SOMOS/DASV 13: The Spirit is Willing

I wish I could bottle it – that synergy that comes from hard work, dedication, diverse training and skills; that instantiation of hope that is the project week for SOMOS and DASV. DASV: Dominican Aid Society of Virginia, a small non-profit with five officers and volunteer medical professionals who give graciously their time and talents. And, SOMOS: Student Organization for Medical Outreach and Sustainability, now in its ninth year of promoting improved health and health care through community engagement and a model of participatory development in Paraiso, Dominican Republic. The spirit is magical. I’m old enough now to say that without blushing, and I say it because it’s true.

Pharmacists and pharmacy students brought acumen to the completion of the clinic’s medical services. Their work reflected attention to detail and pure thoughtfulness that is largely unknown to the residents of this peri-urban and marginalized community. It was obvious in their orderliness and in their exchanges with patients. Julie Jeong (Pharm.D.), Nellie Jafari (Pharm. M.S.), and Tim Pierce and Elizaveta Budko (pharmacy students) demonstrated both professionalism and just plain kindness. And they contributed to the magic with observations flavored by diverse perspectives (Korean, Uzbek, and others).

Nurse Practitioner Margo Potts and nursing students Marie Vu and Marc Bein and a crack team of physicians provided patient consultations and care that was culturally sensitive and discerning beyond the resources of the clinic. Margo is a member of the DASV board and a returning provider for the clinic. In addition, she supervised Marc Bein in a community-based project that will significantly advance efforts to identify patients with chronic illnesses, including hypertension. Our goal is to provide continuous care for those in the community with chronic illnesses, and Margo’s and Marc’s field study provides a strong beginning point for both identification and for understanding possibilities for effective management.

Luke Neillans (’05; MD, Howard University) and Matt Harrington (’05; MD, University of Virginia) were among the small group of students who founded what we know today as SOMOS. Dubbed B.J. and Hawkeye (from MASH fame) for their quick wits, seeming irreverence, and skillful medical practices, Luke and Matt reflect much of what has been true about this undertaking from the beginning: deep commitment; a critical perspective; lively suspicion about good intentions; and a strong sense of adventure, ready to test what is possible in righting inequities. Aye Otubu (MD, Howard University School of Medicine) and Mal Azmi (MD, soon to join the faculty at VCU School of Medicine) joined the team, added to the caring medical professionalism, and brought joy and the power of diverse experiences to the medical team. The clinic and medical staff were led as ever by the quintessential community outreach doctor, Mark Ryan, ’96; MD, Virginia Commonwealth University. Mark’s goodness and his determination to provide quality health care to un-served and underserved people pervade the clinic and reach beyond clinic walls to raise the hopes of residents and project team members alike.

In SOMOS, we promote leadership through practices and processes more than through people and positions. We expect much of each other, we’re slow to blame and we’re quick to take responsibility in an effort that many would guess to be impossible—or at least, improbable. Undergraduate students engaging in knowledge-based, participatory community development that is grounded in systematic social science theory and research: really? Sustaining and advancing a project across generations of students, recruiting and selecting peers to learn, embrace and carry forward a nuanced model that hinges on community ownership: plausible? It’s still too soon to say for sure, but the evidence certainly is accumulating. Three seniors were selected to facilitate the leadership activities this year, and they were remarkable: Jo Weeks (4th year; 6th trip); Amalhyn Shek (3rd year; 5th trip); and Lindsay Schliefer (with an “i,” Schliefer; 3rd year; 3rd trip). They modeled the practices that we hope to see manifested in the community: inclusive decision making, reciprocity, networked communication, and flexible and accountable organizing.

Bruce Pfirrmann (’13; 3rd trip), Rob Marty (’14; 2nd trip), Mel Alim (’14; 3rd trip), and Rebecca Silverstein (’14; 4th trip) helped to organize efforts in flood mitigation, including working with the community’s “boat committee” and Engineers Without Borders (EWB) committee. These fledgling efforts are maturing now and it seems very likely that we will succeed in facilitating a partnership involving the community, EWB, and SOMOS. Rebecca also was instrumental in facilitating the development of a community health committee and a partnership involving that committee, a local government clinic and health promotion program, and SOMOS. She worked with Jeff Rohde (’14; 4th trip), Christian Delgado (’14; 2nd trip), Melanie Rogers (’13; 3rd trip), Betsy Coco (’14; 1st trip), and Cathy Merritt (’15; 1st trip) to advance significantly a role for the community health committee in leading and coordinating efforts to bring resources and coherence to health services. Christian Delgado, Jeff Rohde, Amalhyn Shek, and Jo Weeks were particularly effective in helping to facilitate the community meetings and to guide them gently to outcomes that will advance community efforts.

In addition to the organizing efforts, SOMOS students undertook another round of data collection, this time in anticipation of testing hypotheses about the relationship between social network density, infrastructural development, and social change.

I will forever be awestruck by the way in which these remarkable students move seamlessly from theory to research to praxis to the depths of interpersonal sensitivity and caring—and on to the heights of just plain silliness. And all of it is necessary, essential to this improbable project. It is too soon, still, to know if we are succeeding, but here are some very promising indicators:

1. The concluding community meeting was animated. More than lively, it was contentious. My experience and the accumulating research and theoretical literature suggest that residents of marginalized communities don’t waste time competing when they see little prospect for change and little possibility of accessing meaningful resources. Residents came to the meeting in significant numbers and they spoke directly, assertively, and comparatively about differing ideas for promoting change—and using resources.
2. Residents are beginning to see the “logic” of the emerging infrastructure, comprising “regional” or “block groups,” focused committees (boat, EWB, health), and community meetings for making collective decisions. This logic was articulated eloquently and compellingly by the recently selected co-leader of the community health committee, identified here as “Pastora.” Her summation brought to a productive and hopeful conclusion a meeting that was teetering towards devolution. The beginning of the week brought resident reports of “traditional” understandings that reflect alienation: “No one works for the community.” “We must depend on the government to solve problems, and they won’t and don’t.” “Some people talk about doing things but they don’t do anything.” The ending meeting reflected the anxiety of seeing possibilities but worrying about particularism and favoritism. Pastora offered an alternative view—the view that SOMOS has championed from the first efforts: organized, collective efforts to solve shared problems through reciprocity and collaboration.

So, I’ve more than made up for the blog space left unfilled since last March. It’s too much to read, and I’m not sure I’d bother. But if you’re reading this, perhaps you did—and I appreciate it.