News, Moves, and New Adventures! May 2014 - Month 35 in the D.R.

Dear Everybody,

I've been trying to figure out how to write this post for the past couple of months -- trying to think of how to write it eloquently.  But time moves along and I have finally given up on that, realizing that I can't seem to find the words to say it eloquently, so in place of eloquence, I'll just share the news and leave it at that.

After 3 years in the D.R., (where I have felt very called to be, and have so very much enjoyed working and living, and where I have since day one fallen totally in love with the people and the work I do here -- can hardly imagine being somewhere else --) but God has opened a different door.

My 3 years of contracts at Health Horizons International will end in mid-June 2014 (aka really soon), and though I still very much feel God's call on my heart to the D.R., I'm going to be leaving the D.R. in late June to walk through a new door that God has opened for me and seems to be leading me into at this time. 

I have been offered a position with Mennonite Central Committee in Lancaster, Pennsylvania, and have accepted that position!  MCC is an organization that has always been very much a part of my life (since childhood, growing up in Mennonite Churches) and I have been very passionate about the amazing humanitarian relief and development work that they do in the name of Christ, for many years.

Being offered this position at MCC was an unexpected, rather unplanned opportunity for me and I am excited for the chance to work with the MCC team in Akron!  I have already been so inspired by the welcome I have already received from various members of the staff there -- even though I have not yet even begun to arrive, and I look forward to working with such an amazing, God-filled, and caring group of people!

On the other side of the coin I am woefully sad to be leaving the D.R. and have little doubt that at some point in my life God will bring me back to international fieldwork, like the work I have been doing here, either here in the D.R. or somewhere else.  This work has such a strong hold on my heart (and has for years since I first began feeling "called to the mission field" when I was in elementary school).

I wanted to share this news about my move to PA for the position at MCC and to say the following 2 things to the readers of this blog (my friends, family, church family, and also fellow missionaries from the D.R.).

1.)  Though my location is changing I hope that you will still read this blog every month, because there are a lot more stories that I still want to tell -- stories of what's going on in the D.R. now (while I'm here -- there are several stories of things that have happened this Spring that I have not yet gotten to share!)  Then there will be stories I'll be sharing here of the amazing work that MCC is doing around the word that I will get to be involved in, AND (another exciting thing that I haven't gotten to share stories about yet) I'll be sharing stories of an exciting project in the Dominican Republic that I'm still going to be consulting on remotely as a volunteer, while I'm in Pennsylvania, working with the great programs of MCC.  So the Stories from the D.R. will continue and other stories from around the world will be added.

2.) So, please do keep reading this blog -- there will continue to be posts every month about things I'm working on here (D.R.) and things I'm working on in PA that affect and support the work of MCC around the world.

There are lots of great international mission and humanitarian stories to tell! I'm excited that I'll be able to report on two types now!

1.) Great MCC projects (around the world)

2.) Great D.R. projects that are still on-going!

I hope you will continue this journey with me over the years to come!
  
Thank you so much for all of the on-going love, support, and prayers!

Huge love to all!

- Janelle Bitikofer

Making a Double Difference in Diabetes -- April 2014 - Month 34 in the D.R.

This month (April) I get to talk about something that's super special to me.
Many people know -- and probably some people don't know -- that I have Type 1 Diabetes (the kind you get as a young person that requires you to take Insulin every day).

Because I myself have Diabetes, working here at Health Horizons International in the Dominican Republic, and getting to initiate interventions to help people here learn more about Chronic Illnesses like Diabetes, learning to prevent it, and learning how to live healthier lives if they already have it, has been a part of my job that's very close to my heart.

Here in the D.R. you can walk through any town and see a ridiculously large number of people with amputated legs.  Now many of those amputated legs are due to motorcycle accidents. But many of them are also due to Type 2 Diabetes that has not been well-cared for.  People are living with high blood sugars for years, not realizing the danger that this presents to their limbs, their hearts, and their eye-sight, all of which can be detrimentally affected by high blood sugars due to Diabetes.  Often amputated legs are the result.

