Sent by: Achal Patel
We awoke yet again to a warm, sunny, and vibrant day in Santiago: conditions that seemed to be a recurring theme in the city. Day 4 would mark the separation of the team with Dr. Karotkin presenting three lectures at the Children’s Hospital in Santiago with Dr. Lopez and Dr. Shaw making the trip to Moca to present the PALS course to local physicians. I joined the later group to learn about a different constituency of trainees. Today I shed my cell phone, my only indicator of time, and adopted a mindset of ‘Dominican time.’ Rather than obsessing over regularity and quenching my need for a constant time check as I would at home, I enjoyed the events of the day as they progressed and let them arrive with a more relaxed mindset. While I was trying to go through my day limiting my use of technology, Dr. Lopez seemed set on maximizing its use, skillfully answering calls on his two Blackberry’s at once and always having them both easily accessible. I soon learned how this mastery is part of the reason for our success thus far on the mission.
After breakfast we made the trip to Moca, a much smaller city than Santiago. We made the trip, which was anywhere between 20 and 30 minutes, and arrived at a private Catholic school, our headquarters for the day. Along the way we passed an interesting juxtaposition of man and jungle with buildings and roads surrounded by lush greenery in seemingly flawless harmony. Upon arrival we were greeted by friendly local physicians, many of who traveled from the mountains surrounding the valley to take part in the training.
When these physicians arrived from all around the city of Moca, it became clear that our in country contact Dr. Ramon Lopez had undertaken preparations before our arrival that were both extensive and time-consuming. Without exaggeration, he seemed to know practically everyone everywhere we went, and if he did not he was quick to make local contacts. If it were not for his help the reach of the program would surely not be as significant. In addition, the universal warmth of both the people and weather in the Dominican is clear and outwardly reverberating, welcoming the curiosity of travelers with great kindheartedness making the arrangement of training sessions easier for the entire team.
After setting up and awaiting the arrival of the remaining participants, Dr. Shaw gave an overview of the course to probe the knowledge already possessed by the physicians. Among the questions he asked was whether the physicians had defibrillators in their hospitals or any experience in using them. Thereafter, one of the participants remarked: “we have a defibrillator in our hospital, but we don’t know how to use it.” The lack of training on the use of defibrillators has become a persistent theme throughout this trip and is reason for concern, more alarmingly so when stated by an experienced physician. While the hospitals may have equipment that can be upwards of tens of thousands of U.S. dollars, they obviously will not do patients any good if the majority of the healthcare providers in the hospitals cannot use them. The prevalence of defibrillators in the United States is often taken for granted, with AED’s at hand in a multitude of public areas, such as airports where they are every few hundred feet. The lack of such equipment in hospitals would almost be unimaginable at this point in American healthcare. Yet, in countries such as the Dominican Republic physicians are making do working without such equipment.
The proper training required for the use of a defibrillator is relatively simple and if incorporated into the curriculum of medical schools within the nation it is evident that great progress can be made in the way of resuscitation techniques. We are hoping that the training provided by Dr. Shaw over the course of the two-day training will provide these physicians with enough information to allow them to properly use their equipment at hand. The enthusiasm shown by these doctors was quite evident through both their mannerisms and the questions that they asked throughout the session. Being experienced and having worked in hospitals, the physicians seem to realize the importance of the PALS course and I have confidence that they will pass on the training on to their colleagues as well as students. If Physicians for Peace and other similar organizations can continue their training programs until there are enough in-country physicians who can provide similar classes or until such material is incorporated into medical schools, there is great promise for the future of Dominican emergency care, both pediatric and general. As for the class itself, Dr. Shaw covered a very similar material set as he did on days 2 and 3 of the trip. He also demonstrated nasal intubation techniques and provided a review of the proper form of CPR and general intubation in addition to the more advanced topics in regards to PALS. Some of the physicians seemed to have never been taught the correct methods of performing CPR and have never needed to utilize CPR as general physicians; however, it was apparent that they were more than capable of performing it after being shown the correct approach. The interest level from the practicing physicians on such topics was noticeably higher than the medical students, with Dr. Shaw fielding many more questions than on days 2 and 3, once again indicating the real-world importance of the material covered in the training.
As we made our way back to the hotel after the day of classes, I left with my thoughts on the current medical situation in the Dominican Republic being confirmed. While there are ample enthusiastic and adept physicians present to provide care, many have never received the training necessary to perform proper pediatric advanced life support. However, as demonstrated by the classes, this issue can be easily solved. As I stated earlier, if physicians who currently have the proper training in the country spread the knowledge they have acquired and if there is a desire from local physicians to continue to improve their training, then pediatric as well as general emergency care can be significantly improved. Thus, an internal support and knowledge-sharing network will be vital for the future success of the Dominican Republic’s healthcare system.











t people to know that I am serious about my challenge, more importantly I want to raise awareness for those who haven't even heard about the amazing work we do at Physicians for Peace." - Ellen Libby, Runner, Team Physicians for Peace


On this last Sunday of May, the eighty mothers celebrated their pregnancy or their newly birthed child alongside the now twenty Resource Mothers who have visited, counseled, and grown to love them. 

