Seeing AIDS Through Patient Care in the Dominican Republic
Casa Columbia Gives Students a Home Away From Home in La Romana

By Merri Rosenberg
It’s one thing to treat Dominican patients in Washington Heights. It’s quite another to spend time in the Dominican Republic seeing patients in clinics, hospitals, or sugar cane plantations. Students who have traveled to the island for electives and rotations say their experiences have transformed their interactions with the Dominican patients and neighbors they encounter at Columbia.
   Through the Columbia University International Family AIDS program, which also has a site in South Africa, first-year and fourth-year P&S students gain a unique international experience that complements their experiences in Washington Heights, where Dominicans are the single largest immigrant group in the neighborhood.
   “One reason I came to Columbia was because of the Dominican Republic elective,” says Lauren Taggart Wasson’09, who had a master’s degree in public health from Johns Hopkins when she enrolled at P&S. “So many students have international backgrounds or interests. One of the fantastic things about going abroad is what you practice when you come back to Washington Heights. When you work abroad with a foreign language and culture, you improve language skills and ‘cultural competency,’ that is, your ability to apply knowledge of a different culture to your work with patients from that culture. You are humbled by not knowing very much and often the patient is your teacher. It is important when caring for your patients both here and abroad to apply these lessons of humility and learning from your patients."
   The elective, designed to offer insight into the medical, social, and economic challenges that global AIDS represents, allows two students to work in La Romana in the Dominican Republic each month. Clinical sites there include an
Casa Columbia in August 2006
Casa Columbia in August 2006
outpatient facility for HIV-infected sex workers, an obstetrical clinic for HIV-infected pregnant women, a private hospital, a public hospital, and the bateyes, villages built near sugar cane plantations where Haitian migrants and poor Dominicans live and work. Under supervision, fourth-year students take patient medical histories and perform simple procedures, including the rapid HIV test and immunizations.
   Starting in the summer of 2006, up to 11 students and other program participants can stay in “Casa Columbia,” an ochre-colored stucco-and-wood Caribbean-style house, during their electives and rotations. The house has two bedrooms that can accommodate five people plus living room, dining room, kitchen, bathroom, and wrap-around porch featuring Spanish tiles. A separate six-bed dormitory, with its own bathroom and library with wireless internet access, is also part of the Casa Columbia property. The house and dormitory are situated in gardens blooming with hibiscus, orchids, and red-flowering trees. Casa Columbia shares a swimming pool with a neighboring program.
   The buildings are owned by Florida-based MIR Charities, which raises money to support the education and health of children in the Dominican Republic. MIR Charities provides the space to Columbia rent-free. Furniture, air-conditioning, supplies, and maintenance are the responsibility of Columbia. The Rudin Foundation provides funding and stipends to cover the students’ air fare and room and board.
   Casa Columbia also accommodates graduate students from the Mailman School of Public Health and residents in pediatrics, medicine, and family medicine. Columbia students have priority, but students have been accepted from elsewhere in New York as well as Harvard, Brown, Penn, Dartmouth, Duke, Baylor, and schools outside the United States.
   Casa Columbia also provides a base for a broad range of professionals who are studying or training in the Dominican Republic, says Stephen Nicholas, M.D., currently a Fulbright Scholar who is living in the Dominican Republic this year with his wife and four children while directing the Columbia University International Family AIDS Program, which he founded.
   Although the program for P&S students was initially designed as a fourth-year elective, first-year students now participate in summer research projects and in rotations that allow them to shadow medical professionals. Lauren Hofmann’07, who spent time at La Romana as a first-year medical student, is eagerly anticipating her return in February 2007.
   Participating in this program, she says, helped her “understand how different life is in the Dominican Republic and makes it easier to understand my patients.” Of particular significance was the work done in the bateyes where, Ms. Hofmann explains, “there’s little access to health care, so you are providing something that wouldn’t be there otherwise.”
   Another student, Lisa Bebell’08, found that her interest in international health was strengthened by her experience at La Romana during the summer after her first year at P&S. “Part of being a physician is getting to know your patients and interacting with them on their own terms,” she says. “Working with Dr. Nicholas was an opportunity I didn’t want to pass up.”
   Ms. Bebell helped with a research project to determine the HIV prevalence in pregnant women, worked in the bateyes, and made home visits. “There was a lot of practical learning,” recalls Ms. Bebell, who also has worked in South Africa. “Most of us were still learning Spanish, but we had great experiences asking about their lives. It’s given me better ways to interact with people and how best to influence their lives as a physician. It made me interested in more international work.” Ms. Bebell, who is interested in a career in primary care medicine, is spending this year as a Doris Duke Fellow at the University of California, San Francisco, doing clinical research in infectious diseases.
   The program at La Romana developed from Dr. Nicholas’ pioneering work, which started in 1985, in the care of children with AIDS and their families in northern Manhattan. He personally witnessed AIDS evolve from being the leading killer of children in the Harlem community to a relatively rare occurrence.
   “You’ve got a world filled with AIDS,” says Dr. Nicholas, professor of clinical pediatrics at P&S and clinical population and family health at Mailman, who until recently was chairman of pediatrics at Harlem Hospital Center. “There’s a moral prerogative to get involved internationally. In this instance, we found a local solution right here in New York. That makes it very hard to get up in the morning and ignore the challenge of global AIDS. The island of Hispaniola — with Haiti and the Dominican Republic — has the highest rate of AIDS outside of sub-Saharan Africa. There are lots of Haitian immigrants who work in the Dominican Republic. Where there’s migration, disease follows.
   “When I began thinking about something global, a nurse I’d worked with for 11 years retired to La Romana in the Dominican Republic,” says Dr. Nicholas. “She led me to two groups of Catholic nuns, one working with sex workers and the other with migrant Haitian families, many of whom had HIV. I went down and got involved, in my spare time, and it struck me when I saw sick children with HIV and AIDS that I hadn’t been to a funeral for a child with AIDS for years.”
   Although Dr. Nicholas initially went to La Romana and the surrounding area in 1999 to provide treatment to the people there, the program began more formally in 2004. “There was a big step forward when Bill Clinton’s foundation gave the Mailman School a grant to assist the Dominican Republic with the first AIDS drug treatment program in 2003-2004.”
   No study has investigated the impact of the program on medical students. However, Dr. Nicholas knows anecdotally that some students — and residents — have shifted their career plans as a result of the experience. Three residents, for example, moved into global health and are now in a pediatric AIDS program at Baylor.
   “The benefit to P&S students is self-evident,” explains Dr. Nicholas. “Dominicans are the largest immigrant group in New York City. Our medical school sits in a community that’s 85 percent Dominican. I’d worked in Washington Heights since 1981. Once I started going to the Dominican Republic, I was a better doctor. It changes your perspective. If we can improve health care down there, we can improve health care in our community, in Washington Heights, and in New York City. It’s an unusual way of thinking about training. My ultimate goal is to sensitize young doctors to families that are poor or immigrants. It makes them better doctors.”

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