Archive for June 22, 2013

Home from “The Holler” and Other Thoughts

This last post will come without photos and quotes, because our work in WV has ended. The administrators of Cabin Creek Health Systems (CCHS), saw our presentation and possible recommendations for our Quality Improvement project. Unfortunately, we couldn’t provide them with 3 bullet points on how to reduce hospital admissions for their patients with chronic illnesses. What will happen is probably better than rolling out prepackaged solutions.

Amber Crist, the Director of Education and Program Development has created and accepted the challenge of following up with 9 of the patients we were able to interview. Each patient’s provider will have the chance to do a home visit and get a more in depth understanding of their patient’s environment and social setting. This can help tailor the care plans needed to provide optimal health outcomes for patients at high risk for being re-hospitalized for primary care managed conditions. (Whew! That’s a mouthfull)

The coal miner we interviewed, will hopefully be able to get all the benefits he needs to cover his medical expenses. CCHS will also be getting a lung rehab center that will help ease the burden of COPD and other obstructive/restrictive pulmonary diseases for patients.

Ted Koppel, the famous British American news anchor, will be funding this project with CCHS. He will be reading my previous blog post, and watching the presentation Zane and the rest of the group worked relentlessly on this past week. We’re hoping the video serves as a tool to help spark a move to treat patients in a holistic approach, which will improve health outcomes for the community. This is just the beginning of bigger things for Cabin Creek Health Systems.

I’m excited to see what CCHS does in years to come. We were humbled. Learned lots….experienced great times in “The Holler”.

Thanks for reading, skimming, and browsing!

Ashleigh E. Heath, MPH
ABSN/MSN Candidate 2013/2014

 

We’re on island time now…

We have been busy since Christina’s last update.  The group has been at the East End Medical Center- collecting ambulatory care surveys, observing through put, creating educational materials, organizing charts, and shadowing providers.  Everyone has pitched in to get our quality improvement data in and we are now working on the results and projects that we will present to the Leadership team at the health center.  We are also preparing to assist with a health screening this week!

Mackenzie helps organize and pull charts.

Mackenzie helps organize and pull charts.

Mary Macon helps organize and pull charts.

Mary Macon helps organize and pull charts.

Annie and Kelly work on a bulletin board- just one of our many educational projects for this trip.

Annie and Kelly work on a bulletin board- just one of our many educational projects for this trip.

We have interviewed and surveyed locals here in St. Thomas for our quality improvement projects.  However, we have also had the opportunity to talk with some providers to get more information about what it means to provide health care to St. Thomians.  Tuesday, we had the opportunity to meet with the Dr. Hughes, the Radiation Oncologist here on the island.  He and his physicist, Damien explained not only what they do but why they choose to do it here.  Hearing these men speak gave new meaning to what we want to accomplish here.  The medicine that they practice is awe-inspiring, but their reasons are what motivates me to follow my passion for patient care.

Entering the treatment area.

Entering the treatment area.

Damien explains how the radiation is delivered.

Damien explains how the radiation is delivered.

One final picture of our group with Dr. Hughes and Damien.

One final picture of our group with Dr. Hughes and Damien.

Community Immersion

Over the past several days, we have been working on our evaluation project and have been interviewing leaders in the community and hospital about the vision they have for improving maternal care.

We have finished our interviews and are now compiling our data.

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Over the weekend we had the chance to go to beach! Quite a few of us got some pretty bad sunburns 🙁 but the beach was absolutely beautiful!

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On Monday after we got back from the beach, we had the opportunity to accompany community leaders on home visits. During these home visits, we were able to observe the living situations of those living in the city and see some of the health problems within the communities. We talked with the patients about their health and answered some of their questions. One visit in particular that stuck out to me was a visit with a 23 year old lady that was 4 months pregnant with her first child. Her baby hadn’t moved for over a day and when we started to talk to her, she told us that she fasts 4 days a week including fasting from water. We talked to her for about 40 minutes to emphasize the necessity of food and water for her baby. These visits enabled us to think on our feet, especially how to address these health problems in low resource areas.

