Training

In this entry I will try to give everyone a basic idea of the work I'll be doing for the course of the summer, as much for myself (to get it all straight in my head) as to satiate everyone else's curiosity. Since Wednesday, the day after I arrived, Catherine has been trying to teach me all the little details that I need to know for the job. It's a lot, but I think I'm starting to get it all straight. Fortunately, compared to the clinic I worked at in NJ, the level of disorganization and quantity of useless forms that I have to deal with is minimal, and a lot of my time is spent actually interacting with patients, which is also good.

The Dominican Republic has the highest incidence of HIV in Latin America, mostly due to sex tourism. An estimated 2-3% of the population is infected with HIV, high compared with the United States, where the rate is something like 0.5-1%. Also, a lot of mothers here pass the disease on to their infants because they don't have access to the treatment available to prevent this from occurring. The disease is also so intensely stigmatized here that many people who have HIV keep it a secret, sometimes choosing to tell no one and sometimes sharing the diagnosis with only one or two people. Sometimes an employer will request an HIV test on a potential employee without the person's knowledge. If the test comes out positive, the person may not be told they have HIV, but won't get the job. It is difficult for people with HIV to get treatment, partly because of this stigma and partly because there are very few HIV treatment centers in the country.

The main purpose of the study I'm working for, called "Estudio SeR", is to find out to what extent HIV patients in the DR have or are developing resistance to first-line drugs. There are two forms of resistance. The most common, called "secondary resistance", is when a patient develops a resistance to a drug after taking it for a time, usually because the patient misses several doses or suddenly stops using it because he/she can't afford it anymore, moves, or some other extenuating circumstance. Primary resistance, which is found a lot in the United States but fortunately not so much here, is when someone contracts HIV from a person who has already developed a resistance to one or more drugs. In that case, the person who contracted it will also become resistant. The study aims to follow 500 HIV patients for 5 years, in order to find out if, how and why Dominicans are developing drug-resistant forms of HIV, and this knowledge in turn will hopefully lead to improved treatment in the country.

The treatment center where I'm working most of the time is called the Instituto Dermatologico y Cirugia de Piel (Instutute for Dermatology and Skin Surgery). If the name doesn't sound like an HIV clinic, that's because there indeed wasn't one until recently. Now, however, there is a big sign in front of the entrance announcing the existence of the HIV clinic, which may or may not be the best idea considering that most patients would rather not have the whole world know they have HIV. The Instituto is big and not the brightest or most inviting environment you could imagine, but the people I work with are nice and at least they're getting the job done. The other place where the study is conducted is called Profamilia, which as you might also guess from the name, is smaller, cleaner, brighter, and with a more welcoming atmosphere than the Dermatologico. I may start working more in Profamilia later in the summer, depending on circumstances I'll explain later.

So, every day I (and right now, Catherine) am picked up by Juan, the private taxi driver, who takes me to the Dermatologico. My two main jobs with the study are to lead new potential participants for the study through the Informed Consent process, which may seem simply but is actually the most difficult part of my job. The official Informed Consent document, for legal reasons, is a full four pages long, and considering that many Dominicans can't even read let alone tolerate four pages of technical language, having patients simply read the document on their own or reading the entire thing to them is generally a bad idea. Instead, I have to give them a summary of the Informed Consent in my own words, allow them to ask questions to make sure they understand it, then read the half-page statement they have to sign, then let them sign and make a copy for them to take home. The study reimburses the participants for transportation to and from the clinic, but other than that there are no direct benefits for the patient, so it's important that they have some idea that their participation is for the greater good.

The second part of my job is helping the participants fill out forms with some demographic questions each time they come in for a visit, which is every 3 months for the first year of treatment and every 6 months for the following 4 years. Other than basic things, there are questions about social support ("How many friends do you have?" is one of the more awkward ones), the patient's ability to read and/or fill out medical forms or lack thereof, whether or not the patient has traveled in the past 6 months (some people have relatives in the US and travel back and forth between the two countries, which could affect treatment as well as the spread of the disease), and a whole slew of questions about addresses and phone numbers of the patient and their close relatives, so that we have a million different ways to contact them in case their cell phone isn't working or they try to disappear off the face of the earth. Simple as the questions may look, some of them are tricky. Fortunately, I don't have to ask any medical questions or questions about sexual history. That job is left to the doctor.

So that's my job, aside from mundane office tasks like confirming appointments and entering data into the computer. As for the city of Santo Domingo, I haven't seen much of it yet. I do get the sense that it's very different from Peru, though the closest comparison I can make would be with Lima. I know that the gap between rich and poor is huge. Rich people tend to be so rich they can afford to own multiple Mercedes and Ferraris, while the poor can scarcely afford to feed themselves. You can definitely feel that, moreso than anywhere I've been in Peru I'd say. My apartment is in a nice part of the city, but I've been told not to walk around alone even during daylight hours in the poorer barrio where the Dermatologico is located, and also, never to take public transportation around the city because that's an almost surefire way to lose your wallet. The only two places I've seen in the city so far, besides the two clinics, are two supermarkets around my apartment. You can find pretty much any kind of food in the supermarkets here, so my fear that, like in Peru, I wouldn't be able to find Cheerios was unfounded. I can continue with my usual breakfast staple of Cheerios with soy milk. :)

Obviously, there are ups and downs to living in a big city with so much poverty, and ups and downs to sticking out like a sore thumb, but I think Santo Domingo will be an interesting place to live for three months. I will update later about my weekend adventures.