Celebrating with mom and baby after successful cesearan delivery
Celebrating with mom and baby after successful cesearan delivery

In January, I was given the amazing opportunity to go on a maternity nursing service trip in the Dominican Republic  for two and a half weeks.  It was a crazy adventure and I am so grateful I was able to have this experience.  If you would like to read my detailed trip journal please email me at erin.catarius@gmail.com.  The trip was organized through UMass Amherst and Asociación ADAMES.  I was traveling with five other nursing students who had just graduated from the UMass accelerated RN program, a pre-med student from Mount Holyoke, and a midwifery student from Bay State.

Public hospitals like the one I worked at in San Francisco de Macoris see the poorest of the poor: Haitians, people from the “campo” or countryside, and very young, single mothers.  The nurses told us that if people had any money at all, they would go to a private clinic, because the public hospital was often short of resources and the treatment was inadequate.  The hospital had no running water, partly due to the expensive cost of rebuilding the water infrastructure.  However, parts of the hospital  had wifi as it is easy to install and less expensive than fixing the hospitals piping systems.  I found this observation perplexing, which led me to consider defining the most essential resources when providing healthcare, the costs of those resources, as well as additional barriers to ensuring their implementation.  The delivery unit had three active labor beds and two beds in the delivery room.  This area was really nice and rebuilt with air conditioning and a new bathroom, but it still did not have running water or toilet paper.  The postpartum and early laboring patients’ rooms were not as nice, with six beds per room, one bathroom, and no running water.  The NICU was a pretty standard nursery.  Women were transferred to general surgery for c-sections.  The average mother was probably around seventeen years old

Performing frequent newborn assessments was key to ensuring health of babies postpartum
Performing frequent newborn assessments was key to ensuring health of babies postpartum

The skill sets of the doctors were pretty advanced.  They could perform complex surgeries in less than optimal conditions with very limited resources.  For example, surgeries are done very fast because patients would otherwise bleed out due to the fact that doctors have to tie off each blood vessel manually and do not have access to electrocautery.  Additionally, I was really impressed with some of the nurses’ ingenuity.  A wound care nurse was telling one post c/s patient to wash her wound with boiled water to kill the microbes and then pat her incision dry with a washcloth ironed on really high heat for five minutes to again kill the microbes.  Both the doctors and the nurses proved to have the skills and knowledge to do remarkable things despite a lack of resources.

One thing that I learned from my trip was that Haitian people are generally not welcomed into the Dominican Republic by many Dominicans due to a multitude of reasons including: ignorance, fear, prejudice, and racism.  Typically, Haitians do not speak Spanish, they speak French Creole. They are often given the most menial jobs in the Dominican Republic and discriminated against for simply being from Haiti.  In some situations, this mentality affects the healthcare Haitian patients receive.  For example, I observed the doctors perform a textbook caesarean section on a Haitian mother, who was then left for 30 minutes in sheets soaked in her own blood, cold, wet, and abandoned.  I experienced another situation where a woman in labor who was actively pushing, was dumped on a bed and left by the nursing staff.  Apparently, this woman and her husband had been to three other hospitals but had been turned away because they were Haitian, so by the time they got to San Francisco, she was ready to deliver.

Congratulating mom after a very long and difficult labor (25 y.o. and baby #4)!

My biggest take-away from this trip was acknowledging the power of simply caring for people and the significant difference that I could make in people’s lives by keeping patients warm, dry, fed, and hydrated.  By meeting these basic needs and listening to people’s desires for treatment or the issues they had with a treatment regimen, I could also improve their overall hospital experience.  For me, the trip was a lesson in humanity and humility.  Regardless of the culture or country nurses practice in, these fundamental values of caring for patients remain constant, and as a new nurse and soon to be new nurse practitioner, I do find comfort in that.  Despite all of the craziness I encountered, I learned so much and did have a lot of fun.  I would highly recommend that nursing students consider doing a service trip to enrich their nursing school experience and professional careers.

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