After three too-short weeks in Montellano, following four months of adjusting to life and work in the States, I pressed my face against the airplane window for take-off.  I was surprised to feel the plane arc back, instead of heading straight out over the ocean.  A new flight path, tracing the shore of the north coast from above.

As I watched through a window not much larger than a notebook page, the entirety of my life’s current work was suddenly laid out before me.  I could make out the smokestack of the old sugarcane refinery, and walk my eyes a few blocks to the right, where I knew our office stood in the shade of some coconut trees.  The ocean is much closer than I realized; the tall sugarcane and warnings of danger have prevented me from ever walking that way.  I could trace the main road in Montellano from where it intersects the highway, turning right then left at the old train, memorializing the time when cane was hauled from the fields by rail, and over the rickety bridge to the sugarcane road.  From there, miles of cane and mountains, where I had just said goodbye again to people, communities, hidden from sight in so many ways, the least of which is from up here in the sky.  With the bay of Sosua peeking out from the left, and the unmistakable bend in the highway at Gran Parada on the right, everything and everyone we work so hard to serve and empower were captured in a 10-inch picture frame.

It’s humbling to remember how small we are.  It’s even more humbling to realize how many people — living, dying, suffering, celebrating, healing, hurting, working, fighting people — can exist in a single windowpane.  It’s a dual perspective afforded only by taking a step back — by getting a bird’s-eye view.

The few months after I returned to the States in September were, in retrospect, more challenging than I even realized at the time.  Progress was made and plans were implemented, but every day brought a greater list of things we should do than things we were doing.  We were connecting dozens of patients to needed referral sources, but desperately needed to reassess our capacity and priorities for patient care versus public health and education.  We more than doubled our bank account, but we still needed more strategic and on-going development initiatives.  We were engaging students in project development and fundraising, but were continuing to question how to fit medical service trips into a long-term organizational vision.  It was daunting to manage these conversations and decisions while also establishing HHI’s stateside presence from scratch.

Being back in the DR afforded me the perspective to recognize and articulate these very real challenges, and fostered significant conversations about HHI’s future.  After a year and a half of trial and error, successes and failures, and most importantly, taking the time to learn about and form relationships with people and communities, we are in a position to make tangible moves toward a long-term vision.  Thanks to the more than doubling of our (wo)manpower in the weeks post-medical service trip, we are now focusing on growing our community health workers program, developing public health initiatives, and creating new partnerships to strengthen the existing local health system.  I returned to my office on the Tufts campus in Medford almost three weeks ago, inspired and energized to go.

I still picture that windowpane when I think about the details, the action items, the goals.  I’ll always remember that perspective…

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