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A Look into Urogynecology in the DR

Annie Grossinger

Dr. Kristin Jacobs (left) and Dr. Anne Sammarco (right) at the San Juan Hospital in the Dominican Republic.

Dr. Kristin Jacobs (left) and Dr. Anne Sammarco (right) at the San Juan Hospital in the Dominican Republic.

I’m Dr. Kristin Jacobs, a new Urogynecologist at Rush University. My colleague Dr. Anne Sammarco and I both joined Rush in September of 2018 with passions for Global Health. These passions were founded and bolstered through our experiences living and working in Central and South America as well as Western and Sub-Saharan Africa. We were ecstatic to learn of Rush Department of Global Health’s partner organization, Community Empowerment (CE), and its sustainable medical commitment to the Dominican Republic. We readily volunteered for the upcoming gynecology/urology mission in April 2019.

As Urogynecologists, Dr. Sammarco and I specialize in treatment of pelvic floor disorders in women. These conditions include urinary incontinence, fecal incontinence, and prolapse (relaxation) of pelvic organs, which leads to a bothersome and protruding vaginal bulge. We also have expertise in repair of complex obstetrical lacerations and fistula - connections between the bladder and vagina or rectum and vagina, which can occur after prolonged or traumatic birth. All of these conditions are incredibly common and have a significant impact on a woman’s quality of life due to physical limitations, personal isolation, and societal ostracism. Unfortunately, these conditions are frequently overlooked in countries with advanced medical systems and they are all too often forgotten in areas of the world with significant medical need.

We arrived into Santo Domingo on a Saturday night and met up with our new team – at that time we were relative strangers, but within a matter of a couple hours we would become a strong, cohesive surgical powerhouse. We began by seeing consults in the Community Empowerment facility in Santo Domingo, after which we traveled to a nearby town before arriving at our home base for the week - San Juan Hospital.

Our three surgical teams each ran an operating room from dawn till dusk (or very much past – in some cases!). In all, we completed approximately 60 surgeries over 5 days of operating. Our urogynecology team performed 7 hysterectomies, 6 reconstructive vaginal surgeries for prolapse, a complex fistula repair, minimally invasive urinary incontinence procedure, and several tubal ligations. The surgical volume would not have been possible without the tireless support of our amazing internal medicine colleagues who provided world-class peri-operative care - truly the foundation of the mission.

It is clear that CE is an integral part of the medical world and local communities in the DR. The services provided thru the organization would otherwise not be available to those without adequate money or insurance. Furthermore, CE connects foreign and Dominican physicians to facilitate learning and acquisition of new skills. This infrastructure is vital to provide continuity of care for our patients which is successfully accomplished thru this self-sustaining locally run organization.

The impact of a medical mission can never be measured by counting cases performed or patients seen. How do you measure the success of a surgeon learning the challenges of being a circulating nurse, a medical student learning the intricacies of sterilizing surgical equipment, or the joys of a little Cafecito and maybe a salsa dance after a long day of cases – these are all life altering and expanding lessons. It was an honor to be a part of such a well-run and responsible medical mission.

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