I want to help my patients live happy, healthy lives

by Tyler Barreto

Standing under the Haitian summer sun, treating dehydrated babies, cholera-stricken adults, and malnourished children, I was thankful to be on my last patient for the day. It was the summer after my first year of medical school, and I was eagerly trying to apply what I had learned to help others. “Bonjour,” I said smiling and welcoming a 27-year old-woman who appeared tired and shy. She came closer, and I tried to hide my shock as I noticed the taut skin stretched over her protruding right clavicle. Through my translator I asked what happened, and the woman calmly replied, "earthquake." The earthquake was five months prior and her collarbone was permanently stuck in a position that looked uncomfortable at best. I used the little Creole my translator, Ketner, had taught me: How are you? What is your name? How can I help you? I waited for Ketner to tell me her response. “She wants to know if you can help her use her hands because she can't work, she can't help her family, she can't even take care of herself. Everyone is working trying to rebuild and she can't help, her existence creates more work.”

I put her through a series of maneuvers and finally concluded that there was a lesion in the ventral nerve root. I briefly thought, ‘I learned something in medical school that I am now seeing in real life! I could draw a picture of where she cut her spinal cord, and I know exactly which nerves control which muscles.’ Then I realized that I had no solution for this real woman’s problem. Ketner helped me explain that I could not do anything to return function to her hands, but that she is important. We talked to her about how she could help her family by watching and teaching the children. I gave her daily vitamins, and I told her, "I'm sorry." She thanked me. I must have looked stunned because she clarified that every other doctor she spoke with said there was nothing they could do, but I was the first to be sympathetic, to talk to her about the hardships of this reality, and help think of solutions.

My clinical experience in Haiti is one of many experiences that have solidified my passion in primary and preventive care where I can focus on helping people rather than ridding disease. I have demonstrated a dedication to primary care for many years. I received a grant to research health policy and work in a rural clinic in the Dominican Republic. I taught in Honduras and volunteered at a local health clinic for a year. As related above, I spent an emotional and career-strengthening week providing health care services in earthquake-ravaged Haiti before beginning my fellowship at Memorial Sloan Kettering where I researched disparities in the treatment of early stage lung cancer in the Latino population. I established a student-run free clinic as a response to the needs of the medically underserved in my community of Caguas, Puerto Rico. In the short time I have been in Grand Rapids, I have joined the Engaged Partners Project and I will become a mentor at the Hispanic Center. These experiences have enriched my understanding of issues concerning primary health care. I hope to encounter new experiences and challenges through The Integrated Medical School and Family Medicine Residency Program.

Even when confronted with a rigorous medical student workload, I make time to volunteer. While participating in various health fairs in Puerto Rico, I realized the need for more consistent access to basic care. I took the initiative to establish a student-run free clinic, which was scheduled to open November 5, 2011. The clinic would provide much needed primary and preventive care in my community. This project illustrates my focus on improving primary care for underserved populations and dedication to community outreach. Due to the temporary loss of LCME accreditation at San Juan Bautista School of Medicine (SJBSOM), the opening of this clinic has been postponed indefinitely. My determination has not waivered as I continue to communicate with students and administration at SJBSOM to help student leaders open the clinic after the final LCME decision in March. Fortunately, MSU CHM accepted me as a transfer student, and I have established myself in Grand Rapids where I am excited to find a project to benefit my new community.

My demonstrated passion towards primary care and community outreach draws me toward family medicine. Family medicine is a dynamic field with opportunities to impact patients in various stages of their lives. I enjoy obstetrics/gynecology, but I also want to follow the children as they grow. I like the fast pace of the emergency room, but I would long for continuity of care. As a family physician, I could spend time in an urgent care center while still maintaining a practice where I know my patients. I have fun with pediatrics, but I also want to treat adults. I enjoy the diagnostic games that often face an internist, and was excited to find the extent to which family medicine poses similar challenges. Family medicine is a perfect marriage of these interests, and allows me to explore intriguing subspecialties such as sports medicine and palliative care. However, my main interest in family medicine stems from an understanding of the value of preventative medicine. I want to help my patients live happy, healthy lives. I want to help them stop smoking, talk them through a family tragedy, and guide them in controlling diabetes.

In keeping with these goals, I would like my area of excellence to focus on community outreach and public health. I was shocked to recently read that 75 percent of Latinos in high school in Grand Rapids smoke cigarettes. In medical school we learn how to counsel on smoking cessation, and I would like to help take that training to those kids. Another issue I am interested in is childhood obesity. The rates of childhood obesity are much higher in people of lower socioeconomic status meaning that perhaps they lack access to healthy food, exercise, and nutritional education. I am interested in participating in the residents’ version of the FIT program and documenting the success of the program over my time as a student, resident, and future physician. I would like to find a productive way for medical students and residents to use their knowledge in smoking cessation and obesity to benefit our community.

Grand Rapids is the ideal geographic location for me as it is close to my family in Indiana. As my parents get older, it is comforting to know I am a short drive away if they need me. Having recently moved here from Puerto Rico, I am just now discovering all that Grand Rapids has to offer. I love the culture of volunteering here. I have always created my own volunteer experiences, and I have been excited to take advantage of all the opportunities already established here in Grand Rapids. While creating the student-run clinic in Puerto Rico, I stumbled over many administrative issues I had never realized existed. By recognizing those roadblocks and seeing the administration of successful clinics such as Clinica Santa Maria, the Wege Resident Clinic, and Catherine’s Care Center I will be well trained to provide health care to the underserved. I have enjoyed experiencing what this city has to offer thus far and would ideally stay here for much longer than the time I have left in medical school.

The GRMEP Family Medicine Residency is perfect for me. In addition to dedicated and knowledgeable attendings, GRMEP seems to truly listen to their residents to provide a quality learning experience. The curriculum of this residency is particularly geared towards my interests. For example, I look forward to the required month in community medicine when, according to the residents I have spoken to, they focused on the patient centered home, going on house visits to see underserved patients. Also, many of the residents have participated in an international elective. I am looking for a residency program that teaches me how to provide quality care despite low resources and that allows me to take what I have learned to an international experience where I can expand my cultural competence. I truly believe GRMEP Family Medicine Residency program will allow me to accomplish all these goals.

I have demonstrated a focus on primary care, proven myself academically, and am determined to reach my goals of becoming a bilingual, family physician. Both before and during my medical training, my decisions on where to focus my time and effort show that I am dedicated to providing primary care to those who can least afford it. My experiences have helped me grow and develop as a medical student and person. I am enjoying the opportunities in Grand Rapids, and I remain focused and motivated as I work toward my goal of becoming a family physician.