Here in the D.R., treatment of Diabetes is becoming a priority of the National Ministry of Health  -- but there are many doctors who are still not well-trained on how to treat it, and many people living with Diabetes who don't know what they need to know in order to prevent the negative side effects that come from having high blood sugars for long periods of time.

So this month I'm thrilled to report on two great projects that I've been very excited to be a part of in the fight to get Diabetes information, treatment, and prevention to the masses here.

1.) The first thing:  A co-worker and I wrote a grant application seeking funding to help the Dominican Ministry of Health provide special training to doctors here in our Province of the D.R. related to Diabetes. We recently found out we WON the $200,000 Grant!  Now, with help from HHI, the Dominican National Ministry of Health, and Endocrinologists from the D.R. and the U.S. will be providing new training to General Practice Doctors here -- in the Public Health Hospitals and Clinics throughout the Province of Puerto Plata.  The Doctors will learn up to date info and strategies on how to diagnose, treat, and prevent Diabetes!  The project will also teach local Community Health Workers across the province how to spot the danger signs of Diabetes, make referrals to hospitals and clinics to get people linked to treatment, and help people in their communities live healthier lives to prevent Diabetes and it's side effects!  I'm super excited that this training program will be rolled out across the province, and there will be screening days at the large hospitals helping people discover if they have Diabetes, and if they do, getting them into treatment!  It makes my heart so happy to know that while HHI has only worked in 4 small communities until now, providing direct care to patients with Diabetes, now Doctors and Health Workers across the entire province will be better trained and better prepared to help people in many, many more towns, treat and prevent Diabetes.
 So I'm super excited about that and I thank God for the opportunity to get that project funded and started here at HHI!  

  2.) The second thing I'm really excited about this month is also in the area of Diabetes.

 

Here at HHI I supervise medical students (administratively) and Doctors and get to assign them to projects where they can really make a difference with our patients in the 4 communities where we do the direct patient care.  This month we had a medical student here for 4 weeks, and I asked her to walk alongside some of our patients with Diabetes who were really struggling and seemed unable despite their best attempts to get their blood sugars down to a healthier level.

 

She walked alongside them and their families, educating them about Diabetes, how it works, how to lower their blood sugar by eating healthier, exercising more, and taking their medications as prescribed.  And in the end, their blood sugars are getting lower! (The photo at the top of this post is of the Diabetes group in one of our communities, Pancho Mateo.)

 

So I'm really excited about their success -- and the patients report feeling better, and feeling excited that they can take control of their own health. They state they now understand more about how to take the power back from their Diabetes. It warms my heart!  So here are a few photos of some of the things the medical student (Emily) and I got a chance to do with the Diabetic patients and families over the past month.

Here we are learning to eat more healthy food with less sugar, less fat and less carbs - "Eating a little bit of everything we love" -- but doing it in a healthy way.

 

 

 Getting regular blood pressure and blood sugar checks by Medical Student Emily.

 

 

Here we're checking our Pedometers.  "30,000 steps in 2 days! Wow! That's a lot more than you were walking before. You should be really proud of yourself! We're all so proud of you!"

 

Using the "plate method" to figure out what we're eating, and how we can change our portion sizes and food combinations to decrease carbs and increase protein, veggies,  and implement an individualized food plan that promotes lower blood sugar and weight loss.

The program was well-received and at the end of the month we all shared stories as a big group (photo at top) sharing about the different things that each had learned and started to implement to improve their health.  Hugs were exchanged all around as med student Emily ended her month-long time visiting in their homes and helping them learn more about how to take back control of their Diabetes.  I was thrilled to see the new knowledge that they were all beginning to use in their daily lives!

 Here we are -- some of the group -- me (front/center), Emily, a few of the patients, their family members, and their community health workers who will continue to walk along with them and support them on their road to taking back control from their Diabetes.

 

So far during my almost 3 years in the D.R. these have been two of my favorite projects!

I'm so happy to have had the opportunity to begin helping folks here take 

back control of their health rather then thinking they have to give up

their livelihoods,  

their lives, their legs, and their eye-sight to Diabetes!

