- [Narrator] "Your Fantastic Mind" brought to you in part by Sarah and Jim Kennedy.

(upbeat music) (upbeat music continues) - Welcome to "Your Fantastic Mind".

I'm Jaye Watson.

This week, we are bringing you the show from the Dominican Republic, from the city of San Francisco de Macoris.

Close to 200,000 people live here, many of them in profound poverty.

The average monthly income is just a few hundred dollars.

Strokes are a leading cause of death, and the Dominican Republic ranks number one per capita in traffic deaths in the world, with seven out of 10 involving mopeds or motorcycles.

Physical therapy is a critical piece of recovering from a stroke or an accident, but it's not common here.

It's actually available to very few people.

So this week, we joined a team of physical therapists and students who've been coming here for 11 years, collaborating with local health officials on how best to treat those who need it most and changing lives all along the way.

(upbeat music) (airplane engine roars) - [Sara] So this is our 11th year coming to the Dominican Republic.

Duct tape some of these a little bit.

(airplane engine roars) - [Jaye] Their flight out of Atlanta is not for several hours, but Professor Sara Pullen and her team do not travel light.

- So we are seeing if they will let us bring all of these wheelchairs and everything on board.

- [Jaye] The first year, they took sheets of paper showing exercises.

They gave talks at hospitals and did some assessment visits.

- [Sara] Here's one more.

- [Jaye] Everything has grown.

The size of the trip, the donated mobility aids, and the need.

That's because on the other side of this flight are people who've waited a year for them to come back.

- [Sara] We made it here.

(laughs) - Doctors Sara Pullen, Lucia Rodriguez Vargas, and Tiernan Damas are physical therapists and the group leaders.

- And now it's just us that come once a year.

- [Jaye] Pullen is a professor at Emory University's physical rehab program, and is a researcher who teaches community health.

Students in the third year of the doctor of physical therapy program can volunteer for the trip only after they've taken Spanish for physical therapists.

On the cusp of graduating, they will soon use the skills they've learned in ways they can't imagine.

- I'm just excited to see all of the clinics that we're going to.

(students cheering) - [Jaye] Far removed from the resorts and beaches that make this island popular with tourists, San Francisco de Macoris is two and a half hours away.

Inland, sweltering, impoverished.

- [Sara] It's not Punta Cana.

It's not a resort.

- [Jaye] It's a place where people are accustomed to lack, to accepting they often won't get what they need, much less what they want.

(Sara speaking in foreign language) - [Jaye] Rosa Burgos is a college professor of global health and nursing in the Dominican Republic... (Rosa speaking in foreign language) - [Jaye] At the Autonomous University of Santo Domingo.

- [Sara] Rosa has been our primary support here.

We stay at her house, and we also work with her.

(Sara speaking in foreign language) - [Jaye] Dr. Pullen lectures at the college to medical students every year on various rehab issues, from stroke to long COVID.

The group unloads the bus at Rosa's house, eats a home cooked meal.

- [Speaker] This one works.

Like, it turns on, it just- - [Jaye] And prepares for the visit the next morning in a community called Manhattan.

- Trial by fire.

It is definitely the most vulnerable neighborhood we go to.

(Eduardo speaking in foreign language) - [Jaye] Cuban born Dr. Eduardo Llamas is part of the group.

In his fourth year of rehab residency, he's soon to be a physiatrist, a doctor who treats people with pain and debility for everything from strokes to car crashes.

- And the community health leaders- - [Jaye] For Pullen, the founder of this annual trip, there's really no way to prepare her students for what they will encounter.

- It's emotionally taxing, I will say.

Physically, it's very hot.

The poverty is different poverty.

You know, Atlanta is urban poverty.

This is rural poverty.

It's very different.

So just remind yourself, you have whatever, 15 minutes with a patient, and whatever happens, they're gonna leave with something.

- [Student] We're just making sure it's gonna work for patients tomorrow.

- [Sara] People's expectations are not high here.

(students chattering) (upbeat music) (gentle music) - Manhattan is a place where it really gets you in the guts.

