Getting on the Bus: Jenny Foster

In 2010, I took a bus from Los Toros to San Francisco de Marcoris to meet a nurse-midwife and anthropologist I had never spoken to in person. I brought Lissette with me because I still spoke Spanish like a person who had barely paid attention in high school, and I wanted someone at the helm who knew how to navigate her country. Jennifer Foster had invited us to stay at Rosa's house. Rosa was a Dominican nurse who had gone on to get her Master's degree — virtually unheard of at the time, in that place. The bus ride was long. I was nervous. I had no idea that the meeting would change what I thought I was doing and redirect what I would do for the next decade.

This essay is about that meeting and what it means to encounter someone who is asking the exact questions you are asking, and to have that person take your questions seriously.

The First Trip

I arrived in the Dominican Republic in 2008 with a Catholic mission group from Wisconsin. I was twenty-one years old, barely spoke Spanish, and was going through a difficult time. I had just decided to leave the University of Wisconsin-Madison and transfer to Wisconsin-Oshkosh to pursue nursing. I did not know what I was looking for. I thought I might find it somewhere else.

The mission program was connected to my parish — the parish I was born and raised in, the Catholic community that had baptized me, the place that had taught me to think about service. I arrived with six or seven other young adults. Most of them had been before. I was the newbie.

I stayed with a family named Macho and Aneta in their casita in Los Toros, Azua. They had recently upgraded to a cement floor. They took me in without question. They asked me about my family — who my parents were, where I was from, who I was. They treated me like family. I have two Dominican siblings now: Kenny and Lenny.

Something happened that first trip. I am not sure to this day what it was. Something inside me changed. It was not sympathy or feeling sorry for people. It was anger. There was anger that came with seeing how most of the world actually lives. There was a recognition that I had been born into fortune — born in the United States, born to people who could send me to college, born into a position of structural advantage that had nothing to do with who I am and everything to do with where I happened to arrive.

What pulled me back was not guilt. It was the kindness and openness of the people I met. It was Macho and Aneta's genuine curiosity about who I was and where I came from. It was the recognition that I had been welcomed into a community, and the community was real.

Deacon Don and the Teaching

Deacon Don was the deacon at my parish. He was also the one who had baptized me. He taught me something that summer and in the years after that I have tried to hold onto. He taught me cultural humility. He taught me to listen first and act second. He taught me that understanding comes before doing, and that the doing without the understanding is just performance.

I carried that teaching with me when I came back. My first trip, I taught English to young children. I taught basics of computer use. My broken Spanish was a barrier, and I knew it. But what Deacon Don had taught me made the barrier manageable: if I listened first, the community could teach me. If I acted second, the acting would be grounded in something real.

The Doubt

By my second trip, I was a nursing student. The prenatal program with promotoras had been started. The program emerged from tragedy — a woman in the community had died during her pregnancy from pre-eclampsia and HELLP syndrome. She was the relative of a community leader. The community had said: enough. We need to look after our own. The Los Toros Foundation had provided guidance. The program was real and it was community-driven.

I was fortunate enough to continue the project. We all felt great about what we were doing. We were preventing maternal death. We were empowering community health workers. We were doing good work.

But then I learned something about maternal mortality: it is rare. One maternal death is one too many — demasiado. But statistically, it is rare. So what counted as success? Was it that we all felt good about the work we were doing? Was it the numbers we could report — the number of women screened, the number of referrals made, the number of births attended? Or was success something else entirely?

And underneath that was a harder question. I was aware, by then, of the development world. I knew about NGOs across the globe trying to "make a difference." I knew about the affluent countries sending people to help the less affluent countries. Were we making a difference? Or were we performing a kind of help that made us feel better while avoiding the harder question: were we actually helping the people of Los Toros, or were we helping ourselves?

That question sat with me. And it sat with the community too. We all wanted to demonstrate how great the program was. We all wanted to show that we were making a difference.

The Discovery

I was describing this dilemma to Dr. Susan Bonis, my research mentor at the time. I was an undergraduate nursing student, but I was already thinking about research and impact. Susan listened to my doubt and she gave it a name. What I was describing, she said, was community-based participatory action research. CBPR. It was a methodology. It was a framework. It was a way of thinking about development work that put the community at the center, not the outsider.

She encouraged me to search for anyone doing that kind of research in the Caribbean.

I searched. And I found Jennifer Foster.

She was conducting a maternal health study in the Dominican Republic. The study was ongoing. The framework was CBPR. She was training nurses and community workers as researchers. She was centering community perception and community voice. She was asking the same questions I was asking.

I sent her an email. Naive me had no idea what I was getting myself into. I was from the Midwest. I had very little world experience. I had no idea what Emory was. I thought it was a small school, like Carroll College. I was very wrong about that. But Jennifer Foster was warm and inviting in her response. She was interested in my story. She invited me to come down to the Dominican Republic later that year when she and her team were there.

