Beyond language: Amistad expands Air Force psychologist’s clinical reach

The 12-year-old patient knew what a seizure felt like. What the patient did not know was how to stop the fear that another one was coming. When the patient’s heart began racing and breathing became difficult, fear of another seizure intensified into a panic attack severe enough to prompt a visit to the emergency room at Hospital Regional Dr. Luis Manuel Morillo King. The patient was referred to the hospital’s mental health team, where U.S. Air Force Maj. Milagros Gargurevich worked with the patient and family, teaching techniques they could use beyond the hospital walls. Gargurevich helped them understand the connection between anxiety and the body’s physical response and how to slow that cycle before fear took control. It was one patient in a clinical environment Gargurevich never expected to work in when she arrived for Amistad 2026. Gargurevich, 75th Medical Group clinical psychologist, came to the Dominican Republic as a Language Enabled Airman Program (LEAP) participant, expecting her Spanish-language skills to help bridge communication between U.S. and Dominican medical professionals. Then the psychologists at Morillo King learned their LEAP colleague was also a psychologist, and her role changed. She began working alongside the hospital’s mental health team, applying her clinical expertise to a population dramatically different from the one she normally treats. Morillo King has five psychologists supporting outpatient services, with two typically working each day, according to Dominican psychologist Katty Núñez. Their work extends beyond scheduled appointments to emergency cases and patients coping with serious medical conditions. They treat children, adolescents, adults and families and work with medical students who rotate through psychology. “There’s a lot for us to learn from them,” Gargurevich said. “They’re working with very little resources. Doing therapy is very different. They don’t have the same tools that we have, but they make it work.” For Núñez, who has worked at Morillo King for two years, Gargurevich quickly became more than a visiting language-enabled Airman. “I’ve learned many things from her,” Núñez said. “The way she evaluates the patients, how she conceptualizes them and the techniques she uses.” Gargurevich primarily treats active-duty service members at home. At Morillo King, a single day looked entirely different. There was the patient with epilepsy and panic attacks, a pregnant teen experiencing depression, a patient experiencing paranoia and a medical student rotating through psychology. “Many times when they first come, they don’t report much,” Gargurevich said of the medical students. “Then as they keep coming, they do, because they’re human too. And they’re under, it can be a really stressful career.” The broader patient population has also exposed Gargurevich to behavioral health needs intertwined with significant medical conditions. “I’m seeing some of the same things, but many of the things are not the same,” Gargurevich said. “They have more medical issues here, and the symptoms here tend to be higher too because they have less resources to treat them.” She has seen psychologists work with patients facing serious complications from chronic illnesses and support patients through difficult medical outcomes, integrating behavioral health directly into hospital care. “They’re more side-by-side with their doctors,” Gargurevich said. “I like that way.I feel like you get them super early to do it that way.” The variety of cases is also requiring Gargurevich to draw on parts of her clinical training she rarely uses with her normal patient population. “I can’t say when was the last time I did family therapy,” Gargurevich said. “It’s been years, but I’m trained on it.” Gargurevich is accustomed to a system with specialized providers, technology and multiple levels of behavioral health care. At Morillo King, she has seen providers manage higher-acuity patients with fewer options. Transportation and access barriers can also make referrals difficult for some patients. “I’ve never had to work with so little for such an acute level of problems,” she said. “In the States, we rely a lot on referrals. Here they don’t. Whoever you get, you really have to practice generalized training.” Those limitations require Gargurevich to determine which symptoms need to be addressed first and what she can realistically accomplish with the resources available. Even familiar techniques have required adaptation. At home, Gargurevich may use biofeedback equipment to help patients visualize their physiological response to stress. At Morillo King, she has had to find another way to accomplish the same clinical objective. “Some of the things that I know how to do, I’ve had to get creative and do it a different way,” Gargurevich said. “That’s how we’re having to function when we’re deployed because we don’t have all the things we’re used to in nice little offices with our couch.” For Núñez, the value of Gargurevich’s presence has not been measured by an increase in patients. The clinic did not see the influx initially anticipated. Instead, Núñez said the value has come from seeing Gargurevich work and observing the approaches she brings to patient care. Patients have accepted Gargurevich as part of the care team as well. Núñez said the Dominican psychologists intentionally introduce the U.S. clinicians as colleagues so patients understand they are working together rather than as separate teams. “We tell them they are our colleagues so they know we are working together,” Núñez said. “We are the same team.” Gargurevich will return home having treated a breadth of patients she rarely sees in her normal practice, drawn on clinical skills she had not used in years and adapted care when familiar resources were not available. “They’re very welcoming,” Gargurevich said. “I feel like when they said Amistad means friendship, they took that literally over here.” When asked whether the experience would make her a better psychologist, she did not hesitate. “Oh, 100%,” Gargurevich said. “It’s having to think outside the box.” Gargurevich came expecting Spanish-language skills to be her contribution. Instead, language put her in clinical situations she never expected, challenging her to become a more adaptable psychologist, prepared to provide care even when the patients, resources and environment look nothing like home.

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