Giving infants, moms a healthy chance
Effort to boost Dominican survival rates has roots in Wayland, Waltham
Dr. Kim Wilson took one look at the newborn's skin, and even from across the large room she knew there was trouble.
The tiny infant in the nurse's arms at the hospital in the Dominican Republic was blue from lack of oxygen and faced irreparable brain damage. But the nurse wasn't trained in how to respond. Quickly, however, one of the people from Wilson's class on newborn resuscitation ran over and got the baby breathing again.
That might have been the end of the story; a dramatic anecdote gleaned during Wilson's 2002 trip to Nuestra Señora De Regla Hospital in Bani. But what happened to the baby in the next several days led Wilson and fellow Wayland resident Bill Haney to create Infante Sano, a Waltham-based nonprofit dedicated to improving the health of mothers and infants across Latin America and the Caribbean.
Many of Wilson's patients at the Martha Eliot Health Center in Jamaica Plain are Dominican. Most of them have their roots in the southern city of Bani. Wilson went there trying to understand why so many seemed to have disabilities or chronic illnesses that could have been prevented or better treated earlier in their lives: the toddlers with brain damage from being deprived of oxygen at birth, for example.
If that tiny baby in Bani had been born at Children's Hospital Boston, which runs the Martha Eliot center, it would have been monitored constantly by hospital staff for a few weeks, Wilson said. But when she returned to Nuestra Señora De Regla just days later, Wilson discovered that the newborn had been sent home because the hospital's electricity had gone out and could not operate the incubator. While at home, the baby developed an infection and severe dehydration, and ended up back in the hospital sicker than before, Wilson said.
That was going to take more than the twice-yearly training trips Wilson had been envisioning. It was going to take a long-term commitment.
Haney, a technology entrepreneur turned filmmaker and philanthropist, got to know Wilson when their now-teenage daughters became best friends. In 2003, one of their kitchen table conversations turned to Wilson's experiences in Bani.
Haney saw a way he could make a difference, a way he could put his ideals into action when the biggest stories in world news involved the United States invasions of Iraq and Afghanistan.
"There was a desire to act as Americans in a different way, at a time when the imprint of America that most of the world was seeing was a fighter plane," said Haney.
The two founded Infante Sano - "Healthy Infant," in Spanish - that year. They chose to focus Infante Sano's efforts on the ongoing training of local Dominican doctors and nurses, and on funding a corps of community health workers who would go on to train others. Working on a budget of $30,000, they began finding donors and forming partnerships with local organizations around Bani and with the Dominican Republic's Ministry of Health.
Infante Sano gained official nonprofit status in 2006 and has grown to include services at two other regional hospitals and two rural clinics. Between 2006 and 2007, Infante Sano's work contributed to a 12 percent reduction in deaths among babies in their first month of life at Nuestra Señora. The organization's annual budget is now about $1.2 million, and it has 25 workers and 50 volunteers.
In May, the organization shipped $680,000 worth of refurbished modern medical supplies, including patient beds, incubators, bed sheets, face shields, and rubber gloves. Their newest project is the Sponsor a Birth program, in which a $25 donation pays for some of the supplies and training necessary for a mother to have a healthy delivery and a healthy baby.
But the need persists, the organization's founders stress. They note that the Dominican Republic's problems aren't due to a lack of hospitals or prenatal care. But the island nation has one of the highest maternal death rates in the Caribbean.
According to the World Factbook, published by the CIA, 27 of every 1,000 babies in the country die within the first year of life, which is higher than nearby countries where fewer than 40 percent of births happen at a hospital or clinic.
At Nuestra Señora, where the organization began its work, supplies of running water and electricity are erratic at best. Crumbling concrete stairs are the alternative to the 60-year-old building's broken elevator.
Although healthcare in the Dominican Republic is theoretically free, families of patients usually have to buy supplies, including syringes, medications, and blood for transfusions.
Rachel Breman, a nurse who spends several months in the Dominican Republic each year as Infante Sano's deputy technical director, said sometimes two laboring mothers share a single, sheetless bed, and one doctor may be looking after dozens of patients. Nurses are more available, but don't always know how to identify signs of complications.
Maria Davila, a neonatal intensive-care nurse at Children's Hospital Boston, in March 2007 found that nurses in the rural hospitals weren't trained even in taking blood pressure or heart rates as those tasks were seen as doctors' only.
Even if the nurses knew how to read donated monitors, the electricity to run them was available only sporadiacally.
So Davila and the other trainers had to teach the basics and how to identify alarming patterns.
"The nurse had to learn to do this and be confident enough to tell the doctors. And the doctors had to learn to rely on the nurses' information," said Davila.
This fall, when Davila returns to teach the nurses how to read the electronic monitors, the machines will have battery backups.
Wilson and Haney say the true value of the program is far greater than the sum of its parts.
"A thoughtful redesign, an extraordinarily simple intervention, can have dramatic impact on events," said Haney.
For more information, visit infantesano.org. 