As I made my way through Latin America a couple of years ago, I always said I would return to learn more about healthcare delivery in this part of the world. My travels then were so focused on my own self-development, and music and politics and culture, that afterwards I was curious about some of the substantive global health issues I got a taste of as I bounced from place to place. This summer ("the last summer" as we say in med school) I made my way back to Dominican Republic, the last stop on my whirlwind tour. I arrived here about a week and a half ago and shockingly I'm already almost halfway through my stay. I'm only here for July though to get back for the big bro's wedding, and things generally move slower in this part of the world, so I'm taking the time to reflect on the past year, eat and sleep quite a bit, and do a lot of reading and writing. My romps to places like New Orleans (for Mardi Gras!!) and Namibia (for a FREE African safari trip with my sister) this past year at times made me question if I was actually in med school. So to be honest, I don't need to be all over the place; I'm happy just relaxing.
I'm staying in Puerto Plata, a vibrant coastal city on the northern side of the island, mostly known as one of those all-inclusive resort destinations in the Caribbean. I'm working at CEPROSH, an HIV outpatient clinic serving a large swath of the island since 1987, providing HIV care, testing, social services, education and prevention, and free antiretrovirals. I'm working with a doctor at Penn on this study looking at the impact of a free lab testing program initiated last year on patient compliance with recommended lab monitoring. It's pretty simple data collection from patient charts, not requiring a lot of mental effort at all. But it's certainly been interesting seeing the model they have set up at CEPROSH and how effective it seems.
Apparently, what originally drove the HIV epidemic in this part of DR was the sex tourism industry. While that is certainly still a player, the rates of HIV infection here seem to be driven by the same factors we've seen globally for the past couple of decades or so - women's lack of power when it comes to contraception in heterosexual sex, and the socioeconomic effect of marginalization (the poor, the migrants, etc.). CEPROSH is great because it employs people from the community, many of whom are HIV positive themselves. I had a brilliant conversation with one of the ladies who works in the pharmacy and helps me pull my patient charts. As we were in casual conversation about our lives, she asked to see my list of patients and pointed out her name to me proudly. Her eldest daughter is also HIV positive. This work means so much to her, and she told me of all the positive change she has seen over time. She explained to me how things used to be - the constant death around her, the lack of life-saving medicine, her own uncertainty. Things are different now - people come in every week to get their drugs and see one of the three doctors who come in daily. And CEPROSH staff like my friend in the pharmacy know who the patients are and truly care about them receiving the necessary, adequate services.
I look forward to shadowing the doctors this week or next. Things have been thrown off a bit due to a national strike about gas prices, jobs and the lack of a government response that shut down public transportation. This kept patients from the clinic the other day because it's simply too expensive to come to CEPROSH without public transportation for the patients. The global economic crisis is really taking its toll everywhere. Hopefully the schedule will return to normal though.
Outside of my project here, I'm staying in the home of one of the social workers at the clinic. Lucia is a sweet lady - always brings me some fresh squeezed fruit juice when I'm in the living room. Her 10-year old daughter Eliany has become my partner-in-crime. This little girl has so much energy. She has pigtails and wears glasses and has braces, and peaks her head in my door at random times of the day. She's obsessed with this one gospel CD, always singing the same songs. And we are constantly playing card games, which I always win even when I don't want to. Maybe I should tell her it's probably because she's not shuffling the deck well enough? I wouldn't want to break my hot streak though.
On the weekends, we've visited her aunt and cousins. Her one cousin Lisa is one of the cutest little girls you'll ever see with her little afro, and her huge beautiful eyes. She's so funny - she's kind of gangster too. The other day she called me a "puta". I almost died laughing. I guess being five times someone's size doesn't mean they can't cock their head sideways and call you a bitch. I'm hoping she has no idea what she said - she's hardly 2 years old. Anyway...
The first year of medical school is a beautiful blur. Since my glorious year off in Latin America, I've moved to Philadelphia, made countless new friends, and learned a whole lot of medicine at Penn. I'm exactly where I want to be. Yet something pulled me back down here for my "last summer ever." And that something is global health office funding. With my twenty or so days left, I intend to delve a bit more into the physician and patient experiences respectively, and to finally get to the beach this weekend. I walked along the coast today and the water was so blue, the breeze so refreshing. The only thing that will keep me away is another torrential downpour like last weekend. Which was actually a bit of a blessing. It turned into a day of watching old Kuumba videos and finally getting into The Catcher in the Rye.
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