My Year as a Manos de Ramón Global Health Fellow

Hi everyone! I’m Ericka Jaramillo and it is my privilege to tell you about the awesome work that that Manos de Ramón Foundation (MDR) has been doing this past year in the Dominican Republic. Misión ILAC, or the Institute for Latin American Concern, has been home here in the Dominican Republic. When I first arrived at ILAC (almost 6 years ago), I fell in love with their mission of empowering rural communities via multiple projects including agriculture and health initiatives. It also has a clinic and operating rooms (OR’s) where different groups come to provide care for the underserved rural communities with which ILAC works. Little did I know that so many years later, I would be working here again along with some of the most caring, experienced mentors around in global health and be MDR’s first ever Global Health Fellow! As a recent medical school graduate awaiting residency, this position was an ideal fit for my interests in maternal and neonatal well-being, research, and education. I’ve always wanted to gain skills to be able to empower others in culturally sensitive and equitable ways.

So what did my fellowship entail?

Dr. Roa and I with NeoNatalies, simulation babies

The main professional activity involved helping to assist Dr. Wanny Roa facilitate Helping Babies Survive (HBS) and Helping Mothers Survive (HMS) workshops throughout different regions in the DR. HMS and HBS are educational curriculum aimed at frontline healthcare providers of mothers and babies designed for low-resource settings. They use a train-the-trainer model (T3) in which we train local champions/master trainers, local healthcare providers, who will prioritize the dissemination of courses in their respective institutions and continue to teach others. This experience has been deeply enriching in so many ways and I’ve learned so much mainly—

1) Overcoming performance anxiety and public speaking takes practice! :)

Facilitating the courses and letting the actors come out has been one of the most fun times! Acting as an eclamptic patient and seeing the acting skills of doctors and nurses has been so fun! Participants from all different ages, including high school age students to experienced physicians, are eager to learn and one of the best ways is to review/teach a little theory, conduct simulations, and provide feedback, as well as constant reiteration of concepts! Once you can reach them and assist them in the belief of the story, they really go with it!

I’ve been so lucky to see the growth of students in acquiring different practical skills like ventilation techniques with mask and self-inflating bag has been a real treat!

Participants in the Helping Babies Breathe workshops, practicing ventilation in the Golden Minute. Check out that chest rise in the video!

2) Obtaining a view of the Dominican healthcare system as well as an NGO’s view of collaborative work with multiple partners in promoting the successful uptake of educational curricula.

The landscape of the Dominican healthcare system is varied ranging from a large public system as well as a private system. There are 3 tiers: primary level are composed of CPN and UNAP, unidad de atención primaria, or community clinics; second level-or small hospitals; and tertiary level—or regional hospitals. Recently graduated physicians on their pasantía, or year of government service, are stationed in the community clinics. Particularly in Pre-Eclampsia/ Eclampsia workshops, I’ve had the opportunity to listen first-hand to many of the obstacles healthcare workers face, like limited personnel, changing infrastructure, and lack of basic resources, to name a few. Many challenges exist, but working closely with local health authorities as well as workshop participants so that we can jointly come up with possible solutions, may go far in actually instituting change.

Different institutions where we conduct the workshops

3) Persistence is key!

Maternal and neonatal morbidity and mortality are public health issues that will not be resolved with educational curricula alone. With the support from local health authorities, it involves its dissemination and execution with committed trainers, as well as prioritizing basic resources to be able to do what we teach in the courses. It obviously is no easy task!

However, realizing that we are a little piece of the puzzle and that we are constantly adding drops to the seemingly immense bucket, but we have to do what we can with what we have. The reality and pace of empowering others to institute substantive change and progress can be slow and tedious. In fact, Drs. Leader, Cadet, and Jensen have been working in the DR for years and are deeply committed to capacity building and equity. Dr. Roa, Dominican family medicine-trained physician is MDR’s on site director who leads the workshops and conducts follow up. She has become more than a mentor and role model for me!

First photo: Family Medicine residents from Juan XXIII, a local community hospital, going through a simulation case of a patient presenting with magnesium sulfate toxicity.

Second photo: Reviewing the WHO’s clinical handwashing techniques with the head nurse and a médico pasante in El Seguro Social.

Family Medicine residents from Juan XXIII, practicing urine dips to measure proteinuria, or protein in the urine—and important criteria in the diagnosis of Pre-Eclampsia.

I am incredible grateful and lucky to be able to nurture seedlings of valuable and meaningful efforts. Change takes time and we may not see it right away! I’m only sad to go right now when the workshops are gearing up (we have been and are going to be busy replicating workshops in Santiago and beyond). We are also instituting new ways of helping participants at the trained hospitals to put into practice what they learned in the workshops. For example, we will be working with nurses and doctors in the public hospital of Puerto Plata to organize and rearrange areas where women and newborns are taken care of that they can practice what we preach!

It has all been a wonderful, fun experience that never felt like work. Thank you all for all your support in allowing me to pursue this immensely enriching experience of my life!

Workshop participants, Dr. Roa, and I emphasizing alarm signs of Pre-Eclampsia/ Eclampsia.