 

It's exciting to see people learning more about their health!

 

Thanks to all of you who have continued to support and encourage me in the work

that we are doing here.  I really appreciate it!  Every day here is an adventure full of new challenges but more importantly -- new possibilities. :)

Every day -- both here, and also where you are -- is an opportunity to give, as they say here, 

our own little "grano de arena"

(our own "little grain of sand")

to make a difference right where we are.

 

Togetherness Makes Our Work More Successful! -- March 2014 - Month 33 in the D.R.



One thing that missionary and humanitarian workers notice around the world, no matter where they're working, (and this happens in North America too,)  in places where there is a lot of need there also congregate a number of nonprofit and missionary groups trying to make difference there. While trying to make a difference is always a good thing, sometimes the help is not much help at all, if the various nonprofit and missionary groups don't communicate and work together, and they duplicate services, or give the same aid to the same people over and over again, and miss others. 

 Sometimes -- in places like the Dominican Republic -- many, many groups come from other countries, for maybe a week at a time. They want to help, so they hand out food or Tylenol or they try to build a bridge over a river that seems impassible at the time when they arrive. 

 

But if these visiting groups don't collaborate with the pastors and the community leaders, and the organizations that are locally led, and that have staff and volunteers living and working in that community 24 hours a day seven days a week 365 days a year, then the help the visiting groups try to bring often amounts to very little actual "Help" and the funds they donate are often wasted on small projects that were already being handled by a local group -- it's just that nobody in the visiting group stopped to ask.

 

 

I work in one such community here in the Dominican Republic . The community, named Pancho Mateo is home to between 800 and 2000 people, according to local population estimates. It's a very close-knit community of families and relatives, low-income Dominicans and low-income Haitian immigrants, where almost everyone knows almost everyone else, and people help each other out.  

 

But there is a lot of need in Pancho Mateo. There is approximately 90% unemployment due to a general lack of job opportunities in the area.  While most of the young people -- teenagers and those in their 20s -- are now finishing high school and some going on to college, many of their parents and grandparents living with them in Pancho Mateo  had to quit school early to work, when they themselves were kids, and so many of the adults have between a fourth and an eighth-grade education.  As a medical worker serving in Pancho Mateo I occasionally run across patients of ours who don't have enough food to eat in their homes and therefore don't take their medications because they were told to "take this pill with food" -- and there isn't any rice today.

 More than half of the families in the community do not have running water of any sort their homes, and those who do, have dirty water that is not fit for cooking or drinking (as is true for all of us here in this part of the island).  There are many people in Pancho Mateo with medical illnesses who don't have health insurance or access to affordable  quality healthcare --which creates a phenomenon in which people involved in local traffic accidents lose their legs and lives over injuries that in wealthier countries would've been very curable, fixable, or preventable.

 

 So there are many needs in Pancho Mateo.

Unfortunately until recently more than 15 foreign nonprofit groups were working independently there - helping people with everything from education to health to food and financial assistance.  Many of them were doing great work. The bummer is that most of those non-profit and missions groups didn't talk much to each other. Many of them didn't even know that each other existed!

 

 You could walk into Pancho Mateo on a Monday and see a medical group handing out free medicine for hypertension.  Then if you went back to the same community a few days later you might see another medical group that had just stopped by for the afternoon, changing those people's medications to some other free medication they were giving out that day.  The two groups rarely even knew that they were both working in the same community, nor that by giving out medications -- in this example -- they were harming the people who they were trying to help, by frequently changing people's medications, which does not allow for efficacy of treatment for any of the patients. 

There were also at least 3 educational groups working in the community providing services to children and adults - yet they were generally unaware of each other, and of whether they might accidentally be duplicating services in some way.

 

But I'm thrilled to report that we are beginning to see a positive change! 

 

I and the leaders of two of the other non-profit/missionary groups working in Pancho Mateo had the wonderful privilege of pulling together a meeting the other week in which 5 (plus 1 in absentia) of the largest non-profit groups working in Pancho Mateo all finally came together to get to know each other, to network, to give reports on their existing projects, and to talk about ways in which they can perhaps work together and collaborate!

