By Way of Santo Domingo
The Work Travels With You
Field Notes Series: The Soft Side
Entry #2 of 6
Disclaimer
Field Notes reflect the editorial analysis and personal reflection of the Managing Editor, informed by direct professional experience across Caribbean healthcare systems. These observations are the author’s own and do not represent the official positions of any government, institution, or commercial partner.
I did not speak Spanish.
This is not a small thing to admit about twenty months spent living and working in Santo Domingo. But it is the most honest place to begin — because everything the Dominican Republic taught me grew directly from the experience of being fully present somewhere that did not expect me, in a language I was still learning to inhabit.
The opportunity came in April 2011. Hospital General De La Plaza De La Salud — one of the Dominican Republic’s most prominent public-private institutions — needed someone to support the development of their international department and to work alongside their quality leadership in preparation for hospital accreditation. The role carried board-level access, under the leadership of Dr. Castanos, the Board President. It was a different scale, a different sector, and a different world from Antigua.
I said yes. Not because I was prepared. Because I wanted to stay in the region, and because I have always been drawn toward complexity, toward the places where solutions are most needed and where being different, or dealing with unknowns, is not a deterrent but a reason to show up.
Complexity is not a deterrent. It is a reason to show up.
Most Americans in Santo Domingo at that time — particularly white women — were there through NGO postings or government work. They lived in compounds or expatriate enclaves, insulated to varying degrees from the daily life of the city. I rented an apartment in Piantini. I took a taxi rigged with a propane tank for fuel. I went to work. I came home. I ordered food and measured my progress in Spanish by whether what arrived at the table was what I thought I had asked for.
Some days it was. Some days it was not. Both were instructive.
The streets of Santo Domingo in 2011 were still absorbing the aftermath of the earthquake that had struck Haiti’s capital in January 2010 — one of the most devastating natural disasters in the hemisphere’s modern history. Haitian men, women, and children were visible throughout the city, displaced and struggling, navigating a host country whose relationship with Haiti carries centuries of complexity. I passed them every day. I did not have the language to speak with most of them. I did not have the standing to do much beyond witness. But I witnessed. That too is a form of paying attention.
There were stares. There was, at times, visible confusion about why a gringa was here — not visiting, not passing through, but living in Piantini, taking the propane taxi, showing up at the hospital day after day.
I looked past the stares the way I had learned to look past uncertainty in Antigua: by going to work, staying present, and letting time do what time does when you remain.
Inside the hospital, there was a team that made the work possible.
Dra. Ortiz led the quality work — a physician executive who was kind, diligent, and precise. She already understood the task in front of her and already had the capability to execute it. What she needed was not direction but partnership: someone to stand alongside her and help implement the full complement of what a quality department could and should do to prepare the hospital for accreditation. I understood her immediately, and I believe she understood me. That mutual recognition — across language, across background — did not require fluency. It required the attentiveness the soft side demands: the ability to see what someone is already doing well, and to build from there.
For the HGPS International Department, Dr. Castanos made two defining appointments. Dr. Cambiaso was chosen to lead the clinical responsibilities — bringing the medical authority and credibility that international patient services requires. Dra. Acosta led the administrative side, providing the operational infrastructure without which clinical excellence cannot be consistently delivered. Together, they formed the foundation of what we were building.
What we were building, it turned out, was something the country had not had before.
The launch of HGPS International marked the first formal international patient department in the Dominican Republic. That is not a claim I make lightly. It was the result of sustained work by Dr. Castanos and the executive team, by Dra. Ortiz, Dr. Cambiaso, and Dra. Acosta, and by the clinical and administrative staff who built something real inside a structure that had not previously existed. I was part of that — honored to be part of it — and the work we did together planted seeds that have grown well beyond what any of us could see at the time. Medical tourism is today a priority for healthcare improvement and economic diversification across the Dominican Republic. Some of that lineage traces back to those twenty months in Piantini.
I am proud that HGPS International still exists today. What the team built was built to last.
Part of my role was to work with Dr. Castanos and the executive team to receive every U.S. hospital entering the region or maintaining a brand presence there — institutions seeking to build patient referral relationships with a Dominican partner. New York-Presbyterian. Cleveland Clinic. Baptist Health Miami. Johns Hopkins. Others. The most recognized names in American healthcare, coming to the table to discuss what the Dominican Republic’s health system and its population could offer their institutions.
At that table, representing HGPS, was me.
Each delegation asked the question in their own way — some direct, some with more diplomatic packaging — but the question was always essentially the same: where did you come from? The non-Spanish-speaking gringa on the other side of the table, in a hospital they had not anticipated finding at this level of readiness, making a case for a regional health system they had not expected to take seriously.
Those exchanges formed something in me that has not changed. The assumption embedded in the question — that capacity of this kind should not exist here, that patients requiring serious care should naturally flow northward — was one I sat with every time it was asked. And every time, the answer was the same: the region has capacity. It has always had capacity. Care, skill, and the movement of patients does not have to be outsourced to the United States. Sometimes it is necessary, due to acuity or patient preference. But not always. Not as a default. Not as an assumption.
That conviction is one of the foundations of why Caribbean Currents exists.
Care, skill, and the movement of patients does not have to default northward. The region has capacity. It has always had capacity.
My neighbor in Piantini introduced me to her sister Paula — a radiologist, and a woman who became one of the enduring friendships from the Caribbean region. Her family embraced me with a warmth I did not expect and have never forgotten. In one of our regular conversations, Paula said something I have carried with me across every country and every context since.
She said: if you welcome the world, the world will welcome you.
It was not advice, exactly. It was an observation about how she understood life — and perhaps, in the gentle way of people who know you well, an observation about how she saw me navigating mine. I had arrived in Santo Domingo not knowing the language, not knowing the city, not knowing a single person. I had stayed. I had shown up. I had let Piantini become home, and in doing so, I had been welcomed in ways I could not have engineered or anticipated.
Paula’s family was one of those ways. Fifteen years later, that friendship holds.
If you welcome the world, the world will welcome you. Fifteen years later, I am still learning the full meaning of that.
I have thought about those words in every place I have worked since. In the British Virgin Islands. In the USVI. In St. Kitts. In the Bahamas. In Montserrat. In Colombia. In every room where I was the outsider, the unexpected presence, the one who did not obviously belong. The instinct to welcome — to be genuinely open to a place and its people rather than managing the experience of being there — is not a personality trait. It is a practice. One that requires something. Gumption, perhaps, is the right word. The willingness to be uncomfortable, to be visible in your difference, to remain when remaining is not the easiest thing.
I have had to possess some gumption over the years. I know that. But there is not a day that goes by where I do not experience gratitude — for every place that welcomed me, for every person who made space for someone who was not a daughter of the soil. That gratitude is not passive. It is the energy behind the work. It is why the soft side matters so much to me: because I have been on the receiving end of the human systems that make an institution feel like a place where you belong, and I have been on the receiving end of their absence. I know the difference. I have tried, in every context since Antigua, to build toward the former.
Santo Domingo gave me that understanding in full. By way of a propane taxi, a food order, a hospital team, a neighbor’s sister, and eight words that have not left me since.
If you welcome the world, the world will welcome you.
About This Series
The Soft Side is a seven-part Field Notes series tracing seventeen years of health system work across the Caribbean — and the people, places, and lessons that shaped it. New parts publish each Sunday.
Coming next Sunday:
Part 3 — By Way of the British Virgin Islands: The Weight of Small
Nearly four years based in the BVI. The lesson of small states held close — that proximity is both resource and burden, and that health systems at this scale are fundamentally personal in ways that no policy framework captures.
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