Craig Reed, an editor and webmaster with the College of Osteopathic Medicine, traveled with a group of osteopathic and medical students to the Dominican Republic on a medical mission. He is documenting their experiences with a blog.
Jan. 8, 2010
As the students prepare to leave the Dominican Republic tomorrow for Michigan, a number of them take on activities beyond the clinic, which today was at El Abanico, Herrera. I escorted one student to the office of a dermatologist she had made contact with who specializes in working with patients with Hansen's disease (better known as leprosy). In addition to meeting with her contact and several residents and doctors who work with him, she had an opportunity to see a wide variety of patients who came in concerned that they had contacted the disease. It was a good experience for the student, and she hopes to work again with the doctors she met on research projects.
For the week, the students and their mentors saw more than 500 patients, and the supplies we had brought for the pharmacy had dwindled significantly by the end of the last clinic. The students who used their osteopathic manipulative medicine training had steadily grown their skills and used them successfully on more and more challenging cases - providing some relief from pain that had been bothering patients for a long time.
From an observer's point of view, all the students had grown considerably in their short time here. They learned how to overcome language barriers and connect with each patient, how to organize a well running clinic, and thanks to Dr. Nassiri, learned how to prepare for their upcoming board exams.
Many came here with no experience working with patients nor a lot of knowledge on pharmaceuticals, but thanks to the clinical skills sessions offered by Dr. Louma, the time they had to work directly with patients and the opportunities to interact with the doctors at each clinic, they have all grown as medical students, taking another important step on the path toward becoming quality doctors.
Jan. 7, 2010
As we get draw closer to the end of this medical mission, the daily routine begins to shift. Today, MSU students finished their board exam review early, giving Dr. Nassiri and I an opportunity to visit the Instituto Dominicano De Estudios Virologicos (IDEV), which is one of the premier HIV/AIDS clinics in the Dominican Republic. Nassiri and the College of Osteopathic Medicine's Peter Gulick have been building relations with the clinic for some time now, so our visit with IDEV Director Ellen Koenig and Dr. Robert Paulino - who recently spent one month training at MSU -was another stepping stone in establishing a strong relationship.
Each clinic we have been to so far has presented a unique pattern of cases. Our clinic today at Los Alcarrizos was no exception. There was an unusually high number of cases of patients with impacted ear wax. The treatment for this is called "irrigation," which, as the name implies, involves using water to soften the ear wax enough to remove it. As the students soon discovered, the explanation of the process was the easy part. They had some partial success, but most patients were referred to a local ear, nose and throat specialist to complete the task. The important thing was the patients now knew what their problem was, that it was treatable and where they could go for help.
As we prepared to leave, the village children gathered around the bus to say farewell, waving their hands as they yelled "bye" at the top of their lungs until the bus started moving. It was a memorable sight none of us will forget.
Jan. 6, 2010
As the students continue to improve their clinical skills and spend mornings with Dr. Reza Nassiri reviewing material for their upcoming board exam, they are also broadening their understanding of health care and how very different the needs of one place can be from another — even if they are in the same country.
The clinic today at Los Rios provided a striking contrast to one yesterday in Duqueza. At Duqueza, parasites and disease were extremely common thanks to the village being located within a garbage dump. Los Rios on the other hand was a much cleaner location. A lot of people who work within the factories live in this area. Chronic pain from working long hours performing manual labor was one of the most common complaints. This provided ample opportunity for the osteopathic students within the mission trip to use osteopathic manipulative medicine training to drastically reduce the level of pain the Dominicans live with daily.
Nearly everyone who was sent to have an OMM treatment was suffering from lower back pain. The students worked hard to identify which structures were affected and what methods would be best for treating them. One of the challenges the students had was that the patients had been in pain for such a long time, the muscles in that region were extremely tight and in many cases inflamed.
I watched the osteopathic students as they started to work on each patient's lower back and the pained look on each patient's face as the student performed the treatment. Then I heard the sudden gasp of relief as the treatment took effect and saw the glowing smiles from every patient who talked about how this was the best they had felt in a very long time. The patients also received medication for the inflammation and for any lingering pain, but OMM had its place in serving the community.
Jan. 5, 2010
Today, the students went to Duqueza, Jacobo Majluta, known as a "trash city" because it is located within a garbage dump. Residents earn money by sifting through garbage, picking out recyclable items such as plastic bottles and glass.
