Got up reeealll early to hop on the school bus to go on some home visits. We were going to make the three-hour trek to the province of Samana, which is a peninsula on the far eastern side of the island. The hospital San Vicente de Paul receives more pregnancy complications from this area than any other, so we were very interested to find out why this may be. We had four home visits scheduled, one of which was for a baby that had passed away. We packed PB&Js (a timely and welcome taste of home), and made our way out of San Francisco.
The first visit was in a remote town called Nahua. The further from San Francisco we travelled, the worse the driving conditions became. We swerved around paved roads with potholes big enough to engulf an entire moped. Eventually the paving discintigrated into a haggard dirt road that tossed the bus around like a rag doll. I started counting how many times we bottomed out, but lost track when I reached 20 in a 10-minute period. Figuring that the bus couldn’t possibly make the trek without something breaking, I found myself praying for a flat tire (as opposed to a broken axel).
We learned from the home visits in March that addresses are certainly less systematic here than in the US (“town of Nahua, main road, near the fruit stand, Number 5”—there may or may not even be house numbers). As we approached the town, we asked random people if they knew where the mother-who-had-given-birth-to-a-preterm infant lived. They would point us in the right direction until we reached another fork in the road, and we would ask again. At one point, a man atop a moped motioned us to follow him, and the big school bus trekked behind the tiny moped bouncing around in the potholes. In this way, we eventually found the little shack on the dirt road where the woman lived. We asked her questions about her gestational background, medical history and details about the birth of the premature child enrolled in the Kangaroo Program. We asked about the length and duration of her “kangarooing”, as well as about her education and the type home she lived in.
Meanwhile, others conducted a windshield survey (although it was on foot…) of the community and asked people questions about the population, resources, occupations, schools, churches, transportation, etc about the community to get a sense of where these women are coming from and the conditions to which they return when they are discharged from the hospital.
We also took anthropometric measurements of the now nine-month-old. From first glance, we could tell he was not developmentally appropriate, as he couldn’t lift his own head and was not babbling like normal nine-month-olds would. Without even looking at growth charts, it seems pretty likely that he hasn’t kept up physically, either. Apparently this baby was admitted to the NICU because he had repeated seizures after birth. His head circumference was greatly above normal, and he was diagnosed with hydrocephalus. Whereas in the US, rapid intervention including placement of a surgical shunt would have prevented long-term complications, this baby stayed in the NICU until his head shrunk a bit and he was sent home without much further intervention and probable permanent brain damage.
We then made our way to another town where we visited the public health clinic. The lobby looked like a train station with a gated counter where people reported their chief complaint and were given a number. Rows of chairs lined the rest of the room where patients waited patiently to see the doctor. A nurse there immediately recognized the Dominicans that were working with us. She kindly gave us a tour of the small facility, which included one ward for men, one for women and one for children. She brought us back to the delivery room, which held a medieval-looking bed where women gave birth. The operation room that regularly provided Cesarean sections looked more like a torture chamber.
The nurse answered all of our questions. The DR, like the US, has a severe nursing shortage and often only one nurse works the entire patient care area of the clinic. She, herself, is the only nurse qualified to attend surgery. This clinic, like the Hospital San Francisco de Macoris, lacks running water. But these patients are privileged with a shared bathroom in each ward, unlike those in San Francisco. We were supposed to meet with the father of a Kangaroo baby that had passed away, but couldn’t get in touch with him. We thanked the nurse for her time and hopped back on the bus.
Fully accustomed to the Dominican culture, Jenny made the executive decision that the beach in this part of the country is far too spectacular to miss. Sooo we stopped for a quick dip in the crystal blue ocean and an ice cream break.
The last home visit scheduled for the day was a woman whose infant had passed away. Upon asking where the woman-who-had-given-birth-to-a-preterm-infant lived, a gentleman took off on his moped and returned with the woman on the back. We expressed sympathy for her loss and asked if she would be willing to answer a few questions to help the hospital understand more about infant death and prevention. We would keep this one short.
She told us that her water broke at about 32 weeks (very few women actually know the gestational age). Because of work, she delayed visiting the doctor at the local clinic until the next day. There he explained that this flood of fluid is normal during pregnancy and that she had nothing to worry about. She remembered thinking that was strange since during her previous (successful) pregnancy, her water broke and she was in labor. Regardless, she trusted her doctor and returned home. Ten days later, she eventually made the three-hour trek to San Francisco where she delivered her baby. The baby spent four days in the NICU before he passed away.
The woman was told that women between the ages of 19 and 24 often have difficulty giving birth. At this, Rosa (a very vivacious woman), firmly told the woman that this is the age TO give birth. Apparently multiple doctors are disseminating this type of information.
Leaving on a solemn note, we boarded the bus to make the long trek home. Unbeknownst to us, there was a sale on shrimp in a random town on the way home. Before we knew it, we had stopped in a park and the Dominicans got off the bus to make their purchase. Expecting to pause for 10 minutes, we ended up waiting nearly an hour to continue on the journey. We didn’t get home until nearly 10pm making it quite a long day.