Global Heath Field Notes
Published on in Global Health Update
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Published on in Global Health Update
“As I settle more deeply into my clinical and community health work here, I have come to appreciate the challenges and rewards of a true immersion experience and the intensity of being closely connected to families and communities here, both physically and emotionally.
It is a great privilege and responsibility to be a primary care doctor and be able to walk with Ramona, the community health nurse from Niños Primeros en Salud, through Consuelo’s poorest neighborhoods each day after clinic, being welcomed into patients’ homes and becoming engaged with their lives and stories. I feel very supported by my mentors in Philadelphia and my colleagues here in the Dominican Republic, and in turn I see my role as a Global Health Fellow not only as a learner but also as a support and catalyst to the medical system, my clinics, our patients and their communities, and my co-workers here.
In Clínica de Familia La Romana, we recently gave our annual pediatric department presentation to the entire clinic staff. We also attended a three-day conference led by the Ministry of Health to learn about some of the newest national guidelines for pediatric HIV care. In March, I attended a two-day workshop on how to work with adolescents.
In the clinic, I continue to be impressed and humbled by the dedicated work of the health promoters in the Vertical Transmission Prevention program, who go to great lengths to care for HIV-positive pregnant women and exposed newborns in the community and to connect them to medical care. I have gone on home visits with one of the health promoters to some bateyes (poor communities of sugarcane workers and their families), and I can see that the work of the health promoters is vital, given their ability to connect with patients and support them amidst staggering poverty and often in remote rural locations, far from the clinic.”
“I have been very busy this year at Princess Marina Hospital. I did my second block of service as the pediatric consultant on the general pediatric wards, and I supervised a very large ward team with one chief pediatric resident from the University of Botswana (UB), one senior UB pediatric resident, a ministry of health medical officer (general practitioner), a general intern, three fifth-year UB medical students, and three third-year UB medical students.We had a busy service, with routine cases of newly diagnosed HIV, vomiting and diarrhea with dehydration, asthma, severe acute malnutrition, pneumonia, and febrile infants. We also had some more complex cases, such as severe nephrotic syndrome, seizures in an undiagnosed underlying genetic condition that we diagnosed (neurofibromatosis), and a child in a coma whom we diagnosed with meningitis caused by tuberculosis — a devastating disease that we see too frequently. Since we are the referral hospital, affected children typically present to us late, when they are already in a coma with increased pressure in the brain. The outcomes are unfortunately very devastating, with either permanent irreversible neurologic damage or death.
However, despite the high number of deaths, we have to focus on the successes. I did have one huge success story with a 3-month-old ex-premature infant who presented with pneumonia, heart failure and respiratory failure.
She spent time in the Intensive Care Unit at Princess Marina Hospital and is now off oxygen and doing very well. I saw her recently in follow-up clinic and she looks excellent. I really enjoyed taking care of her and getting to know her family.
The second success story is a patient who was critically ill last November with tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) and was under my care for an entire month. She is now home from the hospital and doing very well. I went to see her at her home in Gaborone and we had a wonderful visit. She is gaining weight, dancing and laughing, and doing well in school. These successes are what keep me going on difficult days.”