The long line of patients waiting outside the hospital as soldiers guard the entrance, the prayers beginning each morning report, the sharing of patient beds/cribs, and the lack of running water … these are some of the things that stood out to me when I first arrived at Hospital Maternidad Nuestra Señora de la Altagracia (HUMNSA). Everything seemed foreign as I tried to learn the workflow and how to integrate into a medical team in a new country and medical system. However, as my ears acclimated to new medical terms while rounding in a different language, my first impressions developed into a realization of the importance of religion in the Dominican Republic as well as the limited resources and high volume of patients at this public hospital. Inside the walls of this institution, work and teaching truly prioritize patient care.
The value of patient care is best exemplified by Dr. Johanna Gomez, a perinatologist at HUMNSA who reminded the residents of the Hippocratic Oath during rounds in the neonatal intensive care unit one morning while we were discussing a new admission from the night before. The patient was a premature 24-week male infant whose birth was complicated by premature membrane rupture of unknown time and lack of prenatal care. The mother’s complicated social history raised questions as to whether she was turned away by an outside hospital previously during her pregnancy. Dr. Gomez took that moment to remind residents and fellows of the promise they made to first do no harm, help the sick, and care for all patients regardless of their background and circumstances. At times, she said, this commitment may require extra work and time just to make sure the patients get the best possible care, regardless of what resources may be available at the hospital. She urged the residents not to lose their humanity despite how tired or overwhelmed they may feel. This inspiring speech left me with goosebumps and an important message just months before starting my residency.
In addition to motivating residents and fellows, the attendings teach and test their knowledge. From the signs and symptoms of preeclampsia and neonatal asphyxia to the importance of proper documentation, a broad spectrum of topics pertinent to pediatrics and obstetrics/gynecology are covered during morning reports and rounds. I recalled learning and discussing these topics previously with the teams I worked with during my third year clerkships and fourth year electives. The familiarity of these discussions, especially as I continue to figure out my role and understand medicine and the medical system in the Dominican Republic, gave me appreciation for the universality of medicine.
The sparse resources and high volume of patients set the hospitals here apart from the ones I have rotated through in the United States. As a public hospital that accepts all patients regardless of their nationality or insurance status, more than half of the patients at HUMNSA are from Haiti or other countries with little or no prenatal care. Yet, despite any language or cultural barriers they may face, the team here successfully helps with 80-100 deliveries a day and cares for 20-40 mothers and babies admitted for complications. I have seen how this high volume requires the team to work quickly as pediatricians and perinatologists run back and forth between different patients while the obstetricians shout “pediatría!” after another delivery.
I can’t help but wonder if the residents here feel burnt out from the long hours they work or the high volume of patients they see a day. What do they do to stay present? I haven’t had the chance to ask the residents yet but perhaps, they achieve this by focusing on the patients, as suggested by a handwritten sign taped to a board by the patient medical records.
“Propósito del día: Tratar mis pacientes como quiero que se me trate a mi.”
“Purpose of the day: To treat my patients as I want to be treated.”
This is a mantra that I have repeated to myself many times throughout my medical training and one I have heard from many teachers and advisors. Seeing this message hit home for me that at the end of the day, patient care is what’s most important in medicine, regardless of the resources available or the language and country in which it is taught.