 

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Embracing Eleuthera

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Walking back from the picnic tables at the library (good wifi, scary bees nest) Elisabeth and I took the long way home. We headed down Lord Street waving at patients we had met last week, hanging laundry and preparing supper.  As we headed to the waterfront we passed Tarpum Bay Primary and a group of boys playing basketball.  We hooked a left onto Bay Street, passing conch salad stands closing for the night. Separating the road and the Caribbean is a cement wall with a few wooden staircases leading to the sand.  Recent storms left high waters and today the steps took us directly into the ocean. We took a quick dip and looked back on the past few days…
 
Friday was bitter sweet as we said good by to our week one clinic spots. After 5 days we felt competent screening patients, answering phones, filing, filling prescriptions, and communicating with the nurses, physicians, and locals. Earlier that morning Rock Sound Airport had a flag raising ceremony commencing the start of a 40 day celebration for the upcoming 40th anniversary of Bahamian independence. Why am I mentioning this you may ask?  Patrice and I walked into our clinic with a packed waiting room and no clinic staff. 
 
We jumped in and started the patient log, pulled files, and began screening. Filling out either a “general encounter” or “child health encounter”, Patty and I took turns taking blood pressures, recording medication histories, and establishing chief complaints. Did I mention it was wound day? We assisted Dr. Smith in draining an axillary abscess, suturing a leg wound, redressing a gangrene toe from a diabetic patient, and assessing an ocular puncture wound.  Patrice and I were moved by Dr. Smith’s empathy and tireless work ethic. He knows his patients beyond their acute or chronic conditions and provides compassionate, holistic care. He also provided us with numerous educational moments, calling us in to hear a murmur, or see an ear infection through the otoscope. We feel so fortunate to have had such a dynamic clinical experience. 
 
Friday night we headed North (or down the island as Eleutheran’s say–South is up island–we learned this the hard way) for the fish fry. We dug into the food–actually dug, with our hands (sorry Patty I had to put a picture in). We watched a man prepare fresh conch salad and participated in some fish fry festivities. Not to toot our own horn, but Emory really delivered-Joanna won second place at the limbo contest and went head to head with Jasmine in a dance off, having already out danced the other fish friers.
 
Saturday Robyn took us on a tour to preachers cave where British settlers first discovered the Bahamas after a ship wreck. On the way home we stopped by glass window bridge where the Atlantic meets the Caribbean. We also made a stop at the Governor’s Harbour library where the first annual youth art show was displayed. There was a band on the porch of the historic building playing what we’re fairly sure was “brick house” (Commodores).
 
On Sunday we attended a lengthy Methodist Father’s Day service at the church below our house. It began with a “welcome” time to meet and greet the congregation. As I reached out to shake the hand of Alia, a 7 year old girl who later read a poem, she bypassed my hand and leaned in for a full hug. We’re so thankful and appreciative of the warm welcome Eleuthera has given us.
 
Today was the first day at our new clinic spots and we all seemed to have a packed day. Patrice and I both removed sutures (two different wounds, two different fights), and provided diabetic education. The nurses at Hatchet Bay are encouraging and make sure to include us in every educational moment.
 
Meanwhile as we experience new clinic sights and gather feedback from the nurses, we’re pulling together some exciting quality improvement initiatives. While it’s hard to imagine coming home, I am beginning to developing heat rash in some unfortunate places…
I’ll leave you with as many pictures as this bandwidth will allow me. Much to my chagrin there is some documentation of my mosquito bites etc, I’ll spare you those. 
 
Warm regards, 
 
Elise  
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A Coal Miner’s Story: From Weak to Running

My time in West Virginia has been a defining moment in my life. I knew nothing of the “Hollers” where residents of Cabin Creek live. It is a very different part of the country that is most likely invisible to the rest of the United States unless you have “kin” from the area. This all changed when I saw the lyrics to the old song “Sixteen tons”.

Scrip was used up until the 60s. This was the main form of currency in parts of WV. The company stores didn't accept US dollars.

Scrip was used up until the 60s. This was the main form of currency in parts of WV. The company stores didn’t accept US dollars.

“…I owe my soul to the company store” is posted on a museum. I’d heard this song as a child, sang the lyrics, yet never knew what it meant . The impact that the coal industry has had on West Virginia and other coal mining states is a part of US history that I didn’t appreciate until now. The company stores only accepted currency from certain coal companies. They owned the homes and land of all coal miners, and could take everything once you couldn’t work anymore. In a sense, their souls were “owned by the company store”.

Thousands used the coal industry to make a living, while sacrificing their lives and lungs to support our mostly excessive needs for energy. Black Lung Disease alone has caused severe morbidity and mortality for coal miners to the point that there are special health plans for those with the disease.

Some clinics were initially established to support coal miners.

Some clinics were initially established to support coal miners.

