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“Visiting Clinica de Familia La Romana”

“Visiting Clinica de Familia La Romana”
Author: Joseph Schowalter, Chief Resident
Date: 2/25/14
Like every morning I was awakened by the constant cackling of the many free roaming roosters
in the city of Gyuamate. The nights are filled with many sounds including the howling of the
stray dog packs and sporadic horns of the sugar cane train, but usually the roosters wake me
up. Back home those roosters would be dinner and I would sleep peacefully.
Today we skipped breakfast and hopped on the guagua to shadow some of the physicians at Clinica de Familia La Romana (CFLR), the largest provider of HIV care in the eastern part of the Dominican Republic (they also provide non-HIV care).  Dylan, the Peace Corp Volunteer, accompanied us to the clinic. At the clinic we were given a tour of the facilities. I was pretty impressed with their patient rooms, friendly staff and their bathrooms. I frequently visited their bathrooms as did the rest of the group.
I was assigned to Dr. William Wish, who was born in and still lives in Guaymate.  Dr. Wish’s patient population is primarily HIV positive, and he also practices general internal medicine. Thankfully Dylan was my interpreter otherwise the communication with Dr. Wish and I would have been
very limited.
Our first patient was an HIV-positive woman with a steadily decreasing CD4 count.  It appears
she was not fully adherent with her anti-retroviral medications. She is unsure how she contracted HIV and has not informed her husband of her diagnosis. She is afraid that her marriage will be over if her husband learns of her HIV status.   Dr. Wish reviewed her basic labs, wrote a script for Bactrim (for PJP pneumonia prophylaxis) and counseled her on strategies to improve her adherence, even in challenging situations such as her’s where disclosure can be problematic.
Our second patient was an elderly gentleman who was pretty vocal about his many sexual
partners throughout his life.  However, since his diagnosis of HIV he has not been sexually active, which can be frustrating for him.  We also discussed his enlarged prostate and the results of a transrectal ultrasound.  He left happy and educated on his conditions.
Because CFLR has a long history of caring for people with HIV, in many ways the patient care challenges did not seem all that different than what I have seen in Chicago.  Barriers of stigma, understanding of illness, secondary prevention – these came up today and often come up back home.  I was impressed by the quality of care delivered at CFLR.
The rest of the day was spent preparing for COPE and the health fair by gathering supplies and printing out flyers. We packed in the guaguas back to home to Gyuamate. We ate an amazing dinner of
rice, beans, chicken and fried eggplant.  The rest of the night was fairly uneventful. I crawled under my mosquito net, everything was quiet except for the thousands of roosters cocka-doodle-dooing throughout the city.
Derrick “Luis” from CFLR orients us to the clinic

 

Patient Education at CFLR is prominent in many locations.  This poster is about family planning options

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