It hits me hard because I think it's hard to get out.

There's a lot of cyclical poverty.

But my little nugget of hope is that if we can help people to at least be more functionally mobile, then they can leave the house and maybe work, or they don't feel like their only option is to stay and have a baby at 16.

We've been coming here for 11 years, and they all trust us and know us.

(Sara speaking in foreign language) (locals speaking in foreign language) - [Jaye] It's a reunion.

The people here know Pullen and her team.

(Sara smooches) The clinic, a cement floor with a covered roof and two small rooms, is packed.

(doctor speaking in foreign language) - [Jaye] People have been waiting since early in the morning.

Pullen, Rodriguez Vargas, and Damas... - Si, okay.

- [Jaye] Will lead their groups for the first patient, and then it's the students who will take over.

- Watch very carefully and listen, because you're in this chair next.

And so I don't let them just sit and be scared, I say, "You have to do it, and if you don't understand the patient, you can't say to me, 'Can you translate?'

You'll say to the patient," (speaking in foreign language), "More slowly, please."

- [Jaye] In six hours, 61 people are seen, some hoping to get help for deteriorating chronic conditions.

(doctor speaking in foreign language) - [Jaye] The patients range from very young... - Gracias.

- Gracias, senor.

- [Jaye] To elderly.

One woman is given some exercises to do at home to strengthen her leg, and a cane to help her navigate and travel her neighborhood.

(doctor speaking in foreign language) - [Jaye] A baby with a rash is diagnosed with scabies.

For a community without resources, the kindness and concern can overwhelm.

- There's no physical therapy available here to people, especially from a public health standpoint.

And so I saw people who had had strokes or accidents, and they basically either died in the hospital or they came home and suffered, suffered, suffered, and died early at home, because they hadn't had any rehab.

(doctors speaking in foreign language) - [Jaye] Something taken for granted in the United States is scarce on this island.

(patient speaking in foreign language) - [Jaye] Physical therapy is extremely limited, and most is private and paid out of pocket.

PT is a luxury for a community trying to endure another day of poverty.

- It's people who are hungry, people who are bedbound, people who don't have their blood pressure medication, because they ran out and they can't make it to the clinic.

Or they ran out of the government issued medication, and they can't buy it.

We have people who we've sent to the hospital because they're essentially having an active stroke in front of us, or they're just about to have a stroke, or they've been in a moped accident and their wounds are starting to become septic.

- [Jaye] This 22-year-old man has a blinding headache and double vision.

He is diabetic.

- His blood sugar was at 326, so you want it to be 150 or less.

And he said that he had insulin, but he didn't really take it.

He had the vial of insulin, but the needle was somewhere he couldn't remember.

- [Jaye] This is the second part of the team's day, when they walk Manhattan, seeing homebound patients.

- [Sara] In Manhattan, there's nowhere to go.

There's nowhere to go.

- [Jaye] With a clean syringe, they head to the home of the 22-year-old who has diabetes.

They find his insulin, and the community health leader, also a nurse, gives him the injection.

(doctor speaking in foreign language) - [Jaye] Inside the house, the young man's grandfather, seen by the team last year soon after he'd had a stroke.

- So he's had four strokes.

We met him for the first time last year.

And he had just had a stroke, he was extremely aggressive, shouting, very angry, crying, labile.

- [Jaye] Trapped in his house, the team returns a few hours later.

- [Doctor] Rosa.

- [Jaye] With a new wheelchair and a comfort cushion.

(all cheering) - [Sara] It was impactful to me because it wasn't us with, like, an MRI machine diagnosing him with this, or it wasn't us with a fancy PT clinic.

Hey!

(laughs) - [Jaye] Almost every home has someone in need.

Someone bedbound.

(patient sobs) The students assessed this man who also recently had a stroke.

- [Doctor] Yeah, si.

- [Jaye] His wife has her own injury from a several years old moped accident, a bone infection that has required multiple surgeries.

(doctor speaking in foreign language) - [Jaye] The man is given some strengthening exercises.

- Si.

- And the team moves on.