Zane and I listened to the story of a disabled coal miner. He has COPD related to Black Lung Disease. When he came into the clinic, we weren’t sure that he would even be able to walk back to the room where we could listen to his story. “Weak”, “feeble”, “worthless”….some of the words that came from his mouth as he described his current state of health.

Surprisingly, he loved his work in the coal mines. He felt free, and loved the camaraderie he had with the other men. He was joyful describing some of the tasks he’d done over the years, but had to quit because of the dust. “It was everywhere, and so thick that you couldn’t see the man right in front of you”. It was a dangerous job, but he was able to provide for his family.

Since being put on disability, he hasn’t been able to get an adequate pension from the union. He has a strong support system, but was brought to tears because he saw himself as a burden. He’s had 8 hospitalizations over the past year due to exacerbations of COPD.

At the beginning of the session, he was was struggling to breathe, but what happened at the conclusion of his story left a deep impression on my heart.

He thanked Zane and I for listening to him. “It feels like a weight has been lifted from my chest. Sometimes it’s nice to talk to someone besides close family and friends. I feel like I could run around this room!”.

Holding back the tears, I thanked him for his time, and for sharing some of the barriers he’d had in his life. He left the room with his head and chest held high.

Neither Zane or I provided our coal miner any medications, didn’t make a care plan with complex nursing diagnoses. We just listened. He felt better leaving than when he came, and this defines what nursing can be for the populations we serve.

Jeff, Rachel, Zane and I have more oral histories this afternoon and hope to glean useful information for the providers of Cabin Creek Health System. We want them to hear some of the barriers their patients have for chronic disease maintenance and staying out of the hospital.

Thanks for reading!

Ashleigh @AshEliseMPH #RuralHealth

St. Thomas: Photo recap of our first week!

 

Greetings from beautiful St. Thomas! Where do I even begin? We have so much to share from the past 7 days, so we decided to do a photo blog so you could experience it with us!

As Holly mentioned in her previous post, the eight of us were split up for the first week (1/2 with Dr. Barzey, 1/2 at the FQHC). The lovely staff at the FQHC welcomed us with a sweet sign 🙂 Annie, Rachel, Eyelle, and Kelly have been working hard to distribute ambulatory care surveys, creating educational materials for patients, shadowing the providers, and making the health center more patient friendly.

Rachel, Eyelle, Annie  & Kelly at the FQHC

Rachel, Eyelle, Annie & Kelly at the FQHC

The other group worked with Dr. Barzey (the only endocrinologist on the island)  to create a comprehensive booklet on diabetes education that she can give to her patients. We also had the chance to go out into the community and survey the locals about their nutrition and exercise choices.

Mackenzie, Christina, Mary Macon, & Holly getting some cultural education from Dr. Barzey

Mackenzie, Christina, Mary Macon, & Holly getting some cultural education from Dr. Barzey

Speaking of food choices, the most popular fruit on the island are mangos! They are sold on almost every street corner, and are some of the most delicious mangos we have ever tasted!

A local fruit stand in downtown St. Thomas

A local fruit stand in downtown St. Thomas

If you don’t believe me, ask Eyelle!

Eyelle enjoying a mango!

Eyelle enjoying a mango!

Both groups worked dilligently all week to meet their goals and deadlines. We have learned so much about the culture here on the island. It is amazing how differently islanders live, and how much they appreciate the small things that we often take for granted.

The most frequent mode of transportation on the island: The "Safari" serves as a taxi to the locals. Usually less than $5 per ride!

The most frequent mode of transportation on the island: The “Safari” serves as a taxi to the locals. Usually less than $5 per ride, and can fit up to 18 people!

At the end of a long week, Dr. Wright invited us to have dinner at her and her husband’s beautiful ocean side home in St. Thomas.

The girls with Dr. Wright and her husband Chip.

The girls with Dr. Wright and her husband Chip.

Did we mention the view from Dr. Wright's front deck? (#nofilter)

Did we mention the view from Dr. Wright’s front deck? (#nofilter) p.s. that is St. John in the distance

Before we knew it, the weekend was here! We took a ferry (only $6, 10 mins) to the gorgeous island of St. John to enjoy our weekend off! Here are some pics of our trip:

St. John

Welcome to St. John!

