Consuela Gabrielle sits on the edge of her bed in house No. 6 in Batey Algodón, Dominican Republic, mumbling words in her native Spanish tongue to a group of visitors who have stopped by. Her bright blue dress seems to contradict the somber mood in the room, dark save for a few rays of sunlight that weave their way through dime-sized holes in the tin roof of the tiny shack. Consuela is blind and mostly deaf — a lifetime of unchecked medical conditions and malnutrition has left her bedridden and slightly demented. It is obvious that the 64-year-old woman, who looks to be 80, even 90, is dying a slow, painful death. But her biggest complaint this day is hunger.
“I want money for carrots,” says Consuela, through an interpreter. “I want money for a stew. I have not eaten in three days.”
The woman’s hunger and deteriorating mental and physical health is no surprise to the group of visitors, a team of nurses and student nurses from the University of Memphis, that has come to examine her. On its fourth mission trip to one of the poorest communities in the Western Hemisphere, the team knows that Consuela’s plight is the norm in the Dominican Republic’s bateyes — rural and isolated villages built by sugar cane companies to house their workers. Many in the village are starving, disease is rampant and the majority of its occupants are unemployed, uneducated and have no access to welfare or consistent medical care. There is no running water, no sewage system and a lack of a real infrastructure.
“These people have no country to call their own,” says Greg Penza, a missionary from the Foundation for Peace, a U.S.-based humanitarian organization that targets the DR, as he looks over a sugar cane field near Batey Algodón. “Almost all are of Haitian descent so the Dominicans look down on them and the government does nothing to help them. They get no welfare, no healthcare, nothing from the government. And with the declining world demand for sugar cane, the jobs are fewer and fewer. The people have absolutely no money for food. They are dying from disease because of a lack of medical care. There is a prevailing sense of hopelessness here.”
To a group of 32 U of M students who have chosen to spend five days of their spring break here, that “hopelessness” is the challenge: to provide health care and a sense of humanity to a population many consider a forgotten people.
Mano y mano
U of M nursing professor Lawrette Axley has already had an exhausting day, helping to treat some 500 patients in a makeshift clinic on day three of the U of M’s mission trip. But on this night in the only church in Batey Algodón, she has somehow found the strength to hoist a small child in her arms for much of the 90-minute service. In fact, most of the 32 student nurses who have come to the service are holding small children as if they were their own.
“The children here are very clingy,” she says. “I think we offer them hope.”
Two years ago, Axley would have never imagined herself in this position. “I had always felt like my calling was teaching,” she says. But it was a trip to take care of a medical problem of her own which unexpectedly changed that. As she sat in the examination chair of her orthodontist, she listened as he described horrific conditions in impoverished communities in the Dominican Republic.
“I recall him saying that if nurses were there, so much more could be done,” Axley says.
Something stirred inside of her. After researching the idea for several months and finding support from her dean, Axley established a course elective in the Loewenberg School of Nursing whereby student nurses would travel to poor areas in the Dominican Republic to treat patients and teach hygiene and nutrition to needy people. She says her students get practical experience while a much greater need is served.
“In the U.S. when you are hungry or need medical help, you can find it through a church, through the government, through welfare,” Axley says. “In the Dominican Republic, families have little access to health care and when they do see a doctor, they often can’t afford the medications.”
Nine students signed up when the course was initially offered in fall of 2005; on the most recent trip, 32 students and four faculty took part. Each student paid the $1,200 cost of the trip out of his or her own pocket. “We get a lot of satisfaction out of going,” says junior Lacey Gault, who said she had other friends taking part in more traditional spring breaks. “No trip to the beach can do that for you.”
Axley’s mission groups target the poorest regions of the DR, the bateyes, made up largely of descendants of Haitians who crossed the border into the DR fleeing violence or seeking economic opportunity decades ago. (Haiti and the DR share the island of Hispaniola, about 500 miles south of Miami.) Those who have found work in the sugar cane fields or coffee plantations are often exploited, making 100 pesos a day, or roughly $3 in U.S. coin. The housing provided by the sugar cane and coffee companies are nothing more than shacks: the structures are either made of sticks or cinderblocks and none have running water or toilets. Unpaved streets with sewage-filled puddles serve as playgrounds for children, many of who roam the slum naked and unsupervised.
Working with the relief organization Foundation for Peace, the students treat almost 3,000 patients during each trip. They see patients for intestinal parasites, pneumonia, chicken pox, skin rashes, high blood pressure, flu, anemia and sinus and allergy problems, among other things. Each student takes one suitcase filled with donated medications ranging from antibiotics to Advil.
Besides Batey Algodón, the group on this most recent trip set up clinics in Barahona, Batey Alta Gracia and Palo Bonito, a small mountainous community made up of coffee industry workers. Wherever they go, they are enthusiastically greeted.
“We raise our hands and say ‘thank you’ to God,” says DeSiderio Amodor, more commonly known as Pastor Jackie in Batey Algodón, through an interpreter. “They bring so much healing to our community, so much love, so much caring."
