In the late 1980s, my colleague Tom Drexler and I started a service program at Georgetown Prep called Somos Amigos. Our challenge: how do you take a young person from a school on a golf course to a place where he could truly experience poverty and gain a sense of the real world? It meant traveling, leaving behind all that made one feel comfortable and confident, including language. We ended up in the mountains of the Dominican Republic, where each summer we’d take teams of high school students and would spend six weeks building schools and water systems.
We were introduced to these communities by an NGO based in the city, one that worked regularly in the countryside. Our requirement: that we be connected with communities that were organized and had already identified a need. From our inception, we never wanted to be the gringo saviors, the ones who told a community what they needed and magically caused it to appear. We would fund the projects, but we insisted on working alongside community members, not just for photo ops, but really working. Besides being organized, the communities had to be isolated and in rural areas, and without running water or electricity. We lived with families in homes in the communities in which we were working.
The settings of these communities could be intoxicating. They were bucolic, homes to happy farmers who lived off the land. We were welcomed warmly and grew close to many over the years. From a student experience perspective, we got the recipe right. But still something was wrong. We repeatedly encountered situations of people suffering due to lack of healthcare. A quick glance at the student groups revealed a mom who was a physician, a dad who was a dentist, nurses, hygienists, etc. How could we connect these two worlds?
Upon the invitation of the community where we were building a water system, all the pieces fell into place, and after some not-so-difficult arm-twisting, my own physician, Dr. Michael Keegan, and my own dentist, Dr. John Conaghan, finally agreed to spend a few days with us seeing patients. I would lie if I said a lot of planning had gone into this. Mike brought a suitcase full of random medicines, mostly samples given by drug reps. John did not have access to running water or electricity. But we knew we had to make it work. And it did.
After seeing most of the population of El Naranjito, we debriefed with the community and among ourselves. We knew what to bring and to do better the next time around. Working closely with the local community leaders, we committed ourselves to returning, and over time more communities were invited to send patients. Somos Amigos Medical Missions was incorporated and secured 501(c)(3) status. Our volunteer groups grew. Equipment was donated. Construction ensued. Today we have five buildings and charts for several thousand patients. People are living healthy lives as a result of our presence. People are smiling happy and healthy smiles as a result of our presence.
Along the way, two questions were essential to all we did: Can we do more? and Can we do better? A local clinic committee was formed, its representatives elected by our host community. To this day that group advises us. Our work is indeed a collaboration between our organization and the people we serve. Our patient target zone has grown from our host community to 34 other communities. Still, we ask ourselves those questions.
In response to those questions, a glimpse of what we have been able to do on the side of a mountain in the Dominican Republic would reveal:
- Teams of dental professionals routinely doing restorative work, oral surgery, endodontics, prophylaxis… all with modern equipment and supplies
- A denture clinic where dental protheses are fabricated and delivered on-site
- A robust blood lab with various analyzers that allow us to perform several dozen tests on-site
- In collaboration with a partner committee of local women representatives, a Women’s Health initiative whereby we offer routine paps and HPV screenings, mammogram referrals, family planning resources, menstruation supplies and “kits” for younger women
- A ground-breaking insulin outreach program, implemented after a year of consultation with renowned endocrinologists, whereby insulin-dependent patients are monitored regularly (including yearly exams by an endocrinologist and an ophthalmologist) and provided insulin and supplies
- Physicians and nurses representing various specialties and who help maintain hundreds of patients with medications and treatments
- A pharmacy whose formulary includes several hundred different medications
- A referral system whereby we have partnered with clinics and specialists in the city; when we send a patient for care, the organization covers all of the expenses
Clearly there is a lot to celebrate. Our patient charts hold up to 25 years of data that demonstrate our success in controlling chronic disease. One can look at the children and young adults of the communities we serve and see beautiful, healthy smiles. A generation has grown up with us caring for them.
Instrumental to our success has been strong leadership, both in the U.S. and in the Dominican Republic. As from our inception, we see our work as a partnership, never wanting to create a need nor impose ourselves. We have also been fortunate to have a group of selfless volunteers (now numbering more than 800) who are loyal and generous. Some volunteers have been on dozens of trips with us. We are now no longer strangers with most of our patients, and vice versa.