The girls enjoying the view of Trunk Bay- one of the beautiful beaches in St. John

The girls enjoying the view of Trunk Bay- one of the beautiful beaches in St. John

A traditional dish of the island: curry chicken, yellow rice, boiled sweet potatoes, and veggies

A traditional dish of the island: curry chicken, yellow rice, boiled sweet potatoes, and veggies

The girls showing off their “Caribbean Hook Bracelets”

"Caribbean Hook Bracelets have been worn for centuries by islanders in the Caribbean, serves as "island time" to be a popular symbol of unity and love. The open end of the hook pointed up toward the heart means your love is take, the open end of the hook worn down away from the heart, means your love is free (unattached or single)"

“Caribbean Hook Bracelets have been worn for centuries by islanders in the Caribbean, serves as “island time” to be a popular symbol of unity and love. The open end of the hook pointed up toward the heart means your love is take, the open end of the hook worn down away from the heart, means your love is free (unattached or single)”

 

We had an amazing time in St. John and were sad to leave 🙁 But also excited to start another week, and this time, all eight of us were reunited at the FQHC!

Annie pausing for a smile while preparing her ambulatory care surveys!

Annie pausing for a smile while preparing her ambulatory care surveys!

Mackenzie and Christina going over some important details for their clinical day

Mackenzie and Christina going over some important details for their clinical day

Rachel and Dr. Wright at the FQHC

Rachel and Dr. Wright at the FQHC

We’ve had an incredible week so far here in the Virgin Islands, and look forward to this week’s adventures!

Nursing love,

Christina

 

 

 

 

 

Collecting Patient Histories: Culturally Sensitive Interviewing

The conclusion of our last post found us busy scheduling interviews with patients in hopes of further understanding – from a culturally sensitive perspective – what barriers exist to our patients’ care.  Since then, after dividing up into teams of two, we have efficiently covered multiple counties in a relatively short amount of time and have collected several stories.

Purposefully, the technique of interviewing introduces neither scripted questioning nor new information, so that the stories gathered remain genuine and unbiased.  The beauty of this process is that the story of the patient interviewed is revealed, layer by layer.  The amount of suffering we have encountered has been tremendous, but it does not eclipse the equally surprising character and resilience of these West Virginians.cheap inflatable water slides for sale

A swinging suspension bridge crossing the river on the way to meet up with a patient and hear their story

A swinging suspension bridge crossing the river on the way to meet up with a patient and hear their story

Each day we continue to attend multiple clinics, shadowing our preceptors in an attempt to understand primary care at its core.  The pace varies, but one student seeing eight patients in the span of two hours is not uncommon for a Mondaychong qi you yong chi.

QUALITY IMPROVEMENT PROJECT STATUS:  At this time, objective data analysis continues but is now (fortunately!) accompanied by a more human dimension as common, underlying themes are teased out of patient stories.  We will report on findings soon as our presentation (presently underway) takes shape, so visit us often! ~ Jeff Lance

A common site in coal country, closed "Company Stores" once required miners to use their earnings - script - to purchase items as they were not paid in US currency

A common site in coal country, closed “Company Stores” once required miners to use their earnings – script – to purchase items as they were not paid in US currency

A Birth in Dominican Republic!

Christina Cummings and I had the opportunity to be in clinical at the hospital on Thursday under the guidance of two midwives from the University of Massachusetts. As mentioned in a previous post, there are multiple women in each room. We started out the clinical day in the post-partum room where we performed newborn assessments. Often, newborn assessments are not completed unless the newborn is in obvious distress. This can cause serious problems to be overlooked and not identified immediately. There were a few pre-nursing students that came with the midwives from the University of Massachusetts. Because Christina and I did newborn assessments in our maternity rotation, we were able to help teach the other students how to assess the babies.

After we did newborn assessments, we went into the room for women waiting for Caesareans. This provided Christina and me the opportunity to learn about antenatal care in an area of low resources. Unlike most places in the United States, electronic fetal monitoring does not occur. We were taught how to perform Leopold Maneuvers to figure out the position of the baby in the mother’s uterus. By doing Leopolds, we were able to estimate where the baby’s heart was and use a fetoscope to listen to the baby’s heart and take heart rate. It was so incredible to be able to hear the baby’s heart beat while still in utero, but it was even more amazing to watch the mother’s face when we let her listen. We were able to do this for a mother with twins also so it was informative to compare what the Leopold’s felt like for a multigestation pregnancy compared to just one baby.