Pastor Mercelino of Palo Bonito agrees. “No one ever comes here to help us because we are Haitians,” he says. “No help from the government. Only help is from the church and missions. There are lots of sicknesses and we’re very hungry. A lot of times the people eat leaves when there is nothing else. What the coffee company pays for one day of work is not enough to feed a family a breakfast."
None of which is lost on the student nurses.
“The only thing I can compare it to is something you see on TV, those commercials that say ‘send money,’ the ones that show sick children with flies around them,” says U of M student Brittnay Weirich.
“The first time I was here, it was a major culture shock — it makes me more appreciative of the things I have,” adds junior Lori Gladney.
The makeshift medical clinic that has been setup inside the church at Batey Algodón looks more like a tent city. Bed sheets have been hung to create six small examination rooms, each staffed by two U of M student nurses and a translator. At the back of the church, nursing school faculty Linda Finch and Joy Hoffman arrange an on-site pharmacy. Outside, patients line up for what might be their only chance for medical care for several months.
“People walk from as far away as 10 miles and stand in line for hours and hours just for ibuprofen or Tylenol,” says graduate student Johna Jenkins. “Some have never seen a ‘white coat’ before. That is how desperate they are for medical care.”
Inside each examination room, the student nurses never know what they get until the patient walks inside. In one exam room, student-nurse Elizabeth Dahl first treats a young baby who has been throwing up for three days, then a young boy who has pain in his shoulder from, as he says it, “beisbol, beisbol.” One room over, student nurses Kate Weeden and Jeremy Webster are seeing a patient who is complaining of abdominal pain.
“The students see a lot of needs they wouldn’t see back in the U.S.,” says Hoffman, who teaches community health at the U of M. “They see people who have parasites, people with poor nutrition, people who live with chronic pain with little hope of ever seeing a doctor. They get to see how health care is so impacted by the nutrition and economic situation of a country.”
Says Finch, “The things we see at home, we see at an early stage. Here, what we see is much worse because the patient has had it for a long time. They see it at the extreme end of the spectrum.
“Nursing is not only a science, but an art and a huge piece of the art is caring,” Finch adds. “Back home we become so sensitized. Here, though, that caring piece is so enhanced. These students will never be the same after they go back home.”
One of the biggest benefits the students get, Axley says, is an improvement in their assessment skills. “Here, they can’t go read a lab report, they have to use their thinking skills,” she says.
Inside each examination room, the student nurses examine and take a medical history of each patient. Because of the large number of patients, families are seen at the same time. When the student nurses feel medications are needed, they collaborate with the nurse-practitioner in charge of the pharmacy. Each family is given vitamins and a hygiene pack consisting of soap, shampoo, a toothbrush and toothpaste.
“Sometimes they say, ‘What is this, what is this?’ when asking about the soap and toothpaste so we have to educate them,” Jenkins says. “They have taken toothpaste and spread it on wounds not knowing what it was for.”
On occasion, the student nurses see immediate results.
“We had a man who was 83 who, when he first came in, was having to use his fingers to open his eyes,” says Elisha McDade, president of the U of M’s Student Nurses Association. “He had infection in his eyes and he had cataracts, which you can have cut off in the U.S., but surgery here is not an option because of the cost. We got him some eye drops and we gave him a pair of eyeglasses. He was so amazed at how well he could see. He thanked us over and over again and told us that God had blessed him, that God would continue to bless us.”
Observed student-nurse Ashley Wagner, “Just the smallest thing, a pair of eyeglasses, made him so happy.”
Sometimes, the results are dramatic. On her first trip to the DR, senior Shirley Rhodes treated a lady who was suffering from pneumonia. “You could see her chest muscles pull away as she struggled to breath,” says Rhodes. “She was fevered and clammy to the touch. We gave her antibiotics and decongestants, but I really thought our efforts would not help this woman. I didn’t think she would survive.”
But Rhodes found out differently on her return trip. She discovered the woman was alive and much healthier. “Seeing that my intervention and the intervention of other nurses had saved a life makes me more determined to continue this mission,” she says.
The student nurses also conduct home visits, such as the one to Consuela’s house.
“When you go in their house, you are in shock,” says Jeremy Webster. “They have very few possessions. This one lady [Consuela] had just a bed and a table and a broken chair. That is all that she owns.”
Says student-nurse Maggie McCullough, “You don’t know how sheltered you are until you take yourself out of your own bubble.”
Back home in Memphis, Axley is looking to the future — she has even bigger plans for the program. She would like to see it take on an interdisciplinary approach, whereby Spanish-language, education and sociology students from the U of M take part in the trip.
“I could see one day where the U of M charters a plane and we go as a school,” Axley says.
As for the effectiveness of the program, Axley only has to point to a suitcase.
“When we returned, we brought back a half-filled suitcase with stomach medications,” she says. “That has not happened before. I believe that does show we are having an effect.”
For more information on the program, including how to donate medical supplies for future trips, contact Axley at