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Wednesday, April 18, 2018 - 1:45pm

Mercy students and faculty from the School of Health and Natural Sciences traveled to the Dominican Republic in March on a humanitarian medical mission. The team — which included 22 students from the Physician Assistant (PA) Studies program and five each from the Physical Therapy (PT) and Communication Disorders (CD) programs — helped treat over 1,000 patients in underserved areas.


“Trips like this are why I chose to come to Mercy,” explains Siobhan McGee, a student in the Physician Assistant Studies program. “Our mission in the PA program is to serve the underserved. And I’m so grateful for any opportunity to do so. When you come back from a mission, you have a humbling revelation of everything you're thankful for and all the good we can do. PA school is competitive to get into, and then once you’re in the program, it’s a lot of work. So it's such a gratifying experience to know that I'm in the right place doing the right thing. I think everyone should have to go [on a mission].”


Over the course of three days, the team served patients in three different locations: a YMCA in a town called Nizao southwest of Santo Domingo, a rural clinic near the sugar cane fields in San Pedro de Macoris, and a school in one of the poorest neighborhoods in Santo Domingo. The trip was organized and sponsored by Friends of Lead Free Children and Continental Food and Beverage Inc./Inca Kola USA — with additional support from Coca-Cola, Aetna, and the United Federation of Teachers.


“The goal of the mission was to expose students to an impoverished area and patients who have limited or no access to medicine,” explains Lorraine Cashin, assistant professor and director of the graduate program in Physician Assistant Studies. “We wanted students to participate in hands-on experiential learning and take a 360-degree view of what medicine is really about.”


Students gained confidence as they put their classroom learning into practice — and saw success. Physical Therapy student Mary Jongoy described a young girl in the Nizao clinic who reported some wrist pain. After an examination and some questioning, the girl revealed that she had fallen over a week before. Because of how she fell and how she presented at the clinic, Jongoy and a fellow student suspected that she might have actually fractured her wrist. When their professors agreed, they referred her to the local hospital for a more in-depth exam. “It was exciting,” Jongoy explains, “because it was a moment when all of our education actually paid off, and we were able to say that it was important to get her wrist checked out and get some more attention to it.”


Humanitarian missions like this one reveal how deeply Mercy values service and giving back. Students in the School of Health and Natural Sciences participate in other missions every year, including one to Antigua last month and one to Senegal and the Gambia later this year. Mercy organizes many other community service initiatives too, such as the annual Day of Service, blood drives, and volunteer opportunities.


Mercy’s Chief Community Relations Officer Lenny Caro who developed the partnerships that made the Dominican Republic mission possible and joined the trip to help coordinate and translate — sees this as particularly meaningful given the College’s long history of commitment to the Bronx.


“This mission hits home.  Why?  Because the Bronx is 56% Hispanic and the majority of them are Dominican.  It is critical for the community to see that through our outreach, these students are responding to the needs of many families back home.”


Approximately 30% of the population in the DR lives below the poverty line, according to the World Bank. “People think of it as a place where you go on vacation, and they don't understand that it's very impoverished,” Cashin says. She explains that the Mercy team was seen as “a precious commodity.”


Early every morning, the team of students and faculty members boarded buses to head to each site. When they arrived, patients were often standing in line already. After a quick set-up, patients entered the triage area where students checked their vital signs and inquired about their primary medical complaints. From there, patients visited the appropriate specialists. Over the three days, the Mercy team treated a wide range of conditions, including fungal and parasitic infections, upper respiratory infections, hearing issues, speech delays, and chronic back pain. Ideally, patients cycled through all rooms before heading to the clinic’s pharmacy to receive vitamins and any prescribed medications. At the end of every day, the faculty members led a debriefing session to give students an opportunity to discuss a specific case, connect their experiences to their classroom learning, or simply to process their own emotions.


For many students, this was one of their first opportunities to observe and work collaboratively alongside practitioners in other fields. Paige DiStefano, a student in the Communication Disorders program, explains, “Getting to observe and assist different PA and PT students at the locations made me not only better understand what they do but allowed me to see how we can work together on very similar goals even though we are in different professions.” And in fact, McGee defines her entire role as contributing to a larger team: “Our job as PAs is to work with others. But we don’t usually get to do that until clinicals or even until we’re practicing. So it’s awesome to be exposed to that now.”


The importance of communication was in the spotlight as non-Spanish speakers worked to overcome language barriers in order to help patients. In most cases, students were able to refer to Spanish handouts with diagrams, act out instructions, or draw stick figures if no translator was available. "It was really interesting to have to find ways to communicate with patients,” Jongoy explains. “It was a good lesson: you don't have to speak the same language to work with someone or help them." Students quickly realized the importance of strong communication within the Mercy team as well. One of few fluent Spanish speakers in the group, Physical Therapy student Javier Hernandez reports, “I was initially focused on the communication hurdles associated with the language barrier, but I started realizing that [communication] is an issue that may affect people even when they are speaking the same language and working in the same office."


Communication and collaboration became critical to success at several points. At one site, for example, a local man who was helping the team manage the long lines of patients began to feel very tired and headed into the triage area. A student recognized that his condition was more urgent than others and quickly moved him into a treatment room where he passed out and had a seizure. While one student ran to get Cashin from the next room, another was already taking blood pressure and a third was testing his blood sugar. A fourth ran to call for an ambulance. Cashin described it as “a great example of teamwork” and praised their calmness, even while there were still 200 people waiting to be seen.


There were inevitable challenges related to working in underserved, under-resourced communities, but this was actually one of the reasons some students, like Hernandez, wanted to join the mission in the first place. “I've worked in some big hospitals where resources aren't scarce,” he explained, “so I wanted to be challenged and go to a place where you have to be savvy with using the resources available. And this trip didn't disappoint!” He describes one patient a man in his 50s who works in the sugar cane fields who complained of hip and back pain. The team discovered that one leg was significantly shorter than the other one, which was at least partially causing his pain. Unfortunately, treatment options were limited without proper equipment: “If we had just had a shoe lift or anything that we could stick under his shoe that would even the length of his legs that would infinitely improve his gait and then hopefully improve his back. I could literally have duck taped a flip-flop under his shoe to increase the length of his leg, but I didn’t have the materials there. We laid out the plan [for him] to make his own shoe lift so hopefully when he got home he could make one on his own…. This simple modification would have made a difference.” Students and faculty remained flexible and adapted their treatments to the context. In another example, DiStefano describes watching Communication Disorders professor Dr. Berkowitz provide feeding therapy to a child using a lollipop to show tongue lateralization and a fruit bar to see if the child could form a bolus.


Since returning to Mercy, several students have shared their experiences and reflections with their classmates or plan to do so. DiStefano, for example, gave a presentation about the mission at the Westchester Undergraduate Research Conference. Hernandez says that he and his fellow students must be “ambassadors of the experience” and discuss their new understandings with their peers, especially to help those who hope to join the next mission.


And there will be another mission. Friends of Lead Free Children has already asked Mercy to return to the Dominican Republic next year “and forever,” says Cashin with a chuckle.