From there, we moved into the early labor room. These women all were having vaginal births and were less than 7cm dilated. A few women were on Pitocin to augment the contractions to speed up the labor process but no pain medication was given. Christina and I provided labor support by fanning them to keep them cool, holding their hands, encouraging them to change positions, and rubbing their bellies during contractions. One lady had been there for several days and had not progressed in cervical dilation. Fear was etched across her face and she kept asking why the pitocin wasn’t working as she had been at 4-5cm for 8 hours. The doctors said that if she didn’t progress to 8cm by 3pm that day, they were going to section her. Therefore, food and water were withheld from the patient. However, this was not communicated to the patient and she was obviously frustrated and scared of what was going to happen to her. One of the midwives really advocated for this patient to have her pitocin turned up because there was really no need for a section. We found out the next day that the doctors listened to the midwife and once her pitocin was turned up, she delivered vaginally 3 hours later. This experience speaks volumes about the role of the nurse in patient advocacy. Because this midwife acted as the patient’s advocate, the patient was able to deliver in a way that was healthiest for both her as well as her baby and in the way that she wanted to.

While we were there, one of the other ladies broke her water and after a vaginal exam was performed to check how dilated she was (no privacy), she was taken into the closed off area of the maternity floor to deliver. Christina and I went with her and in less than half an hour later and after Christina excitedly yelled “Empuje, Empuje!” many times, she delivered a beautiful baby boy. Christina stayed with the mom as she delivered the placenta and I went with the pediatrician and the baby. The babies are not washed but are just dried with a towel. One of the practices that the DR doctors do is stick an NG tube down the baby’s trachea because they believe that it helps to suction the fluid out of the lungs. However, there is no evidence to this practice and actually can hurt the baby. No footprints were taken but weight and measurements were. After all of this was done, the pediatrician handed me a diaper, a baby cap, socks, onesie, and a blanket, and mittens for their hands. I dressed the baby, swaddled him in the blanket, and then gave him to his mother
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No words can describe the beauty of pregnancy. How incredible it is that two people can create another being that grows and develops inside of its mother. It fascinates me that the baby knows how and when to be born and the process by which it transitions from intrauterine life to life outside the uterus. Watching all of this unfold at clinical was breathtaking and it was beyond an honor to share in this moment with the mother and the baby, whom was named Jahle (spelling unknown). I felt undeserving of the privilege to dress the baby for the first time and to hand the baby to his mom and was unable to do so without beaming with tears in my eyes. Yes, birth is messy and laborous, but it is nothing short of absolutely miraculous.

Follow Us to the Islands

We’ve now been in Eleuthera for almost a week, but let us go back to last Saturday at 12:00 PM when our adventure truly began. Eight eager students, one extremely brave instructor, and over twenty suitcases met at the airport to board our flight down to Nassau. After an unknown mechanical glitch kept us on the edge of our seats for two hours, we deplaned only to reboard the plane a mere 600 seconds later. Not to stray from the luxurious norm of us ABSN’ers, we were met by a friendly Bahamian taxi driver who somehow managed to squeeze all 9 of us plus luggage into his lavish van (we will spare you the details, but be on the lookout for us in next month’s issue of Ripley’s Believe or not).
Luxurious Taxi
Although Constance booked us a room at a casino resort, we focused on celebrating Amanda’s birthday, soaking up as much AC as we could, and resting up for our 4 AM wake up call (who thought a 5:30 AM flight was a good idea? we’ll never know). A quick 45 minute flight later brought us to our final destination – the family island of Eleuthera. Our “home away from home” for the next 14 days.
Our Casa

After catching up on zzzzz’s, Monday morning arrived, and we hit the ground running. Students were paired and dropped at 4 different clinics across the island. Rock Sound and Tarpum Bay clinics in the south, and Governor’s Harbour and Hatchet Bay clinics in the north. These clinics have provided us with a snapshot of the people, culture, and the function of healthcare on the island.
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We have witnessed the nurse take on the role of doctor, pharmacist, social worker, secretary, psychiatrist, and friend to all who walk through her door. Here in these community clinics, incredibly personable care (always with a smile) is provided with fewer commodities than we are afforded in our skills lab. The nurse’s ingenuity and passion for her craft and native people mitigates for the lack of resources seen across the land. Throughout the past week, we’ve witnessed first-hand their desire to educate and motivate patients to tackle their non-communicable diseases such as hypertension and diabetes.

