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.
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.
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.
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.
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.
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.