Emerging Technology in the Dominican Republic

THE DOMINICAN REPUBLIC is a country of ten million people, situated on the Caribbean island of Hispaniola. While it is a beautiful, tropical place with a rich culture and history, there are many opportunities for medical humanitarian outreach. Access to healthcare is limited in both urban and rural areas, especially among the working poor who cannot afford private insurance but do not qualify for government support. In the Dominican Republic, 30.5% of the population lives below the poverty line and 7% of people are in extreme poverty.[1, 2] Of all the nations in the world, the Dominican Republic is ranked in the bottom quartile by gross domestic product expenditure on healthcare (4.4% per capita).[1]

Our student global health trip was stationed in the city of Santo Domingo, where we organized free clinics to benefit surrounding communities. Our team was composed of fourteen medical students and four physicians, including local Dominican provider Dr. Griselda Cecilia Lugo (“Dr. Cici”), the medical director in the Dominican Republic for the charitable organization Foundation for Peace. During our time there, we were able to interview Dr. Lugo to discuss the impact of emerging technology on the healthcare system. We also interviewed Mercedes Tejada, the director of nurse education at the women and children’s hospital in Santo Domingo called Hospital Materno-Infantil San Lorenzo de Los Mina. One of the emerging topics in medical technology is telemedicine. When asked if telemedicine has influenced healthcare in the Dominican Republic, Dr. Lugo stated that it isn’t used very frequently but can be useful for patient handoffs. She explained that live teleconferencing between Dominican medical personnel and surgeons in remote locations allows learners to ask questions and make comments in real time. For now, telemedicine remains a teaching tool and is not used to pursue diagnosis or treatment of patients. A few independent researchers are exploring additional applications as well, which may lead to future utilization of this technology.[4,6]

Telemedicine is not the only technological advancement to be utilized in the Dominican Republic. Ms. Tejada showed our group that hospitals predominantly rely on paper records rather than electronic medical records (EMR). With the exception of specialized departments, there are generally no computers in the hospital. Other devices that might include a computerized component in the United States, like electronic intravenous pumps, are also unavailable. In response to this disparity, Dr. Lugo stated that a digitized system would make it much easier to share patient information between providers.[5] In her opinion, paper records create more work for healthcare workers. However, part of the reason why many people still use hand-written records is due to cultural preference. Additionally, resources are not available to purchase computers for each unit of the hospital. She stated that current technology is underused because it’s unfamiliar; immense effort would be required to motivate everyone to learn a new system. According to Dr. Lugo, presently there is only one hospital in the area that does not use a paper system. She joked that if it was up to her, Santo Domingo hospitals would standardize EMR tomorrow, but it all depends upon a government mandate to make the switch. Even in hospitals with computers and laparoscopy in use, technology lags behind newer models found in other countries. When asked which emerging healthcare technology would be most helpful, Dr. Lugo stated that up-to-date surgical robotics would make the biggest difference in Santo Domingo. Ms. Tejada commented that laparoscopic procedures are becoming more accessible, so updating the technology would be beneficial.

It’s not uncommon for imaging technology to also be outdated in Santo Domingo. Dr. Lugo mentioned that while most hospitals have access to X-ray and ultrasound, CT and MRI are not guaranteed. Ms. Tejada confirmed that there was no MRI machine at the women’s and children’s hospital we visited. Private hospitals in the area may have CT and MRI, but patients must have private or government-issued insurance to be seen in these hospitals. Unfortunately, the public healthcare system typically does not provide access to these imaging modalities. This disparity disproportionately impacts the working poor who do not qualify for government plans and cannot afford private insurance. Those living in rural settings usually must come to the city for any kind of imaging, and transportation often represents a major barrier in these cases.[6]

Access to private insurance is also important if an individual wants to undergo cancer screening. Dr. Lugo stated that many high-quality diagnostic options are available at the private level. Ms. Tejada informed us that regular mammography screening begins at age 35, and cervical exams are performed yearly after a patient becomes sexually active. That said, one third of reproductive-age women in the DR have never had a pap smear.[3] Regarding those without insurance, Dr. Lugo spoke about an exciting program recently organized by local government hospitals: a mobile mammography machine. A special truck is commissioned to drive around underserved communities and offer breast cancer screenings to local women. Screening is free for the uninsured, and the program typically runs at specific times throughout the year including during May, which is Women’s Health Month. While this is a great resource to those without insurance, it is far easier to access oncological services in the city than in resource-poor rural areas. Dr. Lugo reported that the program is growing, but many people in the community are unaware of this resource. Educating communities about available programs would be an excellent future public health intervention.

Despite the technological progress made in the healthcare system over the past twenty years, the Dominican Republic still has opportunities for improvement.7 Projects aimed at updating surgical equipment, standardizing EMR use in all hospitals, and expanding access to newer imaging modalities could be instrumental in bettering the health of the nation.[5, 6] Even educational projects to inform communities of what resources are already available to them would make a huge difference in improving preventative medicine. Technology in medicine is only effective if it can be properly utilized to save and change lives. The Dominican Republic is certainly one place where technology could make a significant impact.[8] Our job as healthcare professionals is to work toward delivering these advances to those in need.

1. Central Intelligence Agency. The World Factbook: Dominican Republic. (2018). Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/dr.html
2. Pan American Health Organization. Health in the Americas 2017. Dominican Republic (2017). Retrieved from https://www.paho.org/salud-en-las-americas-2017/?p=4014
3. Richards, S. D., Stonbraker, S., Halpern, M., & Amesty, S. (2018). Cervical cancer screening among transactional female sex workers in the Dominican Republic. International journal of STD & AIDS, 29(12), 1204-1214.
4. Saleta, H. G. G. (2011). Assessing the current state of Telemedicine in the Dominican Republic. A Systematic Review.
5. Shuaib, W., Suarez, J. M., Romero, J. D., Pamello, C. D., Alweis, R., Khan, A. A., ... & Sanchez, L. R. (2016). Transforming patient care by introducing an electronic medical records initiative in a developing country. Health informatics journal, 22(4), 975-983.
6. Sutherland, J. E., Sutphin, H. D., Rawlins, F., Redican, K., & Burton, J. (2009). A comparison of telesonography with standard ultrasound care in a rural Dominican clinic. Journal of telemedicine and telecare, 15(4), 191-195.
7. WHO Global Observatory for eHealth. (2016). Atlas of EHealth Country Profiles: The Use of EHealth in Support of Universal Health Coverage: Based on the Findings of the Third Global Survey on EHealth, 2015. World Health Organization.
8. World Health Organization. Global Observatory for eHealth, & WHO Global Observatory for eHealth. (2006). Building foundations for eHealth: progress of Member States: report of the WHO Global Observatory for eHealth. World Health Organization.