But we must mention, it is not all work.. Thursday we took a field trip to The Island School, which is a sustainable, eco-friendly, and research driven boarding school (for details refer here http://www.islandschool.org/). After learning all about permaculture, aquaponics, and marine conservation initiatives, we set out on a winding, unpaved road to Mrs. Rose’s for a delicious, family-style traditional Bahamian lunch. Mrs. Rose's House
Following lunch, we spent the afternoon swimming along the beautiful pink sand beaches on the Atlantic Ocean until a massive storm sent us running for home.Storm on the beach
We wrapped up the night with an evening filled with karaoke and fellowship with the Tarpum Bay locals (all footage of karaoke will be destroyed upon leaving the island.. sorry folks! But whether she claims it or not, Dr. Coburn can “sang” my friends).
Karaoke Night

So far we’ve met some of the nicest, cutest, and most grateful Bahamian people forever changing our perception on how to provide compassionate and competent patient care.
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Beaches in Nassau

Please stay tuned for updates as we continue our experience immersed in Bahamian culture.

Elisabeth and Jamar

 

So long for now,

Mary Chandler & Elisabeth

 

Dominican Republic Orientation

Before I begin writing about our experiences in Dominican Republic, I want to say that although I will try to capture the experiences of all of us in the group, what I write will inevitably be reflections of my own experience and my perceptions.
After a 3 hour plane ride and a 2 hour bus ride from Santo Domingo to San Francisco de Macoris, we arrived at the homes of our hosts Tuesday evening. Two students are staying at one home and the other 6 and the faculty leader is staying at another.

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The bus ride allowed us to see the country as we traveled from one of the two biggest cities in the country through mountainous rural areas into a different city. San Francisco de Macoris is the third largest city in the country. Motorcycles, taxis, “carditas”, and mopeds speed rapidly along the street and appear not to abide by any sort of traffic regulations. Traffic accidents, including those involving pedestrians, are common and a major reason for emergency admissions into the hospital. The city is noisy with dogs barking and the traffic and trash litters the street. We are able to walk to the hospital in about 25 minutes and receive far too many cat calls from the Dominican men.
Yesterday (Wednesday), all of us went to Hospital de San Vincente de Paul for an orientation. The hospital is at the end of a street off the main street. We met and spoke briefly with the hospital director as well as with the director of nursing. Much of what was said went over my head due to my inadequate Spanish and the Dominican accent. Those who are fluent in Spanish are having difficulty understanding at times due to the accent and different idioms. IMG_1163

 

We then went to see the Kangaroo Program that the hospital has. The Kangaroo Program was created to help premature babies with temperature regulation. Because babies, especially those born prematurely, are unable to regulate their temperature effectively, they can lose heat quickly. Thus, it is critical that babies are kept warm. In a lower resource area like Dominican Republic, isolettes are limited. Kangaroo care uses the heat of the mother’s body to warm the baby by keeping the baby skin to skin with the mother. In order for babies to be in the kangaroo program, they must be stable. In the United States, viability of a premature infant is about 23 weeks gestation. In the United States, viability is at 28 weeks. This reflects a great disparity in the technology and care between the United States and the Dominican Republic as the vast majority of the 28-weekers in the United States survive.

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After spending time seeing the Kangaroo Program, we went to the maternity floor. There are six different rooms that the women are in, with about 8 beds per room. There is no air conditioning in the rooms and the ceilings have water dripping from them.

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Once the women reach 4 cm in dilation, they are moved to Sala de Cinco, which is the room for active labor. Once they progress to 7cm, they are taken back to a delivery bed where they deliver.

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There is also a surgical room for caesarean sections. Something that struck me about maternal care was the fact that 50% of births in Hospital de San Vincente de Paul are elective C-sections and 90% of births in private hospitals are C-sections. Because C-sections carry more risks than a vaginal delivery, I am curious if maternal mortality would decrease if C-sections were performed more sparingly. The women receive no medication for labor pain and are often there for days or even weeks because they are admitted to the hospital under false diagnosis of “active labor.” I met a lady today who had been there for 2 weeks and still is yet to deliver. Approximately 1/3 of all births are to teenagers so there is a Sala de Adolescente (Adolescent Room). Once the babies are born, the mothers return to one of the 6 rooms on the floor and the babies stay in the room with the mom. They do not have beds for the babies so the babies are in the beds with the mom. There is a unit in which they put babies that need some extra care. In this unit, there are baby cribs and a few isolettes. It was incredibly simple compared to a NICU in the United States and personally reminded me more of the set up of the newborn equipment in a normal delivery room.
In addition to seeing the maternity floor, we were able to see a dialysis center that was completed donated by a famous Dominican baseball player whose name I do not know, and we walked through the pediatric floor and the ambulatory clinic (outpatient). The outpatient clinic has multiple specialties, but is not open all day every day like the OB/GYN and pediatrics floors are.

This tour allowed us to have a taste of what the healthcare system looks like in Dominican Republic as well as see the facilities and resources available before we begin our project.

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