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

2. 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

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

5. Stroke

7. 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

8. 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

12. 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

13. 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
Lemtrada infusions

14. 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)

15. 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