If CHOP were in Santo Domingo, it might look something like this.

Yesterday the nine of us, together with Lara (the Global Health fellow) and Dr. Jappa (from NPS) hopped on a guagua (mini-bus) bound for Santo Domingo, for a tour and conference at the Hospital Infantil Dr. Robert Reid Cabral. Named for a famous Dominican pediatrician, it's a 350-bed tertiary care children's hospital that serves as a referral center for the whole country. There are over a hundred pediatric residents, and as of several months ago, its fourth-year residents have started rotating through the Centro de Salud Divina Providencia in Consuelo.

When you walk into RRC, there's a vibe that I can only describe as "tertiary." I got teased a little for saying this, but it felt like home: the hum and buzz of a busy resident-run hospital, immaculate and brightly-lit, with signs everywhere encouraging hand-washing, and with white-jacketed young doctors and nurses peering curiously at the throng of visitors. The residents, mostly young women, were unfailingly polite and friendly, and clearly were proud to lead us through their pediatric wards, NICU, PICU, ER, and cardiology and renal transplant units. As we passed through the ER and stopped to chat with its medical chief, we noticed a resident attempting to draw blood from a young boy beside us. The boy was screaming and flailing, and the unlocked stretcher was rocking back and forth. Cool as ever, Kelly Vuong, CHOP ER nurse, walked over and set the stretcher's brake. The Dominican doctor then did her best to convince Kelly to move to Santo Domingo and take a job at RRC (but we're not giving her up).

After the tour, we took our seats in a conference room for a slide show and presentation. The first two RRC residents to rotate through Consuelo just completed their two-month stint here a couple of weeks ago, and they were eager to share their pictures and observations with their residency colleagues and with us.

As the first slide flashed up on a projector screen, our team exclaimed "Vero!" The snapshot showed the two residents posing in front of Casa Roja with Veronica, who is Ramona's cheeky, be-ribboned 9-year-old daughter and a frequent companion on our barrio treks. The residents went on to discuss their experiences seeing patients in the NPS clinic, doing batey and barrio outreach, and seeing patients in the Maternidad, Consuelo's own small hospital.

As Deb said, the pictures and the presentation could easily have been those of any CHOP resident returning from the D.R. But what we found incredibly moving was the emotion with which the residents described their surprise at seeing, for the first time, such deep poverty and disadvantage in their own country. "We often get upset when our patients arrive late for appointments," one said. "But now we understand the struggle they have to go through to get here," journeying from the countryside with no car, no phone, no extra money. They described the frustration of learning that patients couldn't afford to fill the prescriptions they wrote. It was an elegant summation of the challenges of rural poverty in the D.R., but it rang true to us, too, as applicable to the urban poverty with which we're too familiar back home in Philadelphia.

Next up was the hospital's director, who spoke warmly about the new partnership between RRC, the Children's Hospital of Philadelphia, and the Centro de Salud Divina Providencia -- about how much the three organizations can bring to each other as together we address the moral obligation to provide care to the neediest. We all know that this partnership is the result of long conversations and much effort on the part of leaders from all three institutions. And to me it feels like a major breakthrough. There are times when I find myself nearly overwhelmed by the enormous challenge of improving healthcare for children here (it's even overwhelming to think about the same task in Philadelphia!). But now, partnered with the institution that trains half this country's pediatricians, I feel like a huge piece of the puzzle has just clicked into place. The opportunity to share teaching and learning among the medical staff of the three institutions will be, I think, critical to really advancing the mission of all three.

There were hugs, photos, and even a few tears as the presentation ended and we talked some more with our hosts. The residents, who'd been clustered in the back rows like CHOP residents at noon conference, even lingered to chat for a few minutes before rushing off to their duties. The hospital buzzed on, and we headed off to do a little sightseeing, bolstered with a hefty dose of hope.

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Posted at 09:57AM Nov 11, 2010 by Pamela Mazzeo MD in Health  |  Comments[2]