- [Sara] Here, there's a massive problem with stroke.

And you'll see in the community, the blood pressures are sky high.

(patient speaking in foreign language) - [Sara] Community dwelling people who are either on blood pressure medication but haven't had them in a while, or are undiagnosed.

So, hypertensive strokes are a massive problem here.

(doctor speaking in foreign language) - [Jaye] Dr. David Burke is the head of physical medicine and rehab at Emory University.

- We used to think that when you injured your brain, it was permanent, that there was no way that that brain could recover.

It was dead tissue, and that was it.

But now we know that there's something called neuroplasticity, and there are areas around the damaged part of the brain that can ignite and begin to assume the task of the injured tissue.

(doctor speaking in foreign language) - [Jaye] What appears simple... (patient speaking in foreign language) - [Jaye] Some basic exercises can help the brain's ability to reorganize and form new neural connections.

- Wow!

- [Jaye] Physical therapy helps the brain reroute signals... (doctor speaking in foreign language) - [Jaye] And regain control over affected muscles and movements.

- [Doctor] Okay.

- [Jaye] Day one has been a lot for the students.

- It was not quite what I was expecting.

I didn't know what to expect.

- It was kind of hard emotionally.

- Didn't realize we were just gonna have a roof over our heads and, like, no walls.

- It gets really loud, and trying to, like, be with your patient and hear everything that they're saying.

- It was challenging because we only do get that little time with them.

- Manhattan was nothing like I've ever seen before.

(wildlife chirping) - [Jaye] At the tail end of the day, as Pullen is walking out of Manhattan, a shock.

- [Doctor] Okay.

(doctor speaking in foreign language) - Bien!

- Bien!

- [Jaye] This man had also had a stroke.

He couldn't walk or really talk.

- He was very sick, and he almost died when we met him last year.

- [Jaye] The team gave him a wheelchair and exercises to do.

(Sara speaking in foreign language) (patient speaking in foreign language) - He got better.

Si!

- [Jaye] A year later... (patient speaking in foreign language) - [Jaye] He is well.

Healed.

- You would never know that he'd had a stroke.

We didn't have him at Shepherd Center.

We didn't have him at Emory Rehab Hospital.

He didn't have PT, speech, OT, physiatry, psych.

He didn't have any of that.

But what he had was a supportive family, a community health leader who could follow him.

He said God didn't want him, so he let him stay here.

(laughs) - [Jaye] Commitment and repetition is key.

That's what this man did.

And that's why this team is on year 11 and not stopping.

- [Sara] I'm not used to having really happy tears here.

I'm a crier.

There's so much more to do here.

It is not rocket science to give someone a wheelchair and to give them kind of a plan of care that's monitored.

(doctors speaking in foreign language) - [Jaye] Pullen and her team partner closely with community health leaders, people who live in these neighborhoods.

The health leaders follow up with patients, help with exercises, and try to keep what was set in motion going.

This has a lasting impact, because this trip is a continuing partnership, not a pop in and pop out mission.

(gentle music) (upbeat music) (motorbike engine roars) The Dominican Republic is one of the most dangerous places to drive in the Western hemisphere.

Seven out of 10 road fatalities involve motorcycles or mopeds.

- It's primary transportation.

You'll see few cars and mostly mopeds here.

So it's bringing kids to school, going to work, bringing your baby to the doctor's appointment, and you'll see entire families on it.

And when I first came here, I immediately got my American judgment of like, well, of course people are getting traumatized.

Of course people are being injured.

Of course people are needing PT, it's so dangerous.

But then it's like, check yourself, check yourself, check yourself.

What's the option?

To take a MARTA bus?

To take an Uber?

To drive your own car?

No.

There's no other option.

- [Jaye] In the Dominican Republic, the leading causes of death are ischemic heart disease, stroke, and road injuries.

(Lucia speaking in foreign language) - [Jaye] Lucia Rodriguez Vargas... (Tiernan speaking in foreign language) - [Jaye] And Tiernan Damas were Pullen's students before they were her trip partners.

- Maybe tighten this up just a little bit more.

