"The idea is that you are better today than you were yesterday" (Sunday Week 2)

Classes officially started last Wednesday, but we're still spending more time out of class than in it. We don't have classes on Wednesday afternoons or Fridays, and this Thursday was a Dominican holiday, so we had a four day weekend. We have three classes: Spanish (which includes a separate film component), Medical Sociology, and Community Medicine. Spanish is definitely challenging, but my professor is very nice and engaging. She mixes grammatical lessons with practical tips and information, like idiomatic expressions and how the Dominican accent works. We still haven't seen any films in the film component, but I like the professor a lot and I'm looking forward to having that class on Tuesday.

"The idea is that you are better today than you were yesterday"

The Medical Sociology class and the Community Medicine classes are pretty similar, so sometimes it's hard to keep them straight. They take place in the same classroom, are taught by young female professors, they include a lot of group work and they sometimes cover the same topics on the same day. We've covered the organization of the Dominican health system in both classes, and now we're going over the Millennium Development Goals in Sociology. In Community Medicine, we're talking about the transmission, prevention and treatment of diseases endemic to the DR, including Dengue, Chikungunya, Malaria, Leptospirosis and Salmonella.

We also got to visit three hospitals in the Dominican public health system on Tuesday. The first hospital, Hospital Regional Universitario de José María Cabral y Báez, was built in 1978 and is undergoing a much-needed renovation. The wing that had been completed looked like a different world compared to the un-renovated part. The Dominican health system is leveled, and the this hospital is part of the third level, which is the most specialized. They have almost all of the specialties that you would see in the US, including things like laproscopic surgery and a NICU, and plenty of doctors and medical students, but a huge lack of material resources. They were pretty proud of their one modern X-ray machine and two computers for viewing the images. They don't have an MRI machine yet, but they are getting one as part of the renovation. It seemed like the hospital was slightly, but not hugely overcrowded, but the biggest thing I noticed was that US hospitals have so much more stuff. The hospital rooms have four beds and a bathroom and maybe an IV pole or two--no TV, no monitors, no chairs, no cabinets, no tables, no boxes of tissues, no hand sanitizer, no trash cans, no boxes of gloves and gowns. I'm sure the lack of stuff also carries over to things we didn't see as visitors--lab tests, operating supplies, etc. It makes me wonder how much of the "stuff"in US hospitals is necessary to practice good medicine, and how much of it is spending whole lot of money for little (or no) benefit. The other crazy thing is that this hospital covers the population of 14 provinces--there are only 2 or 3 similar third level public hospitals in the whole country. The government is investing a lot of money in upgrading this hospital, which is very good, but they also need new hospitals altogether, so that people don't have to travel two hours or more to get to this one when they need it.

Regional University Hospital (The wing on the left is being renovated)

We also visited the third level children's hospital and a second level regular hospital. The children's hospital seemed to have more resources than the adult hospital and was a lot less crowded. We saw an oncology unit and a burn unit, and there were a lot of murals and a fish tank and toys for the kids. We didn't spend much time at the third hospital (we were running late) but we listened to an administrator talk about the services they offered as a second level hospital. The system is supposed to work through references--when you have a problem, you go to the primary health center first, and they decide whether you can be treated there or should be referred upwards. However, in reality, people decide on their own to go to the hospitals, because they think they'll be treated better there, even if they have a routine problem. Our professor said that one of the biggest challenges is convincing people to use the system the way that it is designed, so that it can work the way it's supposed to.

Children's Hospital

The hospital visits fit nicely into a larger pattern that I've noticed over the past two weeks: Dominicans are very focused on and committed to improving their country. There are a lot of problems here, but there are also so many projects happening to address them. In the 15 days I've been here, I've read about or heard about a national effort to regulate the prepaid cell phone industry, the opening of the national 911 emergency system, a new naturalization/registration process for Haitians living illegally in the DR, an increase in funding for education to 4% of the GDP, plans to increase the country's use of clean energy, and a campaign to eliminate illiteracy. There are also lots of billboards and announcements (many featuring baseball players or other celebrities) encouraging people to obey speed limits, wear helmets on motorcycles, speak out against domestic violence, etc. I saw a phrase painted on the street that captures this attitude perfectly: "¡La idea es que hoy seas mejor de lo que eras ayer!"which means "The idea is that you are better today than you were yesterday"