Final Reflection

This past week was incredible.  It is always great to travel outside the U.S., but traveling to a Spanish-speaking country and having the ability to practice your Spanish makes traveling even more challenging and fun.  I am in no way fluent in Spanish now, but I do feel a bit more confident in my ability to converse with someone in Spanish (including medical problems).  

This trip was also great because I thought we had the perfect amount of independence and oversight.  I didn't feel like Dr. Rothschild or Anna were micromanaging me, but they were always there to provide help.  I think this was something great to have at the beginning of my medical career (OK, I finally accept and embrace it).  I really feel like I have grown as a physician over the past week. 

Finally, it is incredible to see the efforts local communities are making in providing healthcare to all of their citizens.  Las Lomas was probable the most impressive and obvious example of this. The community had built an entire clinic (including pharmacy) and there was a dedicated physician that sees patients every day of the week.  This is something that was not always available in Las Lomas and is not available in many neighboring towns.  It is great to see a community become self-sufficient.

Alfredo said something earlier in the week at our orientation that I found very interesting.  He said how the best thing that can happen is that Endeavor and Rush are no longer needed in a community.  That means the community has found ways to become self-sufficient and they have found resources to be able to empower themselves.  I hope to continue to do global health trips in the future, but it would be incredible if fewer communities need us in the future.

Other things I learned: 

1. Dominicans are very passionate about dominoes

2. Everyone in the DR has gripe (a cold)

3. Patient are grateful for any help that you can give them

4. If a family shows up, almost 100% of the time you will end up examining everyone in the family

5. It is possible to survive one week without consistent WiFi, even in 2015

6. Santo Domingo is the oldest continuously inhabited European settlement in the New World.  It was actually founded by Bartholomew Columbus, the younger brother of Christopher Columbus.

Thank you for taking the time to read.

Mohit

DR 6/5/15

Today was our last day of clinic. We ended where we started- at the Peralta clinic. We saw 104 patients today. I'm not sure how many patients I saw personally, but I think one of my most memorable patients was one of my last patients. She was an HIV+ patient who was coming in with upper respiratory and pneumonia symptoms. She was on HIV medications (she unfortunately couldn't remember their names) and was supposedly well controlled but did not remember the names of these medications and did not have her most recent labs.  Whether her viral load was 0 or not, she was of course still susceptible to infections.  I had been careful not using many antibiotics with patients this week unless absolutely necessary, but I didn't mess around with this patient.  With Dr. Rothschild I looked up the appropriate antibiotics for community acquired pneumonia.  We needed to give our patient the most broad coverage and we had to have these antibiotics in our small pharmacy.  We decided on doxycycline and augmentin.  I really enjoy studying infectious diseases and am interested in possible pursuing it as a fellowship in the future.  I was excited to see this patient, and I think this patient's story shows how this week has been all about collaboration.

It was bittersweet ending clinic today.  I was happy we saw so many patients today and happy that I had the opportunity to see so many patients this week.  However, at the same time these days have been exhausting.  I am happy though that we ended on a very positive note. The plan for tomorrow is to go back to the Peralta clinic and take inventory/ pack up.

Images of the Peralta clinic:

My office at the Peralta clinic and my view from the window:

DR 6/4

Today was a crazy day. We traveled up the mountains to treat patients at three different clinics. There were about 20 of us that were all packed in the back of a truck along with our lunch and supplies for the day.  The two options were to either sit or stand in the flatbed.  We were going up and down steep hills throughout the trek. The views were amazing though.

The first clinic was at a coffee plantation.  We worked outdoors wherever we could find space.  This is where Anna worked:

We saw about 36 patients at this site.  Most of the patients were farmers and their families. After seeing patients we had the opportunity to eat lunch. The food was cooked in a small hut that looked like it was on the brink of collapse. However, it didn't and the food we had was incredible.

The coffee plantation was the farthest we went up the mountains.  On the way back we stopped at a few of the small towns we saw on the way. We went to a school house where we treated about 20 patients. Again the patient population was farmers who worked hard in their fields.  I saw one patient who had chest pain when working that resolved with rest (stable angina). We didn't have the resources to do a full work up on his, so we gave him a beta blocker, aspirin, and advised him to go see a cardiologist if his symptoms change. Even though we were limited in how we could help him, the gentleman was so grateful for the help we were able to offer him.

