In the Dominican Republic, a medical mission provides valuable lessons on access to care

Like the task ahead of us, traveling from Great Falls, Montana, to Santo Domingo, Dominican Republic (DR), was no easy feat. Our journey took us through Missoula to Dallas, from Dallas to Miami and finally from Miami to Santo Domingo over the course of a 24-hour travel day. However, flying to the DR would prove restful compared to the days ahead of us at Foundation for Peace.

Foundation for Peace (FFP) is a nonprofit organization based in Santo Domingo that works with local communities to set up pop-up clinics where visiting medical students, nursing students and other healthcare professionals can volunteer. Upon our arrival at the Santo Domingo airport, we were met with a bustling atmosphere. Our first mission was to look for our team, who were waiting for us with fresh pizza in hand.

After spending some time getting acquainted with each other at the airport, we were en route to the FFP house, an hour’s journey within Santo Domingo. Upon arrival, we were greeted by a beautiful two-story home painted orange and blue, and we found ourselves gathered around a large oval table to count medications for our clinic days.

Ziploc bags were splayed across the table as the seven of us, including Stephanie Zeszutek, DO (the physician joining us from TouroCOM Montana), divided up pills and placed them into the baggies. I remember being exhausted. We had barely gotten any sleep during our overnight layover in Dallas, and there I was sitting in the heat putting together medication in the living room of a house I was completely unfamiliar with, in a country I had never been to, surrounded by people I did not know. However, as every pill found its place in a Ziploc bag, I was able to find my place in this new space as well as I connected with the staff, the medical director of FFP Cici Lugo, MD, my peers and with Dr. Zeszutek.

The start of our work

I did not know it then, but those pills followed us throughout our three clinic days. On our first day, we quickly learned the backpack EMR software that FFP utilizes within their pop-up clinics and set forth beginning service. Two volunteers were responsible for waking up an hour before the rest of the group to help set up the clinics with FFP staff within the community buildings we housed them in.

Sheets were hung across the wall to create exam rooms; tables seemed to appear out of thin air and were placed within the exam rooms. In the back, a pharmacy appeared with all of the medications we had organized placed into labeled baskets. Our labor was divided—two people on triage, three people in exam rooms and one person in the pharmacy. There was no air conditioning, there were no fans and a makeshift waiting room fit only half a family while most of our patients waited outside in the heat. I couldn’t help but wish I could do more to make them comfortable.

Before our clinic day, Dr. Cici had informed us that our patient population would mainly be Haitians living in the Dominican Republic. In April 2025, the Dominican Republic’s President Luis Abinader imposed new laws on foreigners receiving health services in the Dominican Republic—they must present proper identification, a passport with a valid visa or a work card and a home address in order to receive medical care, and anyone who does not present these materials may be arrested and deported after their treatment.

Haitians often immigrate to the Dominican Republic seeking a better life. In 2010, after the earthquake in Haiti, about 41% of the DR’s population lived below the poverty line, and 80% of the population had access to an improved water source. In contrast, in Haiti, 77% of the population lived below the poverty line, and only 49% had access to an improved water source.

A health crisis

There is currently a health crisis among Haitian populations in the DR. Many of the patients we were caring for do not have routine access to medical care, fear seeking it and/or are not able to tend to their health. Additionally, local doctors have said many Haitian women are afraid to attend prenatal checkups and tend to arrive late at night or when they are about to give birth due to the risk of deportation. Such communities are dependent on organizations like FFP to bring items such as vitamins, menstrual products and toothpaste.

FFP was able to set up individual appointments for pregnant patients within the pop-up clinics and our door-to-door clinic with Dr. Zeszutek, who is an OB-GYN. We were able to provide patients with comfort, solace and care during a time of struggle. With each bag of medication I handed to a family, I felt grateful that I was able to ease a burden, even if it was just for a brief moment in time.

An inside look at Haitian struggles

One of our clinic days was scheduled to be a door-to-door mobile clinic. We were given a unique opportunity to bring essential healthcare to patients in an even more personal setting. Toward the end of a bus commute, we noticeably began to gain elevation. Then, abruptly, the bus groaned to a halt—it had taken us as far as it could and now the terrain was far too steep to move forward in a bus.

