A Global Identity Swerving through the crowded traffic of Santo Domingo, Haydee navigates her Land Cruiser with the aggressive poise necessary to make her own way in the Dominican Republic. Traveling up to the hemophilia camp in the neighboring mountains, I can already see her careful yet fearless driving as a mirror to her personality. She is the mother of a child with hemophilia in a country that was not equipped to treat such a rare condition. Through her relentless efforts utilizing international and local partnerships, she has helped plant the roots for an organization that helps save lives and guide those with hemophilia. My personal diagnosis with hemophilia brought me into their country to provide medical supplies and treatment. Through interacting with their community and culture on this trip, I would come to further cultivate my own identity. My vision to work across boarders in order to promote health and prosperity through my efforts as a doctor and global citizen would become clear.

Hemophilia is an X-linked genetic bleeding disorder affecting around 1 in 5,000 males. This results in missing clotting proteins factors VIII and IX for Hemophilia A and B, respectively. Without proper treatment the condition carries serious morbidities as internal bleeding deteriorates joints and can be fatal. Effective treatment in the form of intravenous IV infusions have become available, yet not all are fortunate enough to obtain the medication.

As a child with hemophilia, my identity started small: me in my own world. I just wanted to have fun, and the more I was warned not to do something because it was dangerous, the more likely I was to do it. There were emergency hospital visits for internal bleeds, broken bones and lacerations. Yet the medical system had me covered.

At 7 years of age I started attending annual weeklong camps for hemophiliacs in the mountains near Big Bear, CA. At first I didn’t want to go, but my parents bribed me with a new Nintendo. To my surprise I met awesome and capable people. Amidst all the fun activities I

learned how to self infuse while cultivating confidence, independence, responsibility, and even a sense of community.

Suddenly I started to see a broader perspective. I understood the connections between myself and with those around me. We were able to run around in the mountains having fun because every time we fell down we went into the infirmary to get an IV infusion. I also imagined the day when we wouldn’t need any infusions because we would have found a cure for hemophilia.

Appreciating what medicine had done for me, I decided to pursue a career in research and medicine to cure hemophilia. After graduating from UCSD, I moved to Vienna, Austria to help advance hemophilia treatment research. Working for 4 years as a Research Associate for Baxter BioScience, I was able to produce two publications into the Journal Blood. At the same time my entire vision of the world became much more expansive. I was ready to move my efforts out of the lab to work with the people I wanted to help directly.

Thus during summer vacation after my first year of Medical School at COMP, I found myself in the Dominican Republic finishing the swerving drive as we arrive at the hemophilia camp in the mountains. I was acutely aware of my position as a privileged outsider, even though I arrived with good intentions. I hoped to inspire the community with new possibilities and also help them receive better access to medication. I raised over $2,000 in a Learn to Surf Fundraiser to sponsor hemophiliacs attending camp, in addition to donating FVIII medicine.

People there are affected with joint disease and life threatening emergencies, as there is no system of health insurance to pay for adequate medication. I tried to motivate the campers and staff to continue their pursuit of accessing better medical treatment. I emphasized the importance of proper nutrition, moderate exercise, taking calculated risks, facing fears, stretching, listening to their

bodies, and employing RICE: rest, ice, compression, and elevation as soon as they notice any increased warmth, swelling, or pain in joints or muscles.

This camp is the central annual activity that ensures everyone meets. Hematologists, hearing doctors, dentists, and barbers made visits. The boys receive needed infusions. This makes it an important four-day health clinic; at the same time, the camp retains its fun spirit.

We played soccer and pool volleyball, laughed and sweated; deep down we were all the same. I gained from these people an appreciation for what I have, and an inspiration of what can be achieved through community outreach, vision and hard work.

After the five-day camp, I spent time at the children’s hospital in Santo Domingo. There I met a 2-year-old boy with hemophilia who was being treated with an IV of antibiotics and factor simultaneously- FVIII medicine that I brought with me. This boy didn’t realize it, but when he looked into my eyes and smiled, I saw so much joy and strength that I was overcome. Combined with his mother’s gratitude and hope, my heart melted. Here, I realized the marvel in being a doctor who takes the risk to travel across boarders.

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On the last day of the trip, we drove into the center of the country to visit a pair of brothers who are active members of the community. I saw they both have some ongoing joint issues in their knees, but

otherwise they have bright eyes and positive moods. Unlike many who have passed away, their life threatening conditions were brought to medical attention when Haydee’s foundation found them 15 years ago. Outreach and identification remains a major concern as many people worldwide go undiagnosed with this potentially fatal disease until it is too late. It is a testament to the outstanding efforts of an unusual community of motivated individuals and doctors that they could be cared for amidst a medical system with too many gaps. Meeting them there enthusiastic and radiant — ready to see a bright future ahead of them, I understood just how global my mission had become.

In the end, I found a true family in the Dominican Republic. Everyone welcomed me with open arms and open hearts. The brotherhood they displayed transcended all conditions into the spirit of humanity. I carry their warmth, kindness, and energy with me to this day. I discovered in this trip my calling to go beyond boarders and beyond expectations to be a doctor who not only cures disease in the office but also promotes health around the world. My connections with a genetic bleeding

disorder may have influenced my course, but it is the identity I have cultivated as a global citizen, which propels me forward.