The residents who came to the health clinic presented a variety of cases you normally wouldn't see in the United States. For example, several children came into the clinic with a fungal infection on their scalp that is preventable with regular access to shampoo. Many patients had intestinal parasites and acute versions of diseases we usually catch in earlier stages in the United States. Malnutrition was extremely common.
Fortunately for these villagers, two local doctors, Francisco and Diane Sabado, offer a clinic once a month that helps keep them in better health than they would be under the circumstances.
For the students, this was a great opportunity to practice their clinical skills and learn more about tropical diseases. This clinic in particular showed how much of an impact a physician can have on a person's life, and the importance of serving the poorer communities.
Jan. 4, 2010
During the morning, the students further honed their clinical skills, practicing how to conduct eye and ear examinations as well as receiving lessons on how to listen for heart abnormalities using a stethoscope.
At this level of training, the students' primary objective is to distinguish the normal from the abnormal. By performing examinations on one another, the students developed an understanding of how broad the normal range is for each portion of the body - especially the heart, which can, as the students discovered, create some murmur-like sounds in a healthy individual that are normal and do not indicate any problems as other unusual sounds might.
During the afternoon, the students set up and participated in their first health clinic for the trip. They were driven an hour outside of the capital of Santo Domingo to a small village called Aut Duarte (which is about 28 kilometers away). Drs. Diane and Francisco Sabado from Santo Domingo, Dr. David Luoma from the College of Human Medicine and two local doctors, Drs. Uyi Aideyan and Abner Saint Gilles, oversaw the students as villagers of all ages took advantage of the clinic. The patients presented a variety of different problems to the students ranging from joint and muscle problems to digestive complaints. One group of students met a patient with a severe heart deformity that provided them a clear contrasting example to the healthy hearts they were listening to during the morning.
The various muscular-skeletal problems also provided students the opportunity to use their osteopathic manipulative medicine skills to help relieve pain and discomfort.
After returning from the clinic, Dr. Reza Nassiri from the College of Osteopathic Medicine gave them their first lecture on how to prepare themselves for their board exam, an important test which all medical students are required to pass shortly after completing their second year of medical school.
Jan. 3, 2010
Students have received two lectures from College of Human Medicine Assistant Dean David Luoma. The first was a pharmacological review of the medications the mission had brought with them, which included information on their uses, side-effects as well as a comparison of similar medications. The second was a more hands-on session where Dr. Luoma instructed the students on clinical skills, specifically on how to take the blood pressure of their patients. Since most of the students on this particular mission are in their first year of medical school, this was for many their first lesson in clinical skills.
Drs. Diane and Francisco Sabado from the Dominican Republic then provided the students a basic orientation on the state of medicine in the country, the structure of the health care system and culture.
Mission participants then visited a leper colony located outside of Santo Domingo. The students saw for their own eyes how a devastating, yet treatable, disease can impact people who receive treatment late. Many of the patients at this facility were missing toes, fingers and in some cases entire legs. The students seemed moved by not only the severity of patients' conditions but also the sincerely warm hospitality the students themselves received during their visit. Mission participants gave the patients numerous gifts including necessities such as socks and toothpaste.
Students also visited the pediatric wards of a government-run hospital. These hospitals are the first of a three tier-system of health care. At this entry level, all basic services are free, but patients or their family must provide bedding for the hospital bed, and if there is a need for a blood transfusion, a family member must donate a pint of blood to replace the blood to be used as well as pay for the cost of having the blood tested for diseases. Significant delays in administering tests, X-rays and other services are quite common at this level.
Most of the wards were filled with children with dengue fever, which is a common occurrence during this time of the year. Treatment is limited to monitoring a child's platelet levels, keeping their electrolytes within the normal range and if necessary, providing a blood transfusion. The prognosis and severity of the disease is roughly related to the number of times a child has contracted the disease. The first time is as bad as the flu, but becomes potentially life threatening by the second time they contract it.
The students also visited a cardiac pediatric ward, where children with heart conditions are awaiting possible life-saving surgeries. Most of the children were very young. Dr. Diane Sabado explained how the best candidates for the surgery are children under the age of two and beyond age two, most will likely die either from the surgery or from complications related to it due to lung problems that develop as a child left untreated with a heart condition gets older.