Kim Wilson, MD, MPH, a primary care pediatrician at the Martha Eliot Health Center (MEHC) and associate director of the Center for International Pediatrics at Children's Hospital Boston, knew she had to go the extra mile to properly care for the Dominican patients who make up more than half of her patient base. But she faced a major stumbling block. Her patients made regular trips back to the Dominican Republic (DR) to visit family, sometimes staying for months or even years at a time, making continual care difficult. Adding to the problem was the different ways doctors and patients approach health care in the two countries.
When a Dominican mother asked if Wilson could communicate with her child's doctor in Baní in the DR back in 2002, Wilson took it a step further and started the Dominican Health Alliance to bridge the communication gap. "There were many things I didn't understand about their health care, beliefs and traditional remedies that I needed to learn," she says. For example, in the DR, preventive care is an unfamiliar concept, and most families only seek care for serious illness. So in collaboration with Sue Torrey, MD, Emergency Department physician, and other Children's staff, Wilson started to travel to the DR to gain a better understanding of their patients' native health care system.
The group soon learned that there was more to be done than simply learning about their culture and health care system. "The quality of health care in the DR was startling," Wilson says. She found that many hospitals lacked basic supplies, relied on an intermittent water supply and didn't have basic infection control practices in place. She also learned some sad statistics: Neonatal mortality is more than three times higher in the DR than it is in the United States, and more than 70 percent of all childhood deaths there occur in the first month of life. Since hospitals' nurseries have limited incubators and oxygen, infants must sometimes share, or go without treatment.
Wilson and her team concentrated their efforts on improving newborn and maternal care by educating the public and local medical staff. In addition to teaching courses on HIV, neonatal resuscitation and pediatric infection and emergency care, they provided equipment and medicine to the DR's main regional hospital, the Nuestra Señora de Regla Hospital Baní, the only hospital for the province's 170,000 people.
By last year, the program had blossomed into a non-profit organization called Infante Sano (www.infantesano.org), Spanish for "healthy infant." Infante Sano focuses on improving the quality of neonatal and maternal care by establishing several community outreach programs in Banˆ‚ and its surrounding areas designed to help mothers realize when their pregnancy or infant are in danger. The organization provides medical supplies and works with the hospital to develop a plan for equipment maintenance. Members also produced videos for local television to train the community about health issues, and staff make home visits to increase awareness. "These interventions are not high-tech or particularly costly, so it's very doable," Wilson says. It's been going so well, in fact, that she hopes to expand to more outposts on the Haitian border by January.
When Wilson is back at the MEHC, she draws on her experiences in the DR to provide more culturally aware care. She knows, for example, that since antibiotics are available without prescriptions in the DR, her patients are used to taking them frequently—even to treat minor viral illnesses. So Wilson makes sure to explain to patients why this isn't always beneficial. After seeing how entire families, including infants and young children, travel by moped in the DR without helmets, she also began educating her patients about safety equipment like car seats and bike helmets. She also learned how to adapt medical treatment for patients with diabetes or asthma, creating a regimen that they can continue to follow while they're visiting family in their home country. This cultural awareness has had a lasting impact on the many MEHC staff who've worked with Wilson.
Infante Sano now has offices in Bani and Boston, with 16 Dominican physicians, nurses, support staff and volunteers. They've succeeded in renovating the special care nursery and the pediatric section of Nuestra Señora de Regla Hospital Bani, and opened two clinics in a rural part of the DR late last year. One specializes in treating malnourished children and the other is a primary care center. Together, their staff sees more than 300 mothers and children a week.
Still, there's work to be done. "Our biggest challenge is to have a sustainable impact," Wilson says. "It's very easy to do interventions with a temporary positive effect, but we want to have a lasting one. We've struggled with how to do that." That's why, for now, they've transitioned into having a sustained presence there. But the hard work is gratifying. "What's really rewarding is that it's immediately clear that we're making a big difference," Kim says. "I really enjoy seeing the program grow and the enthusiasm of the people who are so excited to have the opportunity to improve the care they deliver."