Friday, March 26, 2010

From Janina: La Clinica

One of my goals for my time in Santiago was to see a variety of clinical settings, including both outpatient care and the private sector. It took me a few days to sort out how to even ask about these activities because, as it turns out, the clinics in the DR are referred to as “los consultorios” and the private hospitals are called “las clinicas.” So, after several attempts to ask if there were clinics (las clinicas) in the public hospital (the answer being no, which initially made me concerned that there was actually no outpatient care for uninsured patients, but actually meant that there were no private hospitals in the public hospital. Obviously!), I successfully arranged to accompany Dr. Medrano, my host, to his outpatient clinic in the private hospital, La Clinica Corominas.

This turned out to be an incredibly informative experience as the patients that Dr. Medrano saw seemed to be the demographic that I see most often in my clinic at Columbia. In fact, one elderly woman who came for her first visit accompanied by her daughter had just been sent back to the DR by one daughter who lives in the Bronx because behavioral problems related to her dementia were becoming to difficult to control. Dr. Medrano asked the daughter in his office, had she received a CT scan of her head? Lab tests? Where and when was this diagnosis of dementia established? The daughter knew her mother had been hospitalized several times in the US (St. Barnabas, perhaps?), but, unlike in the DR, she had not been sent home with her records so there was really no telling what kind of evaluation she had. This was an interesting flip side to the patients who I have seen in my clinic in Washington Heights, recently arrived from the DR. I have one patient who was diagnosed with colon cancer in the DR, treated with surgery and chemotherapy and then came to the US for further care. She arrived with a giant package of records and letters detailing her previous care. Her oncologist in New York was even able to get her pathology slides shipped from the DR for review. Practically speaking, this experience made me realize that, when my clinic patients tell me they are headed for a long stay in the DR, I need to print out their important medical history (medication lists, recent labs and studies) to facilitate their medical care if they need it while in the DR. But in a grander sense, seeing the struggle of this family with roots in both DR and New York City to find the best setting for their ailing mother, brought to light the incredibly complex relationship between NYC and the DR and the way this straddling of worlds plays out in the medical sector.

Another way in which I had the chance to glimpse more of these links between New York and the DR was through my extraordinary host family, the Vargas. I stayed in the home of Maggy Vargas and her two children, Miguel, a young lawyer and Leiny, an intern at the University hospital. They were incredibly generous hosts and best of all, welcomed me into their large extended family, most of whom still live in Santiago (though others live in Washington Heights, of course. Everyone seemed intimately acquainted with the Wendy’s on 165th and Broadway). The matriarch of the family, La Abuela, is 91 years old and spends her days napping and sitting in a rocking chair on the terrace of her 2nd floor apartment above the cafeteria owned by her family. She had twelve children, about half of whom I had the chance to meet, including Maggy (my host mother), Jacqueline (who owns a salon in Santiago), Tete (who I believe owns the cafeteria and lives in an apartment connected to her mother’s), Altagracia (who actually lived in New Jersey and New York for at least 15 years. Her daughter, Glory, was born in the US and lived their for her first 15 years but returned two years ago to Santiago, a difficult transition according to her aunts) and Eduardo, who remarkably received a kidney transplant at Columbia twelve years ago (I believe from Tete) and now travels twice a year to New York for his follow up appointments.

Overall, I didn’t even come close to processing the many ways in which the DR and New York City are linked in families like that of the Vargas. I heard stories of how travel to the US provides opportunities for education, work and medical care (even kidney transplants!). I also heard how returning home provided security as well: free university education, work in the family business, family support unlike anything I’ve seen in the US. What a fascinating relationship between two very different countries! I feel very lucky to have had the opportunity to see a little of the DR side of things, to hold in my mind and heart when I interact with patients in the ER, the clinic, the wards, or even my neighbors at 173rd St. and Haven. One final image that I will carry with me from this experience: as I got ready to board my plane back to New York City, I noticed the remarkable number of elderly people in wheelchairs preparing to board with me. What kind of flight has 15 people in wheelchairs? Are they returning from a visit to family in Santiago? Are they traveling to the US for medical care? Are they my future patients? If they are, at least now I have gained a tiny sense of where they might be coming from, why they may have decided to make this journey, and a little bit of what they may be leaving behind.


  1. The photograph of elderly people in wheelchairs about to board a plane bound for NYC says it all. Although the wheelchairs may be the same, the people inside them have very different narratives and family dynamics arising from straddling two cultures and two medical systems. And each family is uniquely affected by the process of watching their elderly loved ones go through the aging process. For some the difficulty maybe the geographic separation, and for others, the geographic closeness. I felt your final questions and observations honored these differences, and that this new understanding of life in the DR was transformative for you.

  2. I think your comments on the pros and cons of a Dominican moving to the US brings up a lot of good points - there are many downsides of moving to the US. As you say, some of the benefits include access to medical care and education, as well as some job opportunities. Although there are many Dominicans who end up working in a less skilled job than they did in the DR because of credentialing and the need to repeat training (which also emphasizes that it is often the better off population who is even able to come to the US). A lot of other things are also left behind, including the beautiful weather and beaches, the relaxed island lifestyle (even in crowded and busy Santiago, there is a lull for a big afternoon lunch), and family. Family seems to be a much bigger deal in the DR - the families are bigger and also more involved in each others daily life than similar families in the US! Most of my patients talk about the DR with a wistful longing, after being there it is not hard to understand why.