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  1. #21
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    My students did a research project on mental health in the DR a few semesters ago. Coincidentally, I had Dr. Mustafa's* kid in my class that semester and we got some great insight - there are only about 300 psychiatrists in the DR. There is only 1 mental hosptial in the whole country and it receives almost ALL of the mental health budget from the ministry of health. Doctors receive 1 psych class at the PUCMM, sometimes 2 (elective credit). In other universities, even that one class is negligible.

    My experience with psychology students is that they mostly want to work with "tame crazies" (their words not mine) like the elderly or in schools with children. Or, they want to get masters degrees in organizational psych (human resources and such).

    *Mustafa is one very few psychiatrists in Santiago. He works in Corominas, and I'd recommend him to anyone looking for an MD. psych.

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  3. #22
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    Quote Originally Posted by Seamonkey View Post
    You did a great thing by talking to him CB...a great act of kindness. Good on you.
    Heroic considering the potential for serious personal injury.

  4. #23
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    Default Typical Saturday night in an ER

    Loved reading your take away from this guy who was definitely in crisis mode. What i don't agree with is your analysis of how this was handled. I'm an APRN - advanced practice RN with many years of ER experience. If this guy acted out in one of my ER's he would be handled in exactly the same way. Thankfully there were multiple security guys around the handle this situation but the majority of the hospitals I've worked at maybe had one or two security people on station at any time. The police would be called at the first instance of violence of any sort. He would have been overpowered "hopefully" and my guess if he resisted would be shot; otherwise be given an injection of valium or haldol while down and then in four point restraints put on a bed and monitored 24/7 until he stabilized and then sent for followup. Seems this is exactly what "they" did. Good thing the guy didn't get shot !!!!!

    Quote Originally Posted by cobraboy View Post
    (They are coming to take me away, ho ho, ha ha, he he..)

    Friday evening was quite an enlightening experience. I never thought I’d ever have to bump into the DR mental health system.

    Unfortunately, I have had a LOT of personal exposure to the GA mental health system, public and private, with a younger sister diagnoses as manic-depressed and paranoid-schizophrenic as an early teen. It has not been fun and takes special people to work in that field.

    Mom CB woke up Friday morning with such excruciating pain in a hip and leg she could not walk. We thought the dreaded Little Old Lady fractured hip or disintegrated hip socket could be at play even though no fall was involved. But at 91, who knows? Severe pain is severe pain.

    We know the folks at bomberos and at 8:30 am they dispatched an “ambulance” right away with two “EMTs” to take her to HOMS, her choice in a facility. It was a 45-minute ride with Alida in the ambulance to translate. In fairness to the EMT’s, they went about their job very professionally, got her on a stretcher, down the stairs and in the ambulance with minimum pain.

    We spent the next 12 hours in the freezing HOMS ER getting X-Rays, sonograms, anti-inflammatories and pain med infusions.

    At around 9 pm we were told Mom CB could check out as soon as the completion of her last pain infusion.

    Now I have spent a lot of time around major ER’s both personally and professionally. It’s not uncommon to hear some loud moaning, cries of angst or yelling for numerous reasons.

    When I was just about to begin the check out procedure, I hear a man yell something in the ER lobby. We were in the far back of the ER, about 100’ from the glass security doors. He yelled again, and I detected both anger…and English. So, I went outside the curtain…with a bunch of other civilians in the ER with family…and saw the source of the noise: an angry black man pounding the reception desk repeatedly, swearing and screaming.

    Yikes!

    He continued ranting, swinging his arm all around and I caught a few words “nobody listens, leave me alone, I have to make a call, leave me alone, don’t touch me, I’ll kill you!” It was clear there was a significant issue with this guy.

    I stuck my head into my Mom’s cubicle to let her know about the kerfuffle. When I looked out to the hall again, I saw a couple of guys…Security?...open the door and putting the guy into one of the hard-walled rooms. He was still yelling and screaming at the top of his lungs. He could not understand their Spanish, and none spoke English. Not a good combination in a serious confrontation with a clearly not-tightly-wound guy.

    So I went to where hospital employees were standing outside the door, afraid of getting too close to this guy, and asked if I could help because I spoke English. These folks pretty much pushed me into the room.

    What I saw: a nice-looking black guy, shaved bald, maybe 6’, at least 225, late 20’s/early 30’s, who has spent a LOT of time pushing steel in the gym. He reminded me somewhat of Evander Holyfield. This guy was built like a linebacker and in obviously great physical shape, very strong and muscular. It was clear why nobody wanted to mess with him. He wore a backpack, a grey T-shirt, jeans and sneakers. He was also trembling uncontrollably, and sweat was just pouring off his body, soaking his shirt and jeans, literally dripping onto the floor. He was sweating like an overweight lineman on the first morning of two-a-days ion FL.

    My first reaction was “Bad drugs? Ecstasy? PCP?”