Finally, we stopped in a small town and saw about a dozen Haitian immigrant workers.  Most didn't speak Spanish and were between the ages of 18-22.  These men were most likely displaced from Haiti after the earthquake in 2010.  It's amazing to think how much these young men have probably gone through in their short lives already.

This was also about the time that it started pouring outside.  Our mobile pharmacy was in the back of a pickup truck, so the pharmacy volunteers got soaked.  I was amazed by how they just kept going though and dispensing medications/vitamins.  

It continued to rain on our way back down to Peralta. It made the already steep and dangerous drive a bit more exciting.

DR 6/3/15

Today was our third day seeing patients. This time we were in a clinic in Majagual and we saw patients In a single room in an elementary school.  The conditions were crowded and hot (the electricity went out within the first five minutes), but the experience was great. Everything was very close, and I was able to ask for Spanish or clinical help very readily.

There was one patient I had who had an accident with a rock falling on her second toe on her left leg who had seen a doctor in the public hospital but didn't follow up/ didn't know to follow up with her physician at the public hospital. The toe was healing fairly well but really needed debridement and dressing changes every week for the injury to heal well and completely. Unfortunately after talking to Anna (an NP and one of the trip coordinators) we decided to instead schedule the patient to see the surgery team that's is flying into the DR in 2 weeks for debridement in the OR. I was simultaneously sad and happy that this patient could get care when the surgery team comes.  I was sad because in the US this patient would be able to follow-up with a wound care physician weekly to get debridement and dressings in an outpatient clinic.  She would not to deal with the extra risks that come with surgery.  However, I was happy that she could finally get definitive treatment for her foot.  This patient was also memorable because she was able to help me translate for the next patient while she waited for her medications (another benefit of working in a single room).

I don't have a picture of the patient described above, but I do have a picture with a patient that presented with skin lesions and rashes all over his arms and legs.  Here is an image of the patients skin lesions and rash on his arms.

During lunch we ate the lamb that Joe and Steve had watched get slaughtered the night before. The meat was delicious.  Image of lunch below.

All of our meals have been this good.

Also got the chance to watch Dominican dominoes. The game was fast paced and didn't stand a chance against the Dominicans I played against.  They have almost a 6th sense of what has been played, the numbers other players are holding, and what to play next.  I was only able to win one game against Alfredo (our liaison this week) but my team only won 4 points that game.  Dominican-style dominoes are fun, challenging, and addicting.  Here is an image of us playing dominoes last night by candlelight.

Saturday 5/30/15

This is my first blog post. Firstly, I'd like to thank Rush and Make A Change International for helping fund this trip.

Today I flew into the DR with 9 other people from the US.  The group is comprised of 1 attending physician, 1 nurse practitioners, 1 nurse practitioner student, 1 resident and 2 incoming residents, 1 rising M2 student, 1 incoming medical student, and 1 person working in a lab.  There is also a nurse that is going to join us, but she had some issues with her flight and won't be able to join us for at least another day.  The total will then be 11.  There are 4 guys and 7 girls.  I'm bringing this up because I think this it's so great that we have a diverse group of people on this trip.  I know throughout my time at Rush and in medicine everywhere this is such a large emphasis now on interdisciplinary teams.  I hope having this diversity will make this trip more interesting and rewarding for both myself and patients.

I recently graduated from Rush Medical College, and when I signed up for this trip nearly 1 year ago with my classmate (Joseph Lee) I thought it would be such a great opportunity for a last hurrah for our medical school careers.  We thought this trip would be a great way to end medical school.  However, standing in line for Customs at the airport in Santo Domingo, Dr. Rothschild, a family medicine physician, mentioned to Joe and I that he thought it was so great that we were starting our medical school careers with this trip to the DR.  I hadn't thought about that before Dr. Rothschild mentioned this to us.  I guess I'm not a medical student anymore, and I can't use the "I don't know, I'm just a medical student," excuse anymore. I've got my medical degree now, I'm no longer a medical student, and I've got to start behaving and acting like a doctor.  I hope this trip will help me accept and embrace the new expectations and responsibilities I now have.