A challenge for inclusion in the Dominican Republic’s health care services

This article was exclusively written for The European Sting by Ms. María Cedeño and Ms. Lia Patricia Reyes Santos, two third-year medical student sat the Iberoamerican University (UNIBE) in Santo Domingo, Dominican Republic. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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“Part of social progress is understanding that a person is not defined only by one’s sexuality, race, or gender” – Tim Cook Since our first year of medical school in the Dominican Republic (DR), we noticed that topics related to sex, sexuality, and gender were considered a taboo. These three concepts are closely associated to the biological characteristics, behavioral, and social connotations of what is considered feminine and masculine, respectively (1). In the DR, no specific study has reported the percentage of individuals who belong to the lesbian, gay, bisexual, transgender, queer, intersex + (LGBTQI+) community. However, this growing community creates great controversy in the country, as religious beliefs are rooted in the cultural and political framework, leading to behaviors of rejection, violence, and discrimination to the LGBTQI+ community (2, 3). Recognizing this social stigma and considering the role of the physician as an impartial entity facing sexual orientation, the following question arises: do DR physicians have guidelines on how to care for the specific needs of their LGBTQI+ patients? The answer is no. As medical students, we find this disturbing because Dominican doctors are unprepared to approach and treat the health priorities and needs of these patients. Although medical care relies on evidence-based clinical practice guidelines, some members of the medical community may still be influenced by moral principles that are governed by conservative perspectives. For this reason, medical students and residents can lead this new paradigm in clinical care by emphasizing objectivity in doctor-patient relationships and respect the diversity within our patient population, including sexual orientation, culture, religion, and perspectives. To address this situation, the medical community must empower medical students and physicians to separate personal ideologies from their medical practice, sticking to the Hippocratic oath. Second, medical students can provide information for the medical community that explains the rise of this community’s rise to help create an environment of inclusion. Finally, they can promote continued education on existing public policies, and initiatives that promote gender equality, such as Article 39 of the Constitution of the DR (4). Changing the social paradigm on sensitive topics is not a simple task. For this reason, we should focus on our leadership to make sustainable changes within our communities. We are being trained in the medical discipline to have an open conscience, ethics related to serving our patients as integral beings, without stigma, prejudice, and categorization. The measures we take today will determine whether or not the future generations will be more tolerant and inclusive. Since these results have a long-term projection, we must promote this call to action now for real change within our communities. References

1. General direction for advocacy and divulgation on human rights. Sexuality and gender. There are no formulas for living, different options exist [Internet]. 2013 [cited 2019 Jun 20]. United Nations Population Fund. Available from: https://venezuela.unfpa.org/sites/default/files/pub-pdf/C4%20La%20sexualidad%20y%20el%20genero.pdf
2. Betances E. Catholic church and politics in Latin America. 2^nd ed. Santo Domingo: Funglode; 2017.
3. United Nations Human Rights Council. Summary prepared by the Office of the United Nations High Commissioner for Human Rights in accordance with paragraph 15 (b) of the annex to Human Rights Council resolution 5/1 and paragraph 5 of the annex to Council resolution 16/21 [Internet]. 2013 [cited 2019 Jun 20]. Universal Periodic Review. Available from: https://lib.ohchr.org/HRBodies/UPR/_layouts/15/WopiFrame.aspx?sourcedoc=/HRBodies/UPR/Documents/Session18/DO/A_HRC_WG.6_18_DOM_3_Dominican%20Republic_E_iDrits.doc&action=default&DefaultItemOpen=1
4. Supreme Court of Justice, Dominican Republic. Constitution of the Dominican Republic [Internet]. 2015 [cited 2019 Jun 20]. Available from: https://www.poderjudicial.gob.do/documentos/PDF/constitucion/Constitucion.pdf

About the authors María Cedeño is a third-year medical student at the Iberoamerican University (UNIBE) in Santo Domingo, Dominican Republic. She serves as an active member of the Standing Committee on Public Health (SCOPH) of ODEM-Dominican Republic. She also serves as coordinator of the UNIBE Neurology and Neurosurgery Interest Group (NEUROX), and as an active member of the UNIBE Hematology and Oncology Interest Group (GHEMOU). Lia Patricia Reyes Santos is a third-year medical student at the Iberoamerican University (UNIBE) in Santo Domingo, Dominican Republic. She serves as an active member of the Standing Committee on Sexual and Reproductive Health  (SCORA) of ODEM-Dominican Republic. She also serves as coordinator of the UNIBE Hematology and Oncology Interest Group (GHEMOU), and as an active member of the UNIBE Neurology and Neurosurgery Interest Group (NEUROX).