    I said to him, “Hey, man, maybe I can help you.” He looked at me surprised a non-Dominican someone spoke to him in American English. “They keep messing with me, nobody listens…”

    I said “I’m listening, what can I do? What's up? What's the problem? Talk to me.”

    He said, “I’m suicidal, nobody listens, I need to make a phone call, I need a gun, [email protected]<k all this, I need to talk to them. I’ll kill these [email protected]<kers, they won’t leave me alone… I want to go to the public hospital. I came here to get a ride to the public hospital.”

    Actually, he was well-spoken.

    I asked, “Have you been drinking? Taken any drugs?”

    "I drink a little before and after.” I never understood what that meant.

    I asked, “You have a number? I’ll call.” “Yeah I have the number”, and he began repeating the digits. I told him I needed a pen and paper. I got it and wrote down the phone number that he knew by heart, a Suicide Crisis Hotline in San Diego. He’s sitting there trembling and sweating but calming down. I called…and got a recording “You’ve reached the blah blah blah Suicide Crisis Hotline. No one is here right now. If you are having a crisis call 911.” Well, that’s not gonna work. Besides: what suicide crisis hotline doesn’t have lines manned 24/7 during the holidays? Aren’t the holidays the most depressing time of year?

    I told him to sit tight, I’ll go get some help. He nodded.

    I went to the doctor’s station to see if they have any shrinks around. As I did, I heard a scuffle and the guy was back in the ER lobby, arms flailing but not hitting anyone. Still screaming, “I’ll mess you up!!! Leave me the [email protected]<k alone!!!” Then he went back into the ER and began throwing chair and tables all around, not at people, but at walls. He was totally losing it, and I was expecting to hear a gunshot at any moment. It was horrible.

    He went back to the lobby, but now at least 10 HOMS Security guys were there and collectively they brought him down in a serious struggle, I counted eight in the take-down, and got handcuffs on him. It was no easy task. Ever hear about guys pumped on adrenaline picking up cars? That was like this guy.

    So the guy is face down on the floor with his face in a puddle of sweat. He yells, “I want that American” (meaning me.)

    I got on the floor and told him he needed to really calm down because if the police get there and he’s still angry it was NOT going to end well, they’d shoot him. He said, “OK, OK, I’ll calm down. Can you help me? I need help. I’m having a depression episode. I came here to get a ride to the public hospital.” I assumed he meant a mental hospital. I told him to chill, it was going to be OK, I’ll go see if it can happen, 911 to the hospital is a lot better than the PN taking him to jail.

    The entire hospital staff and patients and family in the ER lobby were standing around, wide-eyed, not knowing what to do. I saw numerous cell phones out, so there may be video posted somewhere. The guy had 6 private security guys on top of him, pinning him to the floor, and they were obviously scared. The guy was, indeed, scary.

    So I got a reception guy to call 911. Somebody else had called the police. I kept telling the guy help was on the way, stay calm. I got someone to get him some water. This guy was literally on a pool of sweat. But he had calmed down.

    Meanwhile, Alida is calling relatives in medicine to get some help. One knew the head of psyche at HOMS, who called an English-speaking Orthopod at the hospital, who came to the ER. I explained what was going on and introduced him to the crazy guy, telling him I brought some serious help.

    Then we found out a couple of things: 1) 911 was not going to come because he was crazy, 2) There was no mental hospital in Santiago and 3) the public hospital didn’t want him. So that left the NP…who had arrived but weren’t getting too involved…yet.

    The doc asked me to see if he would promise to be calm if they sat him in a chair, and if he’d accept an injection to calm him down. He was very calm now, laying on the floor, and agreed. So I got the guys on top of him to remove their guns…I didn’t want the guy to go grabbing one, even handcuffed…and we got him up and sat him in a chair outside the ER. I sat next to him and chatted. He's from California. He had been in Santiago for two weeks. He had no hotel. He had no money. He had no airline ticket home. He came to the DR to get help for his depression (!!!! WTF???!!!). He was hanging with new “friends” who supposedly messed with him. At this point I got a vibe he may be ex-military by the way he used a respectful “sir” before and after every sentence, like “Sir, I have no money, Sir.”

    I didn’t want to get too deep in talking with the guy.

    The doc came out and wanted to speak with me. Seems he made some calls. He got the OK to pay whatever was necessary to get the guy to the public hospital. HOMS would pay the public hospital, a plane ticket home, and a visit by the local Embassy rep (the local asst. Consul?) because by agreement a foreigner who causes damage must be reported to the Embassy, although they would not report the damage as malicious or criminal (I did not know that. Any comments? Anybody have further insight?)

    The guy let us have his backpack and told us where his passport was. He had no wallet, although he said he came to the country with one. There wasn’t much in the backpack, not even a change of clothes. An empty coke can. An energy drink. A toothbrush. Some receots from stores. I found all this very odd.

    We got his passport and made a copy for hospital records.