Our loyal and generous donors have supported us because they believe that everyone deserves access to quality and reliable healthcare, healthcare delivered with humility and respect and compassion. They deserve it whether they are Dominican or Haitian (20% of our patients), even if they live in isolated and otherwise forgotten communities that dot the mountainsides of a far-away island.
Somos Amigos: Into the Future
What do the next twenty-five years have in store for Somos Amigos? At all levels of the organization, starting with the Board and our local committee, we are thinking strategically about the future, even challenging our model. Guiding all the conversations are those two questions that have always driven our decision-making: How can we serve more? How can we raise the level of care that we offer?
We know that in order to look to the future, we must seek input from our Dominican and Haitian patients. Before the pandemic I had meetings in several communities from which we draw patients. I asked the same questions at each meeting. I learned that everybody knows us in those mountain communities. We are a trusted brand; we represent something bigger than I, or anyone thought we ever might.
We have tended to believe that we have saturated our target area, that we have reached all or most of our target population, but from those meetings I learned that we have not- we are not even close. Yes, we have done well. And yes, we have done incredible things. Yes, we have saved lives. But there is so much more to be done.
I learned that the reality of our model of caring first for our current patients, always giving them priority, has created a system that is hard to enter if you are not already in it. Our success caused us to unintentionally create a disincentive for new patients to try to receive our care while at the same time allowing us to provide extraordinary continuity of care to our established patients.
Even our potential patients understand our process of serving our long-time patients first, however. They respect it. They respect us and trust us. They know there are limits to what we can do with a fixed group of volunteers over a fixed period of time. But this is not why we were founded in the first place; we’ve got to do more and we’ve got to do better. We have to push those limits.
We did an informal census of our target area, through churches and municipal governments. In our 34 target communities is a total population of around 10,000 people. Those are our target patients and we have to reach more of them. And that is what drives our strategic focus of serving more. Because the harsh reality is, if it’s not us, it’s no one.
We are forming a council to supplement our local committee, with representatives from each of our target communities, one person from each, chosen by the community. We will also have our Haitian patients represented, even though they tend not to identify with specific communities. We want to listen to and respect the voices of those we serve.
We know now that our model of a group of volunteers staffing our clinic for a few days every quarter is not sufficient. It makes it very difficult for us to reach those new patients. What we need, and what we are working toward, is a permanent presence in the clinic, between our groups. We want to hire local healthcare providers who will partner with Somos Amigos. Our volunteer groups and our local people will work together; one will feed into the other.
The pandemic has forced us to experiment with this model, as we were not able to have volunteers staff our clinic. We hired local providers. Pandemic or not, we were there for our patients. They knew we would be. And so we know now what is possible. We know the people who will work with us. We know the patients are there. We only need the resources to make it happen.
We have initiated a process with the Dominican Healthcare Ministry that will allow us to reach those targeted 10,000 patients faster and with better care by operating year-round as a permanent provider of healthcare. That approval will require certain modifications to our clinic facilities.
Recently we purchased an adjacent parcel of land in the hope that it will one day accommodate our growth plans. We have been working with a U.S. and a Dominican architect and we have designs for our clinic facility that will satisfy local codes and requirements and usher us into our next quarter century. We have worked with our cost-per-patient numbers and have developed budgets that will allow us to serve several thousand more patients when we reach full capacity.
In addition, having the approval to operate full-time will allow us to undertake even more initiatives:
- We would like to be a provider of adult vaccinations, as there is no such center for miles around
- We would like to be a provider of HPV immunizations for our younger patients
- We would like to establish ourselves as a resource for patients living with HIV, as there is no such facility in the region we serve
- Partnering with the Public Health Ministry and local schools, we want to inaugurate an education and prevention program that recognizes oral health and care as a part of a comprehensive integrated health approach
We cannot do all that we know we could and should on our own. If one could hear the voice of just one of our patients, the reason for our deep commitment would be revealed.
To all of our volunteers, benefactors and other supporters, thank you. And thank you for looking to the future with us. Thank you for believing with us that our brothers and sisters, regardless of where they live or how they live, regardless of their skin color or language or religion, regardless of their status in life… thank you for believing with us that they all deserve access to quality and reliable healthcare. Thank you for allowing us to deliver that care for twenty-five years. Thank you for helping us heal.