September 11th, 2013
Author: Clemence Sulliven, UIC Med-Peds Resident
The sun sets and the night explodes with stars. We gaze above and Panchita states that last night they saw a flash of light across the sky. We are sitting on the back porch of Panchita and her son, William’s, home. We had a busy day today in the Clinica de Familia La Romana: for the first couple hours in the morning, I saw patients with one of the doctors and then went with the health promoter to visit one of Clinica de Familia’s patient with HIV who was having significant diarrhea. This patient is well known to the clinic. One week ago, the health promoter stated that she and the nurse practitioner went to see this patient and gave her an infusion of IV saline at home for dehydration secondary to diarrhea. We took a taxi to get the the patient’s home; when we arrived we found her laying in her bed. Her daughter was cleaning the house around her and the health promoter warned us not to discuss her HIV status as her daughter is not aware. The patient stated she had massive amount of diarrhea and one episode of vomiting and so the health promoter decided to bring her to the clinic for further evaluation. The health promoter informed us of some specifics – the patient has a very low CD4 count, hx of noncompliance to medication and hx of intermittent severe diarrhea. When we arrived to the Clinica, Dr. Wish saw her – she described that she had 15 white-looking stools in the last 24 hours. She was given a 1 L of NS. We discussed with Dr. Wish what next to do. The patient did describe an almost rice looking stool which is concerning for cholera. There have been some outbreaks of cholera in the DR especially in the La Romana region. We also discussed sending the stool for culture, but not all tests are available at La Clinica. They can send the stool to a “laboratorio de referencia,” which is down the street. The patient was able to give the health promoter a stool sample which the health promoter walked down the street to test for amebiasis and cholera. Amebiasis is very common in La Romana. Decision was made to empirically treat the patient with doxycycline in case of cholera pending the results of the stool sample.
After lunch, we visited the Centro de Salud Hospital which is the public hospital in La Romana and then gave our CME-like presentations to the medical staff of clinica de Familia. We were able to leave Clinica de Familia with William, who is currently working as a medico at La clinica de familia, to head back to Guaymate, but first we needed to get our supply of fruits which were all hand-picked by William and which included:
*Fresh cherries – Dominican cherries with a chewable rather than hard pit. Of note when they blend the cherries to make cherry juice they sometimes include the pits
*A picture perfect pineapple – the smell of the pineapple was so strong that it helped overcome the odors of a bus stuffed with sweaty people
* A Dominican melon – small-like cantaloupe – not sure what the difference is, but actually they remind me of the melons that we get in France
After obtaining our key ingredients we boarded the guagua (crowded bus which stuffs as many people as possible until some are falling out through the door), which dropped us off quite perfectly just in front of William’s home in Guaymate. To our dismay, there was no electricity – such is the way in Guaymate – at that exact time to be able to use the liquador to make our juice. However, Panchita arrived and summoned us with our half-cut collection of fruit onto the patio to chat about life – her craft class making souvenirs out of coconut shells, Dominican’s past tyranny of the dictator Trujillo, and the flash of stars across the mid-night sky….
In a place where electricity is off more than half of the time, you find yourself moving at a much slower pace than usual. Yet the times sitting around lead to more chats and more revelations. It is in the dark where we have our deepest discussions about our project and our ideas.