Above are the attenders at the first "Pancho Mateo Non-Profits Networking Meeting" held on March 25th, 2014 at Marua Mai Restaurant in Sosua!

 

Leaders from local non-profits that work in providing health and education services to our local low-income communities attended the meeting today!

 

Health Horizons International (the org I work for)

Dominican Eyes Plus -- run by a local missionary who provides free eye glasses & exams

Project Haiti -- a non-profit from Europe that works in education and health care and that brings social work/sociology student interns to Pancho Mateo D.R. and to Haiti

Makarios International -- a Missionary Run elementary school that serves low-income families with education and health services.

&
The Dream Project -- An organization that runs local schools in low-income neighborhoods, and also provides job training programs, a college scholarship program, and sports/health camps for children and youth in the summer time.

CEPROSH -- an organization that provides HIV and TB prevention and treatment was also reported on "in absentia." 

 

It was a small beginning, but a great first meeting, and I am so happy to see the organizations finally coming together to learn and network, and to see how we can work together alongside the leaders and community members of Pancho Mateo and the surrounding communities.
We've agreed to meet again to begin putting together the final sections of a Resource Guide that will allow us to more knowledgably refer folks in need to local services and non-profit resources available to them!
Resources on everything from medical care, to available college scholarships, to free, church-run summer soccer camps for pre-adolescent boys, will all be at our fingertips at last!

Here are a few highlights from the meeting:

Photo #1: Here are Educational and Health-related Organizations Networking.  "So -- your program is accredited by the Dominican Government. How can we get our program accredited too? What are the steps? Share with us your knowledge."

Photo # 2: Psychologist Mika from "Project Haiti" chats with Medical Director Darren, from Makarios school, While Kakito - pastor and disciplinarian at Makarios school (and soccer camp coordinator in Pancho Mateo) chats with Dream Project staff members who run several schools and a "Sports for life" program that teaches sports and health awareness to teens and kids in communities around the region.

Photo # 3: Here's an impromptu photo of half of the group, including my co-worker -- HHI's Carlos Castillo, Coordinator of the Community Health Worker program that serves Pancho Mateo.

Photo #4: It was a great day consisting of a "great beginning" to better communication and collaboration between the non-profits in the Pancho Mateo area, so that as a united front we can all help Pancho Mateo better, and empower the local leaders even more!

And the on the way home Carlito and I got to see this beautiful sunset over the sugar cane fields in front of our largest local mountain -- Mount Isabel.  It was a great end to a great day in the Dominican Republic!

First Family Visit! & GoMad Ministries :) Feb 2014 - Month 32 in the D.R.

I was super excited this month (February 2014) to have my parents, my aunt Fern and Uncle Rich, my aunt Sue and my Uncle Marlin all come from the U.S. to visit me!  I was so excited to have them come to learn about and experience my life here!  Thanks guys for letting me drag you all over the North Coast!

Here's a little video and a couple of my favorite photos from their 7 days here on our little Island of Hispanola! :)

 

 

 

 

 

We visited GoMad Ministries and

learned more about the work of my friends from church -- Missionaries Chantz and Renee Cutts. Here we are in one of the rooms of their medical clinic.  They'll soon be starting an after-school tutoring program in this same building as well.  Chantz and Renee's ministry began (and continues) with and outreach to women involved in the prostitution and sex-trafficking ring in Sosua Dominican Republic -- where my church is located. They are empowering local churches to reach out to these women, and they offer a safe-house and help with job training for women who want to get out of the trapped life of prostitution here, where older, rich, white men mostly from the U.S., Canada, and Europe come. The foreign men are the primary source of income generated to keep the sex trafficking industry going strong here in Sosua.  Since Chantz and Renee are friends of mine from church, I took my family to visit them to learn about their lives in ministry here in the Dominican Republic.

  

Here's their website it you'd like to learn more about their ministry.

http://www.gomadministries.org/about-us/

 

 

 We got caught in the rain at the Fortaleza (Fortress)!   

