Sweat drips down the side of my face. I do not move, even though it tickles. I am wearing plastic gloves covered with starchy-feeling powder. I am in a cement box with a tin roof, and surrounded on all sides by mint green walls. This is not a clinic, but momentarily I am trying to transform it into one. I have my stethoscope draped across my shoulders, a sign of my medical training (they told us that white coats would be much too intimidating).
So instead of the usual outfit and setting, I am focusing on acting kind and treating my patient with a lot of respect, something I know is lacking at the other state and rural clinics. I leave the room to let her undress and I knock before I come in. I can tell she is not used to this. In my best Spanish I try to gently explain everything, like my OBGYN at home. “Have you had a pap smear before?” “I’m going to tell you what I’m doing, and it won’t hurt. Just pressure.” After all this comes the moment when I can’t wipe my own sweat.
I lean over her with the plastic gloves and jelly covered fingers holding a disposable speculum. She’s on a camping cot, a poor stand-in for a hospital bed. The cot hovers about a foot off the floor, so I am leaning and squatting. I have a small flashlight to guide me, and the presence of a 4th year medical student, Phil, who is a wonderful teacher. She’s very matter-of-fact without any complaints while I’m doing her pap smear. Three brushes from different areas that I smear in order on a glass slide. The final brush must go into the cervical opening. Then, I’m done. I carefully move the brushes and glass slide.
I leave the room quickly- to spray the slide with hairspray. This final step is oddly different from the USA where pap smears usually go in liquid preservative. But my first pap smears are in this hot, mint green world, where I’m not only struggling to focus on my new skills. I am also trying to ignore my sweat, my mosquito bites and stomach cramps.
In these conditions, I’ve had many firsts in medicine. My first time removing stitches from a motorcycle accident victim. My first time unwrapping a finger that’s been half-way severed across the knuckle with a machete knife. We examine it and confirm that the extensor digitorum tendon has been severed. My first time pulling tobacco out of wounds. My first time hearing murmurs and Mobitz Type I. My first positive shifting-dullness test. My first time watching teeth being pulled. My first time interviewing patients in Spanish. It’s exciting and sometimes scary.
Most of the children have never been to doctors like us. Our digital thermometers, metal odoscopes and stethoscopes seem like needles to them, and I flinch as mom has to hold down her screaming child so I can confirm an ear infection or skin rash. I am trying to comfort- I show them the light, I do it to myself and to mom. I tell them it won’t hurt, but to no avail. To them it’s still a scary needle-like metallic glean.
The best part of living with my patients in a small community is seeing them often. There is a sweet guy who was concerned about his prostate- now he’s smiling and hugging me on the street. There is a little boy who I made cry, so hard that he vomited. Now he’s started antibiotics and he’s playing, and waving at me as if to say, “Thanks, I forgive you for that torture.” My host sister’s friend had her tooth pulled and she says she feels so much better now. Overall so many people look familiar- they smile at me, and I know I have seen them in clinic. I can’t remember all the details, but I do know the faces, and in this small town, it’s easy to feel that the patient-doctor relationship is more than a 30-minute visit.
As I get ready for my last days in Sabana Rey, what I have come to love most about this community is what I originally feared the most. It is the conditions of poverty that force everyone to be so much closer than is comfortable in the USA. I have experienced closeness here like I only share with my husband at home. For example, my bed in the Dominican Republic is a full-size bed, and it fits three volunteers sideways. What I feared would be uncomfortable has now become a source of great enjoyment. I love sharing this bedtime where we talk about everything- whatever is on our hearts after a challenging day. We don’t hide anything, and I feel so comforted and protected.
My host family and many of my patients in clinic have told me that they love me, which are words rarely used in the USA. Little children hold my hands, and sit on my lap. It makes me want to share more closeness with my patients, my family, and my friends. Why is it less awkward to share so many close moments with people in the Dominican Republic who I barely know- than back at home with people to whom I consider myself close?
I wonder how I can bring some of this back in a culture, a city and a profession that doesn’t encourage or allow a lot of time for real human relationships. Volunteering in Sabana Rey has given me a lot of new things to ponder mixed with new knowledge. As I prepare to start my second year in a few weeks, I look forward to the fond medical and community experiences that I will bring with me.
Your insight and maturity blows me away! Love you, Evie
hi liz, it is now a year or so after you have been
to the dominican republic and wondered how this has
still affected you?