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Providing Care in Rural Puerto Rico

Jose Rodriguez MD
One of the greatest satisfactions from his work is the love and gratitude of his patients, who are often struggling to survive.
Providing Care in Rural Puerto Rico

As a young child in Puerto Rico, Jose O. Rodriguez Ramos, MD didn’t have much time to daydream; in addition to attending school, by the age of eight he had already started to work to assist his family financially. But he knew he wanted to be a doctor. Recently, Dr. Rodriguez recalled visiting the local Hospital de San Sebastian as a child, where he peeked through the windows to get a better sense of what went on inside. When needing care himself at the hospital at a young age, he enjoyed watching the dynamics and teamwork of the clinicians. Despite the economic struggles, Dr. Rodriguez fulfilled his dream, and now works as a doctor in a rural hospital in Puerto Rico that serves the local agricultural worker community. 

DISSATISFACTION WITH TREATMENT: EARLY EXPERIENCES IN MEDICINE

With community and family support, young Jose joined a high school program for disadvantaged students interested in medical school. While studying pre-med, he sometimes encountered inhumane treatment of patients in the emergency room where he was stationed, and he felt driven to change that environment in his own future practice. 

MCN RodriguezUpon completion of his undergraduate studies, he received a grant from the National Health Service Corps (NHSC) to study medicine at the University of Puerto Rico. After graduating with honors in family medicine, he completed his residency at the Hospital Family Alejandro Otero and Manatee Hospital in San Pablo Bayamon, both rural hospitals serving high numbers of agricultural workers. He found inspiration in working with low-income people with high levels of need. During his residency, he was exposed to the full range of health and wellness issues in the locals’ lives, from assisting in childbirth to attending the funeral of a patient. The residency was unforgettable for Dr. Rodriguez. There, he met his wife, Carmen; he buried his father; he got married; and his wife gave birth to their ​​first daughter, Mayra Alejandra. 

PHYSICIAN AT CASTAÑER GENERAL HOSPITAL

After completing his residency in 1990, he began work as a family physician at Castañer General Hospital, where he still currently works. The rural hospital serves a population of approximately 6,000 inhabitants, of which 80 percent are agricultural workers, many from the local industries of sugar cane, plantains, and coffee. The high number of agricultural worker patients keeps the hospital in line with its mission to serve economically disadvantaged populations, and the associated funding to serve those populations. He has received many awards for his clinical work. For six years, he has been the medical director of the hospital. Interested in issues affecting the community, and inspired by the work of Amy Liebman, the Director of Environmental and Occupational Health at MCN, Dr. Rodriguez began to implement an education program for migratory agricultural workers with attention toward protection from and prevention of pesticide poisoning, utilizing some of the program work on pesticide exposure developed by MCN. Dr. Rodriguez’s program helps agricultural workers learn how to prevent pesticide poisoning by simple measures such as leaving shoes outside and removing clothing before going home. Through this program, he began to visit and train agricultural workers at the local church, community center, and farms. The program is popular, because the owners of the farms receive a certificate, and participants receive a card that certifies they received education on the prevention of pesticide poisoning. This program has helped to significantly reduce exposure to pesticides. Agricultural workers are evaluated at least twice a year. 

STRUGGLES AND SUCCESSES IN MIGRANT HEALTH

Dr. Rodriguez’s pesticide exposure prevention program initially encountered opposition from farmers, who did not want agricultural workers to be trained during working hours. But even after farmers got on board, barriers to safety remain; because Puerto Rico’s pesticides are packaged for the US market, warning labels are typically only in English. Very few of the workers understand English, leading to the possibility of an increase in pesticide exposure incidents. 

One of the greatest satisfactions from his work is the love and gratitude of his patients, who are often struggling to survive. He points to the recent case of a farmer whose illness turned out to be caused by a toxin from ingesting snails -- an indication that the farmer’s food sources were not sufficient. These experiences have motivated him to continue working for agricultural workers, particularly in light of the lack of attention by some of his colleagues to the problems facing agricultural workers, he said. 

MCN RodriguezBeyond pesticide exposure prevention, Castañer General Hospital runs a number of projects to battle chronic disease. Dr. Rodriguez is proud that he and his faculty are participating currently in the management and prevention of diseases such as asthma, diabetes, and hypertension, and cancer prevention with their agricultural worker population. 

For Dr. Rodriguez, MCN has been an organization that has supported him in preventing problems, from pesticide exposure prevention, to training clinicians. For the future, Dr. Rodriguez hopes MCN can push for a physician exchange, wherein US doctors live and work in a rural Puerto Rican setting. Puerto Rican doctors, in turn, would spend time in US hospitals: “I wish MCN could also support [physicians] in an exchange of physicians from Puerto Rico, with US doctors, who work in rural areas.”

30 CLINICIANS MAKING A DIFFERENCE is a project celebrating Migrant Clinicians Network's 30th anniversary through the life stories of 30 clinicians making a difference in migrant health. Learn more about Migrant Clinicians Network.

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