Neurology Elective in Santo Domingo, DR Kathryn Rimmer Rachel Mehendale 3/26/18

Background 41% of Dominican Americans live in NYC Manhattan is the only county in the country where Dominicans make up the largest ancestral group Washington Heights is considered the center of the Dominican American community Latest waves of immigration to US in 1960s spurred by the fall of the Trujillo Regime

Statistics Dominican Republic USA World Bank Income Level Upper middle High Total population (2015) 10,528,000 321,774,000 Life expectancy (M/W) 71/77 77/82 Total expenditure on health per capita $580 $9,403 Total expenditure on health as % GDP 4.4% 17.1%

Stroke

Goals & Objectives Compare the burden of neurological disease in Santo Domingo vs NYC Practice neurology in a resource-limited setting Improve Spanish-language skills Appreciate the cultural background of the Dominican population Develop inter-institutional relationships with the goal of building a bilateral residency exchange program between Santo Domingo and NYC Determine logistics and scheduling for future residents participating in a DR elective

Hospital Salvador B. Gautier Established in 1948, 450 beds Public hospital within the national health system (SNS) Funded through Dominican social security program (IDSS) Major teaching hospital

HSBG Resource Limitations No EMR → all notes and orders handwritten No hospital computers No stroke unit, no tPA No MRI ($50 OOP if not insured) No EEG (routine or continuous) No doppler Available AEDs Phenytoin Valproic Acid Keppra Carbamazepine Phenobarbital

Hospital Padre Billini Public hospital (SNS) in the Zona Colonial Founded in in 1552 Neurology consultation service Dr. Cosme Dra. Ramirez MS Clinic M, Th 8:00 - 12:00 Lemtrada infusions

Medical Education 6 years of medical school 3-4 years of internal medicine 3 years of neurology residency +/- 1-2 years of fellowship abroad (epilepsy, neurophysiology, movement disorders, MS)

Neurology Residency in the DR Santo Domingo, 40 year old program 9 residents total, 3 per year 6 attendings Santiago, 6 year old program 6 residents total, 2 per year Established by graduates of Santo Domingo program Rotations at National Neurology Institute in Mexico included in program curriculum In-service exams in English