January 9, 2015

Kirstie in the exam room in the level two hospital
Photo Credit: Crystal Croom

Sign for the vaccination room at the
level two hospital
Photo Credit: Kirstie Geier 

Kirstie: Today we visited hospitals classified as level two hospitals, which means they do not have all the healthcare services and specialties to offer as a level three hospital. These specific hospitals did have an emergency room, a lab, pediatrics, simple surgeries, and other specialties; however, it was much smaller than the level three hospital we previously visited. The first hospital we visited was extremely crowded and busy. They had many beds per room and separated the men from the women, which is a cultural practice. This was also in place due to the limitations with the infrastructure in the healthcare system of a developing nation. They had consultation rooms for their certain specialties, like pediatrics. They also had a small area for children to receive their vaccinations. Unfortunately, one of the hospitals did not provide follow-up care or appointment dates for the children’s series of vaccinations or next vaccination. The responsibility of ensuring their children receive vaccinations falls into the hands of the parents. This can be an issue because the parents may not have the education or understanding of vaccination series or when the children need to get their next vaccination especially, with a lack of record for their child.

Sign at the level three hospital
Photo Credit: Rose Kalala

Rose: Today we also met Dr. Elisa Fernandez, a Dominican OBGYN who started her own private practice in Santo Domingo not too long ago. She spoke to us about many issues surrounding women’s health in the D.R. including, teen pregnancy, abortion, maternal mortality, and legislation on breastfeeding. She completed her residency and an internship in the Unites States and spoke English. Her presentation opened a lot of our eyes to the realities that Dominican women face everyday. Although this is changing, Dominican women see a lot less support through the above mentioned issues than women do in the U.S. Teen pregnancy rates are much higher and resuming education is not a right, but sometimes refused; women do not have the right to abortion, but are subject to severe punishment if they do abort a pregnancy; maternal mortality rates are very high (160 deaths for every 100,000 births) compared to the U.S. (<10 deaths for every 100,000 births); and reproductive rights, including breastfeeding and paid maternity leave, are all issues being pushed for improvement. All these topics are very heavy and hold a lot of important information that not only speaks on the healthcare system of this country, but also speaks on this country’s culture, which is very important for us, as foreigners, to learn about and understand as future healthcare professionals.

Filing system at the level three hospital
Photo Credit: Crystal Croom

Crystal: At both level two hospitals we visited today, we could clearly see that they lacked organization. What especially caught my attention was what I assumed was the patient filing system. The manila folders were stacked all over the offices. There was not any clear labeling or an organized structure compared to what we are used to have in the U.S., before computer filing. This could cause a lot of problems especially if papers are mixed up with different files. This could potentially cause misdiagnosis or the prescribing of the wrong medicine that could seriously harm the patient. It is shocking to believe that this is a functional system where they have every patient’s accurate paper work.