San Francisco de Marcoris

The meeting was in May or June of 2010. I extended my time in Los Toros to be there. Lissette came with me — a pre-med student on a BECA program, from a small town but someone who knew how to navigate her country. I knew her family well. A very large family. Her older siblings had been part of the BECA program in the early 2000s. I felt safe and comfortable with Lissette at the helm.

We met her at the hospital in San Francisco de Marcoris. We stayed at Rosa's house. Rosa was the nurse who had gotten her Master's degree — a stoic woman, a kind woman, someone who had pushed against the structural limits of what was possible for a nurse in the Dominican Republic.

Jennifer Foster was warm. She was welcoming. She was kind. We talked about the trip. We talked about Los Toros. We talked about the prenatal program. And then she invited us to the Public Health Minister's house for a celebration dinner. It was the end of her team's trip. They were leaving for Atlanta in a day or two.

The Dinner

The dinner was buffet-style Dominican food. Sancocho. Lots of children. Interested people. I was treated as a local celebrity, which I did not expect. The community was interested in what Lissette and I were doing there. They had heard bits and pieces about the program in Los Toros.

Jennifer Foster watched. I think she saw what was actually happening. She saw that the community was driving the project, not the white American coming in to tell them what was wrong. She saw that the cultural driver was the community's own loss and the community's own determination to prevent another loss. She saw that a young white man from Wisconsin was interested in prenatal care in the Dominican Republic not because he wanted to fix problems, but because he was trying to understand.

The cultural anthropologist was curious.

The Seed

Before she left, Jennifer Foster said something to me. She encouraged me to continue the work. And she planted a seed. She suggested that I think about a PhD program in nursing.

A PhD. I was a nursing student who had barely finished his undergraduate degree. The idea seemed impossible and also suddenly necessary. If I was going to understand whether what we were doing mattered, if I was going to be rigorous about it, if I was going to do the work at the level it needed to be done — I needed more education. I needed the methodology. I needed the framework.

The Bridge

Between 2010 and 2012, I prepared myself for graduate school. I took the GRE. I applied to programs that had maternal health focus and Dominican Republic connections: University of Miami, Emory, UMass, UCONN. I continued the work in Los Toros. I conducted a qualitative study. I presented a poster on "Death of our Mothers."

In 2012, I chose Emory. I chose it specifically to study under Jennifer Foster.

The Years After

From 2012 to 2015, I was back and forth to the Dominican Republic. Multiple trips. Conducting research with Foster.

In the summer of 2013, we spent the entire summer in the Dominican Republic. We stayed at Rosa's house. We were at the hospital almost every day. Interviews. Data collection. We were observing how skilled birth attendants provided care. We were listening to women's experience of that care. We were building the dataset that would, four years later, become a published study on "The Process of Intrapartum Care Among Skilled Birth Attendants in the Dominican Republic and Maternal Perceptions of Care During Labor and Birth."

What Mentorship Actually Is

A mentor is not the person who tells you what to do. A mentor is the person who sees what you are trying to do and takes it seriously. A mentor is the person who is asking the same questions you are asking, and who has already walked far enough down that road to know what the road requires.

Jennifer Foster saw that I was asking real questions. She saw that the community was leading. She saw that the work mattered. And she did not tell me what to do. She invited me to do it alongside her.

That invitation changed everything. It redirected what I would work on. It gave me the framework to understand the work I was already doing. It connected me to a methodology that made rigor possible without losing the community at the center.

I took the bus to San Francisco de Marcoris in 2010 because I had read her work and recognized my own questions in it. I had no idea that the person asking those questions would become the person who would mentor the next phase of my work, who would invite me into research, who would model what it means to do community-based work with integrity.

The bus ride was long. The meeting was short. The impact has been the work of a decade, and it continues.

This is what it means to get on the bus — to follow the person who is asking the right questions, to show up in person, to be willing to be taught. Jennifer Foster took me seriously when I showed up. That seriousness changed the trajectory of everything that followed.

About the author

Peter Schindler, MD, PhD is an Assistant Professor of Medicine and Associate Program Director of the Community Health Center Family Medicine Residency Program at the University of Nebraska Medical Center. He practices at Winnebago Comprehensive Health System, OneWorld Community Health Center, and Nebraska Medicine. He completed a Primary Care Research Fellowship at McGill University and holds a BSN from the University of Wisconsin-Oshkosh, an MS and PhD in nursing from Emory University's Laney Graduate School, a Diploma in Tropical Medicine from the Liverpool School of Tropical Medicine, and an MD from the Medical College of Wisconsin-Green Bay. He is board certified by the American Board of Family Medicine. The Interprofessional publishes new essays every week at the intersection of medicine, nursing, and the clinical knowledge that lives between them.

Disclaimer. The views in The Interprofessional are Peter Schindler's own and do not represent the official positions of the University of Nebraska Medical Center, Winnebago Comprehensive Health System, OneWorld Community Health Center, Nebraska Medicine, or any other affiliated institution.