the case mix in Dominican public hospitals is something i want to describe specifically because it is not what people expect. you see advanced presentations of diseases that in the US get caught earlier because people have better access to primary care. late stage TB, decompensated heart failure in patients who have been managing symptoms at home for months, obstetric emergencies, pediatric malnutrition, dengue at every stage, parasitic infections, complications from poorly controlled diabetes. it sounds heavy and it is. but what it does to your clinical eye is significant. by the time i got to my US clerkship in internal medicine my differential thinking was genuinely broader than my co students and my attendings noticed it.