UA Medical Students Serve in Clinics in Dominican Republic

Wednesday, February 1, 2012

PHOENIX – If Brenna Derksen had any doubts about her chosen career path, they were swept away during her holiday break.

“It brought me back into why I wanted to get into medicine in the first place,” Derksen said. “It’s real easy to get caught up in the stress of medical school and I think the trip was invaluable in that sense. Yes, this is why I’m here, this is what I want to be doing.”

The trip was taken after finishing end-of-semester tests in December with six of her classmates from the University of Arizona College of Medicine – Phoenix. The group experienced a different kind of clinical experience – nearly 3,000 miles away from the downtown campus.

The seven students spent their first week of winter break seeing about 400 patients during four days at clinics near the town of San Pedro de Macoris, in the Dominican Republic.

“It was really gratifying to see that physicians care so much,” said Chelsea Thomsen. “You hear so many negative things, like burn out and issues with insurance getting in the way, things like that. It was really good to see all of it washed out and as simplified as medicine can be -- but you still see the humanistic side of it.”

The students paid their way to the Caribbean nation and raised money for supplies and medicines to take to the clinics in a remote area east of the capital, Santo Domingo.

“This was a great opportunity to see it firsthand.  As a student you can become a bit isolated in the academic world,” said Michele O’Shea, a second-year student who helped organize the trip.

“I saw that this is where I see myself years from now,” O’Shea said after the trip. “This is what I am in for and will thrive in this environment. This was the best motivator  for continuing medical school and continuing to deal with the pressure. It just puts everything in perspective.”

Among the valuable experiences for the students was the ability to  conditions less common at home, said David H. Beyda, MD, one of the attending physicians who accompanied the students.

“We saw diseases and health conditions  that few ever see here in the United States,” said Dr. Beyda, a College of Medicine – Phoenix faculty member who is a pediatric critical care specialist at Phoenix Children’s Hospital. “In one week, they gained experiences that take most young physicians years to get.  And they showed poise and professionalism beyond their years.”

The medical students and faculty spent five days based in the town but traveled around the area doing evaluations and prescribing basic medications for infections or pain relief. College of Medicine – Phoenix students are introduced to their clinical experience work during their first two years by shadowing primary care physicians or working in a clinic in an underserved area of Phoenix.

Also participating on the trip were second-year students Kaya Belkap, Atlas Trieu and
Erin Kloos, along with first-year student Ali Raza.

Thrust into these set of conditions, the students had a limited scope. They only had a cache of simple medications – like antibiotics, anti-inflammatory drugs, wound dressings and vitamins -- and were not prepared for complex problems. Although many patients were treated for infections and other common conditions, the students also diagnosed more serious ailments, such as a heart murmur.

As a rural, impoverished area with little, if any, access to health care, most of the residents (mainly sugar cane field workers) wouldn’t likely be able to get care otherwise.

The most challenging case, said Thomsen, was that of a man who arrived with one of his legs consumed by a staph infection below the knee. Thomsen said the man had a fungal infection on top of that and would have faced amputation if he were being treated in the United States.

“This was an ethical issue.  In the US, we would amputate the leg,” Thomsen said. “If we send him to the public hospital to amputate the leg there, on a homeless man, whose only way of doing anything is being mobile– would taking away his leg cause him more harm or benefit?”

She said the man had been living with the infection since injuring the leg in an accident seven years ago and the infection was contained to his lower leg -- with the fungal infection acting as further protection. In consultation with Dr. Beyda, who teaches medical ethics at the College of Medicine – Phoenix, the students treated the man with antibiotics and dressed his wound.

But that was not the memory Thomsen took away from the encounter.  “He said, ‘I just thank God that you are here and that you can do this for me. I feel so lucky.’” Thomsen said. “It was a very emotional moment for me.”