 

 

                                     I got a hug from my friend Wilmeri in Pancho Mateo

  
                   We visited My Friend and Co-worker Willy and neighbors in Pancho Mateo,
                                     and my family got a lesson in hair extensions. :)

             We watched Estela's elementary school aged daughters Hoola Hooping in Negro Melo

                                     
                                     Everyone got hugged by EVERYONE in Pancho Mateo! :)

                                              
                                                          ... And in Negro Melo  too :).

 

We took a walk down by the River in Pancho Mateo and chomped on sugar cane in Negro Melo :)

 

                  It was a real joy to me to have my Parents and Aunts and Uncles here to visit! 

                       A true HIGHLIGHT of the 2 3/4 years that I have been here so far! :)

 

Pharmacies, Meds, and Medical Volunteers (January 2014 -- Month 31 in the D.R.)

 

This month we had another busy week of medical field clinics in 4 low income communities!  We welcomed 6 U.S. PA students and 4 U.S. MDs as they joined our team of community health workers and staff in the clinics.  In the photo above the Community Health Workers are running Intake and Medical Records, while the PA students help set up the triage area, at the beginning of the clinic day.

  We took the PA students and MDs out to check out the Latrines (out-houses) being built by HHI and families in the communities. Here's one that I am sitting on. It will soon have walls and a roof to give the family privacy. Latrines help improve sanitation conditions in communities where people sometimes just use the restroom in the great outdoors around the community which can contaminate their living situation and lead to illnesses in the communities.

Nurse Jenny and Interpreter Pierre (above) proved that sometimes the best medicine for kids is a hug, a nap, and some giggle time. Go Jenny and Pierre! Thanks for the help!

PA student Jen teaches a 1 year old future doctor how her stethoscope works.

 PA students and Community Health Workers check vitals on community members waiting in line to see the doctors in the little church in the mountain community of Negro Melo.Thanks to my friend Jacalyn, there in the corner, for that happy "thumbs up!" :)

Now Here's a Separate Adventure:

Before the week of Field Clinics my colleague Marineli and I got the chance to travel to the big city of Santiago to meet with representatives of medication distribution/pharmaceutical companies, and to visit the lab where one of the pharmaceutical companies that supplies meds to our patients makes and packages those meds.  Since medications made and distributed in the D.R. are not always made correctly (there is inconsistency in how well they work depending on which company made them because they don't all have the right amounts of the correct medication components actually in the pills. It's a problem the Dominican Government is actively trying to combat, which is good, because many doctors and patients here feel that the meds they sometimes take and prescribe are not effective because the manufacturers lied about the components in the meds.)  So it was great to be able to visit the sanitary lab at Iberofarmicos where many o fthe meds we purchase for our patients are made.   Above, Marineli and I suited up in scrubs, lab coats, and sanitary slippers for our tour.

 Here's me (white coat) with our tour guide -- the physician in charge of the labs.

Here are the women packaging the thousands of packets of meds into boxes -- by hand.  A boring job that I suspect is very hard on the hands.  But they did it very carefully and professionally. God bless then for doing this 6-8 hours per day each week, each month, all year.

Here's another shot of the quiet, industrious med-packaging room.

 

Here I am in the lab where they make sure the pills all contain the proper ingredients.

And here is one of many rooms where lab techs in scrubs and gloves check the meds for quality, then move them on to the next step of the packaging process.

It was all very interesting, and the staff at the Iberofarmacos company (photos above) were very proud of the measures they take to provide quality control in their pharmaceutical manufacturing labs.  Marineli and I enjoyed our very informative, scrubbed up adventure, and can now share with local health workers in our region what we observed at the Iberofarmacos lab.

Happy Holidays from the Dominican Republic! (Month 30 in the D.R.)

Dear Friends and Family,

Happy Holidays from the Dominican Republic!

I put my Christmas letter in video form this year.  Click the square at the bottom right of the 

video box if you want to make it full-screen.

I'd love to hear about your 2013 as well! It's hard to receive mail here, but please email me your news at Christmas (or any other time of the year) at jkbiti@gmail.com  :)

May your Christmas be filled with Love, Hope, and Peace.

