of the day, the ceiling was in place and most of the electrical wiring was completed. In addition, our biophysicist, Steve Scott, finished setting up five computers in a small classroom. By connecting them to each other, he established the first intranet in that part of the Dominican Republic and introduced the boys to a totally new educational experience. We ended our day with a typical Dominican meal of stewed beef, rice, beans, fried plantains, and green tomato and shredded cabbage salad. After the long day in the hot exam room, nothing ever tasted so good.
For photos from the spring break trip to Dominican Republic, visit http://live.psu.edu/still_life/2007_04_05_spring_break/index.html online. For past dispatches from the Dominican Republic, visit http://live.psu.edu/story/23470 online.