- [Jaye] Rodriguez Vargas has been here since the first year, and Damas is on her seventh trip.

Both take vacation to go.

- She's the one that, like, took me under her wing to be a part of this project, and was like, "You're gonna be a part of this with me."

Like, "I need you to be a part of this with me."

- The three of us have to depend on each other the whole time, because we're responsible for all these students, we're responsible for being culturally appropriate, we're responsible for the care of these patients, we're responsible, so it's a lot of stress, but we disperse it between each other, I think.

- The three of us, all three of us cried yesterday.

I'm up at night because I worry that there's always more people that we're not catching.

(Sara speaking in foreign language) - [Jaye] The heart of the trip is Pullen.

- The most compassionate human.

Like, when she's with you, she's there with you, and she's just so present, and she just wears her heart on her actual sleeve.

I have to rip her from babies all the time, 'cause she just wants to hold and carry all the babies.

She just has so much passion for public health and really doing things and actually making things happen.

- Sometimes there's someone who, like, sticks with you for days, and yeah, we don't sleep well here.

(laughs) Like, you go to bed and you're like, "I'm not gonna sleep."

So yeah, yeah, you don't...

I don't leave it behind, I wouldn't say, always.

- [Jaye] Day two at the clinic in the Hermanas Mirabal neighborhood is one of those people who will probably stick with Damas.

The man is 92 and lives alone.

He's having trouble walking.

Tiernan and Dr. Llamas assess him.

(Eduardo speaking in foreign language) - [Tiernan] Okay.

Bien, bien.

- [Jaye] Instead of his cane, they teach him to use a walker.

- [Tiernan] Perfecto.

- [Jaye] He thinks he has to pay for it.

Damas explains it's free.

(Tiernan speaking in foreign language) (Tiernan speaking in foreign language continues) (patient speaking in foreign language) - [Jaye] He begins to cry, talking about two nephews who check on him, and that he misses his parents.

- [Tiernan] But he was really sad about living alone.

(doctors speaking in foreign language) - [Jaye] After seeing residents at the clinic, the group stops in homes as they make their way up the hill.

- Uno, dos, tres.

- [Jaye] Treating a woman whose leg has been amputated.

- When we see a lot of the communities, one in particular is at the top of a mountain, and it's paved a little bit, and then it's big, huge divots, right?

Huge rocks.

Broken up earth.

So even if someone could wheel a wheelchair on a flat surface, they're trapped in their house, essentially.

- [Jaye] At the very top of the mountain... (Sara speaking in foreign language) - [Jaye] Is a man known as Chiche.

- Chiche!

So Chiche, we met seven years ago, and he had had an accident, a moped accident.

He was driving, he was a taxi driver on a moped, and he was hit by a car.

And when we met him, his leg was about, I would say, you know, six, eight inches shorter.

One was shorter than the other.

They Humpty Dumptied it back together.

They stuck a metal rod, so his knee is out straight, and then some screws, so basically, his tibia and fibula, which are the bones below the knee, crossed, like, they should be kind of, you know, like that, and they crossed, completely crossed.

- [Doctor] Wow, wow, wow, Chiche.

- [Sara] So they basically screwed them back together, like, stapled, almost, back together in that position.

- [Jaye] Housebound in a plastic chair and unable to walk, Pullen and her team gave Chiche a wheelchair, exercise bands, and some exercises.

(Chiche speaking in foreign language) - [Jaye] Chiche took things further, trying to even out the difference in his legs.

He made himself a shoe.

- So what he did, he asked his friend to get a tire from the side of the road, like a car tire, and he had a knife, like a machete, and he cut around the perimeter of his shoe and glued, he had someone get him some glue from the market downstairs, and he glued a piece of rubber, glued several.

Stood up, not quite solid.

Glued another one, almost, and he glued another one, until his feet were at the same level.

So it's almost like a big platform shoe, which would cost an exorbitant amount in the US.

You know, you'd get it from an orthotics company, insurance may or may not pay for it.

It fits him perfectly.

It makes him exactly, makes his hips level out.