    We helped him back into the ER where the doc administered tranquilizer by IV. They were not going to remove the handcuffs until he was completely calm…with drugs. He had been calm before and then exploded. No mas. Heavy artillery this time.

    Finally, I paid Mom CB’s bill (45-mile one-way ambulance trip, ER visit, X-rays, sonogram, and medications, total= US$215. Just wow.) and got her into the car. I went to check on my new friend and he was already gone, taken to the public hospital in a taxi with two security guys. I have no idea what his outcome is. I just assume the public hospital kept him zombied until he was out of the crisis zone, and somehow maybe the consul would get him back on an airplane out of the country, courtesy HOMS.

    It was quite an evening. The acting Hospital administrator thanked me today, not sure why, I just talked to a fellow American having a real problem. It was the security guys who subdued him, and the doc who put the pieces together.

    But the take-aways are this:

    1) The Dominican Republic has *zero* public mental health crisis system in place, at least that is what the docs at HOMS said. There is nothing in place to mitigate a human in dire angst, no professionals, psych’s on call, inpatient facility, not even two guys in white jackets with butterfly nets. Nada. There are private institutions, but even they, beyond the astronomical expense, don’t seem to have a way to deal with crises in the field. I find this amazing. I don’t expect First World intervention, but not even a tranquilizer dart and padded cell somewhere? (I joke, of course.) So a guy like this flips out…and I doubt it’s the first time for him…and there is nothing that can be done short of police brutality?

    2) As much as I respect HOMS, I am shocked a facility of that size and stature had no policies or procedures in place, not even a holding cell in the basement. One would think a prominent public/private healthcare facility would have some way to mitigate such an incident. They can do robotic and bariatric surgery, but nothing if a patient has a meltdown? Really? Did I think it strange that beyond subduing a man in the middle of a mental breakdown, they needed a patients’ family member to help resolve a tense situation?

    3) Dominicans love a good train wreck, even if they refuse to sort through the carnage. While the “action” moved around the various parts of the ER, you’d have thought it was the walking gallery for Tiger Woods at The Masters. It’s a cultural thing.

    4) I never want to deal with anything like this ever again.

  5. #24
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    Quote Originally Posted by karlheinz View Post
    Loved reading your take away from this guy who was definitely in crisis mode. What i don't agree with is your analysis of how this was handled. I'm an APRN - advanced practice RN with many years of ER experience. If this guy acted out in one of my ER's he would be handled in exactly the same way. Thankfully there were multiple security guys around the handle this situation but the majority of the hospitals I've worked at maybe had one or two security people on station at any time. The police would be called at the first instance of violence of any sort. He would have been overpowered "hopefully" and my guess if he resisted would be shot; otherwise be given an injection of valium or haldol while down and then in four point restraints put on a bed and monitored 24/7 until he stabilized and then sent for followup. Seems this is exactly what "they" did. Good thing the guy didn't get shot !!!!!
    They stuck a lone stranger, whose relationship to the hospital was: family of another patient, in a room with him unrestrained and let the stranger handle the situation. You guys do that everywhere?

  6. #25
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    Great Job CB! In the DR, and I know from experience because my sister is a nut case, they won't address the mental issues as such because of what people will say about the family. They don't care that the person needs help and can't control their behavior, just what are people going to think. Additionally, when the majority of politicians are robbing the treasury, where is the money coming from to implement mental health?

  7. #26
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    Quote Originally Posted by philosopher View Post
    The good news is that there are some doctors around that can help and more then enough medication if you can get it prescribed to help the people in need. Unfortunately in the campo, the first course of action is the brujo.
    Hell Phil, they call the brujo in NY, lol.

  8. #27
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    Good on you Robert,

    I have also helped tourists without Spanish language abilities in medical and police incidents.
    Usually people don't want to get involved.
    It is scary when one cannot communicate.

    Those of us living in the DR are not surprised about the lack of care.
    In the barrios we can see people with mental issues walking around without care, or they may be at home tied up.

    The "lucky" Dominicans have a medical plan and can go to Clínica Unión Médica or HOMS in Santiago, or similar hospitals in S.D.
    And even with a plan one needs extra money for payments.

    Imagine how Dominicans without medical plans and money fare.
    Public hospitals are scary.

    The other issue illustrates foreigners in the DR without funds, return ticket and support of friends.

  9. #28
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    Just read this, good on you man !!

    I hope that all is well with the patient and he is back home, safe and taken care off. Dominicans write off people with mental illness as Americans would have 25-30 years ago as crazy, demon possessed etc.

    When you look at our community as well as puerto ricans, other latinos blacks etc its amazing that there arent more people that suffer mental illness. Sexual abuse, most fathers not involved, those that are with major issues with addictions etc. Violence in our communities is terrible and gravely affects our youth.

    Thank god that this young man can go to the USA where he is guaranteed sustenance and has support.

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