Isaiah 9:6

For to us a child is born, to us a son is given, and the government will be on his shoulders. And he will be called Wonderful Counselor, Mighty God, Everlasting Father, Prince of Peace.

Driving Across the River, A Kitten of our Own, and a Trip to the States -- Month 29 in the D.R.

After a great 2.5 week visit home to Raleigh, NC where I was glad to catch up on the lives of my friends from Raleigh Mennonite Church (a few pictured below), SCBWI and the Goalies (a few pictured above,) my old job friends from CAS, my family, and others, I have now returned to the Dominican Republic.  After almost another year in the D.R. without a visit home, it was wonderful to see you all, to smell the rain, enjoy the beginning of the fall leaves changing, and wear SWEATSHIRTS & SOCKS - something we rarely do in the D.R. Thanks to every one of you for your continued friendship and continued support in so many ways for my work and life here in Hispaniola! I would feel much farther from home than I actually am if it wasn't for all of yoU keeping in touch!

Upon returning to the D.R. I've been delighted to be greeted by my housemate Julienne, Missionary neighbors Sadrac and Leeann, Co-workers, and this little guy below. He's the one cat we have left from our litter of 5 mommy-less kittens that Julienne and I and our friend Elisabeth from Germany bottle-fed for 5 weeks in July after their mother died.  The others have all been parceled out to good homes in our town -- one even went to live at the local veterinarian's office (how lucky for him!)  We decided to keep little "Sol" ("Sun" in English -- pictured below) and are enjoying his fuzziness, antics and purring.

 

Here are a few more photos of life back in the D.R. again!

Above -  I'm sitting in Community Health Worker Coordinator Carlito's front yard where we're planning this past week's Community Health Worker Continuing Education class and discussing patients in need of doctor's appointments. 

Below - Carlito and his wife Claudia (also a Community Health Worker) are discussing patient's needs in their community of Pancho Mateo.

 

Their grandson, little Emmanuel, was born at the regional hospital last Christmas and he'll be a year old soon.  I think that's probably the best name ever chosen for a Christmas baby.  

"God with Us"

He's a great reminder of the 1st Emmanuel celebrated at Christmas after his birth many years ago -- a reminder of what's important as we head toward the Holiday season 2013!

Today I took a new staff member up the sugar cane road
to visit our 4 partner communities .

 

To get to our farthest out community, Arroyo de Leche, we had to drive across the river.  Luckily the water was very low today otherwise we wouldn't have attempted it. We would have gone up the steeper but dryer road on the other side of the mountain on motorcycles, as we usually do, to get there a different way. :)  But no worries. The river was very low today!

On our journey today we visited with 4 of HHI's Community Health Workers in 3 communities, including Dorka (in the purple shirt,) and her teenaged daughter Kaeila. We found them walking down the dirt road in their rural community, Severet, holding a bunch of notebooks.  They were on their way to a place across town where they have started a free afterschool tutoring program for 50 children from their community.  Dorka, the local pastor's wife, is a Community Health Worker with HHI, a full time high school math teacher, and she and her daughters started the tutoring program on the side (as volunteers) to help the kids in their village do better in school.  I really must say that all of my co-workers truly inspire me with their sense of volunteerism, and the way they put aside the fact that they may have worked or volunteered all day already, and have kids of their own to cook for at home, and despite all of the things that they're already doing, and the fact that they're tired, they put others ahead of themselves and volunteer their time to better their communities!  It's really very inspiring!

Here's a photo looking down from Dorka's rural community of Severet, looking away toward large Mount Isabel which towers over far away Puerto Plata city, the seat of Provincial government in our region.  To the left of the Mountain you can see the line of darker blue just below the sky -- the Atlantic Ocean. 

Truly - despite the hard work that we all do here, there are also many advantages to living in the Campo in the Dominican Republic -- not the least of which is the fabulous view!

Huge Thanks for your continued daily prayers for our work and lives here in the Dominican Republic! The notes, Skype-calls, and PRAYERS are always so very much appreciated!