Bridging the maternal-child health education gap in the Dominican Republic

By Nola Holness | 12/14/2016

F
ocuses on neonatal assessment and midwifery care.

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Maternal-child health, Dominican Republic
In 2015, a team composed of a neonatologist, obstetrician, nurse-midwives, neonatal nurses, respiratory therapists, and a student nurse journeyed to Barahona, the main city in the Dominican Republic’s Barahona Province, to develop partnerships with medical and nursing personnel that would help improve maternal and child health in the region. Angelica A. Floren, MD, assistant professor of clinical pediatrics at the University of Miami Hospital, led the team.
 
For many years, Floren and the Fundación Dominicana de Infectologia (the Dominican Foundation of Infectology) have collaborated to provide health services to the needy in the Dominican Republic. Over time, marked improvements in child health have been made, including, most recently, introduction of kangaroo care in several Dominican hospitals. As moms, dads, and grandparents, supervised by nurses and physicians in outpatient clinics, have learned to nestle premature babies to their chests, healthy growth and development of these preemies have resulted along with reduction in infant deaths. 

Maternal-child health, Dominican RepublicReaching out for help
Situated on the same Caribbean island as Haiti, which has the highest maternal mortality rate in the Americas, the Dominican Republic also has high maternal and infant death rates. Located on the mutual border of the two countries, the Barahona region is particularly affected by a large migrant Haitian population that has very limited access to healthcare. Recognizing this critical need, Floren turned to Florida International University (FIU) for assistance in developing guidelines for an educational bridge on childbearing in the Dominican Republic. Jean Hannan, PhD, ARNP, assistant professor in FIU’s Nicole Wertheim College of Nursing & Health Science, contacted me—I’m also an FIU faculty member—and the bridge building was underway. 

Maternal-child health, Dominican RepublicI reached out to the American College of Nurse-Midwives (ACNM) Division of Global Health and harnessed the support and expertise of Wreatha Carner, DNP, MN, CNM, chair of the division’s education section. Drawing upon information from ACNM's "Life Saving Skills Manual” and the American Academy of Pediatrics’ “Helping Babies Breathe” program, our team went to work. After many sessions of brainstorming, revising, and streamlining, we developed educational materials that focus on neonatal assessment and midwifery care. We were set and ready to go!  

Upon arriving in Santo Domingo, all nine of us piled into a minivan already occupied by the driver and his wife. After three hours of navigating mountainous terrain, we arrived at Playazul, a serene seaside hotel in the city of Barahona. Dinner was a three-course affair, beautifully presented and as delicious as it was beautiful. Following a night of much-needed sleep, we enjoyed an indigenous breakfast of “mangú,” a delightful plantain-paste dish. We also ate mangoes, bananas, naseberry, guinep, and other fruits that were simply divine to the palate. 

Maternal-child health, Dominican RepublicInterprofessional collaboration essential
Then, it was on to Jaime Mota Hospital, our base during the visit. Thirteen satellite hospitals and health centers are affiliated with this tertiary hospital center. In the week that followed, we met daily with nurses and physicians from satellite centers as well as the hospital. Through formal presentations and engaging discussions, we highlighted the essentials of midwifery and neonatal care to more than 100 nurses and 50 physicians. 

Carner and I, both certified nurse-midwives, and Luis Caldera-Nieves, MD, an obstetrician, focused on lifesaving midwifery skills and obstetric emergencies. Gladys Cabrera, one of the neonatal registered nurses on our team, held the standing-room-only audience in rapt attention with presentations on neonatal assessment and care of the newborn infant. Sonia Benavides, a respiratory therapist retired from Jackson Memorial Hospital in Miami who now resides in the Dominican Republic, and Maria Flores, a respiratory therapist who accompanied us from Florida, led demonstrations for nurses and physicians on intubation and cardiopulmonary care of the neonate. After hands-on practice of the newborn infant resuscitative measures we taught, participants left with Ambu bags and respiratory supplies to take back to their hospital centers.

Maternal-child health, Dominican RepublicThrough informal dialogue with nurses and physicians, we learned of the need for improved protocols for newborn sepsis and infection prophylaxis, preterm care, and postpartum hemorrhage. We toured the hospital’s neonatal and maternity units and met with patients and their families—as well as nurses, physicians, and support staff. At the end of the midwifery sessions, we presented a Pinard fetoscope to a representative from each satellite center. In doing so, we felt as though we were leaving a small part of us with them. 

Looking ahead
This first fact-finding mission to Barahona, also known as Santa Cruz de Barahona, was highly successful. We observed firsthand the resilience and best efforts of medical and nursing teams to support maternity and neonatal services in that area. Because there is no school for midwifery in the Dominican Republic, we addressed the need for improving education for staff members in the satellite centers and discussed formalizing a maternity education program for the region. This program includes inaugurating student exchanges in which BSN and MSN students from FIU will engage in health assessments and assist with maternity and newborn nursing in Barahona, and nurses from the Dominican Republic will attend structured obstetric classes at FIU. Mary Amusu, the neonatal nurse on our team, expressed the need for additional visits to the region to reinforce and evaluate the results of this initial visit.

Our follow-up trips will be two-pronged: 1) One group will visit satellite hospitals and health centers to evaluate and foster local partnerships and educational exchanges. 2) Another group, led by Danielle Jean, a Haitian neonatal nurse, will cross the border to Haiti to obtain firsthand information about healthcare access in that region of the island.
 
In reflecting on the trip, Maite Levi, the student nurse who accompanied us to Barahona, said: “Wow! I gained so much OB and newborn knowledge and experience, and I am yet to become a nurse!”

Nola Holness, PhD, CNM, NP-BC (adult), is clinical assistant professor at Florida International University’s Nicole Wertheim College of Nursing & Health Science in Miami, Florida, USA. 


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  • Nola Holness
  • Maite Levi
  • Danielle Monfiston Jean
  • midwifery
  • Gladys Cabrera
  • Santa Cruz de Barahona
  • Pinard fetoscope
  • postpartum hemorrhage
  • preterm care
  • infection prophylaxis
  • sepsis
  • Maria Flores
  • Jackson Memorial Hospital
  • Sonia Benavides
  • Luis Caldera-Nieves
  • Jaime Mota Hospital
  • mangú
  • Playazul
  • Santo Domingo
  • American Academy of Pediatrics
  • ACNM
  • Wreatha Carner
  • American College of Nurse-Midwives
  • Jean Hannan
  • educational bridge
  • FIU
  • Florida International University
  • maternal mortality rate
  • Haiti
  • Dominican Foundation of Infectology
  • Fujndación Dominicana de Infectologia
  • Angelica A. Floren
  • Dominican Republic
  • Barahona
  • respiratory therapists
  • neonatal nurses
  • nurse-midwives
  • obstetrician
  • neonatologist
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