Our group climbed onto the back of a pickup truck and watched it battle the beautiful mountainous terrain of the Dominican Republic. Finally, we summited the hill and reached a small village that overlooked a valley. After meeting the pastor of the local church, we set up shop as usual within the church building and loaded medical supplies into backpacks to take to the patients awaiting us in their homes. We separated into three different teams. My team consisted of Dr. Zeszutek, Dr. Cici, another student, a Peace Corps member (who served as our translator) and myself. With the pastor guiding us through the community, we found the patients waiting for us within their tin-roofed homes, ready to receive care.

After seeing a couple of families, we walked up the side of an unshaded hill and I finally felt the Dominican heat start to set in. I looked up to find the pastor speaking to a woman near her house. She seemed reluctant to have us there and upon the pastor’s return to our group, we learned that she did not feel comfortable with us providing care without her husband present. After taking a few retreating steps, the woman called us back to her home and informed us that she preferred to have the encounter outside of her home instead. 

Three chairs were set below a clothesline and under the tropical sun we proceeded with the encounter. As we triaged the patient, we learned that she had recently delivered a six-month-old girl and had two other children, around ages four and six. The mother understood some Spanish but spoke Haitian Creole fluently. With our Peace Corps translator and Dr. CiCi present, we were able to effectively communicate with her. Her children were doing very well and the six-month-old was meeting her developmental milestones. The mom, however, was suffering from chronic low back pain. After some conversation with Dr. CiCi, the mother was open to us performing an osteopathic exam and receiving treatment. She suggested her bedroom as the most comfortable location for treatment.

Walking into her room, we got an inside look at her life. I still remember the TV, an older model, was playing a show she had been watching earlier. As our patient laid on the bed, Dr. Zeszutek guided us through a quick physical exam: her lower back was found to have hypertonicity bilaterally; we also felt her abdomen to be soft and non-rigid. She also had lower abdominal tenderness with palpation which went away with hip flexion. Dr. Zeszutek explained how this likely rules out any serious pathology and her pain was likely musculoskeletal. With Dr. Zeszutek’s help, I performed myofascial release of the quadratus lumborus. Further, we reviewed the ways she could lift her children with minimal bending at the lumbar spine, as this was a likely culprit to her symptoms. After receiving treatment, she had shifted from being reserved to being extremely grateful. Each time I ran into her in town throughout the rest of the day, I was greeted by a smile.

The passion to do more

I was eager to proceed to the next home when we received word that our clinical day had concluded. A sense of disappointment washed over me—we hadn’t reached as many families as I had anticipated. Rejoining the other teams at the church, we listened as the pastor expressed his profound gratitude for our work. Yet his thanks were difficult to fully accept. I couldn’t help but feel that our medical contributions were minimal compared to the magnitude of the community’s needs. We had provided temporary relief for physical ailments, but we were powerless to address the systemic poverty and barriers to receive healthcare that defined our patients’ daily lives.

With that heavy realization, we loaded into the bed of the truck for our descent down the hill. However, the ride down offered a new perspective that helped shift my mindset. The breathtaking view of the valley spread out before us—a reminder of the enduring beauty and resilience of the community we had just served. That wide-angle view lifted the weight I had been feeling, replacing my doubts with a renewed appreciation for the human connections we had made.

As physicians, we have a responsibility to serve and treat everyone regardless of background. A person seeking care is in a vulnerable state and as medical professionals, we have an obligation to strive to give each person a safe and adequate environment. I hope to carry these lessons I learned into my career.

Looking back, I am grateful to have been part of FFP’s mission. Partnering with them allowed us to serve communities that have difficulty accessing healthcare. The impact of these pop-up clinics is immeasurable. These pop-up clinics can go beyond the setting of a rural settlement in a developing country. There is potential to fill healthcare gaps in our own communities as well. In the ever-evolving field of medicine, pop-up clinics can play a future role in providing continuity of care for underserved populations—from the DR to our own backyards.

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