By Michael Good, MD
As I return from my fifth medical service trip with Health Horizons International (HHI), I continue to be struck both by the burden of suffering that I see among the poorer populations around Puerto Plata and also at the progress that can be seen in the health and well being of patients in our target communities. During the early years of HHI, patients were seen in disorganized clinics, there were no charts, all care was for acute and urgent needs. I recall at the time being struck that patients who said they were 50 years old looked like 75 year olds to my American eyes. Patients would commonly have markedly elevated blood pressures, some at levels such as 220/120 that would have prompted a call for an ambulance back home. Other patients would have symptoms of thirst and frequent urination due to extremely high blood sugars; other than giving dietary advice which many patients had trouble comprehending, we had no other available interventions for hypertensives and diabetics presenting to our clinics.
Flash forward five years and there is a world of difference. Now there is a cadre of well trained, experienced Community Health Workers (CHWs) monitoring 160 patients in our Chronic Disease Program. Patients are given chronic medications for diabetes, hypertension and asthma and visited by their Community Health Worker on a monthly basis to be checked, to monitor compliance and look for patients who need to visit our local collaborating physician Dr. Medina at the weekly HHI clinic in Montellano. Now when we see patients for follow-up they come accompanied by their Community Health Worker and we have a chart documenting their past visits, laboratory values and consultations with Dr. Medina. Whereas in the past, follow-up care for complex cases was coordinated by the HHI staff, it is now increasingly the responsibility of CHW Willy Destin and his fellow Community Health Workers.
This year for the first time some of my patients had attended the Sano y Feliz diet and exercise program, showing an impressive level of knowledge of nutrition and exercise that they learned at these HHI organized classes. One of my patients had lost 20 pounds and I was able to discontinue his blood pressure medicine! Little by little the advances are adding up. I am very much looking forward to the future as I continue to work with HHI during my annual medical service trips and to marveling at the progress that can be seen from one year to the next.
All photos by Michael Good, MD