Feeling lucky and blessed

I had the opportunity today to visit a children's hospital in the Dominican Republic.  A few years ago, one of our former residents and neonatology fellows organized a pediatric conference for the pediatricians and nurses in his country.  Several faculty members from my institution speak at the conference, which has been held every 2 years for the past six years.  It's a great opportunity for us to re-connect with a very good friend and colleague, and hopefully the attendees find our lectures meaningful and educational.  I was fortunate to attend this year, and a few us traveled earlier today to one of the two children's hospitals in the capital city of Santo Domingo.  It was a great experience, and one that I am sure none of us will soon forget.

There are apparently two children's hospitals in the city - one is primarily a public hospital (we visit that one tomorrow) and the other is a so-called private hospital (though 80% of their patients are, in fact, enrolled in the public health system).  The hospital is only five years old, but I was amazed by how much its leaders have accomplished in such a short time.  Some of the statistics are staggering - they have approximately 160 beds, including a 6-bed pediatric intensive care unit and a 7-bed neonatal intensive care unit.  There are about 80 physicians on the medical staff, of which approximately half are general pediatricians (the rest being medical subspecialists and surgeons).  More surprising to me was the fact that there were only 150 nurses!  In other words, they have more hospital beds than they do nurses!  I guess that shouldn't surprise me too much - one nurse can take care of more than one patient (and usually does, even in an American pediatric intensive care unit).  But still.  That doesn't leave much wiggle room, considering the nurses have to staff the beds 24 hours a day, 7 days per week.

The Pediatric intensive care unit was about what you would expect - it was full and every single one of the patients was on a ventilator.  One patient was on continuous renal replacement therapy (kidney dialysis).  There was one physician and two nurses working in the unit during our visit.  I asked what kinds of patients they typically see - lots of tetanus (something we rarely, if ever, see in the U.S.), dengue fever, sepsis (mostly from staphylococcal infections), and trauma.  I was impressed with how well the patients were doing - these providers were doing a fantastic job!

The emergency department was something completely different altogether.  We walked into one of the rooms - they called it the "respiratory room."  There were about ten children sitting side-by-side, each being treated with a nebulizer, presumably for acute asthma.  The room next to the "respiratory room" was the "shock room."  We have a similar room in our hospital at home - it's where critically ill patients go to be resuscitated.  On a busy night, we can safely care for up to three critically ill patients at a time.  The "shock room" in the Dominican Republic had around seven or eight patients, all receiving IV fluids and supplemental oxygen. 

We had a great conversation with the hospital administrative staff.  They talked about some of their challenges, and we shared some of ours (mostly because they asked).  I really left the hospital feeling both lucky and blessed.  Lucky and blessed, not just because I work in a hospital with an abundance of resources, but also lucky and blessed because I had the opportunity to see how a hospital operates in a different country.  Sure, there were differences.  But there were many similarities too.  We are all not so different after all.  And that's what really matters most.