This past week, we continued our work in understanding the context of challenges with incubators in the NICU in the Dominican Republic. On my own, I’ve continued my development of the syringe model and researched into possible needs/use cases for NeoFeed.

On Wednesday, we toured the NICU at Los Mina Hospital, meeting Dr. Ruth Encarnación, head of the neonatal unit. She gave us a walkthrough and explained the current setup. Their incubators varied in age, some were new (around 6 months to a year old), while others had been in use for much longer. Compared to other public hospitals we’ve visited, Los Mina seemed to have relatively better equipment. 

We also learned that the procedure for monitoring the baby’s temperature involves placing the sensor at the liver. However, when the incubator temperature sensor stops working, they switch to manually taking the baby’s temperature by placing a thermometer in their armpit. 

She also introduced another warming tool they use for NICU infants, and this is called the Mistral-Air Patient Warming System. It’s essentially an air-pumping device that connects to a blanket and blows warm, HEPA-filtered air. Originally, it was designed to prevent hypothermia during surgery under anesthesia. They’ve adapted it for use in the NICU, but it’s clear that it’s not an ideal fit: it costs about $1300 and is only used in more severe cases. Most babies are still kept warm with basic gooseneck lamps, so there remains a gap in accessible/cost-effective methods for monitored and adjustable thermal care. 

After this, we spoke with a biomedical engineer who maintains equipment at Los Mina weekly. He walked us through how he repairs incubators and showed us the temperature sensors. These sensors are lightweight and fragile, with thin wires that plug into ports on the incubator. He said the most frequent failures occur because staff either don’t understand how to properly connect the sensors or damage them during use. Poor installation and handling practices, such as plugging sensors in incorrectly, lead to malfunctions.

We asked about incidents of sensors burning babies, as I learned that was an issue at Hospital Juan Pablo Pina, and he said it’s possible, usually due to a short or electrical surge. This can happen when the wire isn’t properly insulated. He showed us how you could unscrew the connector and apply heat shrink tubing to protect it. 

Overall, hearing these simple fixes to these problems that we’ve seen again and again has made it clear that a lot of these issues may come down to maintenance and proper training. 

He told us that the temperature sensor is the part of the incubator that breaks most often, which makes sense given how delicate and detachable it is. He also explained to us how incubator temperature regulation takes into account three variables: the baby’s current temperature, the target temperature, and the heater temperature. An alarm sounds when the baby’s temperature falls outside the desired range. Ambient room temperature is also measured, though its specific role was unclear.

These insights clarified key design priorities for our project: durability, low cost, and simplicity. One potential improvement would be designing sensors as non-removable components to reduce breakage. However, beyond these design changes, I’ve realized that technical solutions alone won’t solve these issues. There is a need for a stronger educational effort to be made to ensure proper equipment use and maintenance.

In the delivery area, we saw a newborn wrapped in surgical drapes, taped down, and placed under two gooseneck lamps inside a thermal crib. The engineer quickly fixed the crib’s heater on the spot, which really highlighted how important it is for nurses to know how to perform these simple fixes and avoid the use of gooseneck lamps as much as possible.

The main takeaway from the visit was that training and education are as essential as equipment itself. Many of the recurring issues stem from human error, not hardware failure. Innovation can support improvements, but without user understanding and technical training, equipment will continue to fail.

Later that afternoon, we called with Dr. Floren. We updated her on our findings and discussed next steps, including upcoming hospital visits and potential site visits to bateyes. She also spoke about DOFMI’s collaboration with Fundación Grupo Puntacana, which is focused on improving healthcare infrastructure and health education in the Punta Cana region. Despite its reputation as a luxury tourism hub, the people living and working in Punta Cana, particularly Haitian migrant workers in construction and sugarcane fields, face limited access to public healthcare.

The Dominican Republic, despite its economic development, has the second-highest maternal mortality rate in the Caribbean, just after Haiti. Dr. Floren also emphasized the ongoing issue of congenital syphilis, a preventable but still common infection passed from mothers to newborns, due in part to gaps in screening and treatment.

The rest of the week was focused on research and prototyping. After 3D-printing my first syringe prototype, I created two additional versions to refine the design. I made the syringe tip longer and began experimenting with mechanisms to create a tighter seal for liquid suction. I also spent time researching NICU practices in the U.S. for evaluating infant readiness to transition from NG tubing to breastfeeding, which could inform a use case for NeoFeed. I looked into milk flow sensing technology as well—integrating this with pressure data could give nurses and doctors insight into breastfeeding coordination and milk ingestion, two of the most definitive markers of effective breastfeeding.

I also began looking into low-cost methods for thermal control to support the temperature monitoring device we’re developing in collaboration with UNAPEC and DOFMI. During this process, I came across the Celsi Warmer and have since reached out to its developers. We’re hoping to learn from their approach and, if possible, explore opportunities to introduce it in the Dominican Republic.

Finally, we visited a few cafes around the city, exploring different study spots and enjoying a change of scenery from the apartment.