January 8, 2015

A technician at the level three hospital cleaning the endoscopy equipment
Photo Credit: Kirstie Geier 

Kirstie: Today was an exciting day because I was able to have a first hand experience in a hospital outside of the United States. The sights at this level three hospital were intriguing. The hospital and healthcare differed greatly from that of the U.S. The U.S. has an unlimited amount of resources to provide healthcare, which allows them to administer an elite level of care. As a result, my expectations of healthcare were greatly heightened and skewed. My exposure to this level three hospital in the D.R. opened my eyes to the different scenes and practices that occur in healthcare facilities other than the U.S. This specific hospital was a regional hospital and the mainstay of healthcare for hundreds of thousands of individuals in the surrounding areas. It is classified as a level three hospital, which means it has almost everything to offer in regards to healthcare specialties such as emergency rooms, pediatrics, gynecology, surgery, diagnostics, a lab, labor and delivery and others. The hospital, like many places in the Dominican Republic, was very open and not enclosed like our hospitals in the U.S. Although the fresh air can be therapeutic and beneficial to patients, the open air and doors allows for entry of many insects. Mosquitoes are very popular in the Dominican Republic and can carry diseases like malaria and dengue, which are harmful if they spread them to humans when they bite; therefore, the open system may be detrimental to patient health as well. One method in particular that also caught my attention was their process of sterilization of equipment for colonoscopies and endoscopies. Their sterilization process differed greatly from ours in the U.S. and was not as strictly sterile. From my eyes, the sterilization processes they utilized in the D.R. were not as rigorous compared to the U.S.; however, they created functionality with the resources they had and provided care to their patients in need.

Entrance to the ICU at the level three hospital
Photo Credit: Crystal Croom

Crystal: In addition, while on our visit to the level three hospital, I noticed that the intensive care unit (ICU) had very strict rules. Overall having restrictive rules aren’t uncommon, but I had my own thoughts as to why some of the rules were in place. The ICU at the level three hospital had visitation from 3:00 p.m. to 3:30 p.m. I thought was very short compared to some of the visitations I have encountered in ICUs in the U.S. In addition, I thought we would all be able to go inside and get a look at how the ICU was set up. Sadly, only three students were able to go inside for no longer than a minute. These was upsetting because I really wanted to see for myself what it looked like and compare it to St. Joseph’s hospital. Even though I wasn’t able to witness the ICU for myself, my thoughts on why they had these rules in place meant that they were taking the highest precaution possible to avoid dangerous exposure to their patients, which was a positive aspect of the hospital’s healthcare practices. In opposition to the rules in place for the ICU, it was assumed that with inpatients on units other than the ICU, that family members of the patients were with them while admitted. When we further discussed this topic, I found out that because of the lack of nurses it was up to family members to aid their loved ones back to health. This meant helping the patient bathe, eat, go to the bathroom, and make sure they were taking their medicine. We were informed that family plays a crucial role in healthcare here in the D.R. and their presence has an important part in attaining a state of wellness.

People trying to enter the locked unit at the
level three hospital
Photo Credit: Rose Kalala 

Locked unit at the level three hospital
Photo Credit: Rose Kalala

Rose: One of the most overwhelming aspects of the hospital was the level of security present. We witnessed security guards (a lot of them armed) at almost every entrance. Barred gates, similar to those in a prison, controlled crowds. This sight was very shocking for us students. It was hard to understand why a place like a hospital, which to us is a symbol of care giving and helping one another, would also be home to symbols of violence and inequality. It was explained that families’ frustrations often times turn into aggression and that is why these precautions are necessary. I only began to somewhat understand this when I witnessed a woman arguing with a security guard at an open gate. She was trying to come into the unit, but they would not allow her for some unknown reason. She started to holler and that is when the security began to close the gate on her so that they could be sure she could not enter. This made me wonder how and why these measures of security even came about and since when did they become necessary. There are so many factors that contribute to the aspects of the health system that need improvement, it is hard to really judge one part of the system without taking the circumstances into consideration.