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“No se lo grites, no mama”

“No se lo grites, no mama”

2/20/14

Author: Katie Cabanski, Resident Physician

Today was our first full day in Guaymate.  We are staying in a church with plenty of space- 2 large rooms with bunk beds already made with sheets, pillows, towels, and most importantly, mosquito nets.  We have 2 bathrooms with a flushing toilet, sink, and shower.  The shower does not have heated water, and made for a startling wake-up call this morning.  John Claude, the guard of the church with a contagious smile, does a great job watching over us.  Breakfast, lunch, and dinner are cooked for us by Zoraida and her family.  Lunch today was one of my favorites, pollo guisado, which I have attempted to make on my own in the past, however, theirs was much better tasting.

Today we visited Guaymate Municipal Hospital, which is located right across the street from the church we are staying at.  We met with Dr. Estevez, the medical director of the hospital, and Dr. Mateo, an epidemiologist.  They have both been working at the hospital for well over 10 years.  The hospital consists of 22 inpatient beds, 3 ER beds, an OR, and a delivery room.  The ER mainly functions as an urgent care per Dr. Estevez, because more serious problems typically need to be transferred to the larger hospitals in La Romana, about 20 minutes away.  Many of the doctors that work at Guaymate only work in the hospital ~3 days a week for a few hours a day, and due to low pay, they often then work in La Romana at other private clinics.

Transportation to the hospital is difficult, and even though they have 2 ambulances recently donated by Japan, there is no funding for a driver or gas.  Both doctors talked about many of the challenges in the hospital, including limited funding, government stipulations on how money can be spent, lack of functioning equipment, and lack of transportation.  For example, the hospital generator which provides back up electricity has been out for 5 months and is still waiting to be fixed.   The hospital used to perform approximately 6 surgeries a week, most commonly appendectomies, hernia repairs, c-sections.  However, since some of the old anesthesia equipment broke down, they are no longer able to perform surgeries.  Although the equipment was “repaired”, the anesthesiologists are no longer confident in knowing how much medicine the machine gives, and do feel comfortable performing surgeries.  The autoclave to sterilize equipment works “sometimes.”  In the lab, the microscope is over 25 years old and does not function.

Dr. Estevez discussed the importance of advocacy to try to improve conditions in the hospital.  This often requires concerted and consistent pushing of the central government to deploy needed resources.  This is where the title of this blog comes form – literally, “if you do not shout, you do not nurse” (ie a baby).  Similar to our English phrase of “the squeaky wheel gets the grease.”

Despite these limitations, the hospital has some important strengths.  Most importantly, the staff seem very motivated to improve the quality of care the hospital provides to the community.  Even when describing challenges, Drs. Estevez & Mateo sounded hopeful that the situation will improve in the future.  They passionately described patients they had cared for, and optimistic about how much better care they can provide with more support and resources.  I am hopeful that COPE can be successful here in Guaymate, and empower the staff to identify problems and solutions to make small but meaningful changes to the hospital.

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