Whether you are a surgeon, a medical assistant or a receptionist, sometimes you need a battle helmet to work in medicine. Because sometimes the medical system seems to take extreme measures to prevent patients from getting the treatment they need, and fighting to defend your patients can be perilous. Your Goliath may be a health insurance company, a pharmaceutical company or a phone tree. Regardless of the adversary, you have to come ready to do battle, and there is no better way to prepare yourself mentally than by donning a battle helmet.
When I left Denver to move to the Dominican Republic, I knighted my former coworker Jessie Kainrath and passed on my battle helmet to her. This turns out to have been a mistake. Not because Jesse has proven unworthy of my battle helmet. I am confident she is using it to do great things. No, the problem is that I really need my battle helmet here in the Dominican Republic. When it comes to medicine, everything is a little bit harder to get done here, and some things are much harder.
Transportation, for example. In Denver the most difficult transportation issue commonly facing our patients was RTD, the public bus system. When our patients missed the bus, or when the bus was running late, they showed up late for their appointments. Here in the rural towns near Montellano, transportation is a whole different ballgame. We have one patient who lives in Severete and needs to have a 3-day inpatient surgery at a private hospital in the city of Puerto Plata. This is a two-hour journey on a good day. The first half of the trip is through jungle-like terrain on an unpaved road made of gravel, rocks and dirt (or mud). Parts of the road are very steep and rains have made it uneven, to say the least. The preferred method of travel is on a rugged motorcycle. Sedans certainly can not make it. Our patient is elderly and immobile, so she will need to ride down in a large SUV. But it is expensive to hire a taxi driver who owns an SUV, and even SUVs are stymied when it has rained for several days in a row, flooding the small bridges along the road.
There are other challenges. The small paths in the communities we serve are made from a mixture of pebbles and sharp rocks that seem to have been specifically chosen for their remarkable ability to eat away at those rubber things on the bottom of crutches that keep patients from slipping. There is no Creole-Spanish interpreter in admissions at the large public hospital, even though it is one of the few places where Creole-speaking Haitian immigrants can go for treatment. And trust me, the admissions process is not an intuitive one. I have spent the last week coordinating medical care for many of our patients. I enjoy problem-solving to overcome the challenges that arise, but I wish I had brought my battle helmet.
My last blog post was on the same day as the Dominican presidential election. The ruling Dominican Liberation Party won. On August 16th Danilo Medina will be sworn in as president with Margarita Fernandez as his vice-president.
I am fighting a war of attrition against the colony of ants that inhabits my kitchen. They are wearing me down emotionally and nutritionally. Last weekend I washed my laundry by hand for the first time ever. While my white socks turned out fine, the black ones are now oddly stiff. During my first two weeks here I lived almost exclusively off of Corn Flakes and PB&Js, but on Monday I made the 30-minute trip by taxi to the nearest grocery store. I cherish my new culinary options. After many humiliating nights at the local pool hall, I finally won my first game of pool. Here they play a style of 8-ball called negrita which is distinguished from the American game in two important ways: 1) if you make a ball in it counts, whether you intended for ball A to go in pocket B or not, and 2) if you mistakenly hit the 8 ball into a pocket you do not lose; you put the 8 ball back on the table and continue the game. My old pool buddies Audra and Jessie would fare well here.