And so he said, "I think I'm ready to walk.

Because I can stand and I'm level, I think I'm ready to walk."

So we had a walker.

(doctor speaking in foreign language) - [Jaye] Eight years later at 62 years old, he is walking and strong from physical therapy exercises provided years after a devastating crash.

Chiche's last barrier to not needing the walker is to get rid of a catheter that was put in after the crash.

- He has a catheter, a suprapubic catheter, from the accident.

So, when he had the accident, when he was unconscious, they put a catheter in.

Here, surgery is covered by the governmental coverage, but anesthesia is not, and nor is hardware, rod, screws.

So, he didn't have the money for them to have the anesthesia to take the catheter out.

So it's been 15 years he's had this indwelling catheter.

- Normally in the US, we can do an ultrasound, we can scan, we can check how much is left with the residual now.

We don't have that here, so, you know, we're just gonna check it with a cup and trying to see how much we can measure out from the urine there.

- [Jaye] There is no high tech equipment, but there is high tech health.

- [Sara] He thought he would never level his arm again.

- [Jaye] Telehealth.

(Chiche speaking in foreign language) - Dr. Burke, do you have any questions for him about the catheter and everything?

- [Jaye] From his Emory office more than 1,300 miles away, Dr. Burke advises and troubleshoots with the team.

- Yeah, but wait for eight hours to see if it could, if it fills up and could avoid... Telehealth allows you to reach from an area that has a lot of knowledge and expertise into areas where they have very thin resources.

He should try and try... - [Jaye] They come up with a plan to wean Chiche off his catheter, and also arrange for him to be seen by a urologist in town.

- [David] So that's great.

- [Jaye] It's a final step to freedom, 15 years in the making.

- Wow!

- Oh!

- [Jaye] Emory is the only WHO collaborating center focused on rehab in North America.

This trip is part of that outreach.

While each day of the trip may look similar, people's needs differ wildly, and without expensive, massive equipment or high tech devices, this team is helping people.

(upbeat music) (vehicles rumbling) (gentle music) There is one last visit each year.

(Sara speaking in foreign language) - Bien.

- Bien.

- [Jaye] Pullen met 47-year-old Jose eight years ago as she was walking past his home.

- Oh!

Como estas?

- [Jaye] Jose has cerebral palsy and lives with his mother.

(Jose speaking in foreign language) - He was sitting here on the floor, in the corner.

- [Jaye] Pullen worked to help him stand and sit upright instead of scooting around on the floor.

(Jose speaking in foreign language) - The muscles.

(Jose speaking in foreign language) - The hips.

(Sara speaking in foreign language) Yeah, and he was sitting on the floor.

(Sara speaking in foreign language) To sitting upright more.

We practiced, right?

So, strengthening, (speaking in foreign language), strengthening, but also, also just being more functionally upright.

- [Jaye] Like many, Jose's life is confined to his house, but his paintings are not.

(Jose speaking in foreign language) - [Jaye] They reflect the world as he wishes it to be.

(gentle music) A riot of color and birds and happiness.

(Jose speaking in foreign language) - He's saying he's seen birds flying around, but he imagines birds like that.

Like, he imagines birds in the world like, maybe looks like that too.

- [Jaye] Jose grows serious as their visit draws to a close.

- He's worried at what time the bus is gonna come to get me.

(Sara speaking in foreign language) Similar hearts.

(Sara speaking in foreign language) "He's changed my life," I said.

Si?

- [Jaye] The collaboration with the World Health Organization will allow Pullen and Dr. Burke to work with Dominican health officials and see what more can be done.

It often feels like it's not enough.

- I'm up at night because I worry that there's always more people that we're not catching.

- [Jaye] But lives are changed, improved, saved.

Despair becomes hope.

- [Sara] I'm glad when I cry because I worry about people.

The relationships just grow every year.

- That's gonna do it for us this week.

See you next time on "Your Fantastic Mind".

(upbeat music) (upbeat music continues) - [Narrator] "Your Fantastic Mind" brought to you in part by Sarah and Jim Kennedy.