Divide and Conquer!

On Thursday, we divided and we conquered.  Much was left to do in the two short days remaining.  Xanthia and I met with Nieves, who is employed by PATH and USAID in Washington, DC as the director of the Kangaroo Program for the entire DR (which for now means the Hospital de San Vicente de Paul..).  Finally, all of those implementing the Kangaroo Care program were able to sit down and discuss the challenges that the program faces.  To my relief, Nieves expressed the same concerns that we, the American partners, had expressed separately.  While there are major cultural barriers separating the paradigms from which we and the Dominicans are working, it was encouraging to see that these were far from insurmountable.

We scheduled a couple home visits of Kangaroo babies in a town just outside San Francisco, which Nieves directed.  The level of detail with which she interviewed and the type of information she collected was just what had been missing previously.  The collaborating doctors and nursing students were present ensuring everybody knew the expectations of these home visits.

Meanwhile, Cassie and Larkin were preparing a presentation to give to the current doulas of the hospital regarding education about unnecessary cesarean sections.  They delivered their presentation today, and it was magnificent.  Expecting an audience of about 10 people, they were surprised to walk into a room filled with about 100 doulas, hospital personnel and medical residents.  Even the bigwigs of the hospital attended heightening nerves.  Regardless, they presented research, recommendations and even a role-play beautifully—all in Spanish.

Before this presentation, though, April, Christie and Larkin were able to see the fruits of their labor.  They spent a lot of this week meeting with the nurses and community members that had carried out the pilot study in a town called Vista del Valle.  They analyzed the data and trained the nurses in data collection, analysis and presentation.  The study essentially looked at maternal and infant outcomes.  Interesting findings included that 75% of the women received C-sections, between the first and third prenatal visit most women had received their screening panel, and by one week post-partum only 27% of women were breastfeeding exclusively.  The women reported that they perceived that American women formula-fed, and, thus, it was better.

Christie has been working on a project for our ethics class on sustainability.  In particular, she has been interviewing people from all levels of the hospital about their lack of running water.  Private clinics and many houses, including the one we’re staying at, have plenty of running water, yet the hospital only receives running water for about an hour a day.  Each ward has a communal bathroom (well, most wards.  Some bathroom doors are locked and those patients have to go to a different ward to void—regardless of their condition).  In the shower is a large barrel that collects water for this one hour.  Patients bring their own small tub to collect water and bathe.  Personnel that are on call return home to shower, if they can, but many simply do not bathe.  As one nurse put it, what’s the point in donning sterile gloves, gowns and masks (when they’re available…) for surgery when your hands are filthy?  Great question.  She interviewed nurses, residents, Jenny, community members, the director of the hospital and the director of the province.  And each reported a different cause for the water shortage.  The issue merits an entirely separate document (and a 30 minute presentation, which we have to give in August…).

While the others presented, Xanthia and I finally had an opportunity to teach a few of the Dominicans working on the project how to use Epi Info, which is a free data collection and analysis program.  AND its free AND in Spanish!  As the appointed translator for the project, it was a challenge for me since I am computer illiterate in English, much less in Spanish.  With the patience of the Dominicans and especially Xanthia, and a good sense of humor we forged ahead.  This tool will be an excellent resource for them to have, and they expressed much gratitude for our help.

And with that, our work is essentially finished!

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