This week has been incredibly informative and exciting. From Sunday through Wednesday, we visited multiple hospitals in the southwest region of the Dominican Republic with Dr. Floren, the president of the Dominican Foundation of Mothers and Infants (DOFMI). We observed firsthand the challenges and adaptations present in neonatal care.
At Jaime Mota Hospital in Barahona, we spent quite a bit of time in the NICU, where we observed many of the incubators were visibly outdated, some over a decade old. We saw nurses compensate for broken incubators by taping cracked panels together. Unfortunately, tape traps bacteria and is difficult to clean. Dr. Floren recommended plastic wrap as a safer, low-cost alternative. Many incubators lacked working heating systems and temperature sensors, resulting in nurses relying on placing thermometers in the baby’s armpit to monitor temperature. This method does not allow for continuous monitoring and may delay detection of issues like hypothermia. In addition, thermal support is often provided by gooseneck lamps, which do not distribute heat evenly and pose risks if they fall or overheat.
We also noticed that IV solutions are mixed directly at counters in the NICU rather than in a pharmacy using sterile procedures. This is particularly concerning given the humid and salty coastal environment, which contributes to the rusting of equipment and contamination risks. Dr. Floren emphasized the need for laminar flow hoods and in-hospital pharmacies that can safely prepare IV fluids, something considered standard in higher-resource settings.
One room in the NICU was used as an “equipment cemetery,” filled with broken or unused devices, many of which had been donated from American manufacturers. While these donations are well-intentioned, they often create problems when the devices require specialized parts or training to operate and maintain. For example, one machine had been donated from the US but could only be used with tubing sold by the original company, which isn’t accessible locally. Witnessing this made it very clear to me the importance for solutions to be designed with sustainability and local supply chains in mind.
Despite the challenges, I was deeply moved by the ingenuity of local staff. Wheelchairs made with bicycle wheels, thermal care using gooseneck lamps, and a strong emphasis on kangaroo care demonstrated their commitment to doing the best with what they have.
There was also a surreal moment when entering the NICU: I saw the Pumani bubble CPAP, developed by Rice undergrads, being used here. To think that student innovation could become a standard part of care around the world and save lives was incredibly inspiring.
At Centro de Diagnóstico y Atención Primaria in Neyba, the facilities were more modern, with better air circulation and infrastructure. Still, we observed similar issues: taped oxygen hoods that don’t allow for accurate oxygen concentration monitoring, IV mixing in open areas, and limited temperature warming/regulation for newborns. Despite these limitations, kangaroo care is well-practiced, and there is clear motivation among staff to improve outcomes with the tools available.
We also visited Hospital Regional Juan Pablo Pina in San Cristobal, where several cases highlighted the clinical complexity of newborn care. One baby born to a diabetic mother was significantly larger than average and required monitoring for hypoglycemia. Others were being treated for jaundice with phototherapy, which is common in preemies due to underdeveloped livers. We also saw a baby with Down syndrome and multiple congenital anomalies such as cleft lip and atrioventricular canal defect, which made feeding especially difficult.
Throughout all six hospitals we’ve visited over the last month of being in the Dominican Republic, a consistent pattern has emerged: outdated incubators, broken heating systems and sensors, unreliable monitors, and makeshift thermal care using gooseneck lamps. These issues are systemic and widespread. It’s clear that if improvements are made in one hospital, they could be replicated across the country’s public healthcare system.
At the kangaroo care clinic at Jaime Mota Hospital, I spoke with Dr. Martinez, a pediatrician running the clinic. She explained to me that since preemies often aren’t strong enough to breastfeed, as the act of sucking requires a significant amount of energy. As a result, they’re fed using syringes. This contrasts with practices in the U.S., where preemies are often fed through a syringe and feeding tube directly into the stomach to conserve energy and ensure adequate nutrition.
Another key difference is the duration of hospital care. In the US, preemies stay in the NICU until they are ready to breastfeed. But here, hospitals discharge preemies earlier due to capacity constraints. This means that mothers continue feeding their babies at home using syringes. The issue is however that mothers are reusing disposable syringes, even though they aren’t intended to be reused. Their designs have ridges and internal scaffolding that are difficult to clean and can harbor bacteria, leading to gastrointestinal infections in the babies.
Dr. Martinez proposed I create a solution to this problem by developing a reusable syringe that could be sterilized by boiling, addressing the limitations of existing disposable and hard-to-clean models. She believes this simple innovation could save lives, not only in the Dominican Republic but also in other low-resource settings where syringe feeding is common and the risk of infection is high. I’m excited about the potential of this project and the impact it could have.
Later in the week on Friday, we joined Dr. Floren as she met with the Dominican Republic’s Minister of Health to discuss ongoing public health initiatives, including plans to open health centers that will expand access to maternal and newborn screening. One key concern is maternal anemia, present in over 60% of women at delivery. This increases the risk of postpartum hemorrhage, especially since anemia reduces the body’s ability to form strong clots. DOFMI seeks to raise awareness, ensuring that mothers are identified early for anemia. They want to educate women around the country so that they can be identified for anemia earlier than later, so that by the time they deliver none of these issues will be present.
We also toured Acromax, a local pharmaceutical company working on a more affordable version of Hydroxyurea, a medication used to manage sickle cell disease. With about 10% of the population carrying the sickle cell gene, early diagnosis and affordable treatment could have a significant national impact. DOFMI is working with Acromax and the government to develop newborn screening programs that are expected to roll out in November of this year. This is incredibly important and the potential for impact is immense.
This week offered a closer look at how infrastructure limitations and supply chain barriers affect care delivery. It has also allowed me to learn from the people themselves. I greatly admire Dr. Floren’s ability to treat everyone with humanity, compassion, and respect, characteristics that make her so effective in her work. Leaders like her are exactly the kind who can drive an initiative like DOFMI forward. She builds trust and creates the kind of connection that inspires real change, as evidenced by the impact she’s already made across the country.
In addition, the doctors and nurses we met demonstrated remarkable adaptability and a strong willingness to embrace new tools and drive change. Their resourcefulness was impressive, particularly evident in the kangaroo care practices we observed at every hospital. Despite limited resources, these healthcare workers do an incredible job saving infant lives, and the deep trust between them and the mothers clearly reflects this.
These are some photos we took over the trip!
