DR Update 2: Swiss DEETs

I'm currently wearing 30% DEET, of the "Deep Woods Sportsmen" variety from OFF! I've been using this stuff almost constantly since my first-year micriobiology course left me a bit paranoid about dengue fever and day-biting mosquitoes. I've managed to keep insect bites to a handful during my time here, but I'm not sure how long my chemical stockpile will last. Hopefully, I won't be feeling and "bone-break" symptoms anytime soon.

Update: I've exhausted my supply of 30% DEET, so I'm now using 15% OFF! Sport. One benefit to this change is that the new spray smells like strawberries as opposed to a chemistry lab.

DR Update 1: Language Barrier

I would write this entry in Spanish, but it has been evident during my first 5 days in the Dominican Republic that I speak Spanish about as well Heidi Montag integrates by parts. I've actually been surprised at how difficult it has been for me to understand what people are saying, even at a very basic level. It's true that Dominican Spanish is notoriously fast and often drops syllables. However, the level of my language ineptiude has transcended so many barriers that I am now winning a game of Tower of Babel limbo. At this rate, I am approaching the ground in a truly asymptotic fashion.

Hopefully, in the next few weeks, my Spanish will drastically improve. I've already learned quite a few words, and I'm making an extensive vocabulary list. I'll describe my work in an upcoming entry, but suffice it to say now that I'll need much better language skills if I'm going to do anything of substance. (My original project, which required less speaking, is no longer feasible. It was focused on program evaluation using patient data, but given that said program still does not exist, it will be hard to evaluate it!)

So far, my inability to communicate has been very humbling but also very frustrating. Not being able to express myself has been bothersome since I am used to having a good command of the English language--especially techincal English. On Friday, I tried to explain to my supervisor that I had worked last year with individuals who had comorbid diabetes with HIV/AIDS; that we thought that the protease inhibitors in their combination ARV therapies may have caused insulin insensitivity; and that I'd heard from many people that diabetes was harder to manage than an HIV infection since the latter only requires taking pills whereas the latter requires continual monitoring. As you probably can infer from my previous statements, this attempt was a complete disaster!

For now, I'm going to concentrate on seeking opportunites to practice speaking Spanish so that I can improve my ability to communicate. Fingers crossed, and knock on wood.

Este verano.

Tomorrow, I'm jetting off to the Dominican Republic for 7 weeks. I'm working with the non-profit Infante Sano ("healthy baby" in Spanish) on a project to improve access to HIV testing for pregnant women. Our ultimate goal is to prevent vertical (mother-to-child) transmission of the virus.

In addition, I'm going to be learning Spanish furiously. This will be my first immersion experience in which my coworkers will not speak English. My project involves interviews of Spanish-speaking doctors and nurses. Hopefully, by the end of the summer, my fluency will be much better.

Contact

This isn't the Jodi Foster movie, but it basically lasted as long. I'm talking about the length of time it takes me to put in one of my contacts.

I visited the optometrist a few days back to get my annual eye exam. These days, I'm pretty much convinced that med school is ruining my vision, so I fully expected news that I needed new glasses. For kicks, I also decided to get a contact lens exam.

Well, come to find out, my vision hasn't gotten worse. (Really?... I'm skeptical.) I did, however, get a new contact prescription--for one that corrects less, not more. According to this optometrist, my lenses (same prescription for both eyes) had been overcorrecting for one of my eyes, and it's better to undercorrect rather than overcorrect. Surprise?...

One-third of me is over my head.

A study in Health Affairs last month looked at the amount of money that physicians (in private practice) spend on overhead costs of interacting with insurance companies. The findings were extremely interesting and show just how much money doctors spend on things outside of actual patient care. Perhaps the most striking result was that primary care physicians spend nearly one-third of income, including benefits, on paying for staff interactions with insurers.

One out of every three dollars.

This statistic is outrageous and should be more prominent in discussions about health care reform. However, if you read the statements from the American Medical Association, all you see are proclamations on how patients are best served by private insurance--and that the public option in Obama's policy proposals is a bad idea "for patients." All of this talk persists even though an independent analysis from the Commonwealth Fund has shown the potential for a public option to save as much as 30% through mechanisms such as lowering administrative costs. With 45 million Americans completely uninsured and millions more underinsured, decreasing health care spending that doesn't fund actual care should seem like a prudent option--one that is, dare I say, good for patients. (You know, like the ones who are not getting any health care because they have no insurance and can't afford out-of-pocket costs. Not to mention the people who have their health plans revoked due to post-claims underwriting and rescissions.)

It seems that political pressure has already caused the AMA to backtrack a bit. An email that I received from the Massachusetts Medical Society stated that the AMA has decided to avoid "closing any doors" in analyzing health care options. Regardless, I hope that more physicians step up to the plate and advocate for reform options that are good for the health of patients instead of focusing on options that protect physician pocketbooks.

I'm [Rosetta] Stoned.

I've been using Rosetta Stone during the past few days to brush up on Spanish. First of all, I can never remember the word for kitchen sink: fregadero. But of greater interest, there is a picture in Level 3, Unit 1, that looks oddly like... me.

For those of you who somehow speak worse Spanish than I do, the sentence roughly translates into: "The man has his hands on his knees." The phrase may as well be "El hombre se parece a Swiss Beats, pero con un BMI normal."

Emm One Done.

I apologize for falling off the face of the blogosphere for the last 6 weeks like a Columbus-detractor, circa 1492, who'd gotten to an edge of a flat world. But now I'm back, and I hope that my posts will be more regular now that I don't have to worry about exams.

The last time I wrote, I was concerned about H1N1 influenza, whose outbreak happened to coincide with the virus module in my microbiology course. Since then, H1N1 has has been declared a pandemic, but I've been preoccupied with learning bacterial identification via culture methods and the "hallmarks" of cancer--the latter of which almost sounds like neoplasia has its own line of greeting cards. Two classes and an integration week later, I am officially done with M1, or my first year of medical school.

Now, it's time for my last summer break (*dramatic pause*). Medical school blatantly disregards human concepts of time and seasons. First, as "days" on each planet of the solar system last for differing numbers of Earth-days, the first "year" of classes at HMS actually lasts 10 months. Subtraction implies that I have about 2 months of a full year left, and that's basically how much time I have before classes begin in mid-August. Also, medical school, in all of its professional glory, attempts to capitulate "normal adult life," in which summers cease to exist. After M1, there are no more summer vacations. (I have a potential 4-week vacation next year if I somehow manage to study for USMLE1 during the school year and take the test almost immediately after classes end. Fat chance.) Thus, I'd better make this 8 weeks or so count since it's going to be my last prolonged (>1-3 weeks) time away from school/work for a while.

For now, I need to focus on getting myself home to Georgia!