Overcrowding, severe health problems and inadequate or nonexistent health facilities are a way of life in many communities across the Dominican Republic. Dominican mothers and their babies face difficult odds: this country has one of the highest neonatal mortality rates (babies who don’t survive past the first 28 days of life) in Latin America. According to the World Health Organization’s 2017 statistics, the number of neonatal mortality rates per 1,000 live births was 20.1, as opposed to the rate in the United States, which was 3.6. The number of these deaths can be reduced greatly with improvements to health facilities and equipment and increased staff training.
In 2017, an assessment team from Project HOPE visited the maternity and neonatal wards at the Doña Reneé Klang Viuda de Guzmán Hospital in Santiago, the Dominican Republic’s second largest city after Santo Domingo, the country’s capital. As they toured the facility, they were disheartened to see the conditions. Disheartened, but not surprised, given the high infant mortality rate.
“One of the birthing beds was so rusty and dilapidated that the dedicated staff had placed a cardboard box on top in an attempt to have a safer and more aesthetically pleasing place to start a new life,” recalls Andrea Dunne-Sosa, Project HOPE’s regional director for the Americas and global volunteer programs. “And this was one of only two functioning birthing beds, severely insufficient to meet the hospital’s demand.”
When no birthing beds were available – which happened often – women gave birth in the bustling pre-labor area, surrounded by other women.
A similar lack of equipment – incubators, vital sign monitors, radiant warmers – plagued the neonatal ward as well, placing precious new lives at risk.
Project HOPE’s team was undaunted – they knew that with the right partners in place, they could help. After all, they had already made great strides at a hospital in Santo Domingo, which experienced similar challenges.
Working in close collaboration with the Dominican Ministry of Health, Project HOPE had already helped transform the Maternity San Lorenzo de Los Mina Maternity Hospital’s neonatal intensive care unit (NICU).
The work was part of Project HOPE’s Saving the Newborn campaign. This ongoing initiative aims to reduce neonatal mortality in the Dominican Republic by the maternal and neonatal care units and training staff in maternal and neonatal care at the maternity hospital in Santo Domingo. The hospital was also in need of critical neonatal equipment such as ultrasonography technology, neonatal incubators and ventilators.
The physical transformation included the government’s complete renovation of the hospital, prioritizing the NICU, and Project HOPE’s installation of new lifesaving equipment such as vital signs monitors, incubators and ventilators for newborns.
Beyond the physical transformation, Project HOPE worked in close collaboration with the hospital staff, leadership and external partners to identify and prioritize training needs. Hospital staff – ranging from expert specialists to doctors, nurses and – received targeted training in areas such as use of mechanical ventilators, advanced neonatal resuscitation, newborn breathing and infection-control protocols. They also received training on new national neonatal care protocols, elevating the level of care available at the hospital and addressing the most common causes of preventable death among newborns. In addition to the new physical space, the project resulted in a tangible sense of collaboration and renewed level of energy among the staff. Morale increased as the staff was given the tools they needed for greater success.
“Prior to Project HOPE’s intervention in Los Mina, we only had two ventilators that were obsolete,” says Dr. Christian Mateo Michelis (“Dr. Mateo”), a neonatologist and the MNCH (maternal, neonatal and child health) coordinator for the Dominican Republic’s National Health Service.
“With the upgraded neonatal intensive care unit and Project HOPE’s help, we acquired modern ventilators, including two high-frequency ventilators. We also now have monitors for each of the ventilated patients. In the past we only had one monitor for the entire neonatal intensive care unit.”
Dr. Mateo says that with the modern ventilators, the survival rate of these tiny patients has seen a dramatic increase.
He says that at one time, hypothermia was the fifth cause of death in this hospital. “Now that we have incubators and thermal basinets that regulate temperature, we no longer have those same deaths.”
He is eager to see this success replicated in underserved populations such as Santiago.
After a recent visit to the hospital, Project HOPE’s chief health officer Tom Kenyon reports, “I saw first-hand the improvements in neonatal protocols and lifesaving equipment. Needs like clinical laboratories and critical neonatal equipment have been met, and advanced training for neonatal nurses are bearing results. The hospitals are implementing changes that will send more happy, healthy infants home in the arms of the families that love them.”
Dunne-Sosa says that the hospital staff’s personal testimonials are truly inspiring. “Because of this project, the wait time from birth to receiving care has been reduced, and the staff have the equipment and skills to save lives where they could not before. They are able to prevent more deaths from common causes like hypothermia and asphyxia. Together, Project HOPE (through the generous donation of major donors), the Ministry of Health, the Dominican National Health Service and hospital leadership are succeeding in saving newborn lives at Los Mina Maternity Hospital.”
After seeing the transformation that took place at Los Mina and learning of Project HOPE’s commitment to expand the project to the hospital in Santiago, its hospital director was optimistic:
“Project HOPE for us is a light at the end of a dark tunnel. We have seen the success at Los Mina and believe in Project HOPE’s ability to bring change to our hospital. Many organizations make promises, but we believe in HOPE.”
Since that day, the government has again demonstrated solidarity by completely renovating the NICU at the maternity hospital in Santiago. Similar to Los Mina, HOPE worked closely with staff and leadership to identify priority needs and worked to coordinate a series of training workshops for staff.
In Santiago, the focus has now shifted to efforts to reduce maternal mortality in addition to neonatal mortality, with targeted training and equipment designed to support mothers during labor and to help ensure the safety of both mothers and babies.
“The Saving the Newborn initiative in the Dominican Republic has truly been transformative,” says Dunne-Sosa.
Dr. Mateo agrees and is especially grateful for the training component.
“I want to share that the success of this intervention was due to, number one, the training,” he says. “Through this training, we have been able to become facilitators for other institutions. Regardless of the equipment that we have, the most important thing is the human resource. We have empowered ourselves.”