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“Everything is the same … but different”

 “Everything is the same … but different”
By: Morgan Madison, resident physician
September 10, 2014
This is what Dylan Andrew, one of the PCVs in Guaymate, first responded when we asked him how he was doing.  For those of us returning to Guaymate, we totally got what he meant – pretty much immediately.
This is my second time in Guaymate.  It’s been so nice to come back to familiar faces from our March trip, catch up, and find some of those faces no longer in Guaymate but away at school or working in the capitol.Yesterday, we returned to La Clinica de Familia in La Romana (CFLR) – a clinic that is partially funded by the government because of the care it provides to vulnerable populations (a large subset of their patient population is HIV positive and they also have “la programa para mujeres” for commercial sex workers in the DR – both these groups receive free health care at this clinic).  It was incredible to see the changes happening at La Clinica de Familia and this clinic’s dedication to continuously improving the care that they provide to their patients.  So many new and exciting programs are taking place there: a program for men with a specific LGBTQ sub-program, a diabetes program, new resources for a cardiology section in the clinic, and a program that focuses on improving treatment adherence in HIV positive individuals by connecting these patients with social workers and counselors … to name a few. 

Our group in front of a beautiful mural at Clinica de Familia La Romana
Dr. Leo, the medical director, still with that same passion for continuing medical education arranged for our group to participate in the clinics weekly educational didactics.  We spoke about diabetes diagnosis, treatment, and management for the clinicians and students – well mostly SaeR-om spoke and I would say some parts in my very beginner level spanish that was hopefully understandable.

Then we learned about contraception options in the DR.  Since the rates of teen pregnancy are continuing to rise in the DR and most women have an average of 2-3 children by the time they are 22 years old, birth control access is a huge issue.  Dr. Milagros de the Rosa told us about two partners of CFLR (Segura and KFW, which is basically the German equivalent of USAID) that make birth control readily available to commercial sex workers and adolescents for free (yay!!!) and provide it to young women aged 19-24 years at a subsidized cost (50 pesos, approx $1).  Options include the pill, the shot, emergency contraception, and the implant.  Apparently, the implant is super popular among teens, which is awesome, since it’s such a great form of long-term contraception AND teens don’t need to ask their parents for permission to start any contraception.  It was also interesting to learn some of the popular beliefs surrounding contraception and menses.  The one that stood out the most was that periods are viewed as an infection and sign of health at the same time – every month women need to have their period to “shed the infection” that’s inside of them.  So not getting your period means that “infection” stays inside of you.
Johanna, one of the nurses at CFLR who helped us bring COPE (a quality improvement program) to Guaymate hospital last year, is still as fierce as ever.  Seriously this woman has such an intense drive I’m simultaneously afraid of her and also want to be like her when I grow up.  Johanna is responsible for compiling each department’s accomplishments and future action plans into an annual report for CFLR.  Although COPE didn’t catch on the first few runs at CFLR, it has now become a part of the clinic’s culture.  Johanna was explaining this is because of the director’s support, each department’s ownership and knowledge over the particular projects, and the clinic’s realization that this will not only improve care for their patients – but it will make work easier for the providers.  I hope in Guaymate COPE will catch the same as it has in CFLR and this is where Dylan’s response is particularly particularly accurate.  Yes it’s true that things are mostly the same here … but they are different.  Guaymate hospital is still very busy, the staff is still struggling to work in this very low resource setting, but the spirit is different … much more hopeful. 

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