09 March 2014 by Lawrence Loh
Prepared by Lawrence Loh, MD, MPH, CCFP, FRCPC, Christopher MacKay, and Elizabeth Townsley
February 8, 2014 saw the first breakthrough result of nearly three years of efforts to develop a collaborative community of providers and local leaders around the provision of healthcare, construction and health promotion efforts to batey communities in La Romana. Representatives of several short-term volunteer teams that work with Hospital el Buen Samaritano attended a full-day symposium in Worcester, Massachusetts.
Represented organizations included:
The need and case for collaboration was made clear throughout the day, with a wide range of presentations that enabled information exchange and discussions of the issues in providing care in the bateyes that might serve as a launching pad for collaboration. This report aims to provide background on the origins and history of the collaborative process, review the presentations and discussions associated during the symposium, and discuss next steps to be taken by the groups in attendance.
Work in the bateyes of La Romana by visiting North American teams together with the Hospital el Buen Samaritano l has been occurring since the 1980s. At present, nearly 30 teams are involved in the provision of mobile medical clinic care and construction assistance in La Romana. Nearly 13-14 of those specific teams were represented at the meeting on February 10, along with Hospital El Buen Samaritano leadership and other external experts and new partners who are entering the La Romana ecosystem. This represents a critical mass and tremendous opportunity to build on the great work being done by teams individually.
While previous symposia have been held, the first steps towards developing this specific collaborative symposium occurred in fall 2011, where the leaders of the group The 53rd Week reached out to Bob Beck of the Good Samaritan Mission Council and the then-medical student leaders of the University of Massachusetts Medical School La Romana Medical Trip in Framingham, Massachusetts.
This initial discussion led to the planning and execution of a batey health symposium that took place in October 2012 at the University of Massachusetts Medical School in Worcester, Massachusetts that was attended by members from The 53rd Week, First Baptist Church Wallingford, and the University of Massachusetts Memorial Hospital. The timing of this meeting coincided with a farewell celebration for Kristy Engel, a long-serving nurse in La Romana who was moving to a new position.
Rick North, a professional fundraiser, provided the first session and discussed potential means by which a collaborative model could allow the deployment of various fundraising mechanisms to better support care and development work in La Romana. He highlighted the rise of baby boomers and the opportunity that arises from their significant potential source of individual donor income, and reviewed the Gates Foundation grant process. North also introduced the Salesforce.com platform, a potential tool for tracking data and sharing information between teams, and reiterated the importance of collecting data on joint projects to demonstrate the value of collaboration and to continue to collectively tailor our teams’ work in the bateyes towards scaling up for additional funding.
Lawrence Loh, Director of Operations at The 53rd Week, provided a presentation on the benefits of collaboration. Key messages included the idea that these multiple various teams working in La Romana represent a significant critical investment, and that the time has come to optimize their impact and minimize the duplication of efforts. He highlighted the importance of having local guidance and leadership in setting goals for the initiative while also maintaining open lines of communication between all visiting teams and the local leadership to ensure that important, relevant priorities are met. From the investment perspective, Lawrence pointed out that pooling resources could allow teams collectively to begin addressing some of the root causes of illness in the batey populations by working together to develop local capacity.
The first morning session concluded with introductions, with each group providing background on the length of time they’ve been involved in La Romana, the nature of their work, and what goals they had in attending the symposium. Most encouraging was the willingness to work together even with the enormous diversity in experiences, viewpoints, and professions in the room.
Remaining presentations came from both volunteer groups in La Romana as well as external speakers. We were fortunate to have Dr. Franklin Bido and Moises Sifren Juan join us in-person from La Romana to present an overview of the strategic plan for Hospital Buen Samaritano. We also had two excellent presentations from external speakers Laura Baetscher, who described her time in La Romana as a Peace Corps volunteer, and Amelia Brandt, with Medicines for Humanity, who provided an overview of the projects her organization is working on in other regions of the Dominican Republic involving community health workers and the Ministry of Health. Additionally we heard from Victoria Winslow, a founder of the organization Students for Haiti, who highlighted the work done by her organization in developing a website that helps Haiti-focused volunteers and non-profits connect on common projects and strategies.
We also enjoyed excellent presentations shared by current volunteer team leaders on various projects being conducted in La Romana. Al Biggs provided an overview of the work being conducted by the Village Presbyterian Church’s Dominican Republic Medical Partnership, highlighting the hypertension project, health promoter project, and construction work done by the numerous, well-resourced groups out of Kansas City. The hypertension series was continued by Tammie Kear, from Villanova University, who described some of her research on the cultural consideration of treating a chronic condition like hypertension in the batey-resident population, including the use of traditional and herbal remedies that have the potential to have adverse effects.
Two students from McMaster University in Canada, Chris Russell and Brendan Wong, presented their experiences and thoughts on a study-abroad semester that they spent working with the Hospital el Buen Samaritano, and provided data on sexual knowledge adequacy among adolescents. Matthew Dacso from the University of Texas Medical Branch described some of the wider research initiatives being developed by his team to centralize and standardize research work in La Romana. Finally, Caitlin Fogarty from the University of Massachusetts highlighted issues with the batey-clinic-to-hospital referral system, particularly when a referral arose from visiting medical teams; this led to a spirited discussion and questions about how to improve and ensure that patients requiring referral services would receive the appropriate care.
The presentations at the symposium provided the groundwork for discussions on the collaboration; all teams present agreed on the need to pool information and resources and discussed the best way to move forward. A web platform, under development for some time, was proposed as one possible contact mechanism, at least to ensure that scheduling and availability for teams visiting would be tracked.
The population hypertension issue quickly became a lightning rod for attention, given the possibility for good data and measurement as well as collaboration from team to team on both hypertension education (around the use of the traditional remedy bitter orange, for example) and collaboration in medication delivery, continuity of care, and chronic disease tracking / management. The decision was soon taken to ensure regular consistent communications, through an email list, the web platform, and quarterly teleconferences, and to focus on a multi-team committee that would study the hypertension issue in earnest and come up with a joint response to work on this as a quick win going forward.
Future considerations include the development of guidelines to oversee the processes of the collaboration and/or the creation of an umbrella organization to support information and data exchange among different teams, and to act as a larger fundraising entity. The hypertension project will demonstrate the value of working together through shared data and metrics and common educational messages and programming.
This joint project represents a first step towards developing a wider community of autonomous teams that work towards having a meaningful and lasting impact on the health and healthcare on the bateyes of La Romana and will help fulfil the original purpose of the hospital in improving the health and well being of batey residents. It will be exciting to see where things stand at the 2015 symposium.