Your Royal Highness
Dominica, a low-middle income country with a meager population of 73000, undoubtedly embodies “The Nature Isle of the Caribbean”. Unfortunately, amidst its beauty and splendor, not too far away from the breathtaking beaches where the Pirates of the Caribbean was filmed, lie communities afflicted with extreme poverty and the crippling burden of chronic diseases. Dominica is both my home and one of the most underdeveloped countries in the Caribbean, a reality that did not become apparent to me until I experienced stark differences after moving to the United States.
As a young transfer student, moving to America was both challenging and exciting. Although I was eager to pursue the education of my dreams, I had to navigate a different culture in a very fast-paced society. Perhaps the biggest shock was witnessing drastically different levels of health literacy and prevention compared to my home country. In America, my peers were more autonomous, especially with regards to their health. Many utilized various clinical and preventative services (such as contraceptives and seasonal flu shots) and were knowledgeable on how to integrate them into their daily regime. Meanwhile, it was only through my research experiences, in gynecological cancers, that I was exposed to the power of prevention by screenings and prophylactic surgeries. In fact, it was not until my research mentor inquired about my receiving of the HPV vaccine that the importance of health advocacy and disease prevention finally hit home. To my disbelief, I had no idea that the HPV vaccine existed, and at the age of 21, I had not received the treatment series. But I did know of Ella, a Dominican friend, who became a victim of metastatic cervical cancer. She passed away at the age of 23.
At the University of Miami, I decided to turn my shock, into action by dedicating my energy towards making a difference in women’s lives globally. In Spring 2017, I served as a medical volunteer in Nicaragua with Vida Volunteers - a non-profit organization whose mission is to improve the well-being of rural Central American communities through the implementation of free mobile clinics. My most memorable moment was when a 32-year old woman and mother of 4, let’s call her Maria, walked into the clinic. Maria complained of a burning sensation after eating while also admitting that she often induced vomiting for relief. Despite this, her primary complaint was that she could not understand the results from an ultrasound exam. After perusal of the report, Dr. Ramirez, the head doctor of the program, explained to Maria that she had irritable bowel syndrome, fatty liver grade II and uterine fibroids in addition to her previous diagnosis of hypertension and type II diabetes. As they engaged in further conversation, Maria described her challenges with accessing care and her difficulties with prioritizing health.
She was the sole-provider of her household with a measly income as a craftswoman. With no medical facilities within 10 miles of her home, Maria considered seeking medical advice an inconvenience and a burden to her family. In fact, she had been constipated with a bloody discharge for over 5 years but took no action due to the demanding responsibilities of a single-mother. As Maria sat uncomfortably in pain expressing her frustrations, she began to weep. I was overwhelmed. Although I tried to maintain a professional composure during this encounter, tears ran down my cheeks as I could not help but empathize with her pain. We provided her with medication to control her NCDs, in addition to referrals, as we did not provide all the services, necessary for her treatment. Knowing that we were limited in our scope of aid, I felt powerless. I was even more concerned that she would leave our clinic plagued by diseases, with only fleeting hope that she would follow through with our recommendations.
Through this experience, and my time in Nicaragua, I learnt that while ensuring access to screening for all is a vital part of the transformative work that must take place in healthcare, education and broader support to help those most at-risk, is imperative to inform effective health policy. I also learnt that the risk factors associated with NCDs and other chronic illnesses in LMICs are largely due to socio-demographic effects. LMICs need better surveillance to increase screening and prevention strategies. However, we cannot stop there. High-risk populations need frequent preventive follow-ups, nutrition guidelines, psychological counseling, and information on how to decrease risk factors. They may need support to cover transportation costs or child-care. And we must think about how the broader context – whether it be stigma or violence or the food environment – may make it challenging for those at risk to follow medical advice.
While my encounter with Maria was brief, it created a lasting impression. After leaving Nicaragua, I knew that bridging the gap between underserved populations and access to care was exactly how I wanted to make a difference as a future physician. As a result, I have decided to not only follow a path in female reproductive health as an OB/GYN, but to also use the insights of an MD/PhD dual degree to prepare myself for a career as a revolutionary physician, influencing health policy and administrative decision making within medical delivery.
Since I first moved to America, I have learned that despite the surface-level efficiency of the American health system, many of the deep-rooted issues evident in my home country and other developing countries also exist in the most developed and technologically advanced countries in the world. Therefore, conventional medical practice and education will not suffice when advocating for prevention. We need to be creative. In partnership with Urgent Cuts Barbershop in Overtown-Miami, for example, I’m helping to provide free monthly hypertension screenings and preventive education for cardiovascular disease to men waiting to get their hair cut. Last year, I served as a site leader on a Community Health project at 180 Degree Farm in Georgia – an initiative that provides organic food to families fighting cancer, who may have insurance for treatment but are financially unable to afford a nutritious meal.
These experiences have taught me that effective NCD prevention and control requires multi-sectoral and coordinated multi-stakeholder engagement and an explicit focus on health equity. I also believe a life‐course approach is required, as younger generations globally are exposed to a range of risk factors. My hope is that we translate community input into meaningful communication and teaching resources, especially amongst young adults. I will do everything in my power to ensure that stories like that of Maria are heard, but also to bring my generation along with me as we build a strong foundation for the achievement of the sustainable development goals. Together, we can truly improve the quality of human life, and thus decrease the number of individuals that must face detrimental life outcomes like 23-year old Ella.