Meet CHOP’s Dominican Republic Pincus Global Health Fellow for 2021-2023

Dr. Henna Shaikh recently spent two years in the Dominican Republic, completing the Children’s Hospital of Philadelphia (CHOP) David N. Pincus Global Health Fellowship Program. She answered a few questions about her time as a fellow and shared some advice about pursuing a medical career in global health.

Why did you choose CHOP for your fellowship?

A few things stood out about the Pincus Global Health Fellowship Program. I was drawn by the opportunity to live and work in the Dominican Republic (DR) full-time for a few years. This was important because I wanted to be fully involved with the community, my colleagues, and my patients' daily lives. I find it meaningful to develop and nurture deep commitment with the people I work with. I was also impressed with the program's willingness to be flexible. Early in the interview process, it was evident that program leadership genuinely desired and was committed to understanding my interests and career goals. They were willing to work with me to meet those goals through the fellowship.

CHOP has longstanding partnerships in the DR, which allowed for creativity in branching out to foster new collaborations that aligned with my interests in community health and newborn medicine. Right off the bat, Andrew Steenhoff, MBBCh, DCH, the Fellowship Director and Medical Director of the CHOP Global Health Center, was brainstorming ideas for potential partners in the DR like the newborn ICU at Hospital Materno - Infantil San Lorenzo de Los Mina (Los Mina) or the one at Hospital Regional Dr. Antonio Musa (El Musa).

How is the fellowship structured for a DR-based fellow?

For the DR-based fellowship, you work in two places: La Romana, a city in the eastern region of the DR, at Clínica de Familia La Romana, a family health center that serves more than 40,000 patients a year; and in Consuelo at CHOP's partner clinic, Niños Primeros en Salud (NPS), that serves more than 700 children age five and under each year. CHOP's longstanding relationships with both clinics give fellows a solid foundation to integrate into the Dominican culture of medicine. Both clinics have strong community connections. You don't feel as if you're in an isolated building: Each clinic is a hub, and its spokes are the community health workers who are integrated into the community. That kind of outreach builds trust among patients. I remember going on community visits with Ramona Cordero, Community Nurse Lead at NPS. People would greet us in a very friendly way, asking if we were from the clinic or even asking if we could drop by to follow up on a health issue that their child had.

The two clinics are community pillars. Their deep commitment to the community – a solid backbone of mutual trust and respect – allows the clinics to do amazing work, including establishing new collaborations. For example, Dr. Francisca Vásquez, Medical Director of the Centro de Salud Divina Providencia and a medical leader in the NPS clinic, was instrumental in reaching out and building relationships with colleagues at El Musa Hospital, where I completed my fellowship project. That partnership has grown, and now Family Medicine residents from El Musa come and rotate at NPS.

The partner sites for the fellowship were community outpatient settings. But given my interest in neonatal health, I was also able to incorporate inpatient care through my fellowship research project. I worked with Dr. Amaira Gonzalez, a neonatologist at El Musa. I did a baseline epidemiological assessment of risk factors for mortality among newborns. As part of this, I spent one day a week in the NICU at El Musa, getting to know the providers, nurses, and families and observing how newborn care was delivered there. I spent my time extracting data from hand-written patient charts, so I would sit at one table with my computer, and nurses would come and sit next to me to do their documentation. It was nice to chat with them and get to know them.

Did you have a meaningful experience from your time as a fellow that has stuck with you?

I always enjoyed the weekly home visits with Ramona Cordero. I remember one clinic patient who I was concerned had developmental delays and, potentially, autism. When I shared my concerns with the family in the clinic, they were not engaging in the conversation. I recommended that they get a developmental assessment for their child in San Pedro, the closest larger town to NPS. After an evaluation in San Pedro, I thought they should also see a pediatric neurologist in Santo Domingo. However, it was evident from their body language that they were unlikely to do that. Days later, Ramona and I went to their house, and we sat with the family for an hour and a half. Ramona and I spoke with the mom and dad while their little girl, our patient, ran around and played. Connecting with the family in their own home put the whole conversation on a different level, and I could see them become more receptive to our recommendations.

As a pediatrician, I also learned from the home visit, and came away with an appreciation of what the family’s day-to-day life was like. I saw how hard it would be for them to get to Santo Domingo because of transportation costs, time away from home and other competing priorities. By the end of our conversation, the parents were more receptive to getting a neurological assessment, which I think was possible because we were able to spend time with them in a comfortable setting that helped build trust.

What did you enjoy most about your fellowship experience?

A few aspects of the fellowship stand out as examples of the rich, expansive experience. First, the opportunity to interact with various levels of the healthcare system in the Dominican Republic helped me understand the entire system better. My orientation included time at Los Mina and Hospital Infantil Dr. Robert Reid Cabral (“Robert Reid”), two national referral hospitals in Santo Domingo. This helped me understand where families would go if we referred them to a higher level of care. Second, I got to work with and teach medical students, residents from the DR, and visitors from the US. Seeing our work through their fresh eyes was always inspiring.

I enjoyed living and working in the DR and learning about Dominican culture, which struck me as uplifting. People are very welcoming there; even people I didn't know well always seemed happy to see me. They’d greet me with a giant hug and inquire about me and my family. One of the little things I loved was that when people got on the juajua, the little bus, they would say a universal hello to everyone already on the bus; it would have been rude not to do this. I quickly learned how important exchanging greetings and pleasantries was, even during professional work meetings. There was a genuine appreciation for people as people, recognizing that we can all work together, but there is more to who we are outside the clinic or hospital. We are all human with loved ones and hobbies we enjoy.

This is one of the things that I am trying to take forward in my life and my practice.

What advice would you give to those who may be interested in a Global Health Fellowship program?

• Be open to everything. Go in with few expectations and be ready to learn. Initially you may feel lost and disoriented, but that’s the beauty of the experience.
• Bring humility and curiosity about different ways of doing things. Global health work can be challenging, but recognize that you're a visitor and can learn a lot from how others approach problems.
• Don't get disheartened when things don't go as planned. In my global health experiences, I've gone in with something that I think is my goal, and then it changes ten times before I get to the end result. So go with the flow and when things are hard, look for moments of joy because you will find them.

Tell us a little about your life now and what's next for your career.

I'm now a neonatology fellow at Seattle Children's Hospital. The CHOP David N. Pincus Global Health Fellowship helped me realize that this is what I wanted to do. I've always been interested in newborn care but wasn't 100% certain that I wanted to pursue a Neonatology Fellowship. Spending time in the newborn ICU in El Musa in the Dominican Republic and traveling to Tanzania to participate in the conference Tiny Feet, Big Steps – Advancing Care of Critically Ill and Premature Babies in Africa confirmed that neonatal training was my best next step. It's remarkable how simple solutions can save newborn lives; and it’s this realization that drives me to continue working in neonatal global health.

Of course, none of this would have been possible without the Pincus Family Foundation. I’m immensely grateful to them, and to CHOP, for making it all possible and allowing me to learn from many experiences in the Dominican Republic and Tanzania. I know these experiences will affect how I practice medicine now and in the future.