Spending the summer running social media and indirectly observing healthcare in Fiallo Cabral public hospital and Canela private hospital in the Dominican Republic allowed me to learn so much. I realized I never fully wrote an article composing all of the ways Dominican healthcare juxtaposed from healthcare in the United States and decided to do so with this article. This was my second country outside of the United States that I was able to observe healthcare in and I loved getting a better perspective on Global Health. To read about my time while observing healthcare in a rural province in Thailand, see my article titled: “How Shadowing Abroad Changed my View of Global Health.” I hope that my knowledge can help enlighten students that medicine while universal is not practiced the same everywhere and this can present some challenges that citizens of foreign countries must overcome. I also want to make the point that while I was there, the only people doing the saving were the physicians- the rest of us students had an amazing time learning the healthcare and culture.
I want to first start with the diseases that are more commonly found in the Dominican Republic than what would be found in the United States. The first is Dengue Fever- while Dengue Fever is found rarely in the more tropical areas of the United States, there is an epidemic (a widespread occurrence in a community in a particular time) in the Dominican Republic. The disease is transferred via mosquitos and its symptoms are fever with any of the following: nausea, vomiting, rash, aches and pains in joints and symptoms last for roughly a week. Treatment is more of treating the symptoms than the virus which includes rest, fluids and acetaminophen. Unfortunately it can rapidly spread and progress rapidly as well in which cases patients end up with severe Dengue and have to be hospitalized. Prevention includes: wearing bug spray with DEET in it and wearing loose clothing- this doesn’t sound like a lot in my opinion for a disease that can be fatal. According to the CDC, there is a vaccine available, however it is only used in some parts of the world (Center for Disease Control, 2019). It is most likely not available in the public hospitals in the Dominican because of lack of resources.
This brings me to my next point of: resource availability in these hospitals. I was so impressed at how the hospital staff was able to improvise with the resources they had compared to what would be needed. Examples that I saw: using cardboard and tape to make a splint for a fractured leg or on an IV on a newborn, using a water jug as a weight to hold a fractured leg in place, surgeons bandaged wound sites with gauze and an ace bandage etc. These were all things that were different from what I was used to seeing at home. The lack of resources available meant that patients were awake for a majority of surgeries as general anesthesia was less common to use compared to a local.
Another example of how healthcare was so different: five years ago walk in clinics did not exist in the Dominican Republic. Every morning: patients line the halls with cards or “ticket” numbers and wait for care. Some of which are waiting for nebulizer treatments. Coming to the hospital for the walk-in clinic every morning and waiting for care is cheaper than getting an inhaler. Along with the fact that nine months ago is when emergency medical services or ambulance was put in place in the country. The system is not perfect as a majority of the telephone operators are not medically educated and dispatch ambulances for even prank calls- which can be seen as a waste of resources and crowding of hospitals if not all patients need to be taken.
Multiple public health crises in the Dominican Republic relate to Women’s Health: lack of education that relates to lack sexual contraception usage. A lot of citizens do not know what a condom is. This leads to a high rate of HIV and teenage pregnancy. In relation to C-section rates: Latin America and the Caribbean have the world’s highest rate, with Dominican Republic being the primary leader at 56% of pregnant women have a C-section, according to the Lancet medical journal in 2018 (Kelland, 2018). I observed this first hand as 6/7 pregnancies I witnessed was a C-section and if a natural birth was occurring it was talked about throughout the wards. Why is this the case? Fear of a natural birth for pain, a negative past experience or lack of sexual function afterwards. After talking with multiple physicians in the country, they feel that patients are not educated on the risks or do not hold them high on their priority list in comparison to their perceived benefits. Abortion is illegal and people can be incarcerated if they have one. This leads to patients drinking a “milky” drink to try and terminate the fetus on their own outside of the hospital which is accessible without a prescription and costs roughly 200 pesos- this is four American dollars. A majority of these patients end up going to the hospital for complications of this drink on their GI and reproductive systems.
How care affects the finances of the patients: the most shocking component was that patients had to pay for a blood transfusion. They also had to pay for their own tools that were being used in the surgery in a public hospital- this was an interesting point as that was the only thing patients paid for while being cared for in the public hospital. The tools were the same ones that could be used for a home improvement project and the only requirement is that it is waterproof- this was common in orthopedic surgeries. The community members being treated had their care affected quite often for lack of finances: surgeries were put off and conditions became worse, patients went into cardiogenic shock for lack of funds for a blood transfusion.
I loved learning from the amazing Mentors/Junior Doctors at these hospitals. They took the time to explain the patients, their lifestyles, and how modifications could positively impact their care on an individual and a public level. If you’ve participated or observed medical care abroad, where did you travel and what did you learn during your time there?!