Medical Mission to the Dominican Republic: Interview with Dr. Reza Karimianpour

In this interview, we learn more about Dr. Ahmadreza (Reza) Karimianpour’s ongoing commitment to humanitarian work outside the United States.

Tell us about your medical background in cardiology. 

I am currently a cardiovascular diseases fellow in South Carolina. I completed my internal medicine residency training at the Cleveland Clinic Main Campus, and I received my medical degree from the Edward Via College of Osteopathic Medicine in Virginia. I had always been interested in a career in medicine, and it was in medical school when I became interested in electrophysiology. Since then, I’ve been working towards the goal of becoming an electrophysiologist. 

What interested you about becoming involved in medical mission work? How many trips have you been on thus far? 

The drive has always been with me to do humanitarian work, so when I was accepted into medical school, I made a promise to myself that I would always pay it forward in some way. My medical school conducts an average of 10-15 trips a year to different locations in Latin America as part of their outreach program. As a second-year medical student, I participated in a medical mission trip to the Dominican Republic, and that was the first time I had an opportunity to encounter real patients in the role of a diagnostician. This of course was done under the supervision of 4-5 licensed physicians — faculty members at the school — who came with us on every trip. When you do humanitarian work, the feeling and experience stays with you, so I knew immediately that once I became a licensed physician, I would go back to not only serve the communities abroad that are less fortunate, but also to help educate the next generation of physicians. It had a great impact on me as a student, and I wanted to pay that forward. 

What other team members traveled with you on this year’s trip? What kind of equipment is available? 

The trip is typically comprised of about 20-25 medical students and 5-7 faculty members or licensed physicians that go to precept. Organizations donate medications to us, so we’re able to bring approximately 20-25 suitcases full of these medications (e.g., antibiotics, antiparasitics, blood pressure medications, and diabetes medications) to treat a wide variety of medical conditions, including chronic conditions, skin disorders, and infectious diseases. 

This year I also had the opportunity to bring two portable ultrasound machines, which allowed me to perform bedside echocardiography. This was not only beneficial to the communities there, but also helped with teaching purposes for the medical students.

What dates were you there this year, and how long were you there for? 

This was my second trip going as a licensed physician to precept medical students. The trips are typically one week in duration. On this trip, I was there from October 6-13, 2018.  

Do you travel to various different locations in the Dominican Republic as part of the medical mission?

Our efforts are vetted through the Secretary of Public Health and Social Assistance of the Dominican Republic. Once we land in the Dominican Republic, we are centralized in the community of Verón. From there, we take a charter bus every morning with our medical students and supplies (e.g., examination tables, diagnostic equipment, medications, etc.) to different villages in the surrounding area, within a 50- to 75-mile radius. Since our outreach program has been providing care in that region for over a decade, the locals advertise our expected arrival. Surprisingly, we often get patients who come back to see us again! So although we’re localized in one central area, we do have a broad reach. For the patients who need greater diagnostic workup as part of their care, or for example, they have a chronic disease that needs more attention or follow-up, we have a free clinic that is fully staffed year round by both local and U.S. physicians. This clinic also provides immunizations, pre-natal care, and emergency services. 

What types of cases did you perform during this trip? 

The general trend of these trips is primary care, so we treat a lot of skin disorders and infectious diseases such as tapeworms, pinworms, scabies, and rashes. However, we do have an abundance of patients with chronic diseases. This year, because of the echo machines on hand, I was able to screen patients for various cardiomyopathies. We discovered a handful of patients with cardiomyopathies, acquired valvular diseases, and uncorrected congenital cardiac abnormalities. The most notable cases were unrepaired Tetralogy of Fallot and Ebstein’s anomaly. We also had a few cases of hypertrophic obstructive cardiomyopathy (HOCM) in a patients with a family history of sudden cardiac death but unfortunately no access to care. So alongside primary care, this year I was also able to focus on cardiac diseases for the purpose of diagnosis, treatment, and referral to our clinic for further workup, as well as for the education of the students. 

What would you say were the biggest challenges during this mission?

I think the biggest challenge there is the ability for people to have continuity of care. When doing a one-week or one-month medical mission trip, you catch diseases in a moment in time. Perhaps you can prescribe a one-month therapy for that disease and treat it for a short time, but if there is a lack of follow-up from the patient’s perspective due to finances or lack of transportation to the free clinic, you cannot provide continued care. Another challenge to care on a day-to-day basis while we’re on the trip is the language barrier. Thankfully, an international school there has English-speaking high school students who are interested in assisting with interpretation. Therefore, every morning we pick up anywhere from 5-10 student volunteers to come with us. However, when you’re seeing 120 patients a day in a matter of 6-8 hours, a language barrier can certainly make it more difficult despite excellent interpreters.  

What have been some of your more memorable patients?

I think the most memorable case was one of the patients with hypertrophic obstructive cardiomyopathy that I mentioned earlier. This was a gentleman with 2 or 3 first-degree relatives in the family with a presumed diagnosis of HOCM, as they had unfortunately passed from sudden cardiac death. He has survived into his 50s without an ICD, but has had multiple syncopal episodes. He very casually walked into our makeshift clinic and said, “I’ve been told I have a thick heart.” A thorough physical exam and history from him painted a clear picture of his condition. His echo demonstrated an elevated gradient, dynamic left ventricular outflow tract obstruction, and systolic anterior motion of his mitral valve leaflets. He had a classic case of HOCM, and at the age of 50, had already lost several family members to this. Unfortunately, because of limited access to care, the chance of him receiving an ICD and having it implanted without complication in a developing nation was slim to none. It’s fortunate that we were able to make the diagnosis, and we referred him to our free clinic for follow-up so he could get refills of his beta-blocker; however, we didn’t have the ability, because of a lack of resources, to change the natural history of his disease. 

In a sense, the mission trips illustrate what medicine was like decades ago when a diagnosis could be made, but there was no treatment available for it. Now, we live in a world where we can actually affect the natural history of diseases — we can provide a treatment or perform surgery to change a disease process for the better. Therefore, seeing this gentleman but not being able to change the natural history of his disease, and knowing that at any moment he could have another episode or even sudden cardiac death, was frustrating and saddening. We are trained in America to do what’s best for the patient and try our best to save every life. So for me, it was difficult walking away from a case knowing that if it wasn’t for his financial and geographic circumstances, I could have impacted his life. 

What would you say to others who are considering getting involved in medical missions?

Throughout everyday clinical work, whether it is in training or in practice, we’re all very busy and oftentimes lose sight of the real reason why we went into this profession. We’re dealing with documentation and billing, and busy clinical schedules, so I think sometimes we need something like this to remove us from the outside forces impacting our outlook on our profession. Experiencing a reset like this allows one to appreciate their profession, and realize they’re making an impact. There are people in other corners of the world who are not able to benefit from the research and developments that we’ve had in the last 50-100 years in healthcare in developed nations, and we take that for granted in our daily practice. It’s also beneficial for the medical students on these trips. If it wasn’t for my professors who took time out of their day to teach me and go on that medical mission trip when I was a medical student, I wouldn’t be where I am. So it’s important to pay it forward to the next generation, because one day those students will become the doctors who will take care of my family and I. It’s also important for the advancement of science and for the progression of medicine.   

Will there be another medical mission trip in 2019? 

For these medical mission trips, I use personal vacation time. In residency and fellowship, we have no more than 3 weeks of vacation time. So this trip was made possible by taking one week of my vacation time. If I was able to, I would love to go more frequently, but at this time while I’m in training, I unfortunately can only afford to go once a year. Once I advance into my full-time profession in the future, depending on my circumstances, I will go on medical missions at least twice a year with each class of students to be able to impact their medical education.   

Your YouTube video about your recent trip was very well made. What interested you about starting a YouTube channel? 

I’ve always had an interest in creating things that other people can use or benefit from. In high school, I would make short videos and really got into storytelling through cinematography. However, when I went into medical school and residency, I became very busy, so filmmaking fell to the wayside. When I started fellowship, I thought why not combine my skills in videomaking with my interest in paying it forward, and start a YouTube channel where I can share my experience about medical training and practice. I was becoming tired of listening to colleagues complain all the time about how much they disliked what they were doing, and if they were to start anew, they wouldn’t choose medicine. Perhaps this is a coping method that we have, but I think it is really discouraging to young people who are considering going into medicine. So I created this channel because I wanted to unveil the silver lining that is often missed in the profession of healthcare. On a day-to-day basis, it’s easy to lose sight of why we chose this field and the benefits we’re bringing to people’s lives. Through this channel, I hope to show how through a career in medicine, you can still do all the things that you love. So that was the reason why I made the channel — for inspiration, motivation, and guidance to those who are interested in going into medicine. 

Is there anything else you’d like to add?

I appreciate you giving me the opportunity to share my story and experience. I think the world can never have enough humanitarians, and no matter how much we contribute, there is always more work to be done. Although it may seem like the impact we’re making is very little, we are sometimes the only healthcare contact that the people of impoverished communities have had in their entire lives. So for anyone who is considering going on such trips, please know you are definitely making a big impact. ν

For more information, please contact @officialdrk12 or visit: youtube.com/c/drk12