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Teaching Doctors in the Dominican Republic

Physicians from Rush share knowledge in series of conferences

By Kevin McKeough

In much of the Dominican Republic, primary care physicians largely are responsible for treating hospitalized patients with epileptic seizures, multiple sclerosis and other neurological conditions — the kind of care typically provided by highly trained neurology specialists in the United States.

To help these front line physicians in the Caribbean island nation provide better care, medical specialists at Rush University Medical Center have begun providing continuing education conferences for them. The initiative launched with a neurology conference in February, followed by an internal medicine conference in June. Plans call for four more conferences through next June — including an ear, nose and throat conference in November and a second neurology presentation — on topics chosen by the country’s national medical societies.

“It’s building educational capacity and eventually building clinical capacity, and we’re looking down the road to them sharing their expertise with us, says Stephanie Crane, MD (pictured above), director of Rush University’s Office of Global Health, which organizes the conferences.

“The doctors who participated in these conferences included our top Dominican doctors, neurology specialists. Doctors everywhere need to be continually educated, because guidelines change, and even the diseases change. It’s a very efficient way to bring their knowledge, and we have many doctors who are eager to hear those talks and learn,” adds Cesilia Jimenez, CEO of Feltrex — a Dominican-owned and operated pharmaceutical company based in the Dominican Republic — and the Feltrex Foundation, which sponsors the conferences.

Rush and Feltrex collaborate on the conferences with Community Empowerment, a Dominican not-for-profit organization (Crane is a member of its board), which manages the arrangements.

Conferences build on Rush’s years of working in Dominican Republic

Held in the country’s capital, Santo Domingo, the conferences build on Rush’s long history of work in the Dominican Republic, which dates back to 2005, when Crane first led a medical mission of volunteers to provide care there. The Rush teams established a clinic that now is self-sustaining, accredited by the Dominican ministry of Health, and run entirely by Dominican staff, and work on a second clinic is underway.

Given this involvement, Rush was a natural choice of partner when the Feltrex Foundation identified continuing education conferences for the nation’s general practitioners as a means to increase health care capabilities in the DR. “It is an extraordinary partnership, we are so glad,” Jimenez says.  

“Rush is very well known and very prestigious,” she continues. “We value the experience and knowledge they’ve acquired while working in Rush and appreciate the opportunity for our Dominican doctors and residents to partake in their conferences.”

Neurology conference provided many participants’ first training in complex conditions

The February neurology conference covered neuromuscular respiratory failure (the inability to breathe on one's own) in patients with acute myasthenia gravis; acute manifestations of demyelinating disease (diseases, including multiple sclerosis, that damage the neurons’ myelin sheath); and acute neurological emergencies in pregnancy. “They have a lot of issues with maternal mortality, which can be the result of a neurologic complication,” says Lauren Koffman, DO.

Koffman and Starane Shepherd, MD co-led the presentations, which drew about 420 doctors. They both are assistant professors in Rush’s Department of Neurological Sciences

The second day of the conference also included a workshop for the country’s medical residents – most of whom traveled by bus from the city of Santiago, four hours away – about the diagnosis and management of seizures and status epilepticus (a condition causing prolonged, life-threatening seizures).

Brief sessions could affect care for better for many

“We were surprised to find people coming up to us after the first night who were internists and/or family physicians. The medical system in the Dominican Republic means that patients have to be evaluated by their primary care provider before they can get specialized care from a neurologist,” Koffman says.

“These patients get admitted to internal medicine, and they’re managed by internal medicine residents and attendings,” Shepherd explains. “They’re not neurologists; they don’t read EEGs (a test that measures electrical activity in the brain), and they have to wait for a neurologist to read an EEG at some point, which is crucial in the management of seizures and status epilepticus”

 “I was really excited and happy that our brief session could provide insight to these practitioners that could affect patient care,” Koffman adds.

‘We want to go deeper’

The second conference —which Crane led along with Richard Abrams, MD, associate professor in the Rush Department of Internal Medicine — began with a talk on “Hypertension, Past, Present and Future,” including current guidelines for treatment of special populations, such as patients with diabetes and kidney disease. The second day focused on lipid disorders (abnormal levels of fat in the blood, such as high cholesterol)

“We went through the history of how lipids were identified, what they were and why they were risky and looking at ten-year guidelines. I had residents work through cases, and then we discussed them,” Crane says.

The conference drew cardiologists, nephrologists, internal medicine physicians and residents. “The collaboration was absolutely the best part,” says Abrams. “The people were so nice to us, open and welcoming. I got a whole lot more out it than I probably gave.”

Jimenez hopes the conferences will lead to even greater collaboration. She and Crane are exploring the possibility of arranging for doctors from the Dominican Republic to travel to Rush to be educated there.

“That would be awesome for our country,” Jimenez says, noting that for some situations, such as surgery for strokes, only three neurosurgeons are available in the Dominican Republic. “If we help a few more doctors (specialize), it would completely change the way we do health care here.”

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