by Meaghan Keller, M.D.
Dr. Meagan Keller is a 2nd Year Pediatric Resident at the Carolinas Medical Center in Charlotte, NC. She spent the month of May serving as a long-term volunteer with Timmy Global Health and itâ€™s partner organization in the Dominican Republicâ€”Banelino. During her time there, she consulted on a variety of pediatric health cases, helping to treat both Dominican and Haitian patients living in the bateys.Â
Two words vital to the Dominican society were shared with me early on in my trip: compartir (to share) and confianza (confidence in a relationship). Although I had been learning Spanish since I was in secondary school, and had studied abroad in Mexico as an undergraduate student, Dominican Spanish was initially difficult for me to understand and was full of unfamiliar colloquialisms. But the language barrier didnâ€™t impact my ability to comprehend the importance of the words compartir and confianza. As soon as I was en route to the Dominican Republic, I noticed the kindness of its citizensâ€”even on the plane a woman offered her pen to me for my customs form.
I immediately felt at home with my preceptor (Dr. Miguel Garcia) and his extended family, including his sisters who were my neighbors. Dr. Garcia and I quickly discovered that we have many things in commonâ€”we both briefly studied in Mexico, studied psychology, work in primary care and with adolescents, and he initially studied to be a priest, whereas my brother is a Catholic priest.
With Dr. Garcia, I worked in the public hospital in the mornings, mainly shadowing his work in psychology and with adolescent patients. There, I saw a number of astounding casesâ€”a twelve year old with severe anxiety who was only in the first grade; his mother, who also had anxiety resulting from an abusive relationship; a 14 year old who was pregnant with a 49 year old partner, and many others.
In the afternoons, we rotated through the various bateysâ€”rural, low-income community settlements surrounded by banana fields. In the bateys, the health promoters specifically recruited children for me to examine for sick visits, and we measured children from ages zero to five years to determine their nutritional status and their needs for referral and/or intervention.
While working in the bateys, I witnessed a key example of sharing (compartir) via the public spaces that the health promoters made available to us. They assured us that we could use any possible space for our health care visitsâ€”churches, schools, sewing rooms, and even an outdoor space where cattle meandered through and a new litter of puppies was thriving.
At the latter site, I watched the paper charts blow in the wind, and was amazed at the basic healthcare challenges this community faced. I, personally, struggled to understand many of the patientsâ€™ names, and quickly learned that many parents couldnâ€™t recount their childâ€™s birth date or even birth yearâ€”which was essential in accurately determining age in months and thus age-appropriate body measurements. Often, young children living in the bateys helped me translate Creole or provided me with patient names. Aside from language barriers, we faced other challenges like the oppressive heat, urine pregnancy tests that were falsely negative, frequent shortages of medications, and the subsequent substitutions (we filled our own prescriptions). But, as Dr. Garcia wisely put it, in spite of the challenges we had to practice with â€œour mind, skills and heart.â€ We often left the bateys with gifts of mangoes and bananas.
Many of our patients suffered from a frequent gripe (common cold), caused by overcrowded conditions and empiric treatment for presumed intestinal parasites. We did our best to provide some symptomatic relief, which meant a lot to the patients and their familiesâ€”even offering vitamins provided some comfort. I encountered several interesting physical diagnoses while working in the bateys as well, including mumps (very rarely seen in the US due to widespread vaccination), cutaneous herpes, and a three year old girl who had gripe, and whose father mentioned that she said very few wordsâ€”we later found her to presumably be deaf.
A health promoter, who asked me to review a death record of an infant, illustrated the culture of confianza to me. Two weeks later in the batey, the deceased infantâ€™s mother approached me and asked me details about how her baby could have possibly died. She had two other healthy children, and it had been a normal full term pregnancy, but she noted that the baby was born very white in color, cried initially, then died a few hours later upon transport to a larger city. She was unclear why this happened and was looking for answers. The death record mentioned a large bleed in the brain and insufficient oxygen to the brain. I tried to explain the risk factors for this, none of which she seemed to have, and then explained that sometimes we simply do not know why these things occur.
A mother form one of the bateys illustrated another case of confianza to me when she called Dr. Garcia after her child was thought to have appendicitis. She was in the public hospitalâ€™s emergency department, and no one in town was comfortable performing surgery or providing anesthesia since she was only eight years old. We were on our way to a batey, but after Dr. Garcia made many unfruitful calls, we turned around and met her at the hospital. Dr. Garcia took one look at the patientâ€™s face and believed it to be the face of a child with appendicitis. We carried her out of the hospitalâ€”with her IV fluids in towâ€”and took her to a bus stop, where we gave her mother some money so that she could go to a higher-level hospital. We later heard that she had her appendix taken out that same night. A catastrophe was avoided by getting her to pediatric-specific care.
Unfortunately, not all cases ended as successfully. One of Dr. Garciaâ€™s patients, an elderly man, died earlier in the month after he presented to the emergency department with vague symptoms. The symptoms were misunderstood (perhaps due to a language barrier) and he was sent home, where he later died of a presumed heart attack.
At the end of my month in the Dominican Republic, one of Timmyâ€™s medical teams came to support our work. I was amazed to see the teamwork present among a group of people who were mostly strangers prior to this weekâ€”including optometrists, pharmacists, a cardiologist, an obstetrician, a pediatric ophthalmologist, a family practitioner, undergraduates and medical students alike. In just five days, we treated 561 total patients. During the teamâ€™s trips to the bateys, I saw some of the same children from my prior visits, and was pleased to see they had some continuity of care.
Altogether, it was great working with the â€œTake a Trip with Timmyâ€ winner, Kirsten Devin, coordinating with Jose Vazquez (Timmyâ€™s on-the-ground staff member), and working with Karina Mehta (an undergraduate and two-time trip leader for Timmyâ€™s Washington University medical team). I also got to see TimmyCare (an electronic medical record) initiated in the Dominican Republic (by Zach Wright, Muz Ahmed and